Topical Minoxidil and its Side Effects
Topical Minoxidil is an FDA-approved treatment for male and female pattern hair loss, also known as androgenic alopecia (AGA). Despite its popularity, most people who start on Minoxidil will quit this medication six months after starting due adverse effects.
This article will aim to assess:
- How does topical Minoxidil work
- What are the potential side effects of topical Minoxidil?
- Is topical Minoxidil the best treatment for male pattern hair loss?
How does Minoxidil work?
The exact mechanism of Minoxidil for the treatment of hair loss is still uncertain. It is thought that minoxidil works by stimulating blood flow and improving circulation by opening potassium ion channels.
What are the potential side effects of topical Minoxidil?
The nuances of Minoxidil are more likely to be seen with oral Minoxidil compared to topical Minoxidil. Localised irritation and scalp dryness account for up to 80% of cases for topical minoxidil. This is attributed by the high alcohol content and rarely is it caused by the drug Minoxidil itself.
Is topical Minoxidil the best treatment for male pattern hair loss?
Minoxidil was originally approved by the FDA as an anti-hypertensive. Its discovery for the treatment of hair loss was accidental due to reports of unwanted hair growth. To determine if topical Minoxidil is the right product for you, we need to consider the following:
1. How far you are into your hair loss journey
Minoxidil works by stimulating blood flow and opening of potassium ion channels to stimulate the growth of new blood vessels. It will help to slow down or halt early signs of hair thinning.
For men with noticeable balding areas, topical Minoxidil alone may not provide sufficient hair gain. Combining topical Minoxidil and Finasteride has shown to improve hair count significantly compared to either therapy alone.
2. The presence of hormonal imbalance
High levels of DHT causes hair follicles to miniaturise with each new cycle. Minoxidil works by stimulating blood flow to the scalp area to stimulate new growth and does not have any effect on DHT levels. Without addressing hormone imbalance, hair gain will be slow.
Studies have shown micro-needling can improve hair thickness as well as hair count. When used in conjunction with Minoxidil, the results are superior compared to either therapy alone.
For more information on micro-needling for the management of hair thinning, check out our new articles in the coming weeks.
3. Sensitivity to prolong alcohol exposure
Since its approval for the treatment of androgenic alopecia by the FDA in 1992, topical Minoxidil formulations contain anywhere from 30% to 75% alcohol. A 2023 study published in the Journal of Trichology found that high amounts of alcohol leads to scalp dryness by day 15 of treatment.
Fortunately, this can be overcome with newer formulations with low alcohol (also known as hydro-alcoholic) or no alcohol. Non-alcoholic minoxidil is available through Médicii Laboratories by the name of Minoxidil 5 Plus+. Minoxidil 5 Plus+ is an Australian made topical Minoxidil solution with zero alcohol and propylene glycol.
How long does the effect of minoxidil last?
Studies have found Minoxidil can improve hair weight and hair count by 20-30% from baseline over 52 weeks. This modest increase in hair count was described as cosmetically significant in the eyes of the users.
What is Our Experience with Minoxidil?
Topical Minoxidil is an effective treatment for androgenic alopecia in men and women with early signs of hair thinning. Topical formulations have the benefit that they produce a good response rate with less side effects compared to oral minoxidil. Choosing an alcohol-free Minoxidil formula is key especially for long term therapy.
Author: Dan Atkinson B Pharm
1. American Academy of Dermatology. “What is Male Pattern Hair Loss and can it be Treated?” News release Updated December 13, 2022
2. Olsen, E et al. (2002). "A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men." Journal of the American Academy of Dermatology, 47(3), 377 385.
3. Udare, S et al (2023). "Low-Alcohol or Alcohol-Free Minoxidil Formulation for the Management of Androgenic Alopecia: an Indian Perspective." International Journal of Trichology. 15(1): p13-17, Jan-Feb 2023.