Minoxidil for Hair Loss: Expectations, Side Effects, Oral vs. Topical, and More
Minoxidil’s availability, as well as new oral minoxidil options, makes it a true “gold standard” of hair loss treatments.
July 22, 2024
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I think every person concerned about hair loss should be taking minoxidil, period. Topical minoxidil is the less risky hair loss drug of the two primary hair treatment options (finasteride being the other). And while minoxidil is available over the counter as a topical treatment, there are also more doctors prescribing oral minoxidil to their patients, and considering it a new “gold standard” in treating and preventing hair loss. (I agree with them on that.)
Read more about minoxidil below, and I think you’ll be convinced that it’s important to incorporate into your routine—whether you’ve noticed any thinning around the crown, or whether you’re just trying to stay ahead of any shedding. Remember: As is the case with any hair loss treatment, the sooner you start, the better. And stick with it indefinitely.
What Is Minoxidil?
Minoxidil is a vasodilating agent, meaning it improves blood circulation. So, when applied topically, it improves circulation at the site (and thus fortifies hair growth by delivering more nourishment to the follicles). And taken orally, minoxidil improves blood flow through the entire body; oral minoxidil is a micro-dosed cosmetic version of the blood pressure drug Loniten. Oral minoxidil can also promote hair growth all over the body—not just at the site of application.
In its topical form, minoxidil is the generic for Rogaine and is now available without a prescription; men take 5% formula, women typically take 2% (though some doctors are encouraging women to upgrade to 5% as well). Usually, topical minoxidil is applied once in the morning and again in the evening, to a clean scalp. Oral minoxidil needs to be prescribed, since its cosmetic use has not been approved by the FDA. Either your dermatologist will have Loniten available in the office, or will give you instructions on how to dose it for yourself—likely by prescribing you larger pills and advising you to break them in half; usually that’s the direction, to break a 2.5mg pill into two 1.25mg halves and to take one pill per day. Regardless, do not take my advice on this, because the pills you receive may be a different dose, or your doc may advise you to take a different amount.
And for what it’s worth: two of the common telemedicine sites, Ro and Hims, make it really easy to get oral minoxidil sent straight to your doorstep.
Ro Oral Minoxidil | Hims Hybrid Chews
But all five key telemedicine sites also sell topical minoxidil as well as hybrids of topical minoxidil and finasteride. Standalone topical minoxidil is also fairly easy to get at the drugstore; just make sure you get yours from a verified seller.
Hims | XYON | Ro | Keeps | Happy Head
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How Does Minoxidil Improve Hair Growth?
By improving circulation, minoxidil revives any withering or dormant follicles. It also helps healthy follicles to maintain their strength and defensiveness against any hair-shrinking threats like dihydrotestosterone (or DHT). DHT is the main culprit behind male-pattern hair loss. In this way, minoxidil is more of a defensive fortification approach to hair regrowth and retention, whereas finasteride is more proactive in the interference from DHT.
At the same time, minoxidil is a better treatment or defense against general thinning around the crown, whereas finasteride is usually better targeted at any recession of the hairline and temples.
Minoxidil also changes the growth cycle of the hair. It extends the growth phase of each hair follicle (known as the anagen stage), and also expedites the shedding phase of hair growth (the stage known as telogen). Together, these two changes allow you to have more hairs on your head at any given time, since there are fewer follicles experiencing dormancy between shedding cycles. So, by having more hairs at any given time, you also get to experience fuller hair overall, in addition to having stronger and thicker follicles.
But this adjustment to your hair growth cycles also comes with a bit of shock: You will likely notice accelerated shedding int he first few months of minoxidil use, which is actually a good sign. This just means your hairs are entering their new phase of growth, and will in turn be anchored longer and grow back stronger for the long haul. Fight through that somewhat alarming shedding period, ok? I promise only you will notice the chance because you’ll see extra fallen hairs around your bathroom. (It’s not a noticeable difference for anyone else.)
Minoxidil Side Effects
Studies prove that topical minoxidil is not only highly effective, but also well tolerated. A small percentage of people may experience local irritation or flaking, and a few percent of users may experience mild headaches. And oral minoxidil improves upon topical (in its low, cosmetic doses) by requiring a single daily dose, minus any risk for topical side effects. However, oral minoxidil comes with more inherent risks if not taken as advised, given that it is a medicine for high blood pressure.
I’ll make this point again, because it can “read” as a side effect: When you start minoxidil, it can kickstart the shedding phase of more follicles than usual. So you will notice accelerated shedding for the first couple months, but that’s normal and means it’s working. (Remember, it is basically recalibrating and improving your hair growth cycles.) Just stick it out to month 6 or 7 (and indefinitely from there); you will see incredible results, assuming your most severe hair loss has only been in the past couple years. And to that note…
When Should You Start Using Minoxidil?
It is never too early to start using minoxidil—though, maybe wait until your early 20s if you aren’t otherwise experiencing early-stage loss in high school. (And if you are experiencing early shedding or recession, see a dermatologist to make sure you take the safest approach given your physical developments.) As for anyone 20s+, if you start before you see any hair shedding, you may prevent its arrival for decades to come.
If you’ve already noticed general hair thinning or strand miniaturization around the crown, then start ASAP; topical minoxidil is available over the counter, so don’t waste time. Remember, you’ll need to apply it topically in the morning and night, and may experience extra shedding in those first few months. (Or get that Rx from the doctor for an oral option.) Just hang with it through the first few months of extra shedding; I promise you’ll notice superb results by month 6 or 7, once those follicles have reproduced hairs that are thicker, stronger, and longer anchored.
When Is It Too Late To Use Minoxidil?
If your hair loss is extremely progressed and has been so for a couple years, then it’s probably too late for any hair growth solutions. Any noticeable shedding within the past couple years means you have definitely lost some follicles forever. You need to intervene before the follicles shrivel up entirely; thus, the results you can expect depend on how many follicles you’ve got that are able to be revived. You can probably expect ~30%+ increase of coverage when all is grown back. That’s pretty significant, but that 30% scales significantly if you intervene sooner.
Minoxidil vs. Finasteride: Which Is Better For Hair Loss?
In my opinion, minoxidil is the better hair loss option in terms of universality, even if finasteride is considered an overall better remedy (since finasteride thwarts DHT altogether, while minoxidil just builds up your hairs in defense against DHT, no matter how present it remains).
For one, minoxidil doesn’t have sexual side effects (compared to the risks of oral finasteride; topical finasteride has far fewer risks than oral, see). Secondly, minoxidil is better for general crown thinning and loss (whereas finasteride is superior for treating recession). More often, people who experience recession will also experience general thinning, but not always the other way around; thus I think minoxidil has broader benefits for more people.
And remember: If your hair loss is primarily related to hairline recession, then you almost certainly need to take finasteride to intervene. (It does come with certain risks, so read up.)
You can always take a compound finasteride-minoxidil topical from the key men’s telemedicine sites below—available with an easily booked consultation and prescription. It’s nice to combine both drugs into one less-risky topical option; I find it easier to incorporate into a hair care regimen (usually by applying before bed).
Hims | XYON | Ro | Keeps | Happy Head
All of those brands will sell an OTC topical minoxidil option, too. You should expect to spend about $10-15 per monthly bottle.
In a perfect world, every guy would be taking a compound with both medicines to fight hair loss, or a combination of topical finasteride and oral minoxidil. OK, actually, in a perfect world, we wouldn’t be dealing with hair loss in the first place, but you catch my drift. Still, a combination of these drugs is such a great, lasting defense against hair loss. It just sucks that we have to take them indefinitely in order to maintain the results.
Again, Ro and Hims has oral minoxidil available for home delivery from its telemedicine platform; hopefully the other platforms will offer it soon, too.
Other Hair Loss Treatments
Be sure to check out other hair loss solutions, too, like low-level laser therapy (LLLT), or platelet-rich plasma injections (PRP), and even certain hair growth supplements. It’s probably worth reading up on the latest hair transplant advancements, too.
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