Minoxidil

Minoxidil is an active ingredient for the topical treatment of hereditary hair loss. Unlike finasteride, it is not taken by mouth but applied directly to the scalp.

Originally developed as a blood pressure medication, its hair growth-promoting effect was discovered as a side effect.

Available as:

• Solution (2% or 5%)
• Foam (5%)

Advantages of minoxidil:

• Available without a prescription
• Suitable for men and women (different concentrations)
• Can be combined with finasteride
• Topical use with few systemic side effects

The exact mechanism of action of minoxidil is not fully understood, but several effects contribute to how it works:

1. Improved blood flow: Minoxidil widens the blood vessels in the scalp, improving the supply of nutrients to the hair follicles.

2. Prolonging the growth phase: Hair goes through different phases. Minoxidil prolongs the active growth phase (anagen) and shortens the resting phase.

3. Stimulation of the hair follicles: Minoxidil activates certain ion channels in the cells of the hair follicles, thereby promoting growth.

The result:

• Hair loss slows down in many users
• Existing hair becomes stronger
• In some people, new hair grows back
• The effect is best in the crown area

Time course: First results after 2-4 months, optimal effect after 4-12 months.

For men:

• Hereditary hair loss (androgenetic alopecia)
• 5% solution or foam recommended

For women:

• Hereditary hair thinning
• 2% solution recommended (5% possible off-label)

Particularly suitable:

• As sole therapy for mild hair loss
• In combination with finasteride
• For people who do not want systemic therapy

Less suitable for:

• Completely bald areas
• Scarring or disease-related hair loss

Do not use in cases of:

• Known hypersensitivity to minoxidil

For men:

• 5% solution: 1 ml twice daily
• 5% foam: 1/2 cap twice daily

For women:

• 2% solution: 1 ml twice daily
• 5% can be used off-label but carries a higher risk of facial hair growth

Duration of use:

• At least 4 months for an initial assessment
• Continuous use for a lasting effect
• If treatment is stopped, the hair loss returns

Applying the solution: 1. The scalp should be dry 2. Apply 1 ml to the affected areas 3. Spread with your fingertips 4. Do not blow-dry – let it air-dry 5. Wash your hands after application

Applying the foam: 1. Remove the cap, turn the can upside down 2. Put about half a cap of foam into your hand 3. Spread onto the scalp with your fingertips 4. Let it dry

Timing:

• Twice daily (morning and evening)
• At least 4 hours between applications
• No more than 2 ml per day

Important:

• Wait until it has dried completely before going to bed
• In case of contact with the eyes or sensitive skin, rinse off immediately

Do not use in cases of:

• Hypersensitivity to minoxidil or propylene glycol
• Scalp inflammation or scalp injuries
• Other scalp conditions (have them treated first)

Use with caution in cases of:

• Heart disease
• Low blood pressure
• Concurrent use of other scalp products

Pregnancy and breastfeeding: Minoxidil should not be used during pregnancy or breastfeeding.

Very common:

• Headache

Common:

• Scalp irritation (stinging, burning, itching, flaking, inflammation of the hair follicles)
• Dry scalp
• Rash, skin inflammation (including acne-like)
• Increased hair growth, in women also on the face
• High blood pressure
• Shortness of breath
• Weight gain, fluid retention (swollen hands or feet)

Uncommon:

• Dizziness
• Nausea

Frequency not known:

• Initially increased hair loss (normal, indicates that it is working!)
• Changes in hair color or hair texture
• Redness, irritation or pain at the application site, including the ears and face
• Allergic reactions, up to swelling of the face, lips, tongue or throat (angioedema)
• Racing heart, palpitations, drop in blood pressure
• Chest pain
• Depressed mood
• Eye irritation
• Vomiting

Please note: Stop using it and seek medical advice if you notice a drop in blood pressure, chest pain, racing heart, weakness or dizziness, sudden unexplained weight gain, swollen hands or feet, or persistent redness or irritation of the scalp.

Important note – shedding: In the first few weeks, hair loss may initially increase. This is a sign that minoxidil is working and that the hairs are entering a new growth phase. Do not stop using it!

Interactions:

• Blood pressure medications: An additive blood pressure-lowering effect is theoretically possible, but unlikely with topical use
• Other scalp products: May affect the absorption of minoxidil; leaving time between applications is recommended

Combination with finasteride: The combination of minoxidil (topical) and finasteride (taken internally) is very common.