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Minoxidil

Minoxidil is the generic name for Rogaine, a topical solution used to prevent hair loss and to help regrow hair in people with genetic hair loss or androgenetic alopecia. 

What is Minoxidil/Rogaine?

Minoxidil is the generic name for a topical solution applied to the scalp used to prevent hair loss in those with male pattern hair loss or female pattern hair loss. Together, these two types of hair loss are called genetic hair loss, or androgenetic alopecia. It is also used to regrow hair in people with genetic hair loss, or androgenetic alopecia. When used daily for 3-6 months or more, it is effective at preventing hair loss and stimulating hair growth.

Topical minoxidil solution is one of only two Health Canada and FDA-approved medications specifically designed for regrowing hair. The most common brand name for topical minoxidil solution is Rogaine. These are the same solutions. The other Health Canada/FDA-approved medication is called finasteride; you can learn more about that here.

Although technically topical minoxidil solution is only approved for hair loss and hair growth on the scalp, evidence shows that it can also be effective for enhancing beard and eyebrow hair growth.

What Does minoxidil /Rogaine Do?

Scientists believe that minoxidil/Rogaine works to stimulate hair growth by increasing blood flow to the scalp. This stimulates hair follicles that are in a resting (telogen) phase back into an active growth (anagen) phase.

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How Does Minoxidil/Rogaine Work?

Minoxidil/Rogaine is a “prodrug” that must be converted by your body into its active form, minoxidil sulfate. This active compound causes blood vessels in your scalp to dilate, or open up, increasing blood flow to the scalp.

Does Minoxidil/Rogaine Work?

Yes! About 85-90% of people with male pattern hair loss or female pattern hair loss who use topical minoxidil solution for at least a year will stop losing any more hair. About 50% of people who use it will see some degree of improved hair growth. The amount of improved hair growth can vary from a little to a lot or something in between. Each person responds differently. Improved hair growth is most likely to occur towards the back of the scalp (crown area) compared to the front, especially in people with more advanced hair loss.

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How Long Does it Take Minoxidil/Rogaine to Work?

At a minimum, it takes about 6 months of using topical minoxidil solution to see any improved hair growth. However, many people may only notice a slowing or stopping of their hair loss after 6 months. For them, it may take up to a year of using topical minoxidil solution before noticing improved hair growth. For this reason, we recommend trying topical minoxidil solution for at least a year before deciding if it works for you.

What Types of Minoxidil Products are Available?

Topical minoxidil solution is the only form approved for regrowing hair. Topical minoxidil solution is available in several types.

  1. Over-the-counter, 2% and 5% topical minoxidil solution. These concentrations are available over-the-counter at most pharmacies. Men should typically start with a 5% formula applied twice daily. Women typically start with a 2% formula applied twice daily. However, most women can tolerate a 5% formula applied once daily without unwanted side effects.
  2. Custom compounded, high-strength topical minoxidil solution. The main advantage of high-strength minoxidil is that it only needs to be applied once daily. This makes it more convenient to use, which means patients are more likely to stick with the treatment and get the full benefit. Custom compounded formulas may also contain other ingredients, such as retinoids, to enhance the absorption of the topical minoxidil solution into the scalp. These are not available over-the-counter. 
  3. Custom compounded, high-strength minoxidil combined with other hair regrowth ingredients. High-strength, topical, minoxidil solution can also be combined with other ingredients that have been shown to stop hair loss and improve hair growth, such as bimatoprost and even topical finasteride. Although these other ingredients have not yet sought approval from Health Canada or the FDA to regrow hair, the available scientific evidence shows that they are probably effective and safe to use. These are not available over-the-counter. 

How Do I Use Minoxidil/Rogaine?

Follow the directions on your bottle of topical minoxidil solution. Generally speaking, you should apply a small amount of minoxidil to the areas affected by hair loss. However, you can also apply minoxidil to areas that are not yet affected by hair loss to prevent hair loss in those areas.

Minoxidil should be applied directly to a dry scalp. Most of the minoxidil solution is absorbed within the first hour of application; however, you should wait for at least 2-4 hours before showering or swimming. Do not blow-dry your hair after applying minoxidil solution, as this will cause the solution to evaporate before being absorbed by your scalp.

Minoxidil

How Long Do I Have to Use Minoxidil/Rogaine?

Minoxidil should be used for as long as you want to maintain the hair that was thickened or improved by the minoxidil. It is important to know that stopping minoxidil will not cause you to lose any hair that you wouldn’t have already lost if you’d never used minoxidil at all. Missing an occasional application of minoxidil will not result in hair loss. Stopping minoxidil completely will cause a gradual loss of the improvement achieved by using minoxidil over the course of about 3 months. Hair loss that was being prevented by minoxidil may also occur. 

Will I Build Up a Tolerance to Minoxidil/Rogaine? Will Minoxidil/Rogaine Stop Working After A While?

No. Minoxidil will help stimulate thinning or dying hair follicles to regrow thicker hair for as long as 2-3 years. After that, minoxidil continues to keep the hair in the growing (anagen) phase so that new hair is thicker and grows for a longer period of time. After three years, most people do not see a continued improvement because the thinning and dying hair follicles have been stimulated and have regrown. They might assume they have developed a tolerance, or that the minoxidil has stopped working. However, the minoxidil is still continuing to maintain the previously thinning follicles. Stopping minoxidil will cause the stimulated hair to re-enter a shedding and loss (telogen) phase.

Should I Use Minoxidil if I’m Having a Hair Transplant? Do I Need to Continue Minoxidil After My Hair Transplant?

Minoxidil can be useful in conjunction with a hair transplant for a number of reasons:

    1. It maintains or increases the growth of your transplanted, and non-transplanted, hair, thereby enhancing the overall cosmetic result of surgery. By preventing hair loss of the hair you still have, you will maintain a full head of hair for a longer period of time. It can also improve the hair growth of your transplanted hair.
    2. It works well in younger patients who may not yet be a good candidate for a hair transplant. Topical minoxidil solution can be used by those who are too young for a hair transplant to stabilize or stop their hair loss so that fewer follicles or grafts are needed to fix any hair loss that has already occurred. This is important because everyone is born with only a certain, fixed amount of follicles that they are able to donate for a hair transplant. If you use them up when you are too young and you continue to have hair loss, you may not have enough to fix any areas of hair loss in the future.
    3. It can stabilize or regrow hair in the back part of the scalp, from where donor grafts may be harvested. This may increase the total number of available donor grafts.
    4. It can stabilize or regrow hair in areas of your scalp that are not being transplanted, enhancing the overall cosmetic result of your surgery while minimizing the need for more surgery. For example, you may only have enough follicles to fix the front part of your scalp. Topical minoxidil solution can help you keep your existing hair over the back part of your scalp, or improve hair growth there if you’ve already had hair loss in those areas.

Is Minoxidil/Rogaine Safe? What Are the Side Effects of Minoxidil/Rogaine?

Topical minoxidil/Rogaine is very safe. Other forms of minoxidil, such as oral tablets that you swallow, have a higher rate of undesirable side effects, such as hair growth in unwanted areas, and may have significant effects on your heart at higher doses. For this reason, topical minoxidil solution is the preferred choice for improving hair growth.. Oral minoxidil is not approved for regrowing hair.

The most common side effects of topical minoxidil are:

  1. Hair shedding. Minoxidil can cause an initial mild increase in hair shedding of hairs that were going to shed in the next 100 days anyways, whether or not you use minoxidil. This may be up to about 10% of your total hairs. In areas affected by hair loss, this may be up to 20% of your hairs. For most people, this hair shedding is not noticeable. For some people, this hair shedding can be more dramatic. However, once shed, minoxidil causes these thin, resting hair to be replaced by thicker, healthier hair. Without minoxidil, these hairs would be replaced by smaller, miniaturized hair, until it is permanently lost, resulting in permanent hair loss, or balding
  2. Scalp itching and irritation. This can occur in areas where topical minoxidil solution is applied, and it occurs less than 5% of the time. Often this can be alleviated by simply skipping a day or two of minoxidil until the symptom subsides, and then resuming as normal.
  3. Heart effects. Rarely, a drop in blood pressure can occur, resulting in a rapid heart rate, headache, or dizziness. If this occurs, stop using minoxidil. In some cases simply reducing the amount of minoxidil used can alleviate this problem.
  4. Others. Rarely, people who are sensitive to minoxidil may experience water retention, ankle swelling, or chest pain. This is very rare for people who use topical minoxidil and more common in people who use oral minoxidil. If this occurs, stop using minoxidil.

Is There Anyone Who Cannot Use Minoxidil?

Patients who have a history of heart disease should discuss the use of minoxidil with the doctor who looks after their heart. Patients using systemic cyclosporine should not use minoxidil. Patients with a known adverse reaction or allergy to propylene glycol should not use minoxidil. Minoxidil may not work as well in patients taking aspirin, as aspirin inhibits the conversion of minoxidil to its active form.

How Do I Store Minoxidil?

Keep the bottle tightly capped when not in use. Keep at room temperature. Protect from direct sunlight.