Hair Loss

Minoxidil Side Effects: 16 Most Common With Pictures

Topical minoxidil (Rogaine) is the most common treatment for men and women with hair loss. In this article, we discuss the most common side effects. This will help you understand what to expect before starting treatment. It will also give you tips on dealing with these side effects. You will learn:

  • What minoxidil is
  • How to use it
  • How long till you see results
  • Precautions and special considerations
  • The most common side effects
  • Less common but more severe side effects
  • How these side effects compare to oral minoxidil
  • Easy ways to boost minoxidil’s effectiveness
  • Non-pharmaceutical alternatives

What is Minoxidil?

Minoxidil is a vasodilator (1). It widens the blood vessels, allowing more blood to flow. Scientists in the 1960s originally developed it as a pill for people with high blood pressure.

Doctors soon noticed their patients on minoxidil were also growing hair. This observation eventually led to topical minoxidil for men with baldness (androgenetic alopecia) in the 1980s. The name of this product was Rogaine.

When minoxidil is applied to the scalp, the supply of blood and oxygen to the follicles increases. This optimizes their function and counteracts the hair follicle miniaturization process, a hallmark of androgenetic alopecia (2).

In androgenetic alopecia, the hair growth cycle is also altered. Progressively, more hair follicles switch to a prolonged resting phase (telogen). In this phase, hair does not grow.

Topical minoxidil counteracts this effect. It stimulates hair follicles to transition to the anagen, or growth phase of their cycle. The result is more hairs growing out at the same time. This leads to increased coverage.

Balding men often take minoxidil together with oral medications like finasteride. This combination leads to better regrowth.

What Forms Are Available?

You can buy minoxidil as a foam or liquid solution. There is also a more rare cream version. Users apply it topically and massage it into the scalp. In addition to the branded Rogaine, there are many generic versions available. These typically cost less.

Rogaine was originally a liquid solution in 2% strength. The FDA approved this first for men and then for women with androgenetic alopecia.

In later years a more potent 5% strength came to market. This is now available in both liquid and foam. The FDA has approved both versions for men, and the foam for women.

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How Much to Take?

The manufacturer recommends twice daily application, at least 8 hours apart. The duration of treatment is indefinite. Results only last as long as you stay on minoxidil.

How Long Until You See Results?

The makers of Rogaine state that it may take up to four months to start seeing the effects of minoxidil topical solution and foam.

There is some anecdotal evidence that the solution can give better results. Users can apply it more precisely to the scalp. The foam, on the other hand, can stick to the stem of the hair if users do not properly massage it in.

In the case of people with advanced alopecia, minoxidil offers very few, if any, benefits. Similarly for the completely bald scalp. The drug gives the best regrowth in the crown or vertex area. Frontal hair loss does not usually respond as well.

The 5% strength is generally more effective (3, 4).

Considerations Before Using Minoxidil

  • Minoxidil is effective against androgenic alopecia. It may not be appropriate for treating other forms of hair loss. If you are not sure what the cause of your hair loss is, consult your physician. This is especially relevant if you have no family history of hair loss.
  • If you have a known allergy to any of Rogaine’s ingredients, you should avoid using it. The liquid solution contains an ingredient called propylene glycol (5). If you are allergic to propylene glycol, you should avoid using the solution, as it can provoke dermatitis. Minoxidil foam does not contain propylene glycol.
  • As a precaution, pregnant and breastfeeding women should consult with their doctor before starting treatment.
  • Topical minoxidil has no known interactions with other medications. If you are taking medication, however, it is best to consult your doctor first.
  • People with cardiovascular problems, hypertension, and hypotension are strongly advised to consult their physician before using minoxidil.
  • Minoxidil is not approved for use by minors.
  • Do not apply it to facial or body parts other than the top of your head. Be sure to wash your hands thoroughly after each application.
  • Minoxidil foam may cause dizziness, especially when used with alcohol or other drugs. For this reason, it is advisable to apply it in a safe environment the first time. This will allow you to assess your body’s reaction to the drug. Avoid driving and other potentially hazardous tasks until you are sure minoxidil does not affect you.
  • If you have a rash or sunburn on your scalp do not use minoxidil. Also avoid using other skincare products at the same area.

A man worried about his temporary hair lossCommon Side Effects

Most common side effects of using minoxidil do not pose an immediate threat to your health.

  • The most common side effect is a topical reaction: itching, burning, and/or the appearance of a rash. As mentioned earlier, this is also a common adverse reaction to propylene glycol. If you are getting these side effects with minoxidil solution, you may find that they go away if you switch to the foam.
  • Flaking skin.
  • Dryness. Again, if you experience side effects #2-3 consider switching to the foam. You might also be applying too much minoxidil.
  • Headaches. These will typically start soon after application and go away on their own. They can be a sign that you are applying too much. If they persist, you may have no option but to discontinue treatment.Dryness and itchiness caused by dandruff can make hair fall out more easily
  • Unwanted hair growth. A common problem with the liquid version is that the minoxidil drips to other parts of the head, particularly the forehead. With time, this can lead to unwanted hair growth on the face (hypertrichosis). The first areas to be affected are typically the temples and between the eyebrows, and may be noted between three and six weeks after commencement of treatment.
    This side effect can be particularly unpleasant for women (6). If you are experiencing this problem consider switching to the foam version. There are also anecdotal reports of hair growth on other parts of the body (not the face). These can be signs of systemic minoxidil absorption.
  • Changes in hair texture, and uneven growth. Some users report regrowth that doesn’t look 100% natural or “right.” The new hair might grow unevenly. It also might not grow as fast as the healthy hair on the sides of the head. The end result might not look completely natural.

Rare Side Effects (More Severe)

Severe side effects from topical minoxidil are uncommon. You should stop treatment and seek medical attention if you experience any of the following:

  • Swelling of the hands and feet.
  • Chest pain.
  • Heart pain or discomfort.
  • Unexpected weight gain.
  • Difficulty breathing (shortness of breath).
  • Palpitations or otherwise irregular heartbeat. All these symptoms (#4-8) might suggest minoxidil is affecting your regular heart functioning.
  • Dizziness or faintness.
  • Severe rashes, hives. This could be a sign of an allergic reaction to an ingredient in the product.
  • Swelling of the face, lips, or throat. Another sign of possible allergic reaction.

Many of these side effects can be caused by too much minoxidil reaching the bloodstream. If you resume the drug, ensure that you are administering the correct dosage. Your doctor will be able to assist you with this.

One rarer complaint is dark circles underneath the eyes. We normally associate these with poor or inadequate sleep. And it is also something reported by some minoxidil users. This problem can persist for some time after they discontinue treatment.

What About Oral Minoxidil?

As mentioned, oral minoxidil is a vasodilator. Doctors prescribe it for the treatment of hypertension. By widening the blood vessels, it helps reduce the overall pressure of the blood being pumped around the body.

The side effects of oral minoxidil are far more severe compared to the topical. Oral minoxidil is a potentially very dangerous medication. As such, it is not available over the counter.

Doctors often prescribe as a last resort, after other hypertension treatments have failed. They typically do so in combination with other drugs, in order to counteract minoxidil’s side effects. The most common of these drugs is a diuretic. The diuretic expels fluids from the body, counteracting minoxidil’s tendency to retain water.

The most common side effects of oral minoxidil for hypertension are irregular heartbeat, rapid weight gain, bloating, and swelling of the extremities. In some cases, it can also lead to serious heart complications.

Oral Minoxidil for Hair Loss

In recent years, more doctors are prescribing oral minoxidil for hair loss (7). The dose required for this is many times smaller than for the treatment of hypertension. At these low doses, oral minoxidil is far less dangerous. The most common side effect is hypertrichosis: unwanted hair growth all over the body (8).

If you are considering using oral minoxidil for hair loss, you will need to speak to your doctor.

How to Make Topical Treatments More Effective

There is a simple but powerful way to increase minoxidil’s effectiveness. This method is to use a dermaroller, in a process called microneedling (9).

The dermaroller is a very simple device: a rotating barrel attached to a handle. On the surface of the barrel are many small needles. As the user glides the dermaroller over his scalp, he creates thousands of microscopic holes. These stimulate the skin to rejuvenate itself, without causing permanent damage.

A dermaroller for hair loss.

There are now numerous studies that suggest microneedling drastically increases minoxidil’s effectiveness. For example, a 2013 study compared men treated with minoxidil alone vs minoxidil in combination with weekly microneedling sessions (10). In the graph you can see the before and after results of the two groups.

Men in the minoxidil-only group regrew on average 25 new hairs per centimeter squared. This compared to 99 new hairs for the combination treatment, a nearly 4-fold difference.

The before and after photos of some patients in the combination group also showed extensive regrowth.

 

 

Before and after photos of minoxidil group + dermaroller
Source.

Are There Any Alternatives to Minoxidil?

Applying a topical natural liquid to the scalp

Minoxidil is arguably the most popular treatment for hair loss. It is also the only topical medication the FDA has approved for hair loss. This does not mean there are no other options.

Some of these are pharmaceutical, such as topical finasteride.

There are also numerous natural ingredients. Caffeine is very popular in this respect (11).

Some products contain a combination of non-pharmaceutical ingredients. For example, Hairguard’s Biogaine contains, apart from caffeine, ingredients like zinc, adenosine, and redensyl. These work to promote hair growth synergistically. The end result is regrowth superior to applying any of these ingredients on its own.

Conclusion

Minoxidil is over the counter. This means that you can start treatment without a doctor’s prescription.

However, there are instances when it is best to speak to your doctor first. This will usually be if:

  • you have any other health conditions
  • are on other medications
  • suspect you might be allergic to one of the ingredients.

Individuals will react differently to the drug. Many will use minoxidil with no side effects whatsoever. Some will experience mild topical side effects. By far the most likely side effect is irritation of the skin, which may not be caused by the active ingredient itself. When this happens, users can switch to a minoxidil product that does not contain propylene glycol (e.g. foam).

Rarely, users might experience systemic side effects, particularly relating to cardiac function (heart problems). In these instances, they should discontinue treatment immediately and consult with their physician.

Most – if not all – minoxidil side effects will eventually resolve after stopping treatment.

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You can follow a few hair hygiene tips to make your hair less likely to fall out: Avoid hairstyles that pull on the hair - Avoid high-heat hair styling tools - Don't chemically treat or bleach your hair - Use a shampoo that's mild and suited for your hair - Use a soft brush made from natural fibers - Try low-level light therapy.

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