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Last updated October 3, 2019. 5 minute read

Does minoxidil work? What the research says

Minoxidil is better at stopping or slowing hair loss than regrowing hair. Hair regrowth is more of a secondary gain; stopping hair loss is more likely. But about 40% of men and 25% of women can experience some regrowth with minoxidil.

Self Written by Michael Martin
Reviewed by Dr. Mike Bohl, MD, MPH

Take some porcupine hair, boil it in water and then apply it to the scalp for four days. As an alternative, you could sautee the leg of a female greyhound in oil along with a donkey’s hoof, and spread the resulting goo all over your thinning pate. These are just some of the baldness “cures” detailed in the Ebers Papyrus—an Egyptian text of herbal remedies that was written around 1,500 BCE, though is believed to have been compiled from even earlier texts. This fascinating document now lives at the University of Leipzig, Germany.

If nothing else, these Amenhotep I-era prescriptions show that people have been willing to go to great lengths to retain their crowning glory for a very long time. There’s very little evidence to suggest that any of these interventions did anything to slow, stop, or reverse balding. Nor is there any proof to show that the innumerable lotions, potions, poultices, and tinctures that were touted as topical baldness treatments in the following 3,500 years did much either.

That all changed in 1988 when the FDA approved minoxidil for the treatment of baldness. Men concerned about losing their hair—not to mention porcupines, greyhounds, donkeys and a menagerie of other animals—rejoiced.

Vitals

  • Minoxidil is a liquid or foam rubbed on the scalp to treat hair loss; it must be used continuously to see results.
  • About 40 percent of men experience hair regrowth when using minoxidil.
  • It takes about four months to see results with minoxidil.
  • Minoxidil is most effective when used in combination with finasteride.

What is minoxidil?

Minoxidil is a hair loss treatment, an over-the-counter liquid or foam applied to the scalp twice a day to slow or stop the progression of male pattern baldness (a.k.a androgenetic alopecia) and thinning hair. To maintain results, it must be used continuously — if you stop using the medication, the new hair growth may reverse, and hair loss will continue.

Minoxidil tends to work best on younger men (meaning, those under age 40) who have been balding for less than five years. Once hair loss spreads over a large area and has persisted for a long time, minoxidil is less likely to produce benefits. Basically, the younger you are, and the sooner you start minoxidil, the better the results tend to be.

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Does minoxidil work?

Minoxidil is better at stopping or slowing hair loss than regrowing hair. Hair regrowth is more of a secondary gain; stopping hair loss is more likely. But about 40% of men and 25% of women can experience some regrowth with minoxidil.

In a study published in the Journal of the American Academy of Dermatology, men were assigned to three different groups: 5% minoxidil, 2% minoxidil, or placebo. Men using 5% minoxidil had 45% more hair regrowth than the 2% group (Olsen, 2002).

Studies show that using minoxidil and finasteride together is more effective than using either one alone (Chandrashekar, 2015). However, women cannot use finasteride, and pregnant women should not even touch finasteride tablets. (Minoxidil will be effective whether it’s the pricey brand preparation, Rogaine, or the inexpensive version sold online for a few dollars a bottle).

In a 2018 study, researchers found that men who used 5% minoxidil in combination with low-level laser therapy (or LLLT, an FDA-cleared red light device held to the scalp) were more satisfied with their results than men who used minoxidil by itself (Faghihi, 2018).

How does minoxidil work?

Minoxidil’s exact mechanism of action in the body isn’t completely understood. It was initially developed in the 1950s as an oral medication to treat high blood pressure. In an early study, researchers discovered that some patients developed hair regrowth.

Minoxidil seems to work as a peripheral vasodilator. That means it helps widen and loosen blood vessels to increase blood flow. Researchers believe that minoxidil might increase the flow of blood and nutrients to the hair follicles, stimulating hair growth.

Unlike finasteride—which works by suppressing the androgen DHT, which can attack hair follicles—minoxidil has no effect on hormones.

How long does minoxidil take to work?

Used twice a day, minoxidil 5% can work more quickly than 2% minoxidil (Olsen, 2002). Four months is generally needed to see results. Some people may experience some additional hair loss when they first start using minoxidil. This might make some people feel like their baldness is getting worse before it improves. In actuality, this can be normal and is a result of the hair follicles shifting the phase of growth they are in.

If your hair loss hasn’t slowed after several months of using minoxidil, it’s a good idea to stop applying it and see your doctor. Something else might be contributing to or causing your hair loss. As you use minoxidil, remember that no medication works for everyone—you might see results that surpass your expectations, or minoxidil might not work for you at all.

Does minoxidil work on a receding hairline?

This is a little controversial. Minoxidil is FDA approved for use on the “vertex,” or the top of the scalp, only. You’ll read that it hasn’t been shown to be effective on a receding hairline.That’s because it’s true—multiple studies haven’t been conducted on minoxidil’s effect specifically on the hairline. When minoxidil was developed and released in the 1980s, the initial studies and clinical trials focused on its effect on the top of the head. But a conclusive scientific verdict isn’t in yet.

What are they waiting for? Your guess is as good as ours. But for now, don’t count seeing results from using minoxidil on your receding hairline. (However, finasteride has been shown to be effective there—another good reason to use the two medications together.)

Will minoxidil work if I’m totally bald?

Minoxidil is also unlikely to regrow hair on a completely bald scalp. That’s because male pattern baldness is unlike other conditions that lead to hair loss (such as autoimmune diseases or vitamin deficiencies or trauma)—once male pattern baldness has progressed to the point where the scalp is bare for several years, regrowth is virtually impossible. That’s because hair follicles have undergone more permanent changes that generally can’t be reversed.

Does minoxidil have side effects?

Less than 2% of minoxidil is absorbed by the body when applied topically, so serious side effects are rare. Some men might develop an irritated or itchy scalp or hair growth in unexpected places. To avoid those side effects, don’t use minoxidil more than directed, and wash your hands after using the product, so you don’t transfer it to other areas of your body. If you do develop scalp irritation or unwanted facial hair growth, give your doctor a call.

If you have issues with your heart or high blood pressure, talk with your doctor before using minoxidil to ensure it’s safe for you. If you experience chest pain, rapid heartbeat, faintness, dizziness, sudden unexplained weight gain, or hand or feet swelling while using minoxidil, seek emergency medical attention.

Women shouldn’t use 5% minoxidil, or any form of the medication while they’re pregnant or breastfeeding. No one younger than 18 should use minoxidil.