Too Much Hair with Oral Minoxidil: Should I be Stopping?

Excessive Hair with Oral Minoxidil: Is it a sign I should be stopping?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts related to excessive hair growth with oral minoxidil.

Question

Hi Dr Donovan,

I am a 43 year old health female. I am getting hair on my arms with oral minoxidil as well as other areas I don’t normally see hair. Is this a sign that I should I be stopping this medication? It’s helping my scalp hair amazingly but I’m worried that it’s causing more harm than good.

Answer

Well, you’ll want to speak to your doctors. It depends a little bit on the degree of excessive hair on the body and exactly how worried you are. If you are on acceptable doses of oral minoxidil (ie under 2.5 mg for females) and tolerating it well, then I’m not necessarily worried from a medical point of view. By tolerating it well, I mean no headaches, not swelling in the feet, no swelling around the eyes, no dizziness, no shortness of breath, no palpitations, no exercise intolerance, no sleeping troubles, no cough. But if you are worried about the amount of hair - then I’d be worried about the amount of hair. If you are not worried about the amount of hair, then I’m not worried.

Generally speaking, hair won’t go away unless you remove it. If you are okay with having more hair or if you are okay getting it removed, then this is not generally a problem. Of course, you don’t necessarily have to remove it. If the hair bothers you, there are ways to reduce the hair. If the hair does not bother you, then it can be left. The hair growth itself does not mean there is something harmful going on.

Hair growth on the face and body is very common with oral minoxidil. Some studies have suggested it’s even as high as 50%. Many many people get this side effect. It’s very common. Oral minoxidil grows hair - and that includes hair in places with don’t really want it to grow. You and your doctors can review together what’s best to do for you and your goals. Again, if a person does not mind the extra hair, one does not need to stop. Everyone starting oral minoxidil must be prepared for more hair on the arms, face, and body. One hopes it does not occur - but one has to be prepared for it to occur. The higher the dose of oral minoxidil, the more likely this side effect will occur. Women on 0.25 mg often don’t have much hair growth on the body as a side effect. Women on 2.5 mg often have a higher chance of hair growth on the body.

There are dozens and dozens and dozens of patients in my practice that have had really nice results with oral minoxidil but have not been happy with the hair growth that occurred somewhere else on the body. Many have chosen to have these hairs removed with various cosmetic means (laser, wax stripping, electrolysis).

Thanks again for the question.

REFERENCE

Sanabria B et al. Adverse effects of low dose oral minoxidil for androgenetic alopecia in 435 patients. JAAD 2021; 84: 1175-78