An important issue for all patients undergoing hair transplants is how to reduce the chance of losing 'existing' hair on the scalp. Although transplanted hair follicles taken from the back and moved to the front will help provide a permanent improvement in hair density, the existing hair that is "already" there could be lost in future years. At Donovan Medical, patients undergoing hair transplantation are counselled on the use of medications that are scientifically proven to either help stop hair loss or improve hair growth. This includes the use of finasteride and minoxidil.
What is minoxidil & how does it work?
- Minoxidil is a "topical" medication, meaning that it is applied to the scalp rather than ingested as a pill.
- The exact mechanism by which minoxidil helps hair growth is not completely understood, but it is known that the drug has many actions including affecting potassium channels in hair follicles, affecting blood flow. Unlike the pill finasteride, minoxidil does not work by affecting androgens.
- Minoxidil helps a proportion of individuals who use it to 'maintain' their hair and in some cases even thicken the hair a bit. Minoxidil does not help everyone.
- Minoxidil mainly helps areas of the scalp where the hair is thinning (miniaturized) - it does not help areas that have already lost hair (bald)
- The medication is available in three main formulations - a 2 % liquid formulation, a 5 % liquid formulation (Extra strength) and a 5 % foam formulation (sold under the name Rogaine foam). 5 % minoxidil is significantly better than 2 % minoxidil for men.
How often does the medication need to be used?
- The manufacturers of minoxidil recommend that the medication be used twice daily. Although twice daily may be slightly better than once daily, I advise patients to make certain they apply the medication at least once daily.
How should the medication be applied?
- Minoxidil is applied to the scalp that has been dried. It is very important that the medication be applied to the scalp (rather than the hair). Regardless of whether the liquid or foam is used, the finger tips may be used to gently spread the medication.
- The lotion formulation may be flammable and use of a hair hair dryer (blow dryer) is not recommended.
What are the side effects of minoxidil?
- Minoxidil is generally quite safe and well tolerated. In the USA, minoxidil in both the 2 % and 5 % strengths are available over the counter and no prescription is required. In Canada, 2 % minoxidil is available without a prescription but the 5 % minoxidil requires a prescription.
The most important side effects of minoxidil include:
1. Irritation of the scalp. The 2 % and 5 % liquid formulations of minoxidil have the potential to irritate the scalp on account of the ingredient propylene glycol. Minoxidil foam (Rogaine foam) does not contain propylene glycol and does not generally irritate the scalp for most users. Rarely, an individual can be allergic to minoxidil.
2. Increased shedding during the first month of use. During the very first month or two of use, some users of minoxidil may experience a slightly increased rate of daily hair shedding. It is important to continue the use of minoxidil in this situation as it is usually not harmful. Old hairs are being shed and new hairs are pushing up from underneath.
3. Other more rare side effects including headaches, dizziness, and heart palpitations, and swollen hands and feet.
COMMON QUESTIONS ON THE USE OF MINOXIDIL
1. If I start minoxidil, do I need to use it forever?
Minoxidil needs to be used continuously in order for the benefits to continue. It's completely safe to stop minoxidil at any time, however, any benefits that were seen will be lost over 6-9 months.
2. Can minoxidil be used with other medications?
It's important to check with your physician when using minoxidil with other medications. Minoxidil can be safely used with oral hair loss medications.
3. If I start minoxidil, when will an improvement first be seen?
Individuals using minoxidil will start to see an improvement around 6 months.
4. Does minoxidil help everyone?
About 8-30 % of individuals who use minoxidil regularly will feel that they have an improvement in their hair. It works best during the early stages of hair loss and for men works best for early stages of balding in the crown.
5. Who should not take minoxidil?
Patients with heart disease or vascular disease should not use minoxidil. Individuals with high blood pressure or low blood pressure and patients with irregular heart beats should check with their physician about using minoxidil. Prengant women should also not use minoxidil.