Excessive Facial Hair Growth within One Month of Starting Oral Minoxidil
Facial Hair Growth with Oral Minoxidil in a Female
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts related to the development of hypertrichosis in female minoxidil users.
Question
Hi, I am a female prescribed 2.5 mg minoxidil. I have been taking about one month. So far, I am seeing results. My thin spot on my head is filling in nicely however, hair is growing all over my face! My eyebrows look like caterpillars. For the first time ever I had to get them waxed and had to have my whole face. Is it possible that I can reduce to half or fourth of a tablet to get good results on just my head?
Thanks in advance for answering my question.
Answer
Thanks for the question.
The benefits of oral minoxidil - and many of the side effects - seem dose dependent. In other words, higher doses may give better results for many patients - but the use of higher doses comes with the risk of more side effects.
It could be that use of 1/4 of a 2.5 mg pill or even 1/2 of a 2.5 mg pill gives you satisfactory results and reduces the risk of excessive hair growth on the face of body. The only way to know is to try it. It could also be that you are extremely sensitive to the effects of minoxidil - and even these very low doses could cause excessive hair on the face or body.
I would urge you to speak to your doctors as soon as possible. Clearly, the dose will need to be reduced. One might even consider a trial of “topical” minoxidil rather than oral minoxidil in a situation like this. You are sensitive to the effects of minoxidil. On one hand this is great, because it means that low doses and even topical minoxidil could work well. On the other hand, it means you are going to need to watch very closely for unwanted side effects if you use too much.
FOR MANY WOMEN, TOPICAL MINOXIDIL MAY BE JUST AS GOOD AS VERY LOW DOSES OF ORAL MINOXIDIL
It’s really critical to know about an important study done back in 2020. A 2020 study by Ramos and colleagues showed that for women with androgenetic alopecia, 5 % topical minoxidil was fairly similar in effectiveness compared to 1 mg of oral minoxidil. So it’s not necessarily true that oral minoxidil is always better than topical minoxidil - (at least for treating androgenetic alopecia.) We love to feel that way in our world today. We love to feel that oral minoxidil is the cure to all problems and topical minoxidil is just archaric and a treatment for the dinosaurs. It’s just not always true - especially when one is speaking about the lower doses of oral minoxidil. There is still very much a valuable role for topical minoxidil in the treatment of many types of hair loss in the year 2023.
Not a single day goes by that I don’t recommend topical minoxidil and not a day goes by that I don’t recommend oral minoxidil. Both are in the modern treatment toolbox.
Given that you’ll need to reduce the dose, you and your doctors will need to discuss if 5 % topical minoxidil might be must as effective as some of the lower oral minoxidil doses you’ll also be considering. Those lower doses will be less likely to cause hair on the face and body.
We don’t know if your case if topical minoxidil will be as effective for you as 1.25 mg or 0.625 mg. We can’t predict all that well. You’ll need to try different doses to really get a sense of how well various treatments work, But the key point is that there remains a possibility for any of the following scenarios to be true:
a) that 5 % topical minoxidil gives you good results
b) that 5 % topical minoxidil does not give you good results
c) that 0.625 mg oral minoxidil gives you good results
d) that 0.625 mg oral minoxidil does not give you good results
e) that 1.25 mg oral minoxidil gives you good results
f) that 1.25 mg oral minoxidil does not give you good results
g) that topical minoxidil 5 % with 0.25 mg oral minoxidil gives you good results
h) that topical minoxidil 5 % with 0.25 mg oral minoxidil does not give you good results
It might sound like alot but one thing is important to keep in mind. We already know you respond well to oral minoxidil. We already know a whole lot of great information about how your hair responds. So it’s quite likely that most of the options above will be helpful to your hair. You and your doctors just need to review and carefully monitor HOW WELL it works and HOW MANY side effects you end up getting with a given plan.
SIDE EFFECTS OF ORAL MINOXIDIL
Let’s talk a bit about oral minoxidil.
First let’s talk about side effects. You may find the link below helpful.
There are several side effects including hair on the face, swelling in the feet, dizziness, palpitations, swelling around the eyes. What’s important for you to know is that these side effects may come out at different times after starting. Headaches and dizziness and palpitations usually occur first (within the first days to weeks). Issues like hair growth on the face and fluid retention may not come out fully until 3 months after starting. The fact that you have hair growth on the face at month 1 is an indication that you are very sensitive to this medication. You also may not be at your maximal amount of hair growth on the face or body yet. You may get even more growth over the next few months. Reducing the dose now will lessen that chance.
In addition, some of the possible side effects could still occur for you in month 2, 3, 4 5 if you continue the same dose. Maybe they won’t occur, of course, but we never fully understand side effects of oral minoxidil until a patient has used the drug a full 5 months. We don’t know if these will happen to you or not but these side effects include swelling in the feet and swelling around the eyes and general fluid retention. That takes about 3 months to fully develop those 2 side effects for most users.
HAIR GROWTH ON THE FACE IN FEMALE USERS OF ORAL MINOXIDIL
Hair growth on the face is common among female users of oral minoxidil. Fortunately, for many patients who use 0.625 and 1.25 mg doses it’s more toward the minimal side and more manageable side. But as the dose increases up towards 2.5 mg, it becomes much more common to get hair growth on the face. In fact, some estimates suggest that about 50 % of women using 2.5 mg will experience more significant amounts of hair on the face and body.
2.5 MG ORAL MINOXIDIL IS NOT AN IDEAL STARTING DOSE FOR WOMEN
In my 2021 article, I reviewed 5 Common Errors that Practitioners Make in Prescribing Oral Minoxidil. The first error on the list is starting doses that are too high. Yes, 2.5 mg is too high of a starting dose in my opinion for females. Sure sure, there are many patients that start this dose and are fine. But there are many patients who are not. When patients say to me “I know many people who started 2.5 mg and were okay” I say to them “you have not spoken to enough people.”
When doctors say to me, “I have started many patients on 2.5 mg and they were fine” I say to them “ you have not treated enough patients with oral minoxidil yet.”
You see, oral minoxidil side effects are fairly common with 2.5 mg doses in women. I see many many patients using 2.5 mg with swollen ankles due to fluid retention. I see many patients using 2.5 mg with swelling around the face due to fluid retention. I see many patients using 2.5 mg with puffy eyes due to fluid retention. I see many patients with excessive hair on the face and body on 2.5 mg.
In my opinion, the starting dose in women is ideally 0.625 mg for 1-3 months and then an increase at that time to 1.25 mg. If all is going well, patients can increase to 1.875 mg or even 2.5 mg in the future. But future increases beyond 1.25 mg need to go really slowly with dose adjustments every 3-5 months.
Why the slow adjustment? Well, it takes 3 months AT LEAST to really get a sense if a certain dose is going to be a problem. It takes THREE months to see if a certain dose is going to be a problem with causing too much hair on the face. It’s going to take THREE months to see if a certain dose is going to be a problem with causing excessive fluid retention.
Final Summary
Thanks again for the great question. I would encourage you to speak to your doctors as soon as possible. Yes, reducing the dose is an option and so is switching to topical minoxidil (ie Rogaine and other topicals). You and your doctors will need to discuss what sort of risk you are willing to take as far as excessive hair goes and what sort of timeline you are on to get rapid improvement in your hair.
There are some patients in my practice who accept alot of hair growth on the face and body because of the good benefits they see happening on the scalp. Many choose to remove hair on the face and body with laser, electrolysis threading, waxing. Other patients find the increased hair extremely unacceptable.
It would appear that you are predisposed to experienced excessive growth and that really the only good option is to reduce the dose. You are your doctors can review what risk you are willing to take and to what degree you are willing to remove facial and body hair.
It could be that lower doses are not as effective for you. It could be that they work pretty well too. Time will tell if lower doses are still quite satisfactory to you or not. But certainly 2.5 mg gives better results for many people than 1.25 mg - but that comes at the risk of possible side effects.
As reviewed above, I don’t ever start 2.5 mg in my patients.
Some patients do amazingly well with 0.25 mg oral minoxidil or even 0.625 mg oral minoxidil. Yes, yes, some patients need 1.25 mg or 1.875 mg or 2.5 mg. But we get up to that dose slowly.
As mentioned above, some patients do amazingly well on topical minoxidil (Rogaine etc). Some patients to well on topical minoxidil combined with use of 0.25 mg to 0.625 mg oral minoxidil added a few times per week.
There is lots for you and your doctors to talk about.
Thanks again
REFERENCE
Ramos PM et al. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. .J Am Acad Dermatol. 2020 Jan;82(1):252-253.