Twice a day minoxidil 5% can work faster than 2%. Four to six months is generally required to see results. Some people may experience some additional hair loss when they first start using minoxidil. This is normal and is a result of the hair follicles shifting the phase of growth they are in, namely from resting to growing.

If your hair loss hasn’t slowed after several months of using minoxidil, it’s a good idea to consult a medical dermatologist.

Twice a day minoxidil 5% can work faster than 2%. Four to six months is generally required to see results. Some people may experience some additional hair loss when they first start using minoxidil. This is normal and is a result of the hair follicles shifting the phase of growth they are in, namely from resting to growing.

If your hair loss hasn’t slowed after several months of using minoxidil, it’s a good idea to consult a medical dermatologist.

Can minoxidil be combined with other topicals?

Minoxidil can be bought over the counter in 2% & 5% formulations.

Dermatologists can prescribe other formulations including-

• 5-7% Minoxidil
• Minoxidil with tretinoin/retinoic acid
• Minoxidil with finasteride 0.25-1.0%

*Recent studies have shown that topical formulations containing finasteride have better outcomes compared to minoxidil alone.

Side effects are usually mild & reversible. The most important side effect to understand is paradoxical shedding of hair in the first few months of use. This is a transient event.

Topical 2-5% Minoxidil, possible side effects include: scalp dryness, itch, flake, soreness & allergies. Transient hair loss (minoxidil effluvium), hypertrichosis (unwanted hair) of temples, forehead, face. Systemic side effects are rare.

Oral 1-2mg Minoxidil, possible side effects include: dizziness, swelling of ankles, headaches, & fluid retention. Hypertrichosis maybe generalised, & more common in women.

*Side effects such as irritant, allergic reactions, and excessive hair growth are proportional to the concentration of minoxidil & reversible with cessation of the drug. Discuss the pros & cons with your dermatologist.

Yes. Note that the FDA recommends (approves) 5% minoxidil for men & 2% minoxidil for women. Dermatologists recommend the higher concentration as it works better.

In the context of female pattern hair loss, the daily use of topical minoxidil has shown to improve hair counts by week 24. As with male pattern hair loss, minoxidil should be initiated early in the course of treatment. Currently there are 3 forms of delivery-

1. Minoxidil lotion (with propylene glycol)
2. Minoxidil foam (without propylene glycol)
3. Minoxidil tablets

Discuss with your dermatologist which is the best option. This depends on the stage of hair loss, your scalp sensitivities, length of hair as well as other factors that may increase side effects from tablets (hypertrichosis, postural hypotension, swelling of extremities, other oral medication).

Minoxidil should be discontinued in pregnancy & lactation as per guidelines.

There is a growing trend of prescribing oral minoxidil over topical therapy. In fact, the initial reports of hair regrowth were following oral minoxidil as this drug was originally prescribed to reduce blood pressure.

Oral medications range between 1 to 2.5 mg daily. The advantage of oral medications is convenience (earlier to swallow a tablet than to apply topicals to the scalp). Oral minoxidil also eliminates side effects such as irritant contact dermatitis or allergic contact (usually to propylene glycol).

The disadvantages of oral minoxidil are the higher side effect profile including hypertrichosis (unwanted hair). This is more significant for women as hair can grow on the face, trunk & limbs. Other side effects include postural decrease in blood pressure as well as swelling of the legs & ankles.

*Discuss with your medical dermatologist the pros & cons of topical vs oral minoxidil. Disclaimer: I am a procedural dermatologist & I do not prescribe medications. My work is focused on surgical hair restoration procedures, lasers, surgery & injectables.

Minoxidil is also unlikely to regrow hair on a completely bald scalp. Once 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.

Depending on the hair density & characteristics at the donor site, Follicular Unit Extraction may be a viable option for hair loss.

Ideally topical minoxidil should be combined with other modalities aimed at preserving follicles, & in some cases regenerating hair growth. Note: Minoxidil is best used as a treatment to reduce the progression of hair loss. 

Natural supplements include saw palmetto. In a recent paper, a combination of saw palmetto & minoxidil produces more hair regeneration than either treatment alone.

Microneedling at home. This can be achieved with 0.2 to 0.25 skin rollers or stampers. Use weekly, apply topicals within 15 minutes of rolling. This markedly enhances the penetration of minoxidil & other topicals.

Oral medications include oral minoxidil, finasteride & dutasteride. We also prescribe antiandrogens in women, namely cyproterone acetate, spironolactone & newer flutamide analogues.

Light based treatments include LLLT or low-level laser treatments, using diode based sources within the 600 – 1050 nm range.

Laser treatments include the use of thulium 1927 low density, often in combination with growth factors & or PRP. Lasers can enhance the delivery of growth factors & topicals.

PRP or platelet rich plasma is best for early onset hair loss. This can be applied with microneedling, laser therapy as well as injections.

FUE or follicular unit extraction is a surgical procedure used to treat advanced cases of hair loss. This procedure has essentially replaced older techniques such as follicular unit transplantation & strip harvesting.

Minoxidil is cost effective. In fact, the price of this topical is only one fifth of the original price two decades ago as Regaine had the patent. Generic lotions are available from most pharmacies. Purchase a 3 to 6 month supply as this is more cost effective.

• Minoxidil 5% 30mls $15: about 50 cents a day.
• Compounded Minoxidil 5-7% + Retinoic Acid: about $1.20 a day
• Topical Finasteride. Approx $1.50 a day
• Finasteride/ dutasteride. Approx. $1 a day
• Ketoconazole  /Nizoral shampoo. $12 for 1-2 months

* A cost-effective daily routine combines minoxidil 5% daily (up to twice a day) & 2% ketoconazole shampoo. This cost approximately 60 to 70 cents/day.

Minoxidil’s exact mechanism of action is thought to be via vasodilation & modulation of potassium channels. This allows more blood flow to the hair follicles, in turn pushing them from a dormant sleeping stage to the active phase of the hair cycle. This stimulates follicles to increase in size as well as prolong the anagen (growth cycle).

This shift from the dormant to the active phase of hair growth accounts for the transient shedding of hair, which commonly occurs when you start minoxidil.

Shampoos have been reported to reduce the conversion of testosterone to DHT, however their use as monotherapy is questionable. Shampoos are best combined with topicals such as minoxidil & finasteride, & or as part of medical therapy.

There are many formulations containing zinc, biotin, niacin, caffeine, keratin, & botanicals.

Papers have demonstrated that ketoconazole shampoo can effectively block the formation of dihydrotesterone.

• Another  study found that using a 2% ketoconazole shampoo was nearly as effective for hair growth as 2% minoxidil (Piérard-Franchimont, 1998).
• An animal study comparing ketoconazole to minoxidil and minoxidil with tretinoin had a “significant stimulatory” effect on hair growth, although minoxidil was found to be more effective (Aldhalimi, 2014).

My viewpoint: in the scheme of things, shampoos are cost effective- even if the true effects are marginal. Nizoral or ketoconazole 2% shampoo are available without prescription from most pharmacies for about $12 AUD.

Most hair transplant surgeons will encourage the use of topical (or oral) minoxidil post-surgery.  Remember the aim is to preserve & at the same time encourage growth.

Topical application should be ceased 3-7 days prior to FUE to reduce the incidence of skin irritation. Topical application can be recommenced 14 days post-surgery. Your scalp may be more sensitive after transplantation & hence I often prescribe an anti-inflammatory for a few weeks post.

The use of minoxidil post FUE will improve hair density at the donor & recipient sites. I encourage continued use (either orally or topically) for life. This view is shared by the majority of plastic & dermatologic hair transplantation surgeons worldwide.

Dermatologists are specialists for skin & hair disorders. We undergo 6 extra years of study after medicine (2 in research+ 4 in a training program). For more complex & advanced hair loss we can investigate & manage accordingly.

Dermatologists prescribe medical therapy including finasteride / dutasteride as well as anti-androgen. Dermatologists can also supervise PRP, PRP microneedling, low level laser therapy & laser procedures to stimulate hair growth. In advanced cases they can discuss the option for follicular unit extractions. Inflammatory conditions including complex lichen planopilaris, lupus, FDC & alopecia areata are also managed by medical dermatologists.

Disclaimer: My work is procedural. In the context of hair conditions, I only see complex cases of alopecia for the option of surgical management. I do not prescribe medical treatments. Please make an appointment with our medical team @cliniccutis