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Frequently Asked Questions About Minoxidil

1. What is Minoxidil?

Minoxidil was the first drug approved by the FDA for the treatment of androgenetic alopecia (i.e., hair loss). For decades Minoxidil has been used as an oral pill to treat "high blood pressure". One of the side effects was hair growth and reversal of male patterned baldness. However, taking minoxidil in a pill form had many other side effects that made it impractical to take for the treatment of baldness. In the 1980's, UpJohn Corporation came out with a topical formulation of Minoxidil, called Rogaine®. This formulation of Minoxidil was a 2% strength. In the 1990's, UpJohn's patent expired causing the price to come down due numerous generic forms of Minoxidil hitting the market. Pharmacia subsequently came out with a 5% Minoxidil solution and now Upjohn also makes this strength.

2. How does Minoxidil work?

Minoxidil stimulates hair growth in individuals with male & female patterned baldness. However the mechanism of action is not known. We do know it does not affect the levels of DHT, which is how Propecia works.

3. Who is a good candidate for minoxidil?

The perfect candidate for Minoxidil is a young male who is just starting to bald in the vertex/ crown area of the scalp.

4. Is 5% minoxidil more effective than 2% minoxidil?

Yes, it is much more effective. Minoxidil is dose-dependent. The higher the dose of Minoxidil, the better the results. Using 5% Minoxidil does not give you faster results, but will cause the regrowth of more hair and thicker hair. The 5% Minoxidil solution can cause more skin irritation than the 2% solution.

5. Is Topical Minoxidil safe?

Topical Minoxidil has an excellent safety record. The most common side effects are itching and skin irritation of the treated scalp. Unwanted hair growth may occur in areas adjacent to treatment sites, which can be little distressing to women when the face is involved. There were no clinically significant systemic side effects as compared to placebo.

6. Can both men and women use Minoxidil?

Yes. There has been numerous studies showing Minoxidil causes clinically significant hair growth in both men and women.

7. Does Minoxidil only work in the vertex/crown area of the scalp?

Minoxidil works best in the vertex area, but Dr. McAndrews has had several patients who have obtained hair growth in the front part of the scalp.

8. Can Minoxidil increase as well as maintain my hair count?

In the studies conducted by UpJohn, clinical investigators felt 39% of men had some regrowth of hair at 12 months and it is at least as beneficial in women. In Dr. McAndrews experience, he has many patients that are obtaining good results with Minoxidil. Unfortunately, he can not predict who will get good results and who will not.

9. Can Minoxidil help maintain my hair count?

In Dr. McAndrews experience, he has seen many of my patients maintain their hair while on Minoxidil, even if it did not grow new hair. Many of his patients found this out when they stopped using Minoxidil (because they did not think it was working) and they had a significant amount of hair loss.

10. Who should not take Minoxidil?

Patients with a history of hypersensitivity to any of the component of the preparation

Pregnant or nursing women

11. How long will it take for Minoxidil to work?

Thick hairs have been seen as early as 4 months into treatment, but usually the full benefit from Minoxidil is not see for 12- 14 months. Therefore, Dr. McAndrews tells all his patients to not judge the results for at least 1 year.

12. How long do I have to take minoxidil?

Minoxidil is a treatment for hair loss and not a cure. You need to take Minoxidil for as long as you want to continue to benefit from its use. If you stop taking Minoxidil, you will likely lose any hair you have gained within several months of stopping treatment.

13. Does topical Minoxidil interact with other medications?

There are currently no known drug interactions associated with the use of topical Minoxidil solutions.

14. How does Minoxidil compare with other products available for the treatment of hair loss?

In my personal experience, there is no other medication on the market, prescription or over-the-counter, that is as effective as Propecia®. Topical Minoxidil is the only other medication that is FDA approved for the treatment of hair loss.

15. Would using a topical Minoxidil solution in combination with Propecia® be more effective than Minoxidil alone?

YES. We constantly see in dermatological diseases using a combination of medications with different mechanisms of action, works better than either one when used alone. Propecia® and Minoxidil work on different mechanisms of action.

There was a study looking at the Stumptail macaque Monkey, who appears to have a similar pattern of balding as humans. There were three study groups of monkeys; one group of monkeys were treated with Minoxidil alone, another group of monkeys were treated with Propecia® alone, and the last group of monkeys were treated with both Propecia® and Minoxidil. The monkeys who had both Propecia® and Minoxidil grew significantly more hair than the monkeys that had a single form of treatment. Unfortunately, there has been no studies presently performed on humans to prove this point.

16. How should I apply the Minoxidil solution?

You should apply the 1 cc of Minoxidil solution via a "dropper" directly messaged in with your fingers to the balding scalp 2 times a day, once in the morning and once at night. I personally do not like to apply the Minoxidil solution by a "spray method" or a "dab method" because most of the solution does not get to the required location (i.e.-the skin and hair follicles), it just gets applied and dries on your hair, where it is not effective.

17. Can I use hair care products (hair sprays, hair thickeners, gels, hair dyes, perms, etc.) while using Minoxidil or Minoxidil combined with other products?

Yes, there is no evidence that these agents would interfere with the effectiveness of Minoxidil. Wait till the Minoxidil dries before using any other product.

18. Is it true I might notice an increase in shedding of hairs following the initiation of Minoxidil?

Yes. Hair grows in a cyclical nature. The growth phase (anagen) of scalp hair lasts 4-7 years. Then the hair follicle goes into a resting phase (telogen) which lasts approximately 3 months. As the new hairs grow in, the old hairs are released resulting in shedding. When you start Minoxidil, some of the hair follicles may be shifted from the resting phase into the growth phase resulting in a temporary increase in shedding. This increase in shedding usually starts 2-6 weeks after beginning treatment and subsides within a few weeks.

19. How long after putting Minoxidil on my scalp can I wash my hair or go swimming?

After applying Minoxidil to the scalp, it must remain on the scalp for at least 4 hours so that the medication may be absorbed into the scalp.

20. Can I use Minoxidil more than twice a day, and will it work better?

You can use it more than twice a day and there are many patients and physicians who think it works better when it is used more than twice a day. However, by increasing the frequency it increases the side effects (i.e.- skin irritation, unwanted hair growth on other areas) and cost.

21. If I place it on a wet scalp what will happen?

Topical drugs actually penetrate the skin much more effectively when the skin is wet. Therefore, theoretically, Minoxidil potency would be increased. However with increased potency comes increased side effects, so be careful.

Los Angeles Hair Restoration and Corrective Surgery Expert

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