Minoxidil, better known by its brand name Rogaine, is the world’s most popular hair loss treatment drug. After all, it’s been shown to produce positive results in the vast majority of users.
However, there is one ‘side effect’ that is often overlooked and which may be startling at first – shedding.
In this post, I’ll introduce minoxidil shedding and why it occurs. I’ll then outline what you can expect during this shedding period – when it starts, how long it lasts, and how much shedding you’ll see.
Finally, I’ll share with you three ways you can lessen the minoxidil shedding period so you can get started growing your hair more quickly. Let’s begin.
An Introduction to Minoxidil
Minoxidil is a topical solution that was first developed to treat high blood pressure, also known as hypertension (1). The drug, previously a tablet known by the brand name Loniten, is a vasodilator which means it widens the blood vessels.
It was during human clinical trials that researchers soon discovered minoxidil’s most common side effect – hair growth.
Loniten was soon being prescribed by physicians for the off-brand use of treating hair loss, though the drug soon gained FDA approval as a hair loss treatment in 1988 (2).
The name of this new treatment? Rogaine.
Minoxidil for the Treatment of Hair Thinning and Loss
Rogaine and its generic form, minoxidil, have been used for decades in the treatment of hair thinning and balding.
Its most common use is for Androgenetic Alopecia (AGA), also known as Male-Pattern Baldness (MPB) (3).
What Causes Pattern Hair Loss?
There is still some debate as to the true cause of pattern hair loss, but the majority of researchers agree on one thing – the androgen hormone DHT certainly plays a role.
Dihydrotestosterone (DHT) is a sex hormone produced in both males and females.
This hormone is largely responsible for the development of secondary sex characteristics in males, and it plays a large role in puberty (4).
But interestingly enough, this hormone which plays such a significant role in development may also be responsible for hair loss in those with AGA.
Androgenetic alopecia is an inherited condition that leads to hairline recession and premature balding.
There are many contributors to the progression of the disease, but DHT is perhaps the most prominent. This is because those with AGA are sensitive to DHT.
DHT naturally attaches to the hair follicles, but for those with pattern hair loss, this can trigger inflammation.
If the inflammation is left untreated, it will lead to the miniaturization of the hair follicle which ultimately causes shedding and hair loss (5).
It would seem obvious, then, that the only treatment for AGA is one that blocks DHT. But DHT blockers have many side effects, most of which are sexual in nature (6).
An alternative to DHT blockers, though, is minoxidil.
How It Works
There are a few ways in which minoxidil is believed to promote hair growth.
The most obvious is its vasodilative effects.
Minoxidil is known to increase blood circulation, but when applied topically it’s also been shown to increase cutaneous blood flow in the scalp (7). This enables the delivery of oxygen and nutrients to the follicles.
Potassium channels are proteins that allow for the passing of potassium ions across the cell membrane. These channels have been linked to the regulation of hair growth (10). In this way, then, minoxidil is able to regulate the potassium content of the hair follicle and contribute to the hair growth process (11).
So, what about the upregulation of growth factors?
Growth factors such as Vascular Endothelial Growth Factor (VEGF) have been shown to increase and decrease at different times during the growth cycle. And minoxidil has been shown to upregulate these growth factors in the Dermal Papilla Cells (DPCs) (12).
These three factors are the most likely contributors to minoxidil’s success, but there may be more which are yet to be uncovered.
How to Use
Rogaine and its many generic derivatives are topical solutions that are available in either liquid or foam formulations.
To use, apply the solution to your scalp. Use your fingertips to rub it in, and then rinse your hands thoroughly.
This process should be repeated once or twice daily depending on your dose.
Minoxidil Shedding: A Common Side Effect
As with any drugs, there is a risk of side effects. One common effect of minoxidil, especially in the first few months of use, is shedding.
And while this may seem counterintuitive for a hair loss treatment drug, it makes sense if you know the reason for it.
As the hair grows, it goes through three stages: anagen, categen, and telogen (13).
Anagen is the phase of active growth, and it’s the one that lasts the longest. However, those with AGA have an excessive number of follicles in telogen (resting) phase.
When you begin to use minoxidil (or really implement any new hair regimen), you will be pushing a large number of telogen hairs through to anagen. And this requires those telogen hairs to shed.
How Common Is Minoxidil Shedding?
While there isn’t an exact percentage of users who will experience minoxidil shedding, the vast majority of users will experience shedding to some extent.
The shedding will typically occur two to eight weeks after you have begun using minoxidil (14).
How Much Shedding Should You Expect?
The amount of shedding you see will vary from person to person.
During the average hair cycle, a person will shed anywhere from 100 to 150 hairs per day. This is because there are always follicles in telogen phase.
This will very likely increase as you begin your minoxidil treatment.
But the more important question is, when should you begin to worry?
If the increase in shedding continue beyond eight weeks, it may be time to cease minoxidil use (even if only temporarily). But do keep in mind that the shedding can increase even further when you stop treatment, though it will eventually return to its usual rate in a few weeks’ time.
How Long Until Minoxidil Starts to Work?
You may be surprised to know that, even during the shedding period, minoxidil is already working within the scalp to improve conditions. For many, though, the true sign that the drug is working is hair growth.
So, how long until you begin to see hair growth when using minoxidil? The answer depends.
It’s safe to say that by six months, the vast majority of users will see noticeable hair growth.
You may see results sooner, though, such as the 26 percent of men who reported moderate to dense regrowth after just four months (15).
However, the key to success is consistency.
If you cannot use minoxidil consistently, and this means continuing to use it even when you notice an increase in shedding, you’re unlikely to see good results.
3 Ways to Avoid or Lessen Minoxidil Shedding
It’s likely not possible that you can avoid minoxidil shedding completely. However, there are steps you can take to lessen its impact or at least speed along the process.
Utilize Scalp Stimulation
Minoxidil increases blood circulation, and that’s one reason it’s believed to promote hair growth. But it’s not the only way you can increase blood flow to the scalp.
Scalp stimulation is physical manipulation of the scalp, such as massage and microneedling. These techniques increase blood flow, and they also break up any calcification and reduce tension.
Best of all, scalp massage and microneedling have been shown to induce hair growth in human subjects.
Study: Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue
One study published in 2016 included nine men who underwent daily scalp massage (with a device) for 24 weeks (16).
To determine the effects of massage on the hair growth process, the researchers analyzed gene expression changes using DNA microarray analyses. They also tracked expression of hair cycle-related genes including IL6, NOGGIN, BMP4, and SMAD4 using real-time reverse transcription-polymerase chain reaction.
As the final results showed, stretching of the scalp via daily massage upregulated a total of 2,655 genes and downregulated another 2,823.
Even further, the real-time reverse transcription-polymerase chain reaction demonstrated increased expression of hair cycle–related genes and decreased hair loss–related genes.
And microneedling has had similarly positive study results.
Study: A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study
A study from 2013 recruited 100 men with mild to moderate androgenetic alopecia (17). The first group was given weekly microneedling combined with daily minoxidil 5%, while the second group was given only daily minoxidil 5%.
The researchers tracked results using three parameters – the mean change in hair count, investigator evaluation, and patient evaluation.
The mean change in hair count at 12 weeks was significantly increased for those in the microneedling and minoxidil group at 91.4 hairs. This is compared to the mean change in hair count of 22.2 hairs for the minoxidil-only group.
The researchers also noted that 40 patients in the microneedling group had plus two to plus three response on the 7-point visual analogue scale, while none showed the same response in the minoxidil-only group.
Are massage and microneedling likely to help you avoid minoxidil shedding? Probably not. But they may help to speed the process so you experience less shedding overall.
Use Alongside Other Medications
There’s no doubt that minoxidil is one of the most popular treatments on the market, but it’s not the only one.
Other medications include finasteride (Propecia) and dutasteride (Avodart), but there are also many other options available for consideration.
Finasteride and dutasteride are both medications that were initially developed for the treatment of Benign Prostatic Hyperplasia (BPH). But just like minoxidil, these drugs were soon shown to have an unusual side effect – hair growth.
These drugs work similarly in that both inhibit the enzyme 5-alpha-reductase (5AR).
5AR is the enzyme responsible for the conversion of testosterone to Dihydrotestosterone (DHT). DHT is the androgen hormone that those with AGA have a sensitivity to, and as such, less DHT means less thinning and hair loss.
The difference between finasteride and dutasteride, though, is in how much 5AR they inhibit.
There are two types of 5AR which are so aptly named Type I and Type II (18). Type I is the most prevalent isoform found in sebaceous glands (and, therefore, hair follicles), but Type II is present as well.
Finasteride inhibits 5AR Type I, while dutasteride inhibits both Type I and Type II (19).
These drugs can have side effects – including inability to get or maintain an erection. But there are many people who find them to have greater benefits than risks.
When you use finasteride or dutasteride to treat hair loss, it is less likely to contribute to shedding. And it may also help to balance out the shedding you experience as a result of minoxidil.
Consider Natural Alternatives
There are many treatments on the market – those approved by the FDA, and those that aren’t – which claim to treat hair loss. But sometimes you may want to take a more ‘natural’ approach to hair regrowth.
Natural options, such as essential oils and supplements, do exist.
The most commonly touted hair loss essential oils are pumpkin seed, rosemary, and peppermint. And for good reason.
This means they may be useful in treating the inflammation that comes along with hair loss, and they may also combat bacterial contributors to hair loss such as dandruff (23).
However, there are things to consider before you move forward with a natural treatment.
The first is that the majority of oils have yet to be tested on human subjects, and even those that have been tested on humans were done on a limited scale. As such, there are still many unknowns about their short-term and long-term effects.
Without FDA approval, these natural treatment options may also have a greater risk of causing harm.
This doesn’t mean that you should avoid natural remedies altogether. But you should consider the lack of research and understand that you’ll be taking on a greater risk if you choose to use them.
Other Side Effects and Considerations
Shedding is not the only side effect of minoxidil use.
The most common side effects include itching and dryness of the scalp (24). These are often temporary, though if you have particularly sensitive skin it may last through the duration of your treatment.
Interestingly, minoxidil is not believed to be the cause of this irritation. Instead, it’s thought that the preservatives within the solution – particularly alcohols – have a drying effect on the scalp.
This is why the foam solution was formulated, and it’s recommended in place of the liquid solution for anyone who is experiencing irritation (25).
As a vasodilator, the drug can cause other adverse effects.
These include headaches, lightheadedness, dizziness, and excessive sweating. If you experience any of these effects, you should cease use and speak with your doctor.
When you’re already suffering from hairline recession and balding, there’s nothing more startling than seeing an increase in shedding. This is especially true when you’ve just started with a treatment method such as minoxidil.
But the fact of the matter is, minoxidil shedding is a normal part of the process.
While it may be difficult to deal with at first, the shedding should cease by 8 weeks of use.
There are techniques you can use – including scalp stimulation, and other hair loss medications – which may lessen the impact of the shedding period.
However, the exact amount of shedding you see will vary from person to person. And if you stick it out, it’s very likely that you’ll see positive hair growth results.
Do you have questions about minoxidil shedding? Leave a comment below.