Minoxidil is commonly used as an ingredient in hair loss treatment formulas. However, there are alternatives available that can provide similar results.
This article will introduce the FDA-approved hair loss treatment minoxidil. This will include how it works, the most common side effects, and potential substitutes for this popular over-the-counter treatment.
Minoxidil As a Treatment for Male Pattern Baldness
Minoxidil is the active ingredient in Rogaine, and it has been approved by the FDA for over twenty years as a hair loss treatment,
To understand how it works, it is first important to understand the causes of pattern baldness.
What Causes a Thinning, Receding Hair?
There are various causes of hair fall, though the most popular one is Androgenetic Alopecia (AGA), also known as Male-Pattern Baldness (MPB).
The main cause of AGA is believed to be a sensitivity to DHT, an androgen hormone found naturally within the body.
DHT is produced when testosterone (the sex hormone) and 5-alpha-reductase (an enzyme) interact. This happens in the prostate, but also in places near the hair follicles.
How It Works
As a treatment for pattern baldness, minoxidil works by stimulating blood circulation to the scalp.
As DHT attaches to a sensitive hair follicle’s androgen receptors, the follicle becomes irritated and inflamed. Over time, this leads to hair miniaturization.
The hair growth cycle will shorten, and this will lead to shorter and shorter hairs being produced, eventually leading to no hair at all.
Our Perfect Hair Loss Solution
As the process of miniaturization takes place, the link between the hair follicle and blood vessels becomes thinner. When this occurs, fewer nutrients and less oxygen are delivered.
When minoxidil is used, blood circulation increases. This means more nutrients can be delivered so the follicle can revive.
Does It Work? – Studies On Its Effectiveness
What follows is a sample of the scientific findings regarding the effectiveness of Minoxidil solution.
In summary, they state that Minoxidil solution works for slightly less than half the people who use it, with almost no side effects.
Go here for more information on how long Rogaine takes to work.
Duke University (1990)
A study performed at Duke University, and published in The Journal of the American Academy of Dermatology, followed a group of 31 men over a period of five years. They found that hair regrowth peaked at 1 year, after which it began to slow.
Although the rate of regrowth slowed, at the five-year mark hair growth was still improved over the beginning levels.
Rietschel and Duncan (1987)
Rietschel and Duncan examined subjects who had used Minoxidil topical solution for 2.5 years.
32% of the men in the study had hair that grew long enough to be cut, and 36% were satisfied with the treatment, feeling that the results were worth the effort and cost.
European Findings (2016)
A study done in Germany examined the long term effects (104 weeks) of Minoxidil topical foam. The study began with a 24-week randomized, double-blind, placebo-controlled study, followed by an 80-week, open-label extension phase.
1 group was given 5% MTF for 104 weeks, another group received a placebo topical foam until week 24, followed by5% Minoxidil solution for 80 weeks.
Hair growth was assessed at baseline and at weeks 24, 52, 76, and 104.
The authors concluded that “5% MTF is effective in stabilizing hair density, hair width and scalp coverage in both frontotemporal and vertex areas over an application period of 104 weeks, while showing a good safety and tolerability profile with a low rate of irritant contact dermatitis.”
Gupta and Charrette
Gupta and Charrette performed a systematic review of the existing research on Minoxidil solution, and concluded that there was a statistically significant effect in promoting hair growth. However, only some of subjects were pleased with their results, and a major issue seemed to be patient compliance with the treatment regimen.
Minoxidil Side Effects and Considerations
While minoxidil has proven to be effective in the treatment for alopecia, it does have side effects associated with its use.
The most common side effects are local irritation, including itching, flaking, burning, and rash.
In addition to side effects, there are a few things to consider before beginning treatment.
- Results only last as long as treatment continues.
- The treatment covers symptoms, but it does not treat the root cause.
With these side effects and considerations in mind, it is natural to want to consider other potential options.
Are There Over-the-Counter Alternatives to Minoxidil?
As it currently stands, Rogaine (minoxidil) and Propecia (finasteride) are the only hair loss treatments approved by the FDA.
Are There Natural Alternatives to Minoxidil?
If over-the-counter or prescription medications are not an option, there are alternatives.
As sensitivity to DHT is believed to be a factor in AGA, it makes sense to use DHT blockers.
The problem with DHT blockers (and 5-alpha-reductase inhibitors, like finasteride) is their risk of side effects.
While DHT plays a role in AGA, it is not necessarily the “cause.” And in fact, DHT plays a much larger role in the human body than just hair growth and loss.
Dihydrotestosterone (DHT) is an androgen sex steroid and hormone. It contributes to the development of secondary male sexual characteristics, like the descent of the testes, voice deepening, facial hair growth, etc. That is not the only biological activities it is involved in, though.
In the prostate and elsewhere in the body, DHT is believed to modulate the inflammatory response. This is likely the reason that DHT levels are higher in men with pattern baldness.
All of that to say, while blocking (or minimizing) DHT has been shown to effectively treat hair loss, it can disrupt some key biological activities.
One way to minimize these effects is to use external DHT blockers as opposed to internal ones.
Finasteride, for example, is an internal drug. It is taken orally, so it enters the bloodstream where it then travels to the organs and targets 5-alpha-reductase (and DHT) at the “source.” An external DHT blocker, however, would target DHT at the follicles only. This reduces its impact on systemic functions.
Do keep in mind that the external DHT blockers below are not approved by the FDA. In many cases, they may not have even been tested on humans but only mice or extracted dermal papilla cells.
Some natural DHT blockers to consider include:
For example, pumpkin seed oil has been shown over the course of 24 weeks to increase hair count and hair thickness:
In another study, reishi mushroom (Ganoderma lucidum) was the most effective mushroom species at inhibiting 5-alpha-reductase, the enzyme that triggers the production of DHT.
There are also over-the-counter options.
There are topical finasteride formulations that have been developed. This includes a gel formulation and a cream or lotion.
The gel formulation, when used as a maintenance dosage after treatment with minoxidil and/or finasteride, was shown to maintain the hair growth in the majority of individuals.
Is There Risk Associated with Topical DHT Blockers?
When speaking of DHT blockers, it is important to discuss the potential for side effects.
There are numerous potential side effects associated with internal DHT blockers, like finasteride. These same side effects may be seen even when you use ingredients like saw palmetto and reishi.
But what about the risks associated with topical DHT blockers?
The risk of side effects when using topical DHT blockers is small when compared to internal DHT blockers, but it is not non-existent.
When a topical DHT blocker is applied to the scalp, it is absorbed by the skin. In this way it can enter the bloodstream and interact with the hair follicle.
Since trace amounts of these DHT blockers will be entering your bloodstream, there is the possibility to experience mild systemic side effects. It is very likely that you may experience no noticeable side effects at all, though.
You can reduce the risk of developing side effects by using a topical DHT blocker with a low concentration of DHT-blocking ingredients. This will dampen the positive effects, of course, but it will also reduce risk.
Carefully follow the manufacturer’s directions, and buy products from reliable sources.
Herbal products are not monitored by the FDA. Products brought in from other countries may be contaminated, or they may not contain what the packaging claims.
Scalp Tension Reducers
I mentioned above that DHT plays a role in hair loss, but it is not the cause. Instead, it seems scalp tension is the underlying cause of male pattern baldness in the majority of hair loss sufferers.
Scalp tension is a somewhat ambiguous term, but all it refers to is the chronic tension found in the top-most layer of the scalp known as the galea. The galea is a fibrous tissue connected to the muscles on the perimeter of the scalp (frontal, occipital, temporal, and external auricular).
Contractions from these muscles can trigger an inflammatory response in androgen-sensitive regions of the scalp. As scalp tension increases, so too does inflammation at the hair follicles. This can progress to hair follicle miniaturization, which ultimately means stunted hair growth and the development of pattern balding.
To stop the progression of pattern balding and to potentially even reverse it, the tension must be reduced. Here is how.
Scalp tension occurs when the muscles remain in a semi-contracted state for an extended period of time. This is where scalp massage comes in.
Scalp massage is a gentle manipulation of the muscles and tissues (like the galea) with hands or a specialized massaging tool. The massages will, over time, release the contractions and bring the muscles back to their natural resting state.
In terms of pattern baldness triggered by scalp tension, massage can reduce the inflammatory response and reverse miniaturization of the hair follicles.
There are many scalp massage techniques you can use to your benefit.
To work more muscles for the potential of improved benefits, you can also incorporate scalp exercises into your daily routine.
Scalp exercises are, essentially, an extension of scalp massages. You still manipulate the scalp, but you do so in a less direct way than with scalp massages.
A popular scalp exercise, and one which highlights the indirect nature of the action, is the eyebrow exercise.
- Begin with your eyebrows in a neutral (relaxed) position. Slowly lift your eyebrows up towards your hairline. For best results, hold this position for 10 seconds and then release. You will then return your eyebrows to the neutral position. Repeat this exercise five to 10 times.
- Next furrow your eyebrows. Slowly furrow your eyebrows as deeply as possible, and hold for 10 seconds. Return to the neutral position, and then repeat five to 10 times.
- Lift your eyebrows towards your hairline, hold for five seconds, and then immediately move to the furrowed eyebrows position. Hold this position for five seconds, and then return your eyebrows to rest. Repeat this five to 10 times.
Just like with scalp massages, there are plenty of different techniques to try.
If you want to replicate the way in which minoxidil works, then circulation boosters are the way to go.
I mentioned above that scalp tension is the true culprit of pattern baldness. As the scalp tension becomes chronic, the scalp and hair follicles will experience an inflammatory response. Anti-inflammatories, like DHT, will flood to the area.
As we know, however, this is not ideal for those who are prone to DHT sensitivity. As a result, the hair follicles will miniaturize and this will stunt hair growth until the follicle eventually dies.
It is not as simple as the follicle dying from inflammation, though. The true cause of follicle death is the lack of blood flow, oxygen, and nutrient delivery that occurs during the miniaturization process. Without proper blood flow, there cannot be adequate delivery of oxygen and nutrients. This weakens the hair follicle.
While circulation boosters will not solve the underlying cause of pattern baldness, they can help your follicles to survive in spite of it.
Circulation boosters are things that increase blood flow to the area. They can be medications (like minoxidil), oils and herbs, or even manual stimulation of the scalp.
Scalp massage involves gentle stimulation of the scalp, either with your fingertips or a head messaging device. As you gently work the scalp, blood flow increases.
This leads to improved circulation overall and can stimulate new hair growth when practiced continually over a period of time.
A more intensive (and effective) route is microneedling.
As a practice commonly used to reduce scarring, microneedling involves the use of tiny needles. These needles gently roll over the scalp and small puncture wounds are made.
As the wounds heal, a three-step process occurs:
- Maturation (Remodeling)
While minoxidil is popular in the hair loss community, not everyone wants to use minoxidil as part of their hair growth regimen. That is where alternatives come in.
Not only can the results of many natural methods be more effective than minoxidil, but they can also come with less side effects.