Minoxidil is a common 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. The FDA approved it as a hair loss treatment in 1987. It has been on the market ever since.
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. The most common by far is Androgenetic Alopecia (AGA), also known as Male-Pattern Baldness (MPB) (1).
The main cause of AGA is believed to be a sensitivity to DHT. This is a male hormone (androgen) that our bodies naturally produce.
DHT is made from testosterone, via the action of an enzyme called 5-alpha-reductase. This happens in various tissues throughout the body, like the liver and skin (2). Some of the DHT enters circulation and eventually reaches the scalp and hair follicles.
As DHT attaches to a sensitive hair follicle’s androgen receptors, the follicle eventually alters its normal hair growth cycle. It spends more of its time in the resting phase, where it does not grow hairs, and less in the active growth phase. At the same time, the follicle progressively shrinks in size. Scientists call this process hair miniaturization.
The combined effects of shorter hair growth cycles and miniaturized follicles lead to the production of shorter and shorter hair shafts. In advanced baldness, the follicles completely disappear.
How It Works
As a treatment for pattern baldness, minoxidil works primarily by stimulating blood circulation to the scalp (3). It also has anti-inflammatory properties and modifies certain signaling pathways within the hair follicle cells.
The combined effect of these various properties is to kickstart some follicles back into a healthy growth cycle. The follicles begin to spend more of their time in the growth phase, and less in the resting phase. The result is more and longer hairs.
Though minoxidil does not directly counteract DHT, its action can be sufficient to halt the miniaturization process. Some men will also see moderate regrowth.
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 find that the minoxidil solution works for slightly less than half the people who use it. Side effects are typically mild.
(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 (4).
Although the rate of regrowth slowed, at the five-year mark hair growth was still improved over the baseline levels.
Rietschel and Duncan (1987)
Rietschel and Duncan examined subjects who had used Minoxidil topical solution for 2.5 years (5).
32% of the men in the study had hair that grew long enough to be cut. In all, 36% were satisfied with the treatment, feeling that the results were worth the effort and cost.
European Findings (2016)
A study in Germany examined the long-term effects (104 weeks) of Minoxidil topical foam (MTF). The research began as a 24-week randomized, double-blind, placebo-controlled study. This continued as an 80-week, open-label extension phase (6).
One group received 5% MTF for 104 weeks. Another group received a placebo topical foam until week 24, followed by 5% Minoxidil solution for 80 weeks.
The researchers assessed hair growth at baseline and then 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 (7). They concluded there was a statistically significant effect in promoting hair growth. However, only some of the subjects were pleased with their results. A major issue was poor patient compliance with the treatment regimen.
Minoxidil Side Effects and Considerations
While minoxidil has proven to be effective in the treatment of alopecia, it does have some side effects.
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. When you quit minoxidil, any new hair you have regrown will fall back out.
- The treatment covers symptoms, but it does not treat the root cause.
- If you do not see results after 4 months, you should consider discontinuing treatment.
With these side effects and considerations in mind, it is natural to want to consider other potential options.
Are There Pharmaceutical Alternatives to Minoxidil?
At present, Rogaine (minoxidil) and Propecia (finasteride) are the only hair loss treatments that the FDA has approved.
Unlike minoxidil, finasteride is a pill that works systemically. It reverses hair loss by inhibiting 5AR. As a result, the body produces less DHT. The major disadvantage of finasteride is its unpleasant side effects. The most important of these are:
- loss of sexual desire
- erectile dysfunction
- changes in sperm production
Because finasteride is a powerful medication with potentially more severe side effects, you can only purchase it with a doctor’s prescription.
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 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.” Further, DHT plays a much larger role in the human body than just hair growth and loss.
DHT contributes to the development of secondary male sexual characteristics, like the descent of the testes, voice deepening, facial hair growth, etc. These are not its only biological properties, however.
In the prostate and elsewhere in the body, DHT is also believed to modulate the inflammatory response (8).
All of that to say, while blocking (or minimizing) DHT can treat hair loss, it can also disrupt some key biological activities. The result can sometimes be the unpleasant side effects we discussed above.
Topical vs Systemic
One way to minimize these effects is to use topical DHT blockers, as opposed to systemic ones.
Finasteride, for example, is a systemic drug. Users take it orally as a pill. It then enters the bloodstream and travels throughout the body. For this reason, it targets 5-alpha-reductase (and DHT) at various organs and tissues, rather than just the follicles.
A topical DHT blocker that you apply directly to the scalp, on the other hand, would target DHT at the follicles only. This reduces its impact on other bodily functions.
Do keep in mind that the external DHT blockers below are not approved by the FDA for treating hair loss.
Natural DHT blockers
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 compared to placebo (9):
In another study, the reishi mushroom (Ganoderma lucidum) was the most effective mushroom species at inhibiting 5-alpha-reductase, the enzyme that triggers the production of DHT.
All these natural DHT blockers are widely available and can be purchased over the counter, without a doctor’s prescription. Another advantage is that you can use them both topically and systemically.
Aside from the standard pill version, there is also topical finasteride. 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 hair growth in the majority of individuals (10). Like with oral finasteride, you will need a doctor’s prescription to get topical finasteride.
You will probably also need to turn to a compounding pharmacy in order to prepare the topical. Alternatively, you can find some topical finasteride online, typically fortified with minoxidil.
Is There Risk with Topical DHT Blockers?
When speaking of DHT blockers, it is important to discuss the potential for side effects.
As we saw, there are numerous potential side effects associated with systemic DHT blockers like finasteride. It is also possible to get side effects from natural DHT-blockers like saw palmetto and reishi, though these will typically be far less severe.
What about the risks associated with topical DHT blockers?
The risk of side effects from topical DHT blockers is small compared to internal DHT blockers, but it is not non-existent.
When you apply a topical DHT blocker to the scalp, the skin absorbs it. In this way, it can reach the hair follicle and exert its therapeutic effect. However, some of it might also enter the bloodstream.
Since trace amounts of these DHT blockers will be entering your bloodstream, there is the possibility of mild systemic side effects. Most likely though, you will experience no noticeable side effects at all.
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.
The FDA does not monitor herbal products. As a result, they might be subject to lower quality assurance standards, or no standards at all.
Products you purchase from abroad may be contaminated, or may not even contain what is on the list of ingredients.
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 might be the underlying cause of male pattern baldness in the majority of hair loss sufferers (11).
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, you can start reducing this tension. 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 (12).
Scalp massage is the 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.
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 create small puncture wounds.
(Learn how you can practice microneedling at home with the use of a dermaroller.)
These wounds are not large enough to cause permanent damage. They are sufficient, however, to stimulate the scalp into releasing various growth factors (13). Essentially, microneedling stimulates the scalp to regenerate itself from within.
As this process takes place, healthy hair follicles are able to form. This can counteract the effects of pattern hair loss and restore at least some of your prior hair coverage.
Indeed, studies show that adding weekly microneedling sessions to an otherwise standard minoxidil regimen can dramatically improve regrowth. Users can get as much as three or four times many new hairs compared to using minoxidil on its own (14).
You can also use microneedling on its own, without any other treatment.
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 fewer side effects.
Some of the most popular natural alternatives include saw palmetto, pumpkin seed oil, and reishi mushroom. The advantage of these natural compounds is that you can typically use them either topically or systemically.
The topical administration will likely result in few side effects. Due to their mild pharmacological properties, however, even if you consume these supplements orally, you are unlikely to experience significant side effects.
Due to the lack of safety standards, be especially careful when purchasing natural treatments for hair loss. This is especially relevant if you purchasing these from abroad, or from vendors you have never used before.