This post will take a closer look at minoxidil cream. This will include how it compares to the “traditional” formulations, and what you may expect from use. In addition, it will describe the possible side effects.
In the end, I’ll also share with you my very own formula for a natural minoxidil alternative.
What is Minoxidil?
Minoxidil is a drug that was originally used in the treatment of hypertension but has now become one of the most popular treatments for hair loss.
First developed by the Upjohn Company (now purchased by Pfizer) in the 1950s for the treatment of ulcers, studies showed that minoxidil actually worked better as a vasodilator. As such, the FDA approved and released it for the treatment of high blood pressure under the name Loniten in 1979.
After its market release, it soon became obvious that minoxidil had another surprising side effect: hair growth. By the early 1980s, many doctors were prescribing Loniten off-brand for their balding patients.
Finally, in 1988, the FDA approved minoxidil as a hair loss treatment under the name Rogaine. A version for women soon followed in 1991.
How Does It Work?
There’s still debate about minoxidil’s mechanism of action, though most researchers believe it is linked to its vasodilating properties.
Individuals with Androgenetic Alopecia suffer from a sensitivity to DHT. This is an androgen produced from the interaction between testosterone (the male sex hormone) and 5-alpha-reductase (an enzyme).
While DHT does play an important role in sexual development, those with a genetic predisposition to alopecia (along with other factors) may find themselves with DHT-sensitive hair follicles.
As the DHT attaches to the hair follicles, it activates their androgen receptors. The cells respond to this by modifying the expression of various genes.
Scientists do not understand exactly which of the various genes (or other biochemical processes) are responsible for hair loss. Over the medium and long term, however, DHT leads to thinning and gradual hair loss.
This happens through a process known as hair miniaturization. If untreated, this will lead to permanent baldness.
Throughout the process of hair miniaturization, there is a severe lack of oxygen and nutrient delivery from the blood vessels to the hair follicle. This further speeds up the process, and eventually kills the follicle.
As a vasodilator, minoxidil ensures the continued delivery of oxygen and vital nutrients to the scalp and follicles. While it doesn’t remove the cause of the hair loss (DHT), it does allow the hair follicles to at least survive.
What is Minoxidil Cream?
The FDA has approved two versions of minoxidil: liquid and foam. These are the versions you will find in any pharmacy.
Yet some online vendors offer a cream version of minoxidil. Even though these products are not approved by the health regulators, most vendors sell them without requiring a doctor’s prescription.
Most vendors recommend the twice daily application. After application, the cream should be left on the scalp for a minimum of two hours.
Most often, these creams have very high concentrations of minoxidil, typically between 10-15%. Some even offer a 30% strength. Other active ingredients in the cream can include finasteride, caffeine, azelaic acid, and many more.
Minoxidil Liquid vs. Cream
The liquid is the most popular minoxidil formulation. It has been on the market for a few decades now, first as Rogaine, and then as various generic store brands. How does it compare to the cream version?
Unfortunately, we have no comparative studies. Actually, there have been no studies at all to test the efficacy of the cream formulation.
However, there are a few things we can know about their differences.
First, the minoxidil liquid is likely to have fewer side effects than the cream formulation. This is because as we discussed, the cream formulation tends to be much stronger.
Second, the minoxidil liquid is likely to be easier to work with. Unlike cream, which can leave a greasy, gummy residue, the liquid will evaporate over time. This makes it easier to style your hair.
Minoxidil Foam vs. Cream
Minoxidil foam was first introduced as an alternative to minoxidil solution in 2010. The Women’s Foam was released in 2014.
The foam was produced in response to allergic reactions by Rogaine users, caused by the ingredient propylene glycol. As the foam does not contain propylene glycol, it tends to cause fewer side effects.
Like the minoxidil liquid, no studies have compared minoxidil foam and cream; this makes it difficult to really know which one works best.
Because it will tend to produce fewer side effects, however, the foam should be more effective in the long term. This is because users will simply tend to stick to treatment longer.
It will probably also be easier to apply and less messy compared to the cream.
Are These Creams Really Worth It?
The major selling point of most minoxidil creams is their high strength. The maximum strength the FDA has approved is 5% (and with good reason).
Most minoxidil creams are in the 10-15% strength range. This extra potency, along with the also unapproved cream version, makes this a potentially “exciting” product for users who have not seen results from regular minoxidil.
The truth is, minoxidil’s effectiveness increases with strength, but only up to a certain point. After that point, further increases in dosage will produce no additional therapeutic benefit. They will only increase the side effects.
Over 5%, More Minoxidil Is Generally Not Better
The effectiveness of minoxidil for most men probably levels off around the 5% strength. Any increase in strength after this will only produce more side effects.
This was clear in a recent 2021 study that directly compared 5% vs 10% topical minoxidil for the treatment of baldness (1).
As expected, both 5% and 10% minoxidil performed better than placebo. The surprise was in the difference between the 5% and 10% strengths. Contrary to the researchers’ expectations, the two strengths were essentially identical across all efficacy measures. If anything, the 5% strength fared slightly better.
Unsurprisingly, the 10% strength produced more side effects.
For Non-Responders, the Strength Is Irrelevant Anyway
Around half of the men who try minoxidil will see no results whatsoever. According to a recent review:
“despite significant clinical efficacy, cosmetically acceptable results are present in only a subset of patients (2).”
Clinical studies show that after 16 weeks of treatment with the stronger 5% formulation, about one out of two patients will have no visible regrowth. One out of three will have minimal, barely visible regrowth. Less than one out of every 10 patients will achieve regrowth that is easily visible to the naked eye (3).
Scientists now understand the reason these men do not respond to treatment. It has to do with large genetic differences in the degree to which the scalp converts minoxidil to its active metabolite, minoxidil sulfate.
The human body naturally produces the enzymes that break down minoxidil into minoxidil sulfate. They are called sulfotransferases. Some people express these enzymes far more than others.
The more someone expresses them, the more they convert minoxidil to minoxidil sulfate. This gives better regrowth. On the other hand, men with low levels of sulfotransferases won’t metabolize minoxidil, and the treatment will fail.
For these men, there is simply no point in increasing the strength of minoxidil. The problem lies not in the treatment’s low strength, but in the scalp’s ability to make good use of whatever minoxidil is available. Even the strongest minoxidil formula in the world will not address this problem. (See here for a potential solution).
Side Effects and Considerations
The side effects associated with the cream version will be similar to those of other minoxidil products. However, as the creams come in higher doses, you are more likely to experience side effects, and these might be more severe.
The most common side effects include itching, redness, flaking, and dryness.
The chances of these side effects can be lessened by using a propylene glycol-free product, such as minoxidil foam.
Depending on the cream you purchase, it may have propylene glycol. So, if you’re sensitive to such things, be sure to do your research.
More severe side effects are also possible (though rare). These include dizziness, headaches, nausea/vomiting, difficulty breathing, hives, and swelling of the mouth, lips, tongue, or throat.
If these symptoms occur, stop use of minoxidil immediately and seek medical attention.
If you’re a woman, you’ll want to be wary of high-dose minoxidil concentrations. The FDA has only approved minoxidil liquid 2% and minoxidil foam 5% for women, and with good reason. Higher concentrations can increase risk of side effects. One such side effect is excess hair growth on the face (known as hirsutism).
Costs and Availability
Unlike the 2% and 5% minoxidil solution and foam, the cream version is not available over the counter. In fact, it’s quite hard to even come across in the US, and it can be hard to track in other countries as well.
If you want to use minoxidil cream, you will have to order it online. Often the vendor will be located abroad. As these products will be unlicensed and unregulated, there is a risk of poor quality and a product composition that differs from what is actually on the label.
Since they are not mass-produced, any minoxidil creams you do come across will be pretty pricey.
Another option is to get a doctor’s prescription which you will then present to a compounding pharmacy. The pharmacy will then prepare the minoxidil solution for you. This has the advantage of a) medical supervision and b)pharmaceutical-grade quality of the cream.
Some hair loss clinics also offer their own minoxidil creams to patients. One of the best known is the Belgravia Clinic in London, which offers a high-strength minoxidil cream compounded with other active ingredients.
Are There Any Natural Alternatives?
Minoxidil is a popular hair loss treatment, but not without side effects. This is especially true if you’ll be using a high-dose formulation, such as cream.
To avoid such issues, you can try an all-natural alternative. With natural ingredients, you can tailor the product to fit your needs. In addition, you can save money.
Here is a two-step alternative you can start using today.
1. Salicylic Acid Scalp Peel
Sebum buildup is a common occurrence, but it can cause a number of issues if not treated regularly. Such issues include an excessive amount of DHT on the scalp and hair follicle blockage.
Fortunately, you can handle this issue easily with a scalp peel.
- Salicylic acid (15% solution or less)
- Coconut oil
Wash your hair with a gentle shampoo (I recommend one from here), and then rinse thoroughly. Apply coconut oil to the scalp, enough to cover it in a thin layer. Allow it to sit on your scalp for 30 minutes.
Using an eyedropper (you can pick some up at the drugstore), apply the salicylic acid to your scalp in sections. Pay particular attention to areas with obvious flaking, itching, thinning as these are the areas most likely to have the most buildup.
Leave the acid on your scalp for 10 minutes, and then rinse thoroughly. Peel away any excess acid that has been left behind (you can also use a hairbrush – gently!).
2. Topical DHT Blocker (Minoxidil Alternative)
What You’ll Need:
While not a necessary step, I recommend you first use a dermaroller to stimulate the scalp.
A dermaroller is a microneedling tool that creates small puncture wounds to the scalp. As these “wounds” heal, blood and nutrient flow to the area is increased. This means your scalp is more able to absorb treatments, and it can also promote the growth of new hairs.
You should perform this step after the scalp peel but before the topical.
Now, mix the ingredients together as follows:
- first, add 1 part of emu oil to 1 part of hyaluronic acid.
- then, add 1 part saw palmetto to 7 parts of the emu/hyaluronic mixture.
- finally, add 1 part of pumpkin seed oil to 6 parts of the emu/hyaluronic/saw palmetto mixture.
NOTE: The actual quantities are not that important (so you can make as much or as little as you’d like).
Now, using a pipette or spray bottle (set on lowest spray), begin to apply to areas where you’ve applied the peel and used the dermaroller. Use your fingertips to massage the mixture in, and then let sit for 20-30 minutes. Rinse thoroughly with lukewarm (NOT hot) water.
For best results, apply this mixture as frequently as minoxidil (twice per day). Or, if used as a supplement to another hair loss treatment, you can apply every few days.
To store the mixture, keep it in a dark-colored bottle (preferably glass). I would suggest keeping it in the fridge, though any cool, dry place will do.
When looking for a hair loss treatment, minoxidil cream is an option. However, it is not likely to be a good option for you.
Chances are the cream will offer no additional benefits to the 5% or even 2% standard products. The only likely outcome is more side effects.
These creams will also be more expensive than standard minoxidil products, and the quality might not be to the highest standards.
If you want to increase the efficacy of minoxidil, an easy option is to combine it with microneedling. Alternatively, you can use a regular 2% or 5% strength but combine it with active ingredients likely to increase its efficacy. Two of these are tretinoin and finasteride.
Alternatively, you can try a completely natural approach, like discussed above.