Rogaine (minoxidil) is a popular hair loss treatment. It is often the first medication balding men will try.
A common side effect of Rogaine is a brief period of increased hair loss shortly after treatment begins. This is called Rogaine shedding (or “dread shed”). Understandably, it can be very distressing to start losing more hair after beginning a baldness treatment.
This article will outline exactly why Rogaine shedding happens and how long it typically lasts. It will also suggest methods of limiting the shedding and accelerating the new hairs’ regrowth.
- Using Rogaine to Treat Thinning and Receding Hair
- A Dreaded Side Effect
- The Hair Growth Cycle
- How Male Pattern Baldness Affects the Hair Growth Cycle
- What Causes Rogaine Shedding?
- How Common Is It & How Much to Expect?
- Is It Possible to Avoid Shedding?
- How to Get Better Results with Minoxidil
- Other Minoxidil Side Effects to Consider
Using Rogaine to Treat Thinning and Receding Hair
Rogaine is an over-the-counter topical hair loss treatment. The active ingredient is minoxidil. Application is twice daily.
Rogaine can be effective against various types of hair loss. Its main indication, however, is Male Pattern Baldness, also known as Androgenetic Alopecia (AGA) (1). This is by far the most common type of hair loss in men (2). It accounts for over 95% of instances of hair loss. The first sign of AGA is typically thinning temples and a receding frontal hairline. Over time, it can affect the rest of the head. In severe AGA, hair remains only on the sides and back of the head.
Minoxidil induces noticeable regrowth in slightly less than half the men who try it (3). Results take about 4 months to appear. Users who see no results after this time are advised to stop treatment (4).
The exact mechanism of action is unknown (5). It is possible that minoxidil regrows hair by increasing blood flow to the scalp. Another possibility is that it stimulates certain growth factors critical to hair growth.
A Dreaded Side Effect
As with any medication, minoxidil can cause some side effects.
One of the most common and unpleasant side effects is a temporary phase of hair shedding at the start of treatment. Minoxidil users sometimes call this “dread shed.”
Scientists suggest this shedding phase can happen 2-8 weeks after the start of treatment (5). Anecdotally, however, some users report it as early as a week into treatment.
Psychologically, minoxidil shedding can be very unpleasant. When starting a treatment against pattern hair loss, the last thing one wants to see is more lost hair.
Without proper education on this phenomenon, users might discontinue treatment early. This has the potential to leave their hair at an even worse state than before. It is therefore very important to understand the cause and nature of the shedding.
The Hair Growth Cycle
To understand minoxidil shedding, we first need to understand how hair grows, namely the hair growth cycle. There are three stages of hair growth:
This is the active growth phase, when hair grows and lengthens. It lasts between two to six years.
The transitional phase when the base of the hair follicle, known as the bulb, begins to detach from the follicle’s blood supply. The detachment begins once the follicle receives a chemical signal to stop growing.
This stage is brief, lasting only a few weeks.
This is the resting phase, when the hair shaft no longer grows. The bottom of the hair strand (the bulb) has now detached from the follicle. The hair shaft does not immediately shed from the follicle.
Instead, it waits for a newly formed hair to grow from the follicle and push it out of its place.
Telogen hairs can also shed from everyday activities, such as shampooing or brushing. These are often the hairs you will find on hairbrushes, in the shower drain, or on pillows.
How Male Pattern Baldness Affects the Hair Growth Cycle
Normally, around 90% of hairs are in anagen at any given time. Almost all of the rest are in telogen, and only around 1% are in catagen.
Male pattern baldness interferes with regular hair growth in various ways. One of these is by altering the normal hair growth cycle and skewing these percentages (6).
The precise percentages will vary, but balding men will typically have far fewer than 90% of their hair in anagen. Correspondingly, they will have far more than 10% in telogen. This happens because with every cycle, their anagen phase becomes shorter. Follicles spend progressively more of their time in the resting telogen phase.
Eventually the majority of hair follicles in the balding areas will spend most of their cycle in telogen. Their anagen growth phase becomes so brief that the hair shaft does not even have time to grow out of the scalp.
This partly explains why balding men have so few hairs. It also explains why many of these hairs never grow too long or thick. The growth phase is simply too short to allow for long hair shafts.
What Causes Rogaine Shedding?
A goal of any hair loss treatment, including minoxidil, is to restore a normal hair growth cycle. For this to happen the hairs that are in the extended telogen resting phase need to revert to anagen.
If the treatment is effective, thousands of hairs that are stuck in a protracted telogen phase and are not growing will fall out as they transition to anagen. We mentioned this can happen through gentle friction against your brush or pillow. It can also happen without friction, as the new anagen hair that begins to grow pushes out the old anagen hair shaft.
The result is an increased period of shedding. Scientists call this phenomenon telogen effluvium (7). This is the scientific name for Rogaine shedding.
A Positive Sign
Rogaine shedding is a sign that the treatment is actually working. Inactive follicles that were stuck in telogen will start growing once again. There is no rewinding the hair growth cycle: the only way for a dormant hair follicle to resume its growth is to shed the old hair.
Rogaine and Propecia – the only two FDA-approved baldness treatments on the market – both bring hairs from the resting phase to the active growth phase. They do this in different ways, but the result of both is excess shedding (with Propecia the shedding is less intense).
Rather than despairing, you should view the shedding as a positive sign – minoxidil is affecting your hair follicles as intended. If minoxidil were having no effect, there would be no change to your hair cycle and no shedding.
If the treatment continues to work as expected, the new hair shafts that start growing will also remain in anagen longer. The end result will be more hairs that are longer and thicker. You can expect to see the final results of minoxidil regrowth around 12 months into treatment.
How Common Is It & How Much to Expect?
There is surprisingly little research on Rogaine shedding. There are no reliable figures on the percentage of users who experience shedding.
What is certain is that not everyone will experience shedding. This will be especially true for non-responders to minoxidil: these are likely to see no change to the hair whatsoever, including no shedding.
Similarly, for how much shedding takes place and how long it lasts – each person is unique. Having said that, the 5% strength is likely to cause more shedding (and eventually more regrowth).
What we know for sure is that the shedding eventually subsides (8). If it continues after the 8-week mark, or if it seems to worsen as treatment continues, it is best to speak with a hair loss specialist.
On a side note, shedding is also likely to occur a few months after you stop using minoxidil. In this case, the associated hair loss will be permanent: the follicles that minoxidil was artificially keeping in an extended growth phase return to telogen and fall out.
For this reason, Rogaine is a treatment of indefinite duration. As soon as you stop, you will lose all new hairs (4).
Is It Possible to Avoid Shedding?
It is not possible to avoid the shedding of dormant hair. However, it might be possible to shorten the shedding process. You do this is by improving the scalp’s overall health and hygiene.
How to Shorten the Shedding Period
Here are a few ways to promote overall scalp and hair health.
Like all bodily processes, the hair growth cycle requires nutrients. Many of these come through our diet. If the body is lacking in key nutrients and minerals, the hair growth process might suffer.
Eating a balanced diet rich in unprocessed carbohydrates, proteins, and fats, can help to ensure the hair follicles and scalp are receiving the nutrients they need to thrive.
Some vitamins and minerals have been found to support hair health and growth. These include iron, biotin, niacin, and zinc (9).
Unsurprisingly, worrying about Rogaine shedding might make things worse. Research has long suggested that an aggravating factor for telogen effluvium is increased stress.
This stress is typically in the form of a major event like illness, accident, surgery, or pregnancy.
Yet psychological stress can also affect the course of telogen effluvium. If you find yourself excessively preoccupied with your Rogaine shedding, the suggestion is simple.
First, understand why it is happening (which should happen by the time you are finished reading this). Secondly, stop spending too much on your hair, at least for some time. Resolve to spend less time looking at the mirror for the next few weeks. Fortunately, the shedding process is brief, so if you don’t spend too much dwelling on it, it will be over before you know it.
How to Get Better Results with Minoxidil
After the shedding stops, you might want to look at ways of improving your final results. Two of the most efficient ways of achieving this are scalp massages and microneedling
One of Rogaine’s potential mechanisms of action is increased blood flow to the scalp. It can be beneficial for users to add their own scalp stimulation routine to boost results.
There is an easy way to stimulate the scalp manually: scalp massage.
For scalp massage, your hands are all you need. If you want, you can also use carrier oils and a scalp stimulation tool.
You can perform the massage for about 5 to 10 minutes per day. Scalp massages on their own can be enough to halt or partially reverse hair loss, even without minoxidil (10).
Another way to boost your minoxidil gains is by adding microneedling sessions.
Microneedling is a skin rejuvenation technique commonly to reduce scarring on the face. It has also been found beneficial for hair growth. In fact, microneedling performed alongside minoxidil treatment improved results significantly, as shown by a 2013 research study (11).
In the graph below you can see the before and after average hair counts for two groups of men. The men who used minoxidil only (red line) had a fraction of the regrowth of those who added once weekly microneedling sessions to their treatment (green line).
Similar results have now been independently reported by various research teams around the world (12, 13). The most commonly used microneedling device is a dermaroller. This is a handheld tool that can be used regularly to provide similar effects to in-office microneedling sessions. It consists of a rotating barrel attached to a handle. On its surface, the barrel has dozens of small needles.
As the user glides the dermaroller over the scalp, it produces countless tiny holes in the skin. These are too small to cause permanent scarring. They do, however, prompt the skin to release various growth factors. And, for reasons that are not yet clear, this process also promotes hair growth.
Another tool you can use is the derma stamp. This tool has increased precision and it is great for beginners.
Other Minoxidil Side Effects to Consider
When starting Rogaine, it is important to consider all potential side effects. While shedding is a well-known side effect, it is not the only one.
One inactive ingredient found in many minoxidil formulations is propylene glycol. This ingredient has been shown to cause contact dermatitis. This will account for many of Rogaine’s topical side effects (15). Fortunately, the foam version of minoxidil does not contain propylene glycol. This makes it an excellent alternative for Rogaine users who experience topical side effects.
More rarely, minoxidil can also cause systemic side effects like dizziness, irregular heart body and excess body hair. Often these happen when the users is applying too much minoxidil. Some of this then reaches the bloodstream.
Shedding is common in the very beginning stages of Rogaine use. It is often an inevitable part of the process. As hair transitions from the resting to the growth phase it “sheds” the old dormant hair. This is so the hair follicle can enlarge and start growing new, healthier, longer hair.
Far from being a cause for concern, this shedding is an indication that the medication is working. As such, it should not worry you.
There is nothing you can do to prevent this shedding. It might be possible to shorten the duration of shedding through some simple steps, like improved nutrition. Aside from these, understanding the cause of shedding and being psychologically prepared is very important.
In any case, Rogaine shedding should not last more than eight weeks. If it exceeds this, consider consulting your doctor.