At Advanced Cosmetic Medicine, we always like to advise clients that are suffering from hair loss to preserve their existing hair for as long as possible. Both blocking and stimulating therapies cannot halt the progress of Androgenic Alopecia, however they can go a long way towards slowing down the rate of hair loss. Also, when clients come to us wanting a hair restoration procedure, it is a requirement they they take blocking and stimulating therapies to slow down the loss of hair. Donar hair supply is a finite resource, so existing hair should be maintained for as long as possible.
There are two types of medical treatment for androgenic alopecia. These are known as “blockers” or “stimulators”. Minoxidil is classed as a form of stimulation therapy. It does exactly what it says, it stimulates hair growth.
Stimulators, however, do not address the underlying cause of androgenic alopecia. All they do is stimulate growth of the hair. Minoxidil has been on the market for many years and for a long time was the only treatment available for hair loss. Minoxidil treatment was originally designed for use as an oral tablet for treatment of high blood pressure.
One of the side effects that was discovered from its use is that recipients became much hairier. In fact 50% of people prescribed this treatment were found to become hairier. The pharmacology companies then decided to make Minoxidil into a topical agent that can be applied directly to the area of hair loss. The exact mechanism of action of Minoxidil still remains unclear, although it is thought to have something to do with opening up potassium channels. Minoxidil is known to be a safe therapy. Topical Minoxidil treatment is an over the counter drug which can be purchased from any pharmacy without a script. Most over the counter drugs are known to be very safe if used in the correct manner.
Minoxidil treatment does two things. Firstly, it is known to lengthen the anogen phase of hair growth. In other words more hairs are in the actively growing phase of the life cycle at any one time and less hairs are shed. A small percentage of people will notice an increase in shedding rate when they first start Minoxidil. This is a temporary phase caused by the new hair pushing the old hair out. This is a good thing not a bad thing. After starting on Minoxidil it will take from 4 to 6 months for you to start noticing an improvement in your hair thickness. People often try Minoxidil and think that it has been a failure because they have noticed the original shedding reaction and they have not noticed any benefit. People need to be patient and wait 4 to 6 months to be able to see any benefit.
The first goal of stimulation therapy is to achieve stability and halt the continual loss and miniaturization of hair. The goal of medical therapy is stability. A good analogy is a leaking bucket. In order to stop the bucket leaking we need to plug up the hole. 40% of people that use topical Minoxidil achieve positive results. The most improvement comes from an increase in the shaft diameter of the hair. There is also a small increase in the number of hairs present. The major benefit of Minoxidil is to increase the thickness of the hair shaft.
Minoxidil treatment can be used for any type of hair loss eg loss of hair after giving birth, use of medications, after an acute stressful event or from immune conditions like alopecia areata. 40% of people using Minoxidil over time will notice an improvement. Another 40% of people over time notice that they are not getting worse. This is the second benefit of Minoxidil. So 80% of people are going to use Minoxidil with some sort of success. The only real way to know that Minoxidil is working is to stop taking it and see if you continue to lose hair and lose hair density.
Topical Minoxidil treatment only needs to be used once a day. It can last in the skin for 21 hours. 1ml per day is usually sufficient. The actual quantity of Minoxidil used is not so important; the most important thing is to cover the area that needs to be treated. Minoxidil comes in two different strengths, 7% and 5%. The dose response difference between 7% and 5% is not significant. You will not notice any difference in the response between having 7% or 5% Minoxidil. There is also a mens and womens Minoxidil treatment. Womens Minoxidil comes in two strengths 5% and 2%. Women may experience and increase in beard growth using 5% Minoxidil. If this occurs, reducing the dose down to 2% will reverse this effect. Stopping the treatment will also stop the beard growth.
Many people do not like topical Minoxidil treatment because it can make the hair oily and the scalp itchy. There are two types of topical Minoxidil on the market, there is a liquid and a foam. For the liquid Minoxidil the base preparation is Propylene glycol, which is what causes the itchiness and flaky scalp in about 30% of people that use it. The foam is better tolerated by most people and is less greasy because it does not contain PG. Minoxidil should only be applied to the scalp. There is no benefit from applying it to the hair. Foam is also much faster to absorb through the skin, taking only ten minutes. The liquid base may take up to sixty minutes to absorb through the skin. The foam only needs to be applied for fifteen minutes before doing sports or washing your hair.
In summary, Minoxidil treatment has been around for a long time, it is known to be safe, it is a good stimulator of hair growth, it comes in a liquid and a foam, the 5% Minoxidil treatment is applicable to most people, most people don’t react to the foam, taking it once a day is sufficient, in some people there will be an initial shedding phase after first taking it.
Oral Minoxidil treatment can also be taken, but is a prescription medicine only. People may not like topical Minoxidil for styling reasons. For these people a very low dose of oral Minoxidil may be prescribed , which will not affect blood pressure.
Minoxidil treatment may help to slow down hair loss in androgenic alopecia but will usually not halt the progress of hair loss completely. Minoxidil should be used as a long term therapy to stabilise hair loss. For best effect, blockers and stimulators can be combined. Blockers will be discussed in a separate blog at a later stage.