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Minoxidil - a Hair Growth Stimulant

This article is a personal exploration of Rogaine (minoxidil) by a man who calls himself Anagen on the Discussion Forum.

Minoxidil will enhance hair growth wherever an active follicle lies. It will give a spurt of growth - some extra hair to carry along, but will not hit the underlying cause of MPB, which may be the immune system's response after the binding of androgens to the androgen receptors of MPB prone follicles. Although during the first one or two years, the minoxidil induced regrowth will outrun the balding process, damage to the follicles is not prevented. With time, and relying on minoxidil alone, your gains will start to wither as the balding process continues undisturbed.

Do not rely on minoxidil alone to treat your hair loss.

Minoxidil solutions diffuse into the skin layers so they affect an area larger than that of the application. (in fact Minoxidil will reach the follicle several days after application, so it is stored in the skin's deeper layers and distributed from there). This means that you might experience some unwanted growth - intermediate hairs around the eyebrows and perhaps the forehead. That explains why the 5% version of the topical is not to be used by women. Unwanted growth could be an issue. The most common side-effects of minoxidil use are caused by systemic overabsorption . Bear in mind that any substance absorbed through skin is absorbed systemically to a certain degree. Heart palpitations, and weight gain due to water retention are some of the side effects reported by a minority of people. A portion of the resulting regrowth due to minoxidil is a direct effect of some minor level of systemic absorption caused by the topical application.

Remember: Although minoxidil results are dose dependent, more daily applications do not necessarily equal better results, as there is a theoretical limit to the regrowth that minoxidil has to offer. Multiple daily applications could possibly lead to scalp irritation, eventually compromising the results and increasing the cost of the regimen.

To avoid systemic overabsorption:

Make sure you use 1 to 1.5 ml of minoxidil solution per application no more than twice daily, on a dry scalp (not after shower). A damp scalp is more permeable and could lead to better results, but this should be avoided if any suspicion for systemic absorption arises.

Points on strategy:

A shed 3 to 4 weeks into the treatment is very common with minoxidil. Ironically enough, early progress bears the look of loss. What really happens is that large groups of follicles signaled by the stimulant, enter the exogen (shedding) phase and start producing new thicker shafts, ejecting the older ones out. Many good responders to minox drop treatment, scared by the unexplained dramatic increase in shedding after initiating treatment.

Minoxidil is said to produce results for people using the topical only once per day. A strategy followed by some is to stick to two applications daily for the first two years so that they exploit all the regrowth that minoxidil can give them and then (if they judge that two applications interfere with their lifestyle and daily program) reduce it to once daily - but once per day consistently.

Occasionally skipping a dose, or stopping the use of the topical for a week or two will not change things. What matters is the big picture, but in general you should strive for consistency. Consistency is 80% of any successful treatment When used twice daily, minoxidil should ideally be applied every 12 hours, so that there is a constant flow of medicine to the follicle. Whereas a faithfully followed regimen is a simple and easy one to comply with, try to keep the two applications at least 8 hours apart. (If you miss one application do not double the quantity of the next one.)

Minoxidil use, especially in the case of solutions containing high levels of Propylene Glycol (like Rogaine and Kirkland) might cause irritation and flaking. Usually this irritation subsides with prolonged use, but in case it doesn't, there are minoxidil solutions available containing very low levels of PPG. Nizoral or any ketoconazole containing shampoo is a must and will definitely help. I have also found that the use of olive oil after the topical minoxidil has dried is very helpful in reducing the itch and could possibly trap the topical under an occlusive layer enhancing it's effect. If you try this, make sure that you wash the oil off prior to the next minoxidil application as it would form a barrier preventing absorption. Olive oil has worked great for me substantially increasing the "punishment" my scalp could take from topicals and eliminating redness and flaking.

Some common myths regarding minox:

Myth1#  "The use of an inhibitor can preserve my minoxidil results after quitting minoxidil."

Many think that hair regrown by minoxidil can be maintained by the use of DHT inhibitors alone. This is absolutely not true as the mechanism of action is totally different between minoxidil and inhibitors like finasteride. The discontinuation of minoxidil use will lead to a TE [telogen effluvium], leading the user temporarily below baseline and then eventually up to his initial condition.

Myth 2#  "minoxidil does not work for the frontal areas."

Absolutely not true. Minoxidil works for the front areas too, just not as well. Upjohn chose the vertex area for sampling as it would produce more impressive results in terms of regrowth. This company, now part of Pfizer, would have to pay millions again to repeat the same phase III trials for the frontal and temple areas. Bound by the FDA, Pfizer cannot claim results for the front but that does not mean that minoxidil is ineffective there.

Minoxidil is effective wherever an active follicle lies. Bear in mind that the type of damage done to a follicle by the balding process is critical to the way the specific follicle will respond.

Minoxidil and the SE - the Scalp Exercise

Pfizer has yet to provide a clear description of how minoxidil induces regrowth. It is obvious that regrowth is not a result of it's vasodilating effect on capillaries as many other vasodilators have been tested with no results in terms of hair growth.

One possible scenario is that minox as a potassium channel opener leads to topical production of VEGF vascular endothelial growth factor), which in turn increases hair counts and hair weights. This scenario is also one of the possible mechanisms by which the scalp exercise stabilizes hair loss and grows new hair.

A bit of personal experience:

I had been on the scalp exercise program for 6 months prior to initiating treatment with finasteride and minoxidil. That means that I started drug treatments before the scalp exercise may have produced results. I have been experiencing results from the first month on these drugs. (According to Pfizer, first results usually come at about the 4 month mark).

I, of course, am in no position to attribute a part of this unexpected burst of regrowth to the scalp exercise program and the many hours I practiced the exercise. But if I am not an exceptional responder to minoxidil, I have a feeling that the scalp exercise could have definitely played a role in getting my scalp and follicles in shape. It is common knowledge that a healthy scalp is predisposed to get maximum results from any hair loss treatment.

Anagen

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