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Minoxidil in Hair Transplant – Should I use Minoxidil (Rogaine)?

Minoxidil was first introduced as an oral medication for the treatment of severe and recalcitrant hypertension in the 1970s.

Coincidentally, physicians observed hair regrowth in balding patients and generalized hypertrichosis in over 80% of ( call it the Werewolf Syndrome if you may) , which led to the development of a topical minoxidil formulation for treating androgenetic alopecia (AGA) first in male and then in female individuals.

This led to researchers trying to determine its ability to just stimulate the hairs you wanted to stimulate and not generalized stimulation of hair all over the body.

So this is how topical formulations were discovered in Denver, Colorado (USA).

The 2% minoxidil solution was first launched in the market in 1986, followed by the 5% solution in 1993.

It is FDA approved and an OTC medicine for the last 20 years.

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Minoxidil is a vasodilator and not a DHT blocker. It is hence referred to as a Stimulator.

The positive effect of minoxidil on hair growth is mainly due to its metabolite, minoxidil sulfate, and the enzyme responsible for this conversion is sulfotransferase, which is located in hair follicles and varies in production among individuals.

Even after 35 years, the mechanism underlying the hair growth-promoting effects of minoxidil remains unclear but the following theories have been postulated-

1. Minoxidil is an ATP sensitive Potassium channel opener due to hyperpolarisation of the cell membrane leading to increased blood flow in the skin.

2. It enhances expression of VEGF (vascular Endothelial Growth Factor) which in turn increases the fenestrations in the perifollicular capillary network increasing follicular vascularity.

These in turn prolongs the anagen phase of the cycle on one hand, and decreases the telogen or shedding phase on the other.

With more good quality hair on the head at one time, the head looks fuller.

It does not cause regrowth. Only increases hair shaft diameter.

However, when patents start, they notice an increased shedding in the first 3 months. This is since they are growing new hair which push out the old hair which are weakly sitting on the skin.

However many patients are so dejected, they stop it at 3 months not knowing they have already invested in this period and now on things would only improve.

30% patients on topical will notice increase in density and this is due to increase in hair shaft diameter. There is no regrowth.

40% will state they have no benefit but the hair have not got any worse. But they are content and will continue to use Minoxidil.

The last 30 % of the remaining are cynical. So we need to convince them it is working. I tell them to stop taking Minoxidil. And sure enough the volume decreases and some of them get convinced. This withdrawal of therapy is important for future patient compliance.

Patients expect miracles with minoxidil. Patients need to be made to realize that their hair loss is stable with Minoxidil and if you stop it, it will get worse.

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How frequently do I apply Minoxidil?
Effect of Minoxidil lasts for 22 1/2 hours and hence use of even once a day Minoxidil for hair loss is sufficient but twice a day will not do any harm either.

The container says I have to apply 1 ml of Minoxidil?
This I ml a day is not written on stone, dose will depend upon area to be covered. The I ml written on the carton is the standard does- 1ml twice a day (100 mg Minoxidil a day).

As long as 100 mg is applied in a day it is safe.

Is 10% or 15% better than 5% Minoxidil?
For this you need to know this does not work on the dose-response curve.

If you increase the dose beyond 5% the benefits do not increase proportionally.

However, the side effects do.

So stronger solutions do not work better.

The 2% Minoxidil says Rogaine is pink in color and says it is for Women. Can I use it?
Marketing the pink can works better for women. That is a marketing trick and nothing with a scientific basis. The dosage 2% can be used for men.

Can women use 5% Minoxidil which says for Men?

Yes, the reverse is also true. Women are usually not advised 5% since it causes increased facial and bodily hair growth. But there are women who are ready to try it.

I get a lot of dryness, flaking and itching with Minoxidil. What do I do?
This is due to the propylene glycol in the regular lotion. You can switch to the foam version.

How do I apply it?
Rub it into the scalp. Applying it to the hair will not work since hairs are not living tissue. They are like dead rope. Here we are aiming at stimulating the roots so the skin should be targeted.

How long after the application can I shower?
It takes 90 mins for it to be absorbed s you need to wait that long. Best to apply before you go to sleep.

I am 16. Can I use Rogaine?
Do not use this product if you are 18 years old or younger.

Can I use Rogaine to increase my facial hairs?
Yes you can though this is not an FDA approved indication.

What if I stop and start again?
Depending on how long you stop for before starting again, and the condition you are experiencing, your hair will most likely start to shed again.

Can you apply styling products to the scalp after using minoxidil?
Yes you can after 90 mins of its application.

I am now pregnant. Can I continue 2% Minoxidil?
Once the pregnancy is confirmed you need to stop using it. You can restart once the baby is born. Due to increase in hormones during pregnancy, the hair growh cycle gets prolonged and hair become thicker. When this reverse after child birth, the hair will shed off and that is the time you should restart Minoxidil use.

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