How Does Minoxidil Work? Experts Break Down Why It’s the Only FDA-Approved Hair Loss Treatment
Plus, why it may not work for some forms of hair loss—and how to know if it’s right for you
As anyone who has ever dealt with hair loss will tell you, there’s no shortage of different treatment options out there claiming to be the end-all, be-all solution for sparse strands. And sure, while there are things that may help make hair stronger or look fuller, there’s only one treatment that’s FDA-approved to actually help grow new hair: minoxidil. Available in topical, over-the-counter products and as a prescription oral medication, it’s more often than not the first line of defense recommended by doctors for treating hair loss. But have you ever wondered exactly how minoxidil works? We asked top experts to explain the science behind the minoxidil magic and why it’s such a top-rated treatment for hair loss.
What is minoxidil and why was it created?
Before we get into how minoxidil works, let’s go over exactly what it is. Fun fact: The drug originally had nothing to do with hair loss. “Minoxidil was first introduced in the 1970s as a treatment for severe high blood pressure, when it was noted that excess hair growth and regrowth of hair was a side effect,” explains hair loss expert Jodi LoGerfo, DNP, APRN, FNP-BC, a nurse practitioner specializing in dermatology.
Fast forward to the late 1980s, and minoxidil earned FDA approval as a treatment for hair regrowth. Back then, there was only one, over-the-counter brand using minoxidil, called Rogaine. When Rogaine’s patent expired in December 2000, other brands were then able to sell minoxidil treatments, says Bridgette Hill, a certified trichologist.
How minoxidil stimulates hair growth
Minoxidil both enhances hair growth and reduces hair loss, says LoGerfo. It can also help make your existing hair stronger, adds Kseniya Kobets, MD, a board-certified dermatologist and the Director of Cosmetic Dermatology at Montefiore Advanced Care in New York.
It is worth mentioning that while minoxidil is only FDA-approved for male and female pattern hair loss—a type of hair loss that shows up in very particular areas—it’s still used to treat many other kinds, including alopecia areata and telogen effluvium, says Dr. LoGerfo. (The former is an autoimmune disease that causes patchy hair loss on different parts of the body; the latter is a temporary, intense shedding triggered by a stressful event.) No matter what type of hair loss you’re battling, minoxidil can help. But exactly how does minoxidil work?
How minoxidil works to treat hair loss
Increased blood flow to the scalp has been shown to help stimulate hair follicles, encouraging growth. And minoxidil does just that. “Minoxidil is a vasodilator, which means that it increases the blood flow to the area that it’s applied to topically by increasing the size of the blood vessels in that area, allowing more blood to flow,” explains Tetiana Mamontova, a hair transplant surgeon in London. “This helps by getting a better supply of vitamins, minerals and nutrients in general to the hair follicles in order to stimulate growth.” (Its vasodilating, a.k.a. blood vessel-widening, effects are exactly why it was used as a blood pressure medication in the first place.)
Additionally, minoxidil is believed to “stimulate potassium channels in the cells,” explains Ross Kopelman, DO, a hair restoration surgeon, “which can have a direct effect on the way hair follicles function. While we still don’t know every molecular detail, what’s clear is that minoxidil supports miniaturized or weakened follicles and helps them produce thicker, longer hairs over time.”
Lastly, we know that hair goes through a growth cycle, or certain phases that help shed and regrow hair follicles. Dr. Kopelman says minoxidil helps to prolong the growth phase of the hair cycle, called the anagen phase. At the same time, it also increases the diameter and length of the hairs so that they can grow thicker and longer, LoGerfo adds. And all of these benefits apply to both the oral and topical minoxidil; in other words, they work the same way even though they’re used differently.
What to do if minoxidil doesn’t work for you
Now that we’ve gone over just how it can work to regrow hair, let’s touch on why minoxidil may sometimes not work. While yes, minoxidil is absolutely an amazing hair growth treatment, it’s not one-size-fits-all, or in other words, it’s not going to work for every single person dealing with hair loss.
As mentioned, minoxidil is most beneficial for those with androgenetic alopecia, or male or female pattern hair loss. “Minoxidil won’t work typically [that well] for people that are trying to restore hair where hair isn’t present (this is where a hair transplant comes into play) or for people with other types of hair loss other than the typically male/female pattern baldness,” explains Dr. Mamontova. However, she says, “I have personally not heard of any patient where minoxidil hasn’t worked at all.”
Genetics can also play a factor. “Some people also just don’t respond genetically to minoxidil; their follicles might not be sensitive enough to the drug’s mechanisms,” notes Dr. Kopelman. “I’ve also noticed that consistency is a huge issue. If patients aren’t applying it daily, or they stop too soon, they often won’t see the real benefits.”
Also, if an individual does not have the enzyme sulfotransferase present on the scalp, minoxidil may not work for them, says Christina Han, MD, FRCPC, a board-certified dermatologist. “Minoxidil has to be sulfated into minoxidil sulfate by the hair follicles, which is the much more active form of minoxidil. Lack of therapeutic response to minoxidil treatment is thought to be in part related to lack of this enzyme activity in some individuals,” she tells us.
So if you’re not seeing the results you want with minoxidil, experts recommend speaking with a dermatologist to explore alternative treatments like hair transplants, platelet-rich plasma (PRP) therapy or prescription options that may better suit your hair loss type.
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