Is Topical Minoxidil the best hair loss treatment for women?
Men and women around the world use Minoxidil to regrow their hair only to quit a few months later for several reasons. Is Minoxidil the best hair loss treatment for women?
Minoxidil has been approved by the FDA for the management of androgenic alopecia in men and women since the 1980s. Its efficacy shown in clinical studies and safety profile relative to other prescription ingredients makes it the ideal drug of choice for early onset hair loss.
In this article, we take a look at some of the reasons women (and men) face when using topical Minoxidil.
1. Scalp Irritation
Propylene glycol is a common skincare ingredient and is widely used in pharmaceutical formulations and cosmetics and is well tolerated.
Why is Propylene Glycol an irritant in Minoxidil solutions?
Minoxidil is insoluble in water and is freely soluble at high concentrations of alcohol and propylene glycol. In fact, for every 100ml of Minoxidil 5% solution, you need over 45ml of propylene glycol to dissolve Minoxidil.
In contrast, only 5-10ml of Propylene Glycol is required to make 100ml of skincare serum. This difference is huge!
"too much of a good thing can be bad."
How can you overcome this?
If propylene glycol is the cause of your scalp irritation, it is now possible to dissolve Minoxidil completely in solution using less propylene glycol and even no propylene glycol. Propylene glycol-free formulations are personalised formulations. They are made by compounding pharmacists and is available for almost the same cost as full propylene glycol formulations.
2. Dry and flaky scalp
Traditional Minoxidil solutions contain 30% to 70% alcohol. This can cause scalp dryness and irritation and hair to become brittle and break easily, making it difficult to regrow hair. High concentrations of alcohol can also disrupt the scalp pH and skin microbiome, making it less ideal as a long term solution.
For this reason, foam formulations were invented. Foam formulations contain less alcohol and propylene glycol and is better tolerated by both men and women.
The most recent novel formulation is the alcohol-free and propylene glycol-free Minoxidil topical solution - Minoxidil 5 Plus+ .
The absence of alcohol have sparked concerns that Minoxidil cannot be absorbed, however, this is not the case. Alcohol acts as a chemical abrasion to the epidermis (the outer layer of the skin), thereby allowing drugs and other particles to penetrate the skin. However, chemical abrasion is not the only method for drug molecules to cross the skin barrier.
If the theory that alcohol is required for ingredients to be absorbed holds true, then all creams and gels should have alcohol in them but they do not.
A 2023 clinical study by Udare et al showed that alcohol-free formulations proved to be just as effective as alcoholic minoxidil formulations and with significantly less side effects and is better tolerated. The study followed their subjects for 12 months.
3. Minoxidil is not working for me
A Meta-analysis of several clinical studies showed female responders to 2% minoxidil is as low as 13-20%. In contrast, Minoxidil 5% produced more favourable results. The cost difference between 2% and 5% is negligible so you might as well go for the 5% strength.
But wait, I have been using Minoxidil 5% and it is not working for me ...
The actions of Minoxidil can be enhanced by combining it with other active ingredients that are available as scheduled medicines. These can be formulated with Minoxidil as a personalised formulation for those who do not respond to Minoxidil alone.
How long should I try Minoxidil before I completely call it quits?
We recommend giving it 3 months. In the first two months, you are likely to see more hair shedding as the existing hair follicles are being pushed out of its current hair cycle. By month three, hair shedding resolves almost spontaneously.
What if I want something more natural?
It is possible to keep your hair with only natural ingredients, but we recommend this for the maintenance phase. Research show people have lost almost 50% of their hair by the time they notice any hair loss. Relying on only natural ingredients to regrow hair is risky.
If you are set on using only natural ingredients, we highly recommend combining it derma rolling. Check out our article on derma rolling for hair growth.
Who can I speak to about compounding a propylene glycol-free formulation?
We have in-house pharmacists who can compound propylene glycol-free and alcohol-free formulations.
Author: Helen Huynh (B. Pharm) MPS
References:
- Udare, S et al (2023). "Low-Alcohol or Alcohol-Free Minoxidil Formulation for the Management of Androgenic Alopecia: an Indian Perspective." International Journal of Trichology. 15(1): p13-17, Jan-Feb 2023.
- Olsen, E et al. (2002). "A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men." Journal of the American Academy of Dermatology, 47(3), 377 385.
- Roberts, J et al (2014). "Response to Topical Minoxidil in Female Androgenic Alopecia." Journal of Dermatologic Therapy. Jul-Aug;27(4):252-4
