Women Are Being Ad-Targeted For Minoxidil Like Crazy — But Just How Safe Is It?
For most of my life, my hair has been long, dark, wavy and thick. So thick that when I was growing up, the neighborhood salon charged extra for my cuts because they involved such a great quantity of hair. Blow-drying took ages as the poor stylist worked through layer after layer of my locks. At home, I always left a plentiful accumulation of coiled hair atop the drain in the shower.
I was prepared to shed more hair than usual after each of my pregnancies and definitely noticed the pile on the shower grow in size after my babies were born. What I didn’t understand at the time, however, was that my hair would never go back to “normal” — no return to my thick, youthful mane. After my postpartum hair loss, new growth at my temples seemed to stall out after a few inches, creating wispy tufts that refused to lay flat in my ponytail — which was the only hairstyle I could manage while caring for young children and working full time.
By the time I officially entered my 40s, it was apparent that while the ball of hair in the shower drain was about the same size it had always been, I simply wasn’t regrowing hair at the same rate. My ponytail narrowed inside a third loop of my hair elastic, my hair dried quickly, and I faced the reality that this unwelcome change might simply be one small indignity of aging. I didn’t like it, but there wasn’t much I could do about it, was there?
I had heard of Rogaine, but if it really worked, why were so many men letting themselves go bald? This seemed to be a problem without a solution, so aside from talking wistfully about how thick my hair used to be, I didn’t do much about it. When I mentioned the issue to my dermatologist at my annual skin check, she offered to inject my scalp with steroids, which was a surprisingly painless and quick procedure. She also gave me a prescription for a shampoo with ketoconazole, an antifungal doctors use to treat ringworm and sometimes dandruff. I didn’t notice that either treatment made a difference.
It seems, however, that either my phone was listening to me complain or the algorithm knows my age and made a lucky guess. Every time I open a social media app, I’m scrolling past advertisements promising me hair loss solutions. I’m beckoned by confident women with long, thick hair, wearing soothing neutral tones. There are no men, no unseemly bare scalps, and no mention of Rogaine.
Is there something new out there? I wonder.
Curious, I click and enter the page of a company that promises prescriptions to women looking to halt their hair loss or lose weight. I continue clicking through a user-friendly quiz that asks me about changes I’ve noticed in my hair. The implicit promise is that if I identify with these symptoms, they have a treatment that will alleviate them. The tone of the text is upbeat and reassuring. “Don’t worry,” it says, promising a treatment that will “minimize shedding” so that I can “look and feel like [myself] again.”
All I have to do is answer a few questions. Then, a provider will review my responses and the company will ship the prescription to my home. I am promised “better hair days ahead.”
What exactly is this new treatment, with prices starting at $35 a month?
It’s minoxidil, a drug that, the website tells me, has been “trusted by doctors for 30-plus years.”
I learn that minoxidil, the active ingredient in the Rogaine you can buy at your local pharmacy, is available in pill form for oral use. The one marketed on this website also contains vitamins “for hair growth.”
Is it safe to eat Rogaine? I wonder. More importantly, does it work?
What is minoxidil and how does it work?
“Minoxidil is a medication that acts primarily as a vasodilator, which means it improves blood flow with dilation/relaxation of the blood vessels,” Dr. Susan Massick, a board-certified dermatologist and a professor at the Ohio State University Wexner Medical Center, told HuffPost.
“It is a medication originally developed to treat high blood pressure,” Massick explained, “but was also found to stimulate hair growth.”
Oral minoxidil was approved by the FDA for treating high blood pressure in 1979. “The topical version of minoxidil was FDA-approved in 1987 to treat
male pattern hair loss, followed by female pattern hair loss several years after that,” Massick said.
Scientists don’t understand exactly how the drug spurs hair growth. One theory is that “the increased blood flow can help stimulate hair follicle activity and extend the anagen growth phase of your hair follicles,” Massick said.
The dose at which oral minoxidil is prescribed for hair loss is much lower than the dose at which it is used to lower blood pressure, so most patients don’t need to worry about their blood pressure dropping.
“None of the new drugs that have been tried in the last 10 years perform better than topical minoxidil. Everything new works less than that,” Dr. Antonella Tosti, a professor of dermatology at the University of Miami and author of a study on the safety and efficacy of low-dose oral minoxidil, told HuffPost.
Why don’t people want to use minoxidil topically?
In spite of the big, cross-gender market for hair loss treatments, most patients don’t like using topical minoxidil solutions or foams such as Rogaine, and eventually abandon them, undoing any progress they’ve made in growing back their hair.In order to keep new hair growth, you have to continue using minoxidil.(Rogaine’s website suggests that you make application part of your daily routine, just like brushing your teeth.)
It can be bothersome to apply the treatment to the scalp every day, and some people report itching or flaking, or an unpleasant texture. One study found that the vast majority of patients — 86.3% — prescribed minoxidil in the past five years had stopped using it. Those who did not see a benefit from the medication or who experienced side effects were more likely to discontinue use.
My general impression, that minoxidil is not a guaranteed hair loss cure, doesn’t appear to have been too far off: Only 22% of the people in that study reported improvement in their hair loss. An additional 9.8% reported “stabilization.”
This might be attributed to patients not using the medication as directed. Tosti noted that patient follow-through with topical minoxidil is poor. “There are very few people who are compliant,” she said.
Tosti also said that since hair loss will often get worse if not treated, patients may assume the medicine is not working if they don’t see their hair getting thicker — but in fact this stabilization represents progress.
Is low-dose oral minoxidil safe?
Tosti’s study, published in 2021, did find that low-dose oral minoxidil was an “effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulations.” Researchers did not conclude that it was more effective than topical minoxidil.
There are a couple of additional concerns to keep in mind when taking the medication orally. “It is typically prescribed at very low dosages,” Massick said. However, “it is a blood pressure medicine, so you may experience lightheadedness or dizziness.”
Taking the medication orally instead of topically means more concern about growing hair in unwanted places (think: those perimenopausal chin hairs).
Other possible (though not common) side effects include edema (swelling of the lower legs or feet), increased heart rate and other cardiac issues. It is not recommended for people with a history of certain heart problems. It is also not recommended for pregnant or nursing individuals.
Both Massick and Tosti recommend seeing a physician in person before beginning treatment. This doctor will want to take your medical history and examine you in order to make sure the medicine will be safe. They will also want to rule out other potential causes of your hair loss such as anemia or thyroid issues.
Low-dose oral minoxidil is prescribed “off-label,” meaning that it has not been approved by the FDA to treat hair loss. It has been approved, however, to treat blood pressure. Off-label “does not mean that the medication is unsafe,” Massick said. Tosti noted that many drugs in dermatology are prescribed off-label.
Massick emphasized that you need to be very consistent in taking (or applying) the medication in order to see results, which may take up to six months to become noticeable. She added that responses to the medication vary significantly from one patient to the next.
Tosti noted that she generally recommends that patients use both the topical and the oral formulations at the same time for best chances of success.
“Hair loss can have a tremendous effect on self-image and self-esteem,” Massick said. “People are wanting to treat their hair loss and hoping to start treating at earlier stages to avoid noticeable hair thinning.”
I’m not sure if my thinning hair is having much of a psychological impact, other than being a persistent reminder of my mortality, a little wink from death in the shower drain. But I endure it in private: It hasn’t gotten to the point where other people can really notice.
I don’t want to have to rub something sticky or oily into my scalp twice a day. I couldn’t even manage to wash my hair that often. I’m also not interested in risking the growth of any facial hair.
I may ask my dermatologist to repeat the steroid injections or prescribe the shampoo again. I will most certainly continue to scroll past ads promising an easy solution.