The first few weeks of minoxidil can be disconcerting. Your scalp may itch. More hair appears to be growing — in the shower. You may spot a patch of facial fuzz in a place where you had not a shred of intention to encourage body hair to appear.
That does not necessarily signify that your minoxidil therapy is doomed. Most minoxidil side effects are nothing to worry about, but the answer really depends on the vehicle you have chosen. Topical preparations (foam or liquid) primarily interact with your scalp whereas oral minoxidil — and that has an entirely different set of concerns.
Topical minoxidil tends to give you scalp problems
Minoxidil foam and liquid are available without a prescription in the States. Most likely to worry you is the possibility of localized adverse effects: dryness, scaling, itching, redness, and a burn at the site of application — all things that happen to your skin when you apply something liquid to it.
Another culprit in the mix may be the solution itself, commonly containing propylene glycol as a solvent, an ingredient that can irritate your skin. Foam, on the other hand, does not typically contain it, and switching to it may be a good idea should your scalp feel unusually dry and itchy. Our guide to topical minoxidil foam vs. liquid goes into more detail on the topic.
Additionally, applying a larger quantity will not make your hair grow faster. It will simply leave your scalp even wetter, with all the additional irritation that implies, and may end up getting into your forelock or facial hair with alarming ease.
Why can you start losing more hair soon after starting the treatment?
This seems to be the one that gets people worried.
They sign up for a minoxidil journey in hopes of saving their hair, and then, two or three weeks in, realize that more of it is deciding to leave at the same time as the shedding they already saw, and think quitting sooner is the best option.
It is true that early shedding (the one not caused by the medication) can occur as the follicles move from resting to growing phase — and some hairs are just pushed out as new ones come in their place — but that is generally a short-lived phenomenon, lasting up to a few weeks.
However, not all instances of ‘heavy’ hair loss are equal. The same can be said for any abrupt, unhealthy-looking episode of loss — and there may be reasons why it occurred besides minoxidil.
Hair loss occurs commonly with illnesses, extreme stress, rapid weight loss, iron deficiency, thyroid dysfunction, pregnancy, and the post-partum period — among other conditions. If your episode of loss is especially worrying, lasts for a long time, or is accompanied by other, odd symptoms, asking the opinion of a professional is a better alternative to waiting until it resolves itself.
Hair growth takes a while — on average, a few months of consistent minoxidil usage, and possibly longer, are to be expected. We have more on the topic on how long minoxidil takes to work.
Does minoxidil make your face hairy?
It is possible to see side effects like unwanted facial hair growth, particularly if your topical solution manages to get on other parts of your skin. Wash your hands before and after applying the medication. Wait for the liquid to dry before laying your head on the pillow — and never apply a fresh dose on a damp scalp. The more is not the merrier.
Hair growth on your face, body, or anywhere else not covered by the hairy parts of your scalp is much more common with oral minoxidil, as the medication gets into your system. In one large observational trial of 1,404 people who received low-dose oral minoxidil, about 15% of patients developed unwanted extra hair growth, and only a fraction of those discontinued the medication — but some people find the change much more unpleasant.
Oral minoxidil is a different class of action
Low-dose oral minoxidil is becoming increasingly popular for hair loss, particularly among people who are not fond of the idea of using a topical solution every day. However, the use of minoxidil tablets is an off-label use — the medication has been approved for the treatment of severe hypertension, not baldness or thinning.
Still, at lower doses recommended by your dermatologist, there is little reason to worry — those studies involving many thousands of patients receiving oral minoxidil for hypertension do not speak of terrifying side effects happening frequently at those low levels — only that “low dose” does not equal “no dose”.
That same observational trial of 1,404 patients mentioned above found the following rates of adverse effects:
Light-headedness — 1.7%, fluid retention — 1.3%, palpitation — 0.9%. Headaches, puffiness around the eyes or insomnia were less common. The study was observational, not interventional, which means those are rough approximations of your likelihood of experiencing those.
Depending on your personal history and the state of your vital signs, your physician may want to examine your blood pressure and heart function, your kidney function, and possibly other factors before recommending oral minoxidil tablets.
A minoxidil tablet the person receiving it has low blood pressure is very different than the same dose of the same drug given to a healthy, physically fit person who does not take any other medication. Oral and topical minoxidil preparations are fundamentally different and should not be substituted for one another.
Which side effects require medical attention?
Call your doctor and inform them of your intent to discontinue the topical solution immediately if you experience chest pain or tightness, light-headedness or fainting, irregular or rapid pulse, swelling of the legs or sudden weight gain. These are unexpected effects that can happen with minoxidil, but they also indicate serious issues with your cardiovascular system potentially exacerbated by minoxidil.
Severe and persistent discomfort or pain in the scalp, redness, scaling, and a rash spreading across your head should also be evaluated — the root cause may range from contact dermatitis to infection, or some other condition unrelated to your minoxidil treatment that will not help from the minoxidil therapy.
Topical minoxidil treatments are unsafe around small children and pets; a minoxidil overdose can be extremely dangerous, and just a tiny splash can poison a cat or a dog.
Topical minoxidil is generally not recommended during pregnancy or breastfeeding, unless your obstetrician recommends it.
For more information on why hairs begin to fall and thin, and why the correct diagnosis is crucial for effective treatment, go here: Hair Loss Uncovered: Essential Facts
Most people are reasonably safe when using topical minoxidil solutions. A dry scalp or an episode of hair loss on its own are not a reason to panic — but they are certainly different from sudden light-headedness, swelling or irregular heartbeats. Understanding the difference makes it simpler to understand what, if anything, you should do about it.
