How minoxidil works
Minoxidil was originally developed as a blood pressure-lowering medication. During clinical trials, it was noticed that patients experienced increased hair growth as a side effect. This eventually led to the hair products now available in pharmacies.
The exact mechanism of action is not yet fully understood, but it boils down to two things. Firstly, minoxidil widens the blood vessels around the hair follicles, providing them with more oxygen and nutrients. Secondly, it extends the anagen phase, the growth phase of the hair. Hair follicles that were slowly shrinking thus remain active for longer.
Minoxidil does not block DHT. It does not address the cause of androgenetic alopecia but slows down its effect on the hair follicles.
Topical or oral: what's the difference?
Previously, there was only the lotion or foam that you apply to your scalp. Nowadays, there is also oral minoxidil, a low-dose pill that you take daily.
A meta-analysis from 2025 compared both forms and found no significant difference in effectiveness. One result stood out slightly: oral minoxidil scored better on hair density on the crown. But the overall conclusion was that both work comparably.
The big difference lies in the side effects. Topical minoxidil sometimes causes irritation, itching, or flaking on the scalp. Oral minoxidil more often causes headaches and unwanted hair growth elsewhere on the body, which is called hypertrichosis. This can include hair on the cheeks, back, or arms.
Which form you choose depends on what you prefer: applying something topically or taking a daily pill. Discuss this with your doctor or pharmacist, especially if you are considering oral minoxidil.
What to expect in the first months
This is where expectations often go wrong. Many men start with minoxidil and are alarmed in the first few weeks: they lose more hair than before they started. This is called the shedding phase, and it is normal.
What happens: minoxidil prompts dormant hair follicles to enter the growth phase earlier. For this to happen, old hairs must first fall out. This temporary loss usually begins two to eight weeks after starting and lasts for several weeks.
After the shedding phase, true growth begins. But keep in mind that you will only have an accurate picture of what minoxidil does for you after four to six months. Some men even need a year. Those who stop earlier draw the wrong conclusion.
How to use it?
For topical minoxidil, the standard dosage for men is 5%, twice a day on a dry scalp. Apply it to the areas where hair is thinning, massage it in lightly, and let it absorb. Avoid touching your hair too soon afterward and do not wash the product off immediately.
Consistency is everything. Skipping it once is not a disaster, but consistently irregular use will lead to fewer results.
One point that few people know beforehand: you can support the effectiveness of minoxidil by stimulating blood circulation in the scalp. A dermaroller for use can improve absorption because it creates small channels in the skin through which active ingredients penetrate better.
The biggest disadvantage: you cannot stop
This is the point that many people don't fully consider before they start. Minoxidil works as long as you use it. If you stop, the hairs that were present thanks to the product will fall out within three to six months. You'll be back to square one, or worse.
That makes minoxidil a long-term decision. It's not a short-term treatment. It's a product that, if it works, you'll need to continue using indefinitely. For some men, that's acceptable; for others, it's not.
Does it work for everyone?
No. Studies show that some users see little to no results. A possible explanation is the amount of sulfotransferase in the hair follicles, an enzyme needed to convert minoxidil into its active form. People with less of this enzyme respond less well to topical minoxidil. Oral minoxidil partly circumvents this problem, which may be a reason for the slightly better results in some users.
The chance of effect is also greater in men in the early stages of hair loss. Hair follicles that have already fully shrunk barely respond to minoxidil anymore.
Combining Minoxidil with other approaches
Many men combine minoxidil with finasteride because they address different mechanisms. Finasteride blocks DHT, while minoxidil directly stimulates hair follicles. This can be effective, but consult a doctor for advice on the combination and the correct dosage.
For men who do not want to use medication but still want to actively do something for their hair, there are alternatives. The Hairborn Growth Serum contains Redensyl, caffeine, and other active ingredients that support hair follicles without side effects like shedding or mandatory long-term use. It works differently from minoxidil and is not a substitute, but for those looking for a conscious first step or supplement, it is a fair option.
Summary
Minoxidil is one of the few remedies that actually works for some men with hair loss. It's not a miracle cure and doesn't address the root cause, but it can slow down deterioration and stimulate new hair growth in some individuals. The shedding phase is normal and no reason to stop. The biggest caveat is that you have to use it lifelong if you want to maintain the results.
If you want to start using it, consult your doctor, especially if you are considering oral minoxidil. For the topical variant, you don't need a prescription, but a good expectation is just as important as the product itself.