Myths regarding Minoxidil and MPB

Yes, but the answer needs to be qualified. Only hairs already in the telogen (resting) phase will be caused to shed by the use of topical minoxidil. With the initial use of topical minoxidil, hair follicles in the telogen phase, normally about 10% of all of the hair follicles on the scalp, can shed their hair shafts. That's not necessarily bad news. Those hairs were imminently going to shed in any case and continued use of minoxidil may help the thinning hair to be replaced with thicker, healthier hair.

No. Minoxidil doesn't work for everyone. Approximately 17% of patients will continue to see progression of their MPB while using topical minoxidil. But don't mistake the progression of MPB as an adverse reaction to topical minoxidil. In almost all cases, the use of minoxidil is slowing the rate of progression of MPB, even if it is not entirely preventing its progression.

How well minoxidil works to treat MPB is not so much dependent on the patient's age as it is dependent on the genetic propensity of the patient to have MPB. Unfortunately, one's genetic propensity for MPB is not something we can assess. In any case, there is no evidence that minoxidil will force hair in the anagen phase into the telogen phase and cause it to shed or 'not to regrow'. Just the opposite reaction occurs. Minoxidil helps to keep the hair follicles in the anagen phase. It may not have visibly positive results for everyone, but it does not hasten MPB, i.e. it does not cause miniaturization of the hair follicles.

Wrong. Minoxidil doesn't really cause a tolerance, i.e. as long as you apply minoxidil, it will extend the anagen phase of the hair follicles. However, the amount of scalp hair loss reversal is maximized at about two to three years. It's unlikely that more hair follicles will be recruited to produce a terminal hair shaft again after that time unless you increase the concentration of minoxidil delivered to the follicles and/or take measures to protect the follicles from DHT. There seems to be a threshold level at which hair follicles can be recruited to grow a terminal hair shaft again. Using a high concentration topical minoxidil ensures the best results. Some patients will be able to maintain the hair on the scalp with continued treatment, but most patients will gradually see some thinning again. Patients who stay on treatment with topical minoxidil definitely do much better than untreated patients, but the positive results will decline over time.

This myth requires explanation. The packaging for Rogaine says topical minoxidil is for 'growing hair at the vertex'. That doesn't mean it won't promote hair growth in the frontal areas. Actually, it does, but it is not as effective in promoting hair growth as it is at the vertex. Understandably, Upjohn did not include statistics for frontal hair growth to the FDA, when it applied for an approval. So, the FDA required Upjohn to state that Rogaine is to be used to 'grow hair at the vertex". And the myth persists that topical minoxidil "does not grow hair in the front hairline area".

Hair affected by MPB on the anterior (frontal) parts of the scalp is more resistant to treatment than is hair at the vertex. Using topical minoxidil alone or using an agent to reduce the DHT alone has rather limited success in reversing hair loss in the frontal or temporal areas of the scalp. So, male patients are usually better off using both medications.

Wrong. If you discontinue using minoxidil after a single application, or even after a few days of applications, you will not experience any minoxidil induced shedding. The effects of topical minoxidil are very much dose/time related. You will not have started any significant biochemical changes after a single dose.

It just doesn't happen. It would be nice, if minoxidil were such a potent promoter of hair growth, but it isn't. Besides, the palms of the hands do not contain hair follicles and the hair follicles on the face of women do not usually have the potential for growing terminal hair. Even with an alcohol base, the amount of absorption of minoxidil averages only 1.4%. After the solution has dried on the scalp, there is negligible additional absorption.

Unfortunately, not. With the current treatments for MPB, the amount of scalp hair loss reversal is maximized at about two to three years. Many patients will be able to maintain the hair on the scalp with continued treatment, but most patients will gradually see some thinning again. Patients who stay on treatment with topical minoxidil definitely do much better than untreated patients, but the positive results will decline over time. Of course, if a patient discontinues treatment at any time, he will lose all of the gains he has made, and it may not be possible to achieve the same recruitment upon restarting treatment.