The Side Effects of Minoxidil | The Hair Loss Show

Summary

In this episode of 'The Hair Loss Show,' Drs. Russell Nudson and Vicam J. Aash explore the side effects of minoxidil, comparing topical and oral forms. They discuss the history of minoxidil's use for hair loss, its effectiveness, and common side effects such as contact dermatitis, facial hair growth, and systemic issues like palpitations and migraines. The doctors emphasize the importance of proper application and dosage, highlighting the benefits of minoxidil as a long-standing treatment for hair loss, despite misconceptions about its efficacy and duration of effect.

Takeaways

• 👨‍⚕️ Minoxidil is used to treat hair loss in both men and women, available in topical and oral forms.
• 📜 Originally used to treat high blood pressure, minoxidil's side effect of stimulating hair growth led to its use for hair loss.
• 🇦🇺 In Australia, topical minoxidil is available over the counter, while oral minoxidil requires a prescription.
• 💧 Topical minoxidil can cause contact dermatitis due to propylene glycol in its formulation, but foam versions reduce this risk.
• 💊 Oral minoxidil, used in low doses, can cause side effects like palpitations, migraines, and weight gain.
• 🩺 Shedding is a common initial side effect of minoxidil, indicating the treatment is stimulating hair follicles effectively.
• ⚖️ Dosage of oral minoxidil needs to be carefully managed to avoid side effects, particularly in women who might experience facial hair growth.
• 💡 Minoxidil needs to be applied to the scalp, not the hair, for best results; foam absorbs faster than liquid.
• 🧴 Transitioning from liquid to foam minoxidil should involve a recovery period for the scalp if irritation occurs.
• 📈 Compliance with the treatment is crucial for effectiveness; oral minoxidil can be easier to maintain than topical forms.

Q & A

What is the main topic of the 'Hair Loss Show' episode featuring Dr. Russell Nudson and Dr. Vicam J Aash?

The main topic of the episode is the discussion of side effects of minoxidil, specifically comparing topical minoxidil with oral minoxidil.

In what forms is minoxidil commonly available in Australia according to the transcript?

Minoxidil is commonly available in Australia as a topical liquid or foam, and it can be obtained over the counter without a prescription. There is also an oral tablet form which requires a prescription.

What was the original purpose of minoxidil before it was used for hair loss treatment?

Minoxidil was originally used to treat high blood pressure, and its side effect of general hair stimulation led to its use as a hair stimulant.

What is contact irritant dermatitis and how is it related to the use of minoxidil liquid?

Contact irritant dermatitis is a skin reaction that can occur in a small percentage of patients using minoxidil liquid, potentially due to the propylene glycol in the formulation, causing an itchy scalp and other discomforts.

Why was a foam version of minoxidil developed?

The foam version was developed to address complaints about oiliness and greasiness associated with the liquid form, especially for women, and to potentially reduce the occurrence of contact irritant dermatitis.

What is the difference in absorption time between the minoxidil liquid and foam?

The minoxidil liquid absorbs in about 60 to 90 minutes, while the foam absorbs in just 10 minutes.

What are some side effects associated with the oral form of minoxidil?

Some side effects of the oral form of minoxidil include hair growth on the face in women, palpitations, migraine aggravation, and weight gain due to water retention.

Why is it important to apply minoxidil on the skin and not on the hair?

Applying minoxidil on the skin ensures better absorption and effectiveness. It also helps avoid the side effect of greasiness or oiliness of the hair.

What is the significance of the 'monox shed' mentioned in the transcript?

The 'monox shed' refers to the initial shedding of hair experienced by some users of minoxidil. It is considered a positive sign as it indicates that the user is responding to the treatment and new hair growth is being stimulated.

How does the doctor in the transcript suggest dealing with side effects from topical minoxidil?

The doctor suggests starting with a lower dose of oral minoxidil if side effects from topical minoxidil occur, and then gradually increasing the dose while monitoring for any issues.

What misconception about minoxidil does the doctor address in the episode?

The doctor addresses the misconception that minoxidil stops working after 12 or 18 months. He explains that it's not that the body becomes used to it, but rather that minoxidil may not be fully effective at stopping hair loss progression on its own.

Why is patient compliance important when using minoxidil, according to the transcript?

Patient compliance is important because if patients do not enjoy using the topical product or find it difficult to remember or fit into their schedule, they are less likely to use it consistently, which can affect the treatment's effectiveness.

Outlines

00:00

🧑‍⚕️ Introduction to Minoxidil for Hair Loss Treatment

Dr. Russell Nudson and Dr. Vicam J Aash introduce the topic of the Hair Loss Show episode, focusing on the side effects of minoxidil, a medication used for treating hair loss. They compare topical and oral forms of minoxidil, explaining its availability in Australia and its history as a medication originally used for high blood pressure. The doctors discuss the formulation of minoxidil, including the alcohol and propylene glycol used in the liquid form, which can cause contact dermatitis in some patients. They also mention the development of a foam version to address issues of oiliness and greasiness associated with the liquid form.

05:05

💊 Minoxidil Usage and Transition Between Forms

The hosts delve into the specifics of using minoxidil, including the importance of applying it to the scalp rather than the hair. They discuss the differences in absorption times between the liquid and foam forms, and the potential side effects of the liquid form, such as contact dermatitis. The conversation turns to transitioning from the liquid to the foam form, emphasizing the need for the scalp to recover before making the switch. They also address the misconception that minoxidil causes increased hair shedding, explaining that this is actually a sign of a positive response to the treatment, as it indicates the growth of new hair.

10:06

🔍 Navigating Minoxidil Dosage and Side Effects

The doctors discuss the importance of finding the right dosage of oral minoxidil to avoid side effects such as palpitations, migraines, and water retention. They stress the individual variability in response to the medication and the need for a personalized approach to dosing. The conversation highlights the benefits of oral minoxidil, such as ease of use and compliance, especially for those who find topical application inconvenient. The hosts also touch on the importance of persistence with minoxidil treatment, as it is a stimulant that can slow down hair loss but may not completely stop it.

15:12

📈 Minoxidil's Track Record and Effectiveness

In the final paragraph, the hosts reflect on the long-standing use and effectiveness of minoxidil, emphasizing its status as a key treatment for hair loss. They address common misconceptions about the drug's effectiveness over time and the importance of setting realistic expectations for its results. The doctors also caution against comparing minoxidil to newer treatments without solid evidence, advocating for the value of minoxidil's extensive research and track record. They conclude by encouraging viewers to like and subscribe to their channel for more informative content on hair loss treatment.

Keywords

💡Minoxidil

Minoxidil is a medication originally developed to treat high blood pressure but later found to have hair growth as a side effect. In the context of the video, it is a key topic as the hosts discuss its use in treating hair loss, both in topical and oral forms. The script mentions its history, different formats, and side effects, emphasizing its role as a hair stimulant.

💡Hair Loss

Hair loss is the primary theme of the video, with the hosts focusing on the medical treatment of this condition in both men and women. The script discusses various aspects of hair loss, including its management with minoxidil and the importance of finding the right treatment for individual needs.

💡Topical Minoxidil

Topical minoxidil refers to the liquid or foam form of the medication that is applied directly to the scalp. The script explains that it is available over the counter in Australia and is used to stimulate hair growth locally where it is applied. It also mentions potential side effects such as contact irritant dermatitis.

💡Oral Minoxidil

Oral minoxidil is the tablet form of the medication, which is taken by mouth. The script notes that it requires a prescription in Australia and discusses its potential side effects, such as palpitations and migraines, which are related to its impact on blood pressure and blood vessel dilation.

💡Contact Dermatitis

Contact dermatitis is a type of skin inflammation that can occur as a reaction to certain substances. In the script, it is mentioned as a potential side effect of the liquid form of topical minoxidil, possibly due to the propylene glycol content, causing an itchy scalp for some patients.

💡Propylene Glycol

Propylene glycol is a carrier substance used in the liquid form of topical minoxidil. The script suggests that it may cause contact dermatitis in some patients, leading to an itchy scalp, and is one reason why a foam alternative was developed.

💡Foam Minoxidil

Foam minoxidil is an alternative to the liquid form, designed to be less greasy and less likely to cause contact dermatitis. The script discusses its benefits, such as quicker absorption and reduced greasiness, making it a preferable option for some patients, especially women.

💡Palpitations

Palpitations refer to an abnormal awareness of the heart's action, typically felt as a fluttering or pounding in the chest. The script mentions that some patients may experience palpitations as a side effect of oral minoxidil due to its impact on blood pressure.

💡Migraines

Migraines are severe headaches often associated with pulsating vessel dilation and constriction. The script notes that minoxidil, which dilates blood vessels, could potentially aggravate migraines in sensitive individuals, even at low doses.

💡Weight Gain

Weight gain mentioned in the script refers to the potential side effect of water retention caused by oral minoxidil. This is an important consideration for patients who may be monitoring their weight or have concerns about fluid retention.

💡Compliance

Compliance in the context of the video refers to the consistency and adherence to a medication regimen. The script discusses the importance of finding a treatment method that fits into a patient's routine to ensure they take the medication as prescribed, which is crucial for effectiveness.

Highlights

Minoxidil, originally used for high blood pressure, was found to stimulate hair growth as a side effect, leading to its use as a hair loss treatment.

Topical minoxidil is available over the counter in Australia in liquid or foam form, without a prescription, while oral minoxidil requires one.

The liquid form of topical minoxidil can cause contact irritant dermatitis in some patients due to its formulation with alcohol and propylene glycol.

Minoxidil foam was developed to address the greasiness issue associated with the liquid form, making it a preferable option for some users.

Proper application of topical minoxidil is crucial, with advice to apply directly to the scalp and not on the hair.

Oral minoxidil can cause side effects such as palpitations, migraine aggravation, and weight gain due to its blood pressure effects.

The 'minoxidil shed' is a sign of response to treatment, indicating that new hair growth is occurring.

Only about 50% of people are good responders to minoxidil, as it needs to be converted into minoxidil sulfate in the skin to work.

Compliance with hair loss treatments is key, and oral minoxidil may be more convenient for some patients.

Finding the optimal dose of oral minoxidil is important to minimize side effects and maximize effectiveness.

Minoxidil's long history and extensive use provide reassurance of its safety and efficacy in treating hair loss.

Patients often misunderstand the purpose of minoxidil, expecting full hair regrowth rather than stabilization and slowed hair loss.

The belief that minoxidil stops working after a certain period is a misconception; it continues to slow hair loss but may not completely halt progression.

New medications claiming to be similar to minoxidil should provide evidence of their effectiveness before being considered viable alternatives.

Minoxidil remains a key treatment for hair loss due to its proven track record and understanding of its effects.

The importance of patient education on realistic expectations and proper use of minoxidil for effective hair loss management.

Transcripts

hi everybody I'm Dr Russell nudson and I'm  Dr vicam J aash welcome to this episode of  

the hair loss show where today we're  going to discuss the side effects of  

minoxidil and we're going to specifically  compare tropical minoxidil with oral

minoxidil welcome to the hair loss show Dr  Russell nudson and Dr vicam J aash discuss  

issues relating to hair loss and the medical and  surgical treatment of hair loss in both men and  

women right so welcome back to the show thanks  again for watching so uh one of the uh one of  

the medications that we use a lot when we're  managing patients with hair loss both men and  

women is minox and minox comes in in a variety  of different uh formats commonly uh you can  

certainly here in Australia you can get topical  monoxil either as a liquid or a foam and that's  

freely available over the count so you don't  need a prescription here in Australia to get  

that um but there's also you can get monoxil in  the oral format and the tablet format and that  

here in Australia you do need a prescription  there are other forms as well there are subl  

uh forms of minoxidil but in essence you know  there what we describe as a topical form of  

monoxil and an oral form of uh monoxil which  we're seeing excellent results really good  

results in terms of you know helping and managing  people that are suffering from from hair loss so  

just a little history of monoxil was originally  orally used to treat high blood pressure and one  

of the side effects of oral monoxil was General  stimulation of hair which tweaked the idea that  

perhaps you could use Minoxidil to assist as  a hair stimulant and so the idea was we only  

wanted to stimulate hair on the head so we put  it into a liquid form and so that came into the  

marketplace in Australia in 1989 after we did the  research in 1984 85 I was one of the five doctors  

in Australia the research um and so the the idea  behind it was that you apply it just to the area  

that you needed and we've learned a lot obviously  in the last you know 40 years or 35 years about  

monoxil so in the liquid form it's formulated  with alcohol propylene glycol as the carrier  

and water and propylene glycol unfortunately has  the potential in a small percentage of patients to  

call the contact irritant dermatitis and this is  one of the complaints we get about the uh the use  

of the liquid form that you can get a contact  dermatitis get an itchy scalp and some people  

say tness all of that sort of stuff so if you get  that then really you don't it's the probably the  

propine glycol although I also seen it in people  when you when you get a special formulation made  

with no propline glycol in it they still can get  that reaction seen that as well so I think there  

is a reaction potentially to the monoxil itself  so that's why later on they the company that was  

making um the original form of monoxil developed  as a foam because the foam would not have uh  

the propline glycoline would be less oily less  greasy and for particularly for women this was  

a big complaint that they got um oiliness they  got greasiness of the hair associated with it  

so there are a few things that are important to  remember about it firstly that you don't measure  

the amount you use because if you got a small area  you use a small amount of if You' got a large area  

you use a large amount the second thing I would  emphasize is that we want it on the skin not on  

the hair and so what I often say to my patients  is use a cotton Bud dip and paint yeah and then  

you get less of this side effect of greasiness or  oiliness of the hair the other thing that people  

um you know uh can complain about um is more to  do with the oral form um you can get hair growth  

in the face in women from the topical form that's  why they formed in a 2% version that's distinct  

from the 5% version for the men so there was  less risk of getting the facial growth which  

women weren't very happy about um so you can get  that you still can get it with the topical form  

but when you get into the oral form you need to  use it in a dose that's not going to affect the  

blood pressure which is quite a low dose but it  can have other effects now in my experience I've  

had a couple of patients complain about getting  palpitations from it so that's a function of  

the way it affects blood pressure so even in do  if you're sensitive you could get a palpitation  

from it I've had someone tell me that aggravated  the migraine so if you understand how migraines  

work it's it's the pulsatile Dil dilation and  constriction of the blood vessels in the scalp  

that cause the throbbing headache and the nausea  and because the drug opens up blood vessels again  

if you're very sensitive even in low doses it  could aggravate a person prone to migraine so  

I've had that and the other other one that that  the people have complained about is weight gain  

which would be water retention as part of the the  side effects so these are kind of the different  

side effects you can get but apart from the one  big one they complain about and they all think  

they're going to get which is I've heard if I use  monoxil all my hair is going to fall out very very  

quickly sheding and the dreaded monoidal shed  the monox shed and they and and people obviously  

think that's a bad thing whereas I try and you  know reverse the idea and tell them it's a good  

thing because for the 50% of people that respond  well to monoxil what's happening is the monoxil  

is stimulating the hair F will produce the next  hair which pushes out the previous hair faster  

and starts the next cycle so it means that the new  hair the stronger hair is coming through well it  

tells me that if you are shedding on the noxel  you're a responder and only about 50% of people  

are very good at responders because minox has to  be converted in the skin into monoxy sulfate to  

work and that doesn't happen with everyone does  no not everybody has enough enzyme to do it yes  

so if you're shedding it means you're a responder  so that's really good and so I mean there's a lot  

to unpack there so I I guess the first thing let's  talk about uh the topical version so uh I'm sure  

you you you this is in your experience probably  the liquid is probably more prevalently available  

uh readily available in in pharmacies than the  foam uh so most people if they're buying uh  

topical monox that will probably be their Pap than  the phone uh so that's probably their first go-to  

so I think if you're using that that's fine you  know as as Russell was saying remember it's got  

to be applied to the scalp but if you are getting  uh and once a day and once a day it says twice a  

day in the box but I would ignore that because  it lasts 21 hours in the skin so again you can  

make it go a lot further if you're using it once a  day and get exactly the same effect well there two  

yeah so that's that's very true there's also the  other aspect of things is that they they're quite  

prescriptive on the bottle of of the volume that  you need and well if someone is thinning over a  

large area versus someone's thinning in a smaller  area well that will inherently dictate the volume  

of of the actual medication that you need so you  want to apply it to to the scalp and remember you  

know parting the hair and applying it to the  scalp in that in that fashion now let's say  

someone uses the topical Mo oxal liquid starts  getting uh it starts getting bit red itchy the  

next thing to suggest and what we do normally in  clinic saying right swap to the foam what about  

transitioning between the liquid to the to the  foam is there should there be a gap in time or  

you just go right okay I think you need to let the  scalp recover yeah before you do it um so I would  

want the dermatitis if that's what the the problem  is to settle down before I um apply the fir um and  

that's probably not going to take very long it it  be weak maybe it would settle down and they're not  

going to lose hair during that time no not in  that week and the other thing that's important  

to understand um for people who are worried about  we to apply it um and grooming is that the foam  

absorbs in 10 minutes the liquid absorbs in about  60 to 90 minutes right so when people say well you  

know like how do I have to sort of shower like I  had an email last week from Guy saying he doesn't  

shower for two weeks or he doesn't work two days  after he applies the Theo because he's because  

he's he's worried he's he's washing it off before  it's absorbed and I was trying to reassure him  

that even if he's using the liquid it's an hour  not two days and uh and that if it's the foam  

it's even quicker so there are slight differences  in the absorption between them yes um but I think  

that the the the incidence of side effects from  the foam is lower than it is with the liquid but  

it's not eliminated we still get people that react  to the foam because the foam doesn't contain the  

propylene glycol which is probably caused the main  irritant and of course in most of the cases but  

like you said there are certain people who are  probably sensitive to the to the active uh drug  

I find it if we swap them from the topical to the  oral yes usually solves all of those problems yes  

um it's it's there's side effects on arod oxid  dool less than than anything else that we that  

we use as long as you're using a low enough  dose and you can start with a low dose like  

a half milligram or a milligram and make sure that  there's no dramas there particularly lower dose in  

the women because they don't want the facial hair  than the men and then you can gradually increase  

it as you go along uh and we do that through  compounding right so the tablet comes in one  

size and people can cut it in halves or quarters  but with compounding you can specify the dose you  

want and Vary that and then slowly dial it up with  people to see that they're they're not getting any  

problems with it and the other very important  thing about this is that the what we want is  

something that's easy for people to do yes and if  they are not enjoying using the topic or product  

or they find it difficult to remember to do it or  find time to do it that fits in with their sleep  

schedule or their washing schedule then oral  makes it a lot easier for them and it'll work  

a lot better if they take it then if they don't  yes so compliance is a big issue but I think to  

to the point that you made about the dosing or  certainly the side effects with the with oral  

monoxil if you're a patient and you've been put  on oral monoxil and you experience some of those  

side effects the palpitations or the the migraines  uh or the the LI headedness does not mean that you  

cannot take oral monoxy it just means you need  to find what the right doses for you well I mean  

everybody's unique yes in this world and and and  so there is no one- siiz fit sort approach that  

works for any of these medications and as I said  you can start low to make sure that you're okay  

particularly if someone's had side effects from  tropical monoxor you would want to start low on  

quite low on the orom oxil and then just gradually  dial it up if a little bit I mean the the quarter  

of the 10 is still allegedly at the point where it  doesn't affect the blood vessels and there is a in  

the literature it tells you that even if you use  10 milligrams in a person who's got normal blood  

pressure doesn't lower blood pressure uh it's it  only lowers blood pressure uh for people that um  

have high blood pressure but I don't think  that's entirely correct because if you have  

borderline borderline low blood pressure I've had  patients tell me they get what we call postural  

hypertension which means they go from sitting  to standing and they feel dizzy because they've  

dropped their blood pressures they've got up so  if you're on orom minoxidil and you find that you  

get dizzy from changing from a line position or a  sitting position to a standing position that means  

that you've got borderline low blood pressure  and we have to get the dose down lower yeah so  

it and and I think that's probably you know for  me one of the the the mission critical parts of  

this whole process which is that not every like  you said not everyone is the same everyone has  

a unique response into How uh how they respond  to different medications and so they may need  

to be taken down that path of right okay well  this is how we're going to try and build up and  

find the optimal dose for you and that's why  it's important if you're suffering from hair  

loss to make sure that someone who knows how to  manage this how to navigate through the different  

you know versions of of the medication and the  different doses why that's really important as  

particularly because that's right the the topical  ones are off the shelf uh and so you know you're  

going to need some good advice if you're going  to use it Lally perfect oh good I think that's  

a really good summary of the of the side effects  so uh and I hope I hope you found that uh useful  

and again thank you very much for watching I  would reassure everybody that it's one of our  

favorite treatments because when we're treating  any type of hair loss you know uh when people  

are concerned about the hair volume even when  they're aging right and and as we age we get a  

little bit thinner and the hairs get a little bit  finer anything that is a genuine stimulant that  

gives people that feeling of a bit more volume  uh in their hair is is beneficial so I think that  

an oxal is a very useful drug it's one of that  key it's one of our key treatments that people  

as you mentioned you know it started in 1984 so  it's it's it's held it's still the test of time  

oh yes we've got plenty of experience with that  we know exactly what we're dealing with and and  

that's that's really important and and you know  sort of leads on to a great point because there  

are you know you get a lot of questions uh about  oh what about this Medicaid you know uh you know  

this medication that's coming on the market that's  you know in phase three of of Trials and all this  

sort of thing what do you think and you know  is it better than monoxil and and one of the  

things I say is that look monoxil has got this  great history you're writing on the coiles of  

you know millions of people before you that have  uh you know walked that path and then the other  

thing is that there are the lookalikes the stem o  you so they basically change one or two things in  

the format of an oxal and go oh this works just  just as well well show me the evidence right show  

me the evidence that changing these this part of  the formula to that part of the formula actually  

gives you an equivalent response don't just  say well you know it's it's similar yeah and  

I think the fact that it's got that much data  behind it you know gives me that sort of uh  

much you know that much more reassurance to be  able to authentically you know suggest it to to  

our patients when we're when we're having that  conversation and one last last point is that  

people who give up on minox give up on it for two  reasons either they don't stand it long enough to  

see a response or number two they're looking  for the wrong response so we know that the  

higher response rate with monoxil is stabilizing  you and slowing or stopping further hair Lots at  

least for a period of time um but they all think  that it's failed unless it's regrown here and the  

other one that I that I want to address because  we're talking about mon oxal is all I I hear it  

stops working after 12 or 18 months no it it's  still a stimulant but if you use a stimulant  

by itself in some people it's not enough to stop  progression of the hair it'll just slow it down  

so it's not that your body becomes used to it it  stops working it's just was never going to be 100%  

effective at stopping further hair loss good well  thanks again for watching I hope you that's giving  

you a really good summary uh and insight in that  discussion about the monoidal and its uses and  

side effects um again please remember to like And  subscribe to the channel uh thank you for all your  

support and uh we look forward to seeing you on  the next show thanks everyone byebye [Music] bye