The Side Effects of Minoxidil | The Hair Loss Show
Summary
TLDRIn 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
🧑⚕️ 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.
💊 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.
🔍 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.
📈 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.
Mindmap
Keywords
💡Minoxidil
💡Hair Loss
💡Topical Minoxidil
💡Oral Minoxidil
💡Contact Dermatitis
💡Propylene Glycol
💡Foam Minoxidil
💡Palpitations
💡Migraines
💡Weight Gain
💡Compliance
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
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