FAQ's - Minoxidil

Q. What was the first FDA approved medication for the treatment of MPB? 
A. Topical minoxidil.  A 2% solution with the proprietary name of Rogaine® or Regaine® was manufactured by Upjohn Pharmaceutical and approved by the U.S. FDA in 1988. Ironically, we still do not know exactly how or why minoxidil promotes hair growth. Although we know that it is a potassium channel opener, other medications that also function as potassium channel openers do not promote hair growth. Minoxidil promotes enhanced follicular size, resulting in larger hair shaft diameters. It also stimulates and prolongs the anagen (growing) phase of the hair growth cycle.

Q. Does minoxidil harm healthy hair? 
A. Not at all.  Although the exact pharmacodynamics of minoxidil are not well understood, the effect of minoxidil is to safely promote growth and to maintain maturity of the hair follicles.  These effects are most observable in hair follicles affected by MPB.

Q. Is there a difference between The Upjohn-Pharmacia Company’s active ingredient (i.e. minoxidil) and that of Regrowth, LLC? 
A. No. Minoxidil is a single molecule rather than a compound or mixture.  Using sophisticated analytical techniques, the minoxidil used by Regrowth, LLC has been assayed repeatedly by Bioscreen of California to be 100% pure.

Q. Why use a 5% or higher minoxidil solution or lotion when 2% - 5% minoxidil solutions are readily available over the counter in many countries?  
A. Minoxidil displays a dose-dependent effect with higher concentrations, improving the responsiveness and greater regrowth of hair. The higher the effective dose of minoxidil, the better the results, albeit there is not a directly proportional response.

Q. Why do the Rogaine®/Regaine 5% Extra Strength® solution and its generic versions feel so oily? 
A. Rogaine®/Regaine® and the generic OTC 5% minoxidil solutions contain a 50% concentration of propylene glycol in their liquid base, which leaves a long-lasting greasy film on the scalp.  Regrowth, LLC offers a 5% minoxidil solution that contains only 30% propylene glycol in the liquid base, and which does not have a greasy feeling to it.   For the 7% of patients who have an untoward allergic reaction to propylene glycol, a 5% minoxidil solution that has NO propylene glycol in the base is offered.

Q. Are minoxidil solutions exceeding 5% more effective in promoting hair growth?
A. As previously stated, minoxidil displays a dose-dependent effect with higher concentrations improving the responsiveness and greater regrowth of hair. Using standard compounding techniques, minoxidil in alcohol based solutions reach their saturation point at approximately 5%.  After years of intensive research, exhaustive experimentation, assistance from consulting pharmaceutical biochemists and extensive clinical testing, Regrowth, LLC offers minoxidil solutions of up to 15% in concentration.  They are stable and dry rapidly after they have been applied.

Q. How can I know that using a high concentration minoxidil solution and/or lotion isn’t an overdose and/or won’t be counterproductive to hair growth? 
A. Minoxidil has to have a serum concentration of 20 ng/mL to have any hemodynamic or other systemic effect in the human body.  Allowing for 1.7% absorption of minoxidil from topical application, a 2% minoxidil solution will result in 0.6 ng/ mL and a 5% minoxidil solution will result in 1.2 ng / mL of minoxidil in the serum.  So, there is more than a 16-fold safety margin from the use of 5% topical minoxidil and a 5-fold safety margin with the use of a 15% topical minoxidil solution.

Q. Do Regrowth, LLC’s formulations ‘feel’ any different than 2% and 5% Rogaine®/Regaine® and their generic equivalents? 
A. Yes. There is proportionately less propylene glycol in Dr. Lee’s formulations than there are in 5% Rogaine®/Regaine® and its generic equivalents. The 'greasy' feeling due to propylene glycol that is often associated with Extra Strength Rogaine®/Regaine® and their generic versions is not present when using Regrowth LLC’s minoxidil solutions. However, propylene glycol can be quite irritating to the scalp for approximately 7% of the patients. To accommodate those patients who have untoward reactions to propylene glycol, we have formulated minoxidil solutions that substitute hypoallergenic glycerin for propylene glycol.

Q.  Does glycerin make minoxidil formulas less effective? 
A. No.  Both glycerin and propylene glycol are pharmacologically inactive ingredients in the minoxidil products. They are used in minoxidil solutions because (1) they are humectants, i.e. they help to moisturize the skin and help protect from the drying effect of the alcohol; (2) they increase and stabilize the solubility of minoxidil; and (3) they keep a small quantity of minoxidil on the surface of the scalp to allow for continued absorption after the alcohol necessary to the base solution has penetrated.    

Q. Can I expect improved results with the higher concentrations of minoxidil? 
A. The 5% and higher minoxidil solutions and lotions have the potential to promote  regrowth of more hair and thicker hair, but they do not change the genetic properties of the hair follicles.  Although the growth (anagen) phase may be lengthened, the dormant (telogen) phase of approximately 100 days is unchanged. In order to see results, the existing thin hair shafts need to be replaced with thicker ones. This is why it usually takes between 3 and 6 months to appreciate significant hair regrowth with any concentration of minoxidil solution of 2% or greater.  

Q. What are the possible side effects of which I should I be aware? 
A. In the vast majority of patients there are no side effects.  If side effects do occur, patients who have a known adverse reaction to minoxidil, should avoid using Xandrox® formulas or any minoxidil preparations. Although rare, patients who are sensitive to minoxidil can experience a rapid heart rate, a drop in blood pressure and water retention. As a result, they may experience headaches, dizziness, chest pain and/or edema of the ankles. If such side effects occur, these patients should discontinue any formulas containing minoxidil. In our experience, these side effects have occurred in less than 0.1% of patients.

Q. What are 'direct dermatological events'? 
A. These are skin reactions in the areas to which the minoxidil solution is directly applied. These reactions may include soreness, redness, irritation, drying or flaking, etc. It is unusual for minoxidil to cause any of these events. Any untoward reactions are almost always due to the propylene glycol.

Q. Do I have to continue to use topical minoxidil solutions even after my hair has grown back?  
A. Yes. Topical minoxidil solutions are still treatments and are not cures for MPB. If you discontinue using minoxidil solutions, the scalp will revert to its baseline (before-use) condition in three to four months. However, some patients can achieve acceptable maintenance with once/day applications of 1 mL 5% minoxidil or Xandrox®.

Q. What applicator is the most effective and convenient? 
A. Since topical minoxidil preparations are absorbed most effectively when they are applied directly to the scalp, use whatever applicator would accomplish this task most efficiently for you. For most patients, the calibrated dropper works well to apply the solution directly onto the scalp.

Q. How about using a dabber-type applicator? 
A. Regrowth, LLC has always liked the idea of a dabber-type applicator, but it has one major disadvantage. The amount of solution being dispensed cannot be accurately calibrated. We have made available for the nominal price of $1.00/each a 2 oz. plastic bottle with a fitted dabber top and custom cap into which you can transfer the minoxidil and/or Xandrox® solutions. A separate label can be applied on which you can indicate the type of medication and the date.

Q. If I use the dabber applicator, how can I be sure I’m using approximately 1 mL of minoxidil or Xandrox® solution? 
A. You can’t be sure.  However, the exact amount of solution used is not critical and most patients have sufficient experience to estimate the amount of coverage that 1 mL affords on the scalp. It is only important to moisten the scalp in the area(s) of thinning and/or recession.  Generally, four passes of the dabber over the scalp, from side to side, equal approximately 1 mL of solution.

Q. Will the solutions be as effective if I just spray them on my hair? 
A. Not really. It’s important that the maximum amount of the medicated solutions be deposited on the scalp, so they can be absorbed into the dermis to the level of the hair follicle. There is essentially no effective delivery of medications through the hair shaft.

Q. Should the scalp be wet or dry when I apply the minoxidil solutions? 
A. As a general rule, medications are more readily absorbed when the skin is hydrated.  But minoxidil solutions can be applied to a dry scalp as well.  Our recommendation is to apply the minoxidil solutions to a dry scalp or to the scalp that is at least towel dried in order to avoid dilution.

Q. Will it help to apply the minoxidil solutions more than twice / day? 
A. Yes, but the additional benefits will probably be minimal, especially with the Xandrox® 5% solutions, because the azelaic acid also promotes maximum absorption of minoxidil.

Q. Will minoxidil as an ingredient in shampoos and conditioners work for me? 
A. No. Minoxidil must penetrate the scalp to work effectively at the level of the hair follicles. Shampoos and conditioners would have to contain very large amounts of alcohol and/or remain on the scalp for hours in order to transfer minoxidil through the scalp.