Guest post alert!

I recently received a call from a friend who I hadn’t heard from in years. After 15 awkward minutes he finally just asked, “so… can I get in to see your wife in clinic?” Calcium scores and lipoproteins are pretty sexy stuff, but I have a feeling that once you start hearing from Desiree, you are going to want more.

For this first collab, Desiree tells us about the journey of a cardiovascular medicine that made its way to everyone’s preferred specialty, dermatology.

Desiree is a Board Certified Dermatologist who completed residency at the Mayo Clinic in Rochester, MN. In addition to her very busy practice she is an award winning teacher who works with dermatology residents instructing them in both general dermatology and cosmetic procedures. She is an absolute wealth of knowledge and it is such a pleasure to be able to share her article!
-Appesh Mohandas

Minoxidil: From Blood Pressure Pills to Hair Growth Magic

Side effects take over

Ah, minoxidil—an unlikely hero in the world of hair restoration. Originally developed in the 1970s as a treatment for high blood pressure, this drug stumbled upon its destiny in the most unexpected way. Let’s dive into the journey of how minoxidil went from saving hearts to saving hairlines.

Minoxidil started its life as an oral medication for stubborn high blood pressure. It worked by relaxing blood vessels, making it easier for blood to flow. But then something strange began happening. Patients taking it started reporting a rather hairy side effect—literally. Hair began sprouting in the oddest places: foreheads, cheeks, even hands. 

Pharmaceutical companies quickly realized they were sitting on a gold mine and developed Rogaine, the topical form of minoxidil. By isolating its hair-growing powers and leaving the blood pressure control to other drugs, minoxidil found its true calling.

For Hearts and Heads, Prevention is Key

Fast forward to today, and minoxidil is a household name for hair loss solutions. It’s reliable, effective, accessible and safe. The typical dose is 5% twice daily. If this is ineffective you can increase the strength or consider combining it with other topical medications (such as retinoic acid or finasteride).  These combinations are not available over the counter and in some cases not commercially available at all but can be made by utilizing a compounding pharmacy in conjunction with a dermatologist. Minoxidil doesn’t stop hair loss entirely, and its effects wear off if you stop using it. It is best to start it early to help prevent hair loss as it is sometimes not effective for more advanced hair loss. Typical side effects include local irritation and itching but it is generally well tolerated.

Pills make a comeback

While topical minoxidil has been a staple for decades, some patients find it messy, inconvenient, or irritating to their scalp. Enter oral minoxidil, the simpler alternative. By taking a small daily dose of the pill, patients can bypass the need to apply anything to their scalp. It’s also been noted that oral minoxidil may provide broader and more consistent hair regrowth since it reaches all hair follicles via the bloodstream. Oral minoxidil may be particularly effective for individuals with more advanced hair loss or those who didn’t respond well to topical treatments.

Minoxidil is still a vasodilator, so theoretically, it can lower blood pressure. However at the low doses prescribed for hair loss, the risk of significant blood pressure drops is minimal in healthy individuals. Oral minoxidil can still encourage hair growth in other places even at low doses. It can also cause mild swelling of the hands and feet.

Out with the old, in with the new

Because minoxidil works by stimulating hair follicles to move from the telogen phase (resting) to the anagen phase (active growth) there is a small catch to its use - hairs in the telogen phase must first shed to make way for new, healthier growth.  Think of it like renovating your house—you’ve got to clear out the old, broken stuff before you can bring in the new furniture. The initial shedding phase is essentially your scalp’s “demo day.” The shedding typically begins about 2–8 weeks after starting minoxidil and can last for several weeks. While this timeframe varies from person to person, most patients notice it tapering off by the third month. The amount of shedding can vary but remember: you’re only shedding the weaker hairs that were destined to fall out anyway.  As frustrating as it is, the initial shed means the treatment is working and is actually a good sign.

As for its original role in controlling blood pressure? Let’s just say it’s taking a backseat to more modern medications. But the legacy of minoxidil remains proof that some of the greatest discoveries happen by accident.  So next time you’re applying your daily dose of Rogaine, spare a thought for those early patients who unknowingly paved the way with their unexpectedly hairy arms. Science is weird—and wonderful.

-Desiree Mohandas, MD

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As always, health is personal, and for personalized advice please consult your healthcare professional.