Minoxidil 2%, 5% and 10% which is better to use?

Minoxidil is, without a doubt, one of the most popular treatments for hair loss. Since its approval by the FDA in the 1980s, its use has expanded worldwide and has given rise to a huge industry of hair growth products (Olsen et al., 2002).

However, along with its clinical success, minoxidil has been the subject of intense marketing, leading to the proliferation of products promising spectacular results without proper scientific backing. To what extent does science support the commercial claims?

The origin of minoxidil and its path to popularity

Originally developed as an antihypertensive drug, minoxidil was notable for its unexpected side effect: hair growth in patients who used it. This led scientists to explore its topical application to treat androgenetic alopecia. In 1988, the FDA approved the first topical formulation of 2% minoxidil to treat male pattern baldness, and in 1991 extended its approval for use in women (Messenger & Rundegren, 2004). Over time, higher concentrations were introduced, such as 5% minoxidil, which has demonstrated greater efficacy in hair regeneration (Tosti et al., 2007).

As minoxidil became established as a viable treatment for baldness, its presence on the market multiplied. The cosmetic and pharmaceutical industry capitalized on its fame, giving rise to an endless number of presentations, formulas and combinations with other ingredients. Today, it is common to find products that include minoxidil along with biotin, caffeine, peptides, among others, with the promise of enhancing its effects.

However, most of these combinations do not have robust scientific evidence to support improved efficacy compared to minoxidil alone. The FDA and EMA (European Medicines Agency) have only approved the use of minoxidil in its specific concentrations without any other additional compounds (FDA, 2017).

Despite this, marketing strategies have led many consumers to believe that certain combinations offer superior benefits without conclusive evidence.

Minoxidil and its formulations: Are there differences in efficacy?

Minoxidil is found in different formats, the main ones being topical solution and foam. Liquid solutions usually contain propylene glycol, which allows for better absorption, but can cause irritation in some people. Foam, on the other hand, reduces the possibility of irritation and makes application easier, although its absorption may be slightly lower (Olsen et al., 2002). There is a study that analyzes the different presentations and mechanisms of action of minoxidil to treat androgenic alopecia. It is important to say that, currently, the FDA approves its use in 5% foam and in 5% and 2% solution for both men and women (FDA, 2017).

To understand this research, we have to say that minoxidil acts through several mechanisms: it dilates blood vessels, reduces inflammation, activates the Wnt/β-catenin signaling pathway (important for hair growth) and has a certain antiandrogenic effect. It can also prolong the hair growth phase (anagen) and shorten the hair loss phase (telogen) (Buhl et al., 2016).

Only a small amount (1.4%) of minoxidil applied to the skin is absorbed into the body. It is a prodrug, which means that it needs to be converted into its active form (minoxidil sulfate) by an enzyme called sulfotransferase. People with higher activity of this enzyme respond better to treatment (Vano-Galvan et al., 2019).

As for its effectiveness, this five-year study with 2% minoxidil in men showed that hair growth peaked in the first year and then progressively declined. Minoxidil was observed to stimulate growth at the crown and hairline. However, the study found no major differences in efficacy between the 5% solution and foam and the 2% solution (Olsen et al., 2002).

The use of oral and sublingual minoxidil is also mentioned, which are not approved by the FDA but have been shown to be effective. In men, a dose of 5 mg daily orally was more effective than topical 5% and 2% minoxidil after six months. In women with hair loss or chronic telogen effluvium, low doses of 0.5 to 5 mg daily may be safe and effective (Suchonwanit et al., 2019).

Finally, what does the community say?

Many users have shared their personal experiences using 5% minoxidil to combat androgenic alopecia. Some have combined this treatment with additional techniques, such as using dermarollers and 2% ketoconazole shampoos.

One user reported that after 2.5 months of applying 5% minoxidil twice a day, using a 1.5mm dermaroller once a week, and washing his hair with 2% ketoconazole shampoo, he saw noticeable improvements in the thickness and density of his hair. This user mentioned having started losing hair at age 18, and at the time of sharing his experience, he was almost 24 years old. Another community member expressed interest in this approach, especially since he was unable to tolerate finasteride due to side effects. This user, aged 38, was experiencing diffuse hair thinning, with approximately 40% less density compared to his 20s.

It is important to note that although these personal experiences can be helpful, results may vary for each individual. In addition, it is always advisable to consult a health professional before starting any hair loss treatment.

References

Buhl, A. E., Waldon, D. J., Conrad, S. J., Mulholland, M. J., Shull, K. L., Kubicek, M. F., & Johnson, G. A. (2016). Potassium channel conductance: A mechanism affecting hair growth cycling, Minoxidil, and Hair Follicle Biology. Journal of Investigative Dermatology, 136(1), 66–74. https://doi.org/10.1016/j.jid.2015.08.024

FDA (2017). Drug Approval Package: Rogaine (Minoxidil) Topical Solution. U.S. Food & Drug Administration. https://www.accessdata.fda.gov

Messenger, A. G., & Rundegren, J. (2004). Minoxidil: Mechanisms of action on hair growth. British Journal of Dermatology, 150(2), 186–194. https://doi.org/10.1111/j.1365-2133.2004.05785.x

Olsen, E. A., Dunlap, F. E., Funicella, T., Koperski, J. A., Swinehart, J. M., & Tschen, E. H. (2002). A five-year study of the efficacy of topical minoxidil in the treatment of androgenetic alopecia in men. Journal of the American Academy of Dermatology, 47(3), 377–385. https://doi.org/10.1067/mjd.2002.124088

Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: A review. Drug Design, Development and Therapy, 13, 2777–2786. https://doi.org/10.2147/DDDT.S230278

Tosti, A., Piraccini, B. M., & Camacho-Martinez, F. (2007). Topical minoxidil in the treatment of androgenetic alopecia. Journal of the European Academy of Dermatology and Venereology, 21(5), 629–634. https://doi.org/10.1111/j.1468-3083.2006.02012.x

Vano-Galvan, S., Saceda-Corralo, D., & Blume-Peytavi, U. (2019). The role of sulfotransferase enzymes in the efficacy of topical minoxidil treatment. International Journal of Dermatology, 58(4), 476–482. https://doi.org/10.1111/ijd.14338

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