Safety profile of hair loss treatment, Minoxidil?

[JohnBoy2000]

First consideration:

Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases - PMC

Alopecia is a dermatological condition with limited therapeutic options. Only two drugs, finasteride and minoxidil, are approved by FDA for alopecia treatment. However, little is known about the differences in adverse effects between these two ...

www.ncbi.nlm.nih.gov

The top 10 most commonly reported adverse events among female and male alopecia patients using finasteride or minoxidil
��

Female​	Male​	Female​	Male​
Rank​	Finasteride​	Minoxidil​
1​	Abortion Induced​	Erectile Dysfunction​	Swelling Face​	Erectile Dysfunction​
2​	Abortion Spontaneous​	Sexual Dysfunction​	Dermatitis Contact​	Depression​
3​	Paternal Drugs Affecting Fetus​	Depression​	Arthralgia​	Dizziness​
4​	Uterine Cervix Stenosis​	Anxiety​	Palpitations​	Anxiety​
5​	Menstruation Irregular​	Cognitive Disorder​	Dizziness​	Libido Decreased​
6​	Menorrhagia​	Libido Decreased​	Nausea​	Hypoesthesia​
7​	Endometrial Hypertrophy​	Loss Of Libido​	Tachycardia​	Headache​
8​	Phalangeal Agenesis​	Fatigue​	Weight Increased​	Dermatitis Contact​
9​	Fatigue​	Semen Volume Decreased​	Visual Acuity Reduced​	Chorioretinopathy​
10​	Arthritis​	Ejaculation Disorder​	Pruritus​	Skin Disorder​

Damn, anxiety, depression, cognitive disorders.

I understand it essentially works as a vasodilator, but seems to carry some potentially intense side effects.

If it generates psychiatric sides, the assumption would be it readily cross the blood brain barrier?

Any experiences with topical minoxidil?

 

[JohnBoy2000]

Also, apparently induction/exacerbation of tinnitus can be rare side effect?

Using Minoxidil / Rogaine for Hair Loss — Impact on Tinnitus?

I have tried Minoxidil for hair growth and I noticed my tinnitus got quieter, after a while I researched about it and found it is a potassium channel...

www.tinnitustalk.com

Many anecdotal reports of this association.

 

[elgoucho9]

Looked into these before and was quite weary of some of the side effects sounding rather serious.

I've seen on YouTube several people reporting a few drops of rosemary oil mixed in with coconut oil as a carrier oil works.

Decided to give it a go. Will report back my findings.

 

[TheUltimateFixx]

"most commonly reported adverse effects" doesn't mean that people routinely get them. It does reportedly have very good results in doing what it's supposed to do, and lots of people use it without incident. You might just try it out and if you notice any bad side effects, stop.

Herbal methods for helping with hair loss that apparently have some verified results are essential oil of rosemary (already mentioned), and saw palmetto.

 

[Foreigner]

I've been on minoxidil 2.5mg (half of the lowest dose) for about 3 months and it has been very helpful to hair conservation. My beard i also really lush.

My MD, who is very knowledgeable and not a pro-pharma shill, said that 4% of patients get minoxidil sides and it's usually at 5mg or higher. None of her patients on the 2.5mg dose have had sides. One patient on the 5mg dose had pericardial effusion which is scary AF. She has been an MD for 15+ years.

I already tend to be hypotensive, so I take my dose close to bedtime so that I don't notice it as much while I'm sleeping.

I also use a commercial shampoo that has caffeine, aspirin, B vitamins, to which I add apple cider vinegar, as well as rosemary and peppermint essential oils. The oils aid DHT suppression (more so the rosemary). I use this every 48 hours and no more because it does have some systemic effects. I also use a ketoconazole shampoo a couple times a week for dandruff as it also has DHT inhibiting effects.

I tried oral finasteride at the lowest dose and topical finasteride, but both had catastrophic side effects so I will never touch that drug again. It destroyed my sex drive and erectile function, made my penis numb, made me depressed, low energy, and gave me a lot of cognitive deficits like poor memory, brain fog, difficulty concentrating. It was scary. I was not willing to wait weeks to months for my body to "adjust." I think it's way too strong for me even though I was on half of the lowest dose. Plus DHT is central to a man's life... what's the point of keeping your hair if your dick stops working. The stories of post-finasteride syndrome also freaked me out.

My crown already has an unrecoverable bald spot because I didn't figure out a protocol sooner, but it's not terrible. I'm not ready for total baldness so that's why I'm doing this. It's too bad modern medicine doesn't have anything better for this but oh well.

 

[AlsoTapered]

The former is a neurosteroid so is that used topically? The latter is frankly unusual BUT it carries a formal charge so it shouldn't pass the BBB (and anyway I believe it IS used topically).

 

[JohnBoy2000]

Not very common but there are some concerning anecdotal reports on topical-minoxidil:

Post Minoxidil Syndrome - RxISK

Greetings all, I want to thank RxISK for presenting this opportunity for me to share my experience with this drug and my persisting side effects from it. It all started in April 2021, I was an insecure eighteen year-old Canadian guy slowly losing his hair like many others out there. Desperate...

rxisk.org

Increased HR and chest-pain aren't that uncommonly reported.

......

I tried Nizoral and even that kind of mildly messed with my mood (that's how sensitive I am).

 

[ecstacylover]

I think if you're going to try finasteride, don't start reading about potential side-effects too much because you're setting yourself up for a placebo effect. No difference in sexual function was observed in randomized trial of TRT+dutasteride vs TRT at varying TRT doses, which suggests that generally T alone is sufficient to maintain sexual function. So perhaps make sure your free T levels are normal first.

 

[Hexagon Sun]

There´s the rumor than peppermint oil (3%) works topically like minoxidil without some sides. IIRC it was experimented in rats and they grow like a good chunks of hair in the tested area

There´s anechdotacl evidente that works in humans in scalp and beard. I started the experiement on myself but quitted due forgetting to apply the liquid every day

 

[JohnBoy2000]

There´s the rumor than peppermint oil (3%) works topically like minoxidil without some sides. IIRC it was experimented in rats and they grow like a good chunks of hair in the tested area

There´s anechdotacl evidente that works in humans in scalp and beard. I started the experiement on myself but quitted due forgetting to apply the liquid every day

I tried rosemary and caster oil.

Neither proved of any growth benefit.

 

[Genetic Freak]

Rather than pharmaceuticals with a dubious safety profile, have you tried natural remedies such as:

1/4 cup coconut oil
1/4 cup castor oil
6 drops rosemary

Rub in, and leave all day...

Individual genetics can make mitigating hair loss difficult for some people.
DHT causes hair follicle death, a GG: version of SRD5A2 gene will most likely convert testosterone to DHT in an optimal manner, leaving the recipient prone to DHT toxicity of which pale pattern baldness is very likely..

 

[JohnBoy2000]

Update on this.

Got a camera scan of my scalp yesterday.

Oils are bullshit.

Oils are almost certainly the reason my har thinned in the first place, because;

If one puts heavy oil on their scalp every day without cleansing it = it clogs the hair follicles and causes the hair to shrink/thin/shed.

I started going thin at 33 years of age, EXACTLY the same time I began rubbing heavy oils on my scalp every day (to avail of their "growth" properties).

.........

FUUUUUUUUUUUUUUUUUUUUUUUUUUUU.....................

 

[Neuroprotection]

i’d definitely rather try minoxidil, wouldn’t even think about touching 5-Alpha reductase inhibitors like finasteride or dutasteride due to their potential catastrophic side-effects, which can be long-term and persistent.

 

[Neuroprotection]

I think if you're going to try finasteride, don't start reading about potential side-effects too much because you're setting yourself up for a placebo effect. No difference in sexual function was observed in randomized trial of TRT+dutasteride vs TRT at varying TRT doses, which suggests that generally T alone is sufficient to maintain sexual function. So perhaps make sure your free T levels are normal first.

I may be wrong, but I don’t think finasteride or related drugs have any effect on testosterone levels. rather, they inhibit the conversion of testosterone to dihydrotestosterone and likewise, inhibit the hydrogenation of many other steroids. this dramatically reduces the amount of neurosteroids synthesised in the brain, promoting anxiety, reward deficiency and other depressive like behaviours. you do have a point, sometimes reading about the side-effects of medication in advance can bring on a placebo effect, but I think extra caution and a healthy amount of fear is justified with these medications. The majority of people who suffered from catastrophic, sometimes permanent psychiatric and sexual side-effects with 5Alpha reductase inhibitors were not even aware of these side-effects. all drugs can be dangerous and many potentially have life changing side-effects if something goes wrong, but with finasteride and it’s analogues, my personal opinion is that it’s just not worth it.

 

[ecstacylover]

I may be wrong, but I don’t think finasteride or related drugs have any effect on testosterone levels. rather, they inhibit the conversion of testosterone to dihydrotestosterone and likewise, inhibit the hydrogenation of many other steroids. this dramatically reduces the amount of neurosteroids synthesised in the brain, promoting anxiety, reward deficiency and other depressive like behaviours. you do have a point, sometimes reading about the side-effects of medication in advance can bring on a placebo effect, but I think extra caution and a healthy amount of fear is justified with these medications. The majority of people who suffered from catastrophic, sometimes permanent psychiatric and sexual side-effects with 5Alpha reductase inhibitors were not even aware of these side-effects. all drugs can be dangerous and many potentially have life changing side-effects if something goes wrong, but with finasteride and it’s analogues, my personal opinion is that it’s just not worth it.

Of course it can impact testosterone levels, it's inhibiting testosterone breakdown. This can lead to reduced androgen receptor activation (as DHT is a more potent androgen), and also to increased estradiol levels. Reduced allopregnanolone levels might explain some of the negative reactions to finasteride, but other individuals might be reacting to increased estradiol or insufficient androgen receptor activation.

Although the point I was making with the study I linked is that most of the sexual side-effects from finasteride seem to be due to a baseline testosterone deficiency, since the study showed that testosterone in the absence of DHT was sufficient to maintain sexual function.

I guess everyone has to weigh the cost and benefit, but for most people losing hair is psychologically traumatizing in and of itself. I've personally had no negative side-effects from finasteride, but one person's experience is meaningless for a drug with over 8 million prescriptions in the USA alone. Ofc finasteride might produce adverse side-effects in a small subset of the population, but that's no different than any other drug really, so I don't understand the cultish fear mongering when it comes to finasteride. And these people would have the population at large replace it with what? Oral minoxidil and its association with cardiovascular abnormalities?

 

[Foreigner]

Tl;dr Minoxidil will thicken the hair you still have. The 5AR will prevent more miniaturization. You really need both IMO. The drugs are not harmless, especially finasteride, no matter what the studies say.

The topical preparations absolutely have systemic effects. I tried topical finsteride at half of the lowest dose and still got all of the sexual side effects, beginning within 48 hours. It was not "placebo." You can't pronounce that it's a placebo effect just because the studies by drug companies don't acknowledge certain things. They don't acknowledge post-finasteride syndrome either and many men suffer from that, though admittedly this is rare. Most men who stop finasteride recover their virility within a few weeks; others say the loss of virility is temporary and their body adjusts later. So clearly something receptor-mediated is happening (DHT receptor blockade by finasteride followed by compensatory upregulation perhaps). Additionally, the product says to not apply on broken skin, but "broken skin" is ambiguous. Anyone with dandruff, for example, likely has a compromised skin barrier on the scalp even though they don't have visible open wounds. The scalp is extremely thin compared to tissues elsewhere on the body.

Essential oils don't clog your scalp or whatever. They are potent at lower quantity, even though the quantity is spread over a large area. For example, if you apply a high grade lavender or thyme oil neat to the thin skin on your forearm or your belly, you will smell it coming out of your nose within 20 minutes. I prefer to combine the EOs with a shampoo because the shampoo has emulsifiers to help with penetration. I did go through a stint of using thick oils though, like castor oil. What a pain in the ass.

If you really want to save your hair, you need to do more than one thing, and one of those things has to be a 5a-reductase inhibitor. And don't wait. If you notice hair loss now, don't tinker with bullshit marketing. Nothing works as efficiently a 5-AR. Yes, there are guys out there doing insane protocols to avoid taking pharmaceuticals, like buying redlight helmets, applying complicated treatments to their scalp twice a day, and taking supplements, cutting out PUFAs, and all kinds of things. Yes, those things may have impact, but often they don't, and by the time you realize it (or have convinced yourself you're stopping hair loss but haven't actually), you will have lost ground. And with those methods, saving your hair will become an obsessive, neurotic task. You will be looking in the mirror all the time, monitoring your bald spots. You will be hyperanalyzing hair fall. Honestly, these people are kind of batty. Just use a 5-AR (topically or internally) and minoxidil, and call it a day. Jesus. I'm a clinical herbalist by training so I completely understand the desire to be "all natural" and avoid pharmaceuticals, but male hair loss is actually natural. It's meant to happen. So you have to do unnatural things to stop it.

For myself, the pharmaceutical 5-ARs (finasteride, duasteride) are way too strong. Applying rosemary EO to my scalp every 48 hours has stopped loss. I take oral minoxidil because the topical preparation is messy, cumbersome, smells terrible, and makes my hair look greasy. It's also expensive AF. Oral minoxidil is cheap. I also had bad side effects from the topical, like flushed face/eyes, puffy eyelids, and shortness of breath. There are unconfirmed rumors that it ages the face due to some kind of interaction with collagen, but I have no idea. I already take collagen so I'm not worried. Minoxidil has not been comprehensively analyzed for exactly what it does besides the blood pressure lowering quality. It has a black box warning for a couple of things, like pericardial effusion, so it's considered a drug of last resort for blood pressure and is probably why it's not extensively studied anymore. I find the 2.5mg daily dose tolerable, even though it definitely lowers my BP. As me in 12 months how I feel on it -- hopefully I don't suddenly have a heart attack due to fluid retention around my heart cavity. At least I'll be a handsome corpse? Heh.

That said, there are guys online who say that oral minoxidil is inferior and it's the topical that really works for them. Some use both oral and topical! I know that the oral is working because all the hair on my body has become terminal hair, including chest, beard, pubic, eyebrow, eyelash, etc. It all looks thicker. Even my leg hair is more pronounced. But I was not so hairy to begin with, so I don't mind these changes. If you already have thick body hair then expect to become a gorilla on oral minoxidil.

 

[JohnBoy2000]

Rather than pharmaceuticals with a dubious safety profile, have you tried natural remedies such as:

1/4 cup coconut oil
1/4 cup castor oil
6 drops rosemary

Rub in, and leave all day...

Individual genetics can make mitigating hair loss difficult for some people.
DHT causes hair follicle death, a GG: version of SRD5A2 gene will most likely convert testosterone to DHT in an optimal manner, leaving the recipient prone to DHT toxicity of which pale pattern baldness is very likely..

Castor oil can also have a devastating side effect is some:

“Castor Oil” – The Culprit of Acute Hair Felting

Acute hair felting is a rare disorder of scalp hair. In this condition, the hair becomes twisted, entangled as a hard stony mass resembling a bird's nest. Sudden hair matting has been reported earlier in the literature after vigorous use of chemical and ...

www.ncbi.nlm.nih.gov

"Felting".

Basically destroys ones hair for perpetuity.

 

[JohnBoy2000]

Essential oils don't clog your scalp or whatever

Citation?

 

[JohnBoy2000]

Applying rosemary EO to my scalp every 48 hours has stopped loss.

How do you apply it?

Mix it with another oil, or in a shampoo as you mentioned?

If it works, great. But more and more anecdotal reports suggest this may be less successful than initial thought, for most.

Using rosemary oil exclusively for me did nothing to stop hair shedding.

The hair system Nioxin is very effective and stopping hair shedding in my case.

Finasteride produced immediate and intolerable side effects.

Based on this

Reddit - Dive into anything

www.reddit.com

and how hypersensitive I am to chemicals (I tend to get the worst side effects from just about anything), I'm personally avoiding minoxidil.

 

[Foreigner]

Citation?

EOs are volatiles, mostly terpenes (about 90%). They absorb or evaporate rapidly on contact with body heat -- mostly absorbed. Terpenes are a transdermal delivery system in pharmacy. EOs have to be combined with waxes or other fats (think lip balms) in order to be retained for long periods, otherwise they disappear. If the EOs are very high quality, then there should be no residue.

Pure EOs are highly unlikely to clog pores. If anything, they will cause dermal irritation as they burn or penetrate the skin barrier, triggering immune responses. Peppermint and rosemary are relatively gentle compared to say, thyme or tea tree.

How do you apply it?

Mix it with another oil, or in a shampoo as you mentioned?

If it works, great. But more and more anecdotal reports suggest this may be less successful than initial thought, for most.

Using rosemary oil exclusively for me did nothing to stop hair shedding.

The hair system Nioxin is very effective and stopping hair shedding in my case.

Funny you mention Nioxin, that's the shampoo I use! Nioxin 2. Wish I knew about it years ago, I only discovered it relatively recently. It makes things simpler.

I transfer some Nioxin from the huge bottle into a smaller bottle, to which I add caffeine, the EOs, and the other ingredients I mentioned above.

I was using the EOs on their own already, and they helped. An old folk remedy is to put the EOs into vodka and dab or spray over the thinning area, so I started with that. Then I just used a 50/50 blend of neat rosemary and peppermint, right on the scalp, and I could tolerate it (which is a feat, given how sensitive I am). Usually within 20-30 mins, I can feel the EOs in my face, I can smell them in my sinuses, etc. So they do absorb.

Then I was looking at combining aspirin, caffeine, niacinamide, succinic acid, and the EOs into ethanol/water to make a spray for hair loss, but in my research I stumbled across Nioxin and decided to use that as the base instead. I dissolve the caffeine and succinic acid into warmed apple cider vinegar and then add it directly into the Nioxin, give the bottle a shake, and call it a day. Nioxin already has aspirin and niacinamide in it, which saved me some effort. I add apple cider vinegar because that was in a hair loss shampoo I used a long time ago (at great expense) and I found that formulation also helpful. The ACV cuts excess oil on the scalp and it has a PH balancing quality that prevents fungus. (I still use ketoconazole too though.) In the future, I may add saw palmetto, but I don't want to suppress DHT too hardcore because I start to feel like shit.

Finasteride produced immediate and intolerable side effects.

Ditto. I was not willing to wait any longer to see if they got better. It was ruining my life and I felt like I had been poisoned. I felt so depressed and psychologically messed up.

Based on this

Reddit - Dive into anything

www.reddit.com

and how hypersensitive I am to chemicals (I tend to get the worst side effects from just about anything), I'm personally avoiding minoxidil.

There are less than 1500 people in that group, so that's a very small sample size. I'm not saying Minoxidil can't produce intolerable side effects, but it's far less likely at the lower doses. I misspoke earlier, I'm not taking 2.5mg/day, I'm taking 1.25mg/day. I take the 2.5mg pills and halve them. Like you, I'm super sensitive and avoid pharma whenever possible, but I don't seem to have bad effects from these pills. Again, ask me in a year.

I don't like taking oral Minoxidil, but there do not seem to be many good options for male pattern baldness. I tried a lot of other things before landing my current successful protocol. In the years of time I wasted, I permanently lost hair on my crown. I've saved the rest of my hair, but that bald spot will require a hair transplant, which I'm not willing to do because it's invasive and barbaric. One day I'll just stop all this and let my hair fall out, I think... but not for years to come. I am still too young. I've shaved my head before and I look good bald, but I'm still attached to my hair.