Minoxidil experiences: what men report and what the research shows

The complaint I hear most about minoxidil is not the price or the sticky feeling. It is week three.

Men start treating their hair loss, see more hairs in the sink after a few weeks, and stop. Right at the moment the treatment is doing what it should.

Dutch sales pages rarely explain that well. Hence this piece, with a timeline and the sober numbers alongside.

Does minoxidil actually work?

In hereditary hair loss it demonstrably does something, though it is no miracle cure. In a randomised study in men, the 5% solution produced more hair growth than 2% and than placebo (Olsen, 2002). A later trial with 5% foam likewise showed more hair than placebo (Olsen, 2007). The effect sits mainly in keeping and thickening what is there, not in restoring a bald crown.

Managing expectations is half the work here.

Minoxidil works best on areas where thin hair still stands. On skin that has been smooth and shiny for years, expect little.

How it works has never been fully explained, incidentally. It widens blood vessels and appears to extend the follicle's growth phase, but it blocks no hormones. That last point becomes important further down.

Why do you shed more hair at the start?

That is the initial shedding phase and it is a known effect. Minoxidil pushes follicles from the resting phase into a new growth phase. To make room, the old hair lets go, often between week two and week eight. It looks alarming while it usually means something is finally moving.

It rarely lasts longer than a few weeks.

If shedding carries on undiminished after three months, or if whole clumps come out, that is a reason to call your GP. Something else may be involved.

This is what a realistic timeline looks like.

That first photo is not optional. Without a baseline you will judge your hair on feeling in six months, and feeling is a poor yardstick.

What happens if you stop minoxidil?

You lose the gained hair within roughly three to six months, ending up where you would have been untreated. Minoxidil does not change your predisposition, it keeps follicles active for as long as you use it. That makes it a long-term choice, not a course of treatment.

That is the sentence men like least and sales pages skip most eagerly.

So reckon with it honestly at the start. Twenty euros a month, applying it twice a day, for years. If that does not suit you, that is a perfectly good conclusion to reach up front rather than after eight months.

What is the difference between minoxidil lotion and tablets?

The lotion and foam work on the scalp and are available without prescription in the Netherlands. Minoxidil in tablet form is originally a blood pressure drug and is prescribed off-label for hair loss, at much lower doses. Because it then works throughout your body, blood pressure and fluid retention come into play.

The tablet form has grown popular in recent years, including on social media. That does not make it casual.

In a randomised study in JAMA Dermatology, oral and topical minoxidil were compared directly in men (Penha, 2024). What goes with the tablet form: doctors watch for things like palpitations, swollen ankles and your blood pressure.

If you are considering that route, discuss it with a doctor and check the substance in the Farmacotherapeutisch Kompas. For the blood pressure side we have a separate piece on high blood pressure in men.

Does minoxidil change your blood values?

The lotion on your scalp does not touch your hormones. Minoxidil blocks no testosterone or DHT, so your testosterone, your SHBG and your PSA are unaffected. The tablet form is different, because it can influence your blood pressure and fluid balance.

For many men this is exactly the point where they choose.

Imagine two men who both see more hair in the sink in week 4.

One stops immediately and concludes the treatment does not work. The other knows about the initial shedding phase, carries on, and sees the first thickening around month four.

I think that difference costs more men than any side effect does. The treatment is not failing, the expectation around it is.

Anyone who wants to leave their hormones or PSA value alone lands on minoxidil. Anyone who wants more effect on the hairline looks at finasteride, and that drug lowers PSA sharply. What that means for prostate testing is in finasteride experiences.

The two also get combined. That is a conversation with your doctor, not something to assemble yourself.

If you are still wondering whether your hair loss is hereditary at all, start with hair loss in men.

What you can do now

Take the photo from above today, in daylight, with the date on it. Do it again at month three and month six.

Count on at least four months before a judgement is meaningful, and do not panic at the shedding in the first weeks.

If your hair is thinning diffusely rather than at the temples, have your ferritin and thyroid checked before starting any treatment. Our extended health checkup covers those values in one go.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

References

1. Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002. PMID 12196747.
2. Olsen EA, Whiting D, Bergfeld W, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2007. PMID 17761356.
3. Penha MA, Miot HA, Kasprzak M, Muller Ramos P. Oral minoxidil vs topical minoxidil for male androgenetic alopecia: a randomized clinical trial. JAMA Dermatol. 2024. PMID 38598226.
4. Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. J Am Acad Dermatol. 1998. PMID 9777765.