Does minoxidil (minoxidil) cause shedding when first started?

Minoxidil and Initial Hair Shedding

Yes, minoxidil typically causes a temporary increase in hair shedding when first started, known as "dread shed," which is actually a sign the medication is working. 1

Understanding Minoxidil-Induced Shedding

• Minoxidil causes a temporary increase in hair shedding during the first 12 weeks of treatment, which is more pronounced with the 5% formulation compared to the 2% formulation 1
• This shedding occurs because minoxidil synchronizes the hair growth cycle, causing telogen (resting) phase hairs to shed so they can be replaced by new anagen (growing) phase hairs 2
• The increased shedding is actually a positive sign that the medication is affecting your hair follicles and is part of the process for how minoxidil regrows hair 3

Timeline and Expectations

• Hair shedding typically begins shortly after starting minoxidil and may last up to 2 weeks 3
• In some patients, this shedding phase can extend through the first 12 weeks of treatment 1
• If shedding continues beyond 2 weeks, it's recommended to consult with your doctor 3
• Results from minoxidil may be seen as early as 2 months with twice daily use, but for some men, it may take at least 4 months for visible results 3

Clinical Significance of Shedding

• Research indicates that the severity of this initial shedding phase may actually predict treatment efficacy, particularly with 5% minoxidil 1
• The maximum relative amount of hair shedding (MRAHS) has been correlated with improvement in hair classification scales, suggesting that more pronounced initial shedding might indicate better long-term results 1
• This correlation was significant for both 2% and 5% minoxidil users when measuring overall hair classification improvement 1

Proper Usage to Minimize Side Effects

• Apply 1 mL of minoxidil solution twice daily directly to the scalp in the hair loss area 3
• Allow minoxidil to dry completely before wearing hats or lying on pillows to prevent staining 3
• When applying at night, ensure 2-4 hours of drying time before going to bed 3
• Using more product or applying more frequently than recommended will not improve results and may increase side effects 3

Important Considerations

• Continuous use of minoxidil is necessary to maintain hair regrowth; discontinuation will result in loss of newly grown hair within 3-4 months 3
• The most common side effects are limited to irritant and allergic contact dermatitis on the scalp 2
• Some formulations contain propylene glycol, which can cause allergic reactions in sensitive individuals 2
• Minoxidil is available in 2% and 5% formulations, with 5% generally recommended for men and 2% for women 3, 2

Understanding that the initial shedding phase is a normal part of the treatment process can help patients persist with therapy through this potentially discouraging period to achieve the desired hair regrowth results.