Does minoxidil really work

False promises won't grow hair

Hair loss is when more than 100 hairs go out every day over a long period of time. Hereditary hair loss (androgenetic alopecia) is the most common form, affecting an estimated one in two men and one in ten women in Europe. In both sexes, a hereditary predisposition is causally responsible for the loss of the main hair. Genetic changes to the androgen receptor lead to an increased effect of the androgens with normal amounts of male sex hormones. The result is a genetically determined hypersensitivity of the hair follicles to dihydrotestosterone (DHT), a metabolite of testosterone, which ultimately leads to an increasing shrinkage and ultimately to the death of scalp hair follicles.

Gender-specific pattern of hair loss

Since hereditary hair loss is not inherited by one, but by several genes (polygenic inheritance), it cannot be predicted what course the hair loss will take in the course of life. It can come to a standstill temporarily and then go through an active thrust again. Which expression will occur in the individual case depends on the inherited disposition.

However, the clinical picture differs considerably in men and women. In men, the first signs to be observed are the receding hair on the forehead and the formation of receding hairlines. As the process progresses, the hair in the upper back of the head (vertex area) is thinned. If it is severe, it can ultimately lead to complete loss of hair, leaving a fringe of hair on the back of the head. A classification of the various stages of development has been worked out by Hamilton and Norwood. Today a combined Hamilton-Norwood classification with seven stages is mostly used. Unlike in men, in women the hair begins to thin out in the crown area, so that the crown becomes wider and wider. This is the beginning of a progressive process, usually in phases: phases of active hair loss alternate with periods in which the hair loss seems to normalize. Later, the hair on the top of the head becomes thin. There are practically no bald spots or even complete hair loss in women. The hairline on the forehead is also retained. The typical female hair thinning pattern was described by the Hamburg dermatologist Ludwig, in which three stages are distinguished. The Ludwig scheme describes a rather diffuse hair loss around the middle parting area, in which the hair density in the area of ​​the temples and back of the head remains normal. This pattern is typical of androgenetic hair loss in women, but it also occurs in about a fifth of affected men.

Medical follow-up checks promote compliance

The diagnosis of genetic hair loss is usually made by the clinical appearance of the hair thinning and by means of a trichogram examination (hair root examination). A doctor who specializes in hair loss - usually a dermatologist - is the right contact for this. Such specialists can be found on the websites www.haar and The hair specialist can not only accurately diagnose androgenetic alopecia, but also has the option of initially recording the status quo photographically and objectively documenting the progress by means of regular check-ups (overview photographs, photo trichogram). In this way, the person affected can easily observe the success of the therapy and is motivated to continue.

Recommend scientifically proven therapy options

For the treatment of androgenetic alopecia, on the one hand, systemic drugs are available that are subject to prescription. For men, the 5-alpha reductase inhibitor finasteride can be prescribed by a doctor. The 1 mg finasteride tablets are approved for the treatment of early stages of hair loss in men between 18 and 41 years of age. An effectiveness in the bitemporal receding of the hairline (,, receding hairline ‘‘) and in hair loss in the end stage has not been proven. However, finasteride must be taken continuously to stop the progression of hair loss. The hair falls out again when you stop. Finasteride does not work in women and is also contraindicated in women of childbearing age because of possible damage to the fetus.

For women, hormone preparations with androgenic gestagens can be prescribed. Clinical scientific data on effectiveness are also available for this therapy option.

In addition, the scientifically well-documented non-prescription minoxidil solution (Regaine®) can be used. This is available for men in five percent and for women in two percent concentration.

Topical minoxidil therapy

The minoxidil originally developed as an oral antihypertensive agent acts externally by widening the capillaries, forming vascular endothelial growth factor (VEGF) and opening ATP-dependent potassium channels, which leads to an enlargement of the hair follicle and a lengthening of the hair's growth phase. This can stop hair loss and reverse the miniaturization process of the hair follicle used by androgenetic alopecia. In order for the Minoxidil solution to be effective, the solution must be regularly applied to the dry scalp twice a day (morning and evening). After application, you should wait at least four hours before the scalp or hair can be moistened.

Advice in the pharmacy is of great importance

Breaks in therapy that lead to the progression of androgenetic alopecia should be avoided. This is a message that must be passed on to those affected when they are advised in the pharmacy. Only regular use leads to the desired effectiveness. In addition, the person concerned must be informed that the first effects can be expected after a few months of minoxidil treatment at the earliest. Therefore, a check-up to observe the effectiveness is only useful after eight weeks for men and after three to four months for women. In addition, the patients should be informed about the phenomenon of "shedding". This is understood to mean increased hair loss in the initial phase of Minoxidil therapy. A positive communication of this fact with the words "This is how you can tell that the remedy is working" prevents the person concerned from breaking off the treatment prematurely. The advice should also mention that in the course of years of therapy there is often an additional increased diffuse hair loss at some point, which is independent of the hereditary hair loss and should not be misunderstood as a lack of effectiveness.

No false promises

In order to avoid disappointment, the person concerned should not be given false promises. The primary goal of treatment is to stop hair loss and thus prevent androgenetic alopecia from progressing. This is possible in 80% of patients with minoxidil treatment if therapy is started in the initial stage. A thickening of the coat cannot be achieved as often.

Ongoing cooperation with the doctor makes sense

In conclusion, it should be noted that the pharmacy is an important point of contact for many people with hair loss. But even if androgenetic alopecia should be clearly identifiable by the PTA or the pharmacist, it usually makes sense not to immediately provide the affected person with over-the-counter products, but to send them to a doctor who specializes in hair loss so that they can do so Start of treatment clearly differentiates androgenetic alopecia from other forms of hair loss. In addition, the affected person is advised to have a regular medical follow-up so that treatment successes can be clearly documented. This procedure generally contributes to increased patient compliance and thus helps to prevent treatment discontinuation. Since the treatment of hereditary hair loss is a lifelong long-term therapy, it is important to support those affected in their adherence to the therapy.

source Prof. Dr. Hans Wolff, Munich, Dr. Christian Kunte, Munich and Dr. Uwe Schwichtenberg, Bremen: Seminar "Interdisciplinary Management of Androgenetic Alopecia" on the occasion of the 14th annual meeting of the GD - Gesellschaft für Dermopharmazie e. V., Berlin, March 24, 2010, organized by Johnson & Johnson GmbH, Neuss.


Pharmacist Gode Meyer-Chlond