Minoxidil
Minoxidil was a blood pressure drug before anyone noticed what it did to hair. Applied to the scalp, it lengthens the growth phase of the hair cycle and increases the size of miniaturising follicles, so existing hairs grow for longer and thicker than they otherwise would.
It does not block DHT and it does not address why the loss is happening. It works on the follicles rather than the cause, which is why it pairs so naturally with finasteride and why using both is standard for anyone with active loss.
It is available without a prescription almost everywhere, in 5% and 2% strengths, as a liquid or a foam.
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What to expect from it
Visible thickening rather than new coverage. Areas that are thinning respond best, the crown responds better than the hairline, and skin that has been completely bare for years responds least.
The effect is modest and it is real. In the trials, most users either maintained or improved over a year, with the improvement concentrated in the vertex. It will not rebuild a hairline and it is not competing with surgery.
Where it earns its place is as the low-cost, low-risk baseline. Anyone with early thinning who does not want a systemic drug should be using it, and anyone already on finasteride generally does better with both.
Foam, liquid and oral
Liquid minoxidil contains propylene glycol, which irritates a good number of scalps and can leave hair looking greasy. Foam avoids the propylene glycol, dries faster and is more pleasant to use. Both work. Adherence is what differs, and the version you will actually apply twice a day is the better one.
Application matters more than people think. It goes on the scalp, not the hair, twice daily, on a dry scalp, and it needs a few hours before washing. Missing doses is the commonest reason it appears not to work.
Oral minoxidil at low dose is increasingly prescribed off-label, and the results reported are better than topical for many people. It is a systemic drug with real cardiovascular considerations, it commonly causes hair growth elsewhere on the body, and it needs a prescriber who will monitor you. It is not a self-service option.
When you start
Attach it to something you already do twice a day, like brushing your teeth, and keep it in the same place. This is a treatment that fails on adherence far more often than on biology.
The shedding phase
Two to eight weeks in, many people shed noticeably. It happens because minoxidil pushes follicles from their resting phase into a new growth phase, and the old hair has to come out for the new one to come through.
It looks exactly like the treatment making things worse. It is not, it settles within a couple of months, and it is a reasonable sign the drug is doing something.
Stopping during the shed is the classic mistake, and it leaves people convinced the drug caused hair loss.
Side effects and stopping
Topically, most problems are local: itching, flaking, dryness or irritation, usually from propylene glycol in the liquid. Switching to foam solves most of it.
Unwanted hair growth on the face can happen, generally from the product transferring rather than systemically, and washing your hands after applying it largely prevents it. Rarely, people get dizziness or a racing heart, which is worth reporting.
Stopping returns you to baseline over three to six months, usually with a noticeable shed on the way. Everything it was holding is lost. As with finasteride, this is permanent or it is nothing.
If your scalp reacts
Switch from the liquid to the foam before giving up on it entirely. Most irritation comes from propylene glycol rather than the minoxidil itself, and people abandon an effective treatment over an ingredient they did not need.
Frequently asked questions
Foam or liquid?
Whichever you will actually use twice a day. Foam avoids the ingredient that irritates most scalps. See foam, liquid and oral.
Why is my hair falling out more since I started?
A shedding phase at two to eight weeks, as resting follicles restart. It settles. See the shedding phase.
Is oral minoxidil better?
Often more effective, and it is a systemic prescription drug with real considerations and body hair growth as a common effect. Not a self-service option.
Can I use it with finasteride?
Yes, and it is the standard combination. They work by different mechanisms.
What if I stop?
You return to baseline over three to six months. See side effects and stopping.