Minoxidil: how it works and how to use it

What minoxidil does

Each hair on your head grows from a follicle that works in cycles (see the hair cycle, explained). For years it grows a hair. Then it rests for a few months, the old hair falls out, and a new one starts. At any moment, most of your follicles are in the growing phase.

In pattern hair loss, follicles that are sensitive to the hormone DHT slowly shrink. With each cycle the growing phase gets shorter, so each new hair is thinner and shorter than the one before. Over years, a parting widens, the temples recede or the crown thins.

Minoxidil works on that cycle. It seems to keep follicles in the growing phase for longer, which gives each hair more time to grow longer and thicker. Exactly how it does this is not fully understood. It began as a blood-pressure tablet, and doctors noticed extra hair growth as a side effect.

What minoxidil does not do is touch DHT. It does not change the cause of pattern hair loss, which is why it works only while you keep using it. Finasteride takes the other route and lowers DHT; you can read about it in our finasteride guide.

Who it is for

Minoxidil is for adults with pattern hair loss. In men, that usually means a receding hairline, a thinning crown, or both. In women, it usually means a wider parting or thinner hair over the top of the head.

The 2017 European guideline on pattern hair loss recommends topical minoxidil for both men and women. "Recommend" is its strongest level of advice.¹ For women, a Cochrane review found that those using minoxidil were nearly twice as likely as those using a placebo to report moderate or marked regrowth.²

You can combine it with other treatments. The guideline says men can consider using it together with finasteride, and it suggests light therapy as an add-on (see red light therapy).¹

Minoxidil is not the right first step for every kind of hair loss. Sudden shedding all over the head after an illness, stress or childbirth has a different cause (see shedding after stress, illness or birth). Round, smooth bald patches need a doctor. Products are for adults only, and leaflets usually say not to use minoxidil if:

• you are pregnant or breastfeeding
• your scalp is red, sore, sunburnt or infected
• your hair loss is sudden, patchy, or has no clear cause

If you have a heart condition or take medicine for blood pressure, ask a doctor or pharmacist before you start.

2% or 5%, and where to buy it

Topical minoxidil comes in two strengths, 2% and 5%. Lotions (also called solutions) come in both strengths. Foams are usually 5%.

For men, the stronger product works better. In a trial of 393 men, the 5% lotion gave 45% more regrowth than the 2% lotion at week 48, and results came sooner.³ Itching and scalp irritation were also more common with 5%. The 2017 European guideline suggests 5% for men who want the greater effect.¹

For women, the picture is different. The Cochrane review found no difference in hair count between 2% and 5%, although the evidence was of low quality.² The guideline recommends either the 2% lotion twice a day or the 5% foam once a day, and treats the two as about equal.¹

In many European countries you can buy minoxidil in a pharmacy without a prescription. We checked the official medicines registers:

• Czechia: 2% and 5% products are registered for sale without a prescription.⁴
• Poland: 2% and 5% products are sold without a prescription.⁵
• Hungary: 5% products can be sold without a prescription. We have not yet confirmed the 2% strength.⁶
• Slovakia: at least one 5% product is listed as not needing a prescription. We have not yet checked the 2% strength.⁷

Rules can change, and the products on the shelf differ from country to country. A pharmacist can tell you what is available where you live.

How to use it

Follow the leaflet that comes with your product. It tells you how much to use and how often. For a fuller routine, with tips on washing, styling and missed doses, see how to use minoxidil lotion and foam. As a general guide, lotions are used twice a day, and foams once or twice a day, depending on the product and on who uses it.¹

1. Start with a dry scalp and dry hair.
2. Part your hair over the thinning area so that you can reach the skin.
3. Put the dose on the scalp, not on the hair. Spread it gently with your fingertips over the thinning area.
4. Wash your hands straight away.
5. Let it dry before you go to bed, put on a hat or style your hair.

More is not better. Extra product, or extra applications, will not speed things up, and they make irritation more likely. If you miss a dose, skip it and carry on as normal. Do not use a double dose.

The hard part is keeping going. Minoxidil only helps on the days you use it, so link it to something you already do every day, such as brushing your teeth. You can wash your hair as usual; apply minoxidil afterwards, once your hair and scalp are dry.

What to expect over time

Minoxidil is slow. A follicle that starts a new growing phase needs months before its hair is long enough to notice, so the first weeks can feel like nothing is happening.

The first surprise for many people is a shed. In the first eight weeks you may lose more hair than usual.¹ The usual explanation is that resting hairs are pushed out as new growing hairs start beneath them. It is generally read as a sign that follicles are responding, not that the treatment is failing, so keep going.

123456789101112Possible early shedLittle visible yetJudge at 6 months

The 2017 European guideline advises judging the result at six months.¹ Before that, there is often little to see. Take photos of the same areas, in the same light, before you start, and compare them at six months. Day-to-day checks in the mirror are hard to trust.

At six months, a good result can look like less shedding, a parting that has not widened further, or new fine hairs that thicken over the next months. Keeping what you have counts as a result too. If you see no change after six months of regular use, talk to a doctor or pharmacist about other options.

If you stop

Because minoxidil does not change the cause of pattern hair loss, it works only as long as you use it. If you stop, increased hair loss usually starts about three months later.¹ Over the following months, your hair is likely to return to where it would have been without treatment.

123456You stopNo change yetShedding returns

So think of minoxidil as a long-term habit, not a course of treatment. If you are not ready for that, it is better to know before you start.

Side effects

Most side effects of minoxidil on the scalp are local and mild.

• Itching, dryness, flaking or redness. These were the main side effects in the trial of men, and they were more common with 5% than with 2%.³ Many lotions contain propylene glycol, which irritates some scalps. Foams are usually made without it, so a foam may suit you better if a lotion bothers you.
• Unwanted hair where the product lands, such as on the forehead or cheeks. This is more likely if the liquid runs, or if it transfers from your hands or pillow. Careful application, clean hands and a dry scalp before bed all help. Leaflets say this hair usually goes after you stop.
• The early shed in the first weeks, described above.

Effects on the rest of the body are uncommon with a lotion or foam, because little minoxidil passes through the skin. In the trial of 393 men, there was no evidence of effects beyond the scalp.³ Still, leaflets list a few warning signs to take seriously.

What about tablets?

You may have read about minoxidil tablets for hair loss, often called low-dose oral minoxidil. Some dermatologists now prescribe them. This is off-label use: minoxidil tablets are a blood-pressure medicine, they are not licensed for hair loss, and they need a prescription. Whether they suit you is a decision for you and a doctor, who will look at your heart, your blood pressure and your other medicines.

The research is newer and thinner than for lotion and foam:

• A 2021 review gathered 17 studies with 634 patients. It concluded that tablets can be an effective, well-tolerated option for healthy people who have trouble with lotions or foams, and it called for larger randomised trials.⁸
• A 2024 trial in men compared a 5 mg tablet with 5% lotion for 24 weeks. The tablet was not better than the lotion. The most common side effect of the tablet was unwanted hair growth on the face and body, in 49% of the men who took it.⁹
• A 2022 analysis that ranked hair-loss medicines in men put oral minoxidil 5 mg first for thick, pigmented (terminal) hairs at 24 weeks.¹⁰ The authors warned that randomised evidence for the tablets in men was scarce, so this ranking is not a final verdict.

The 2017 European guideline was written before most of this research and makes no recommendation on tablets.¹ In plain terms, tablets are an option to discuss with a doctor if a lotion or foam does not work for you. They are not a stronger version you can try on your own, so do not take minoxidil tablets without a prescription. For a side-by-side view, see minoxidil: tablet or lotion?, and if you and your doctor decide to try them, read starting minoxidil tablets.