LESS HAIR IN YOUR BRUSH, MORE CONFIDENCE IN THE MIRROR

If you've come to this page, you're probably concerned about your hair, and we understand that this can be very annoying. Hair loss among women is a common problem, and the search for an effective remedy is often difficult. Everyone claims to have the hair growth product for women.

In short, there is only one scientifically proven hair loss medicine for women that really works, and that is minoxidil. This hair growth product is available in both liquid and pill form, but what's the best option? In this article, we explain everything about minoxidil, how it works and what the differences are between the liquid and the pills. This way, you will soon be able to make an informed choice for the treatment that suits you best.

💡 Published in November 2024 JAMA Dermatology an international consensus of 43 hair loss experts from 12 countries. They concluded that low doses of oral minoxidil (usually 1.25 mg daily in women) are a safe and effective treatment for various forms of hair loss, including hereditary baldness and diffuse hair loss. As a result, oral minoxidil is increasingly accepted worldwide as a serious treatment option for women, even though it is still officially off-label prescribed.

What is Minoxidil and how does it work?

Minoxidil is a medication that was originally developed to treat high blood pressure. During the clinical studies, a remarkable side effect was discovered: hair growth. Since then, minoxidil has been used worldwide as an effective remedy for hair loss in both women and men.

Minoxidil works by improving blood flow to the hair follicles, allowing more oxygen and nutrients to reach the hair roots. This stimulates the hair growth phase and helps prevent further hair loss.

Minoxidil pills vs. Minoxidil liquid: Which is better?

Minoxidil is available in two forms: a liquid solution (lotion or foam) and oral tablets. Both have advantages and disadvantages, depending on your preference and lifestyle.

The liquid variant is applied directly to the scalp and is available in 2% and 5%. For women, the 2% variant is the usual dose. You should apply the liquid to problem areas on your scalp twice a day. In the Netherlands, this variant is available online without a prescription. In addition, this form of minoxidil has been approved by the FDA (U.S. Food and Drug Administration), the U.S. drug authority that monitors the safety and effectiveness of drugs.

Minoxidil pills are taken orally and are only available with a doctor's prescription. The usual dose for hair loss in women is 1.25 mg per day. Although the risk of side effects is slightly higher when taken orally than with the liquid, the ease of use is significantly greater. However, the oral variant of minoxidil has not yet been approved by the FDA for the treatment of hair loss. This means that doctors can prescribe it off-label, which means prescribing the drug for a use other than what it's officially approved for.

Minoxidil side effects

While minoxidil has been proven effective and safe, it may have some side effects. The most common ones are:

• With the liquid: Irritation, itching, redness, or peeling of the scalp.
• With the pills: Low blood pressure, dizziness, fluid retention, or excessive hair growth on other parts of the body.

In addition, this medication should not be used during pregnancy.

Minoxidil experiences: what do users say?

Many women who use minoxidil report significant improvements in their hair growth. The best results are achieved, especially when used for a long time (at least 6-12 months). Some users experience side effects, such as mild scalp irritation with the liquid variant or low blood pressure with the pills. Whether you get side effects and which ones vary from person to person.

Some users, on the other hand, notice more hair loss when using minoxidil in the first months. This is normal and is called shedding. If you continue to use the drug consistently, this process stops and the hairs grow back stronger.

What's the best choice for you?

The choice between minoxidil in pill form or lotion depends on your preferences and lifestyle:

• Do you want a simple solution without applying it daily? Then choose minoxidil pills.
• Do you want a local effect and a lower risk of systemic side effects? Then go for minoxidil lotion or foam.

Conclusion: Is minoxidil the best hair growth product for women?

In short: yes. In fact, minoxidil is the only scientifically proven hair growth product for women.

Do you want to start a treatment with oral minoxidil? Then go through our online consultation immediately. Our BIG-registered Dutch doctor will assess whether minoxidil is a safe option for you. If found to be safe, you can order the minoxidil pills in subscription form, so you never have to go without medication for a day.

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In November 2024, an important publication was published in JAMA Dermatology: 43 hair loss experts from 12 countries came to an international consensus on the use of low-dose oral minoxidil against hair loss.

They formulated 76 best-practice recommendations regarding dosage, safety and monitoring of oral minoxidil. There was strong agreement that oral minoxidil in low doses may be effective and safe for various forms of hair loss, including hereditary baldness, alopecia areata and telogen effluvium.

This means that oral minoxidil, although officially still off-label, is now seen worldwide as a serious and increasingly accepted treatment for hair loss. For men, the experts often recommend a starting dose of 2.5 mg/day, for women 1.25 mg/day.

At 3CO, you can easily go through an online consultation to get minoxidil pills with a doctor's prescription. Your consultation is always personally reviewed by a BIG-registered doctor to determine if it is a safe option for you. One pill a day can reduce hair loss and make your hair grow longer and thicker.

What is minoxidil in pill form?

Minoxidil was approved by the FDA as a high blood pressure medication in 1979. An unexpected side effect was hair growth, which led to it being developed as a treatment for hair loss. The topical variant is freely available, while minoxidil pills are prescribed off-label by doctors for hair restoration.

The recommended dose for hair loss is 1.25 mg per day for women and 2.5 mg per day for men, significantly lower than the dose for blood pressure treatment (10-40 mg per day).

What does off-label mean?

Off-label means that a medication is prescribed for a purpose other than that for which it was officially approved. Oral minoxidil is not officially approved for hair loss, but more and more studies are showing that it is effective and safe.

How does minoxidil in pill form work against hair loss?

Minoxidil stimulates hair growth by improving blood flow to hair follicles. This is done via the enzyme sulfotransferase, which prolongs the growth phase of the hair and reduces hair loss. As a result, the hair grows longer and thicker.

Minoxidil pills vs. Topical minoxidil

Topical minoxidil

• Apply to scalp.
• Use twice a day.
• Works locally on hair follicles.
• Freely available.

Oral Minoxidil (Minoxidil Pills)

• In pill form, taken once a day.
• Works via the bloodstream, stimulates general hair growth.
• May cause hair growth on other parts of the body (e.g. eyebrows).
• Only available with a doctor's prescription.

Why choose minoxidil pills?

Many users choose oral minoxidil because:

• It's easier than applying lotion twice a day.
• It does not cause irritation on the skin, as topical minoxidil sometimes does.
• It has a wider effect and may be more effective in some forms of hair loss.

What are the possible side effects of minoxidil pills?

Side effects occur mainly at higher doses. At low doses for hair loss, they are rare. Possible side effects include:

• Hypertrichosis (extra hair growth on face/arms/legs)
• Edema/fluid retention (ankles, feet, sometimes face)
• Heart palpitations/increased heart rate (tachycardia)
• Low blood pressure/dizziness (orthostatic hypotension)
• Headaches
• Dizziness/light-headedness
• Weight gain (due to moisture)
• Shedding (temporary more hair loss in the initial phase)
• Fatigue
• Gastrointestinal complaints (nausea, abdominal pain, rare)
• Skin reactions (allergy, rash — rare)
• Very rare: cardiovascular complications in people with underlying heart disease

Note: Minoxidil should not be used during pregnancy or in breast-feeding women.

Minoxidil pills and finasteride: an effective combination

Minoxidil is often combined with finasteride, another proven hair loss remedy. Studies show that this combination provides better results than used separately. Please note that the use of Finasteride is currently only allowed for men.

At 3CO, you can go through an online consultation, where a doctor assesses whether minoxidil pills and/or finasteride are a suitable treatment for you. When approved, you can order them directly as a subscription, so you never have to run out of medication again.

Scientific sources

• Yagiz, M.A., Mirmirani, P., Roseborough, I., Mathes, E., Bhutani, T., Ambrosy, A.,... Fu, J.M. (2024). Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement. JAMA Dermatology. Advance online publication. https://doi.org/10.1001/jamadermatol.2024.4593
• Arca, E., et al. (2004). An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology. https://pubmed.ncbi.nlm.nih.gov/15316165/
• Asilian, A., et al. (2023). Clinical efficacy and safety of low-dose oral minoxidil versus topical solution in the improvement of androgenetic alopecia: A randomized controlled trial. Journal of Cosmetic Dermatology. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jocd.16086
• Bryan, J. (2011). How minoxidil was transformed from an antihypertensive to hair-loss drug. The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/news/how-minoxidil-was-transformed-from-an-antihypertensive-to-hair-loss-drug
• Chen, L., et al. (2019). The efficacy and safety of finasteride combined with topical minoxidil for androgenetic alopecia: A systematic review and meta-analysis. International Journal of Dermatology. https://cdn.mednet.co.il/2012/05/the-efficacy-and-safety-of-finasterideminoxidil.pdf
• LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2020). Minoxidil. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548394/
• Panchaprateep, R., et al. (2020). Efficacy and safety of oral minoxidil 5mg once daily in the treatment of male patients with androgenetic alopecia: An open-label and global photographic assessment. Dermatology and Therapy. https://link.springer.com/content/pdf/10.1007/s13555-020-00448-x.pdf
• Ramírez-Marín, H.A., & Tosti, A. (2022). Role of oral minoxidil in patterned hair loss. Indian Dermatology Online Journal, 13(6), 729—733. https://doi.org/10.4103/idoj.idoj_246_22
• Sharma, A., et al. (2020). Low-dose oral minoxidil as treatment for non-scarring alopecia: A systematic review. International Journal of Dermatology. https://dermatologycentral.typepad.com/files/minoxidil-ijd-sustematic-rev-2020.pdf
• Suchonwanit, P., et al. (2019). Minoxidil and its use in hair disorders: A review. Dermatology Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
• Tanglertsampan, C. (2012). Efficacy and safety of 3% minoxidil versus combined 3% minoxidil/0.1% finasteride in male pattern hair loss: A randomized, double-blind, comparative study. Journal of the American Academy of Dermatology. https://pubmed.ncbi.nlm.nih.gov/23193746/
• Villani, A., et al. (2021). Review of oral minoxidil as treatment of hair disorders: In search of the perfect dose. Journal of the European Academy of Dermatology and Venereology. https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.17216

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1. Female hereditary baldness (FPHL)

Just like men, women can also have a genetic predisposition to hair loss. This is called Female Pattern Hair Loss (FPHL), or female hereditary baldness. However, the pattern differs from male baldness: women rarely get a completely bald head. Instead, the hair becomes diffusely thinner, especially at the crown and parting. The hairline usually remains intact.

FPHL, like men, is affected by DHT, but the relationship is less direct. Women naturally have lower testosterone levels, and follicle sensitivity plays a larger role. After menopause, when estrogen levels fall, FPHL may accelerate.

2. Telogen effluvium: temporary hair loss

This is probably the most common type of hair loss among women of reproductive age. Telogen effluvium occurs when a large part of the hair leaves the growth phase at the same time and goes to the resting phase, after which they fall out.

Causes include:

• Childbirth (postpartum hair loss, very common)
• Severe weight loss or crash diets
• Severe stress, illness, or surgery
• Discontinuing birth control pills
• Iron or protein deficiency

The good news: telogen effluvium is temporary. The hair usually grows back on its own within six to twelve months. Treatment is rarely necessary, but addressing the underlying cause does help.

3. Other causes of hair loss in women

Thyroid disorders An underactive thyroid (hypothyroidism) is a common and under-diagnosed cause of hair loss in women. A blood test at the doctor can provide an answer.

PCOS (Polycystic Ovary Syndrome) PCOS is associated with increased androgen levels, which can cause hair loss on the head, at the same time as excessive hair growth elsewhere on the body.

Alopecia areata An autoimmune disorder that is as common among women as it is in men. Characterized by sudden, round bald spots.

Traction alopecia Hair loss due to prolonged mechanical stress on the hair follicles, caused by tight hairstyles such as braiding, bunting or hair extensions.

Drug use Certain medications may cause hair loss, including certain contraceptives, blood thinners, and antidepressants.

4. How do you recognize hair loss in women?

The signs of hair loss in women are more subtle than in men, which makes it more difficult to intervene in time. Please note:

• A wider separation the space between your hair on the skull becomes visible
• More hair in the brush or on your pillow than normal
• Thinning ponytail the same amount of hair feels lighter
• Visible scalp in strong light or when raising your hair
• Less volume that is not easy to explain

5. Treatments: What works?

Treatment depends a lot on the cause. With telogen effluvium, the problem often resolves by itself. In the case of female hereditary baldness, however, active treatment is necessary to prevent further decline.

Oral minoxidil This is currently the most promising treatment for female hair loss. In an international consensus published in JAMA Dermatology (2024), 43 experts from 12 countries agreed that low doses of oral minoxidil are effective and safe for women with female hereditary baldness and telogen effluvium. The recommended starting dose for women is 1.25 mg per day.

Oral minoxidil works by improving blood flow to the hair follicles and prolonging the growth phase. The hair grows visibly thicker and fuller. Learn more in our in-depth article: Minoxidil: the best hair growth remedy for women.

Topical minoxidil (lotion/foam) The topical variant has been approved for women for some time and is freely available. Disadvantage: You have to apply it twice a day, which sometimes leads to skin irritation and oily hair.

What works not for women? Finasteride is currently not approved for women and is not prescribed for female use with 3CO. This is because finasteride carries a teratogenic risk (harmful to an unborn child) and the evidence for effectiveness in women is less strong than in men.

6. When to see a doctor?

Go to the doctor if:

• Your hair loss occurs suddenly and severely
• You also have other symptoms (tiredness, weight change, irregular periods)
• Your hair loss doesn't improve after six months
• You have bald spots instead of diffuse hair loss

At 3CO, you can also discuss whether oral minoxidil is suitable for you via an online consultation with a BIG-registered doctor. Fast, discreet and from home.

Scientific sources

• Yagiz, M. A., et al. (2024). Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss: An International Modified Delphi Consensus Statement. JAMA Dermatology.
• Piraccini, B.M., & Alessandrini, A. (2014). Androgenetic alopecia. Italian Journal of Dermatology and Venereology, 149 (1), 15—24.
• Blumeyer, A., et al. (2011). Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and men. Journal of the German Society of Dermatology, 9 (S6), S1—S57.

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