Bernstein Medical - Center for Hair Restoration - How Minoxidil Works
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Q: Can Rogaine Cause Miniaturization?

When I am on Rogaine it seems – to my untrained eye – that I am having hair miniaturization and when I stopped briefly, I had shedding. Does this seem accurate based on what you have seen? Can Rogaine cause miniaturization? Is there a point you would recommend I stop Rogaine or is it something that likely can’t cause a negative impact on hair? — B.T., Brooklyn, NY

A: Minoxidil reverses miniaturization. It does not cause it. Shedding can occur after starting use of Rogaine but this means the medication is working should resolve with continued use. New miniaturized hairs are either from the progression of your genetic male pattern hair loss or newly forming hair that was stimulated by the minoxidil which can mimic miniaturized hair.

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Since 1993, minoxidil has been the most successful topical treatment for hair loss in both men and women, yet its exact mechanism of action remains unknown.

A 2004 review of minoxidil’s possible mechanisms of action ((Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150(2):186-94.)) suggests that the best evidence supports the idea that minoxidil causes hair follicles in the later phases of their resting phase (telogen) to shift prematurely into an active growth phase (anagen) sooner than they otherwise would; this causes a rapid increase in hair growth. They also found good evidence that minoxidil works to thicken the hair by increasing hair diameter.

While minoxidil’s effects on other critical factors known to affect hair growth — such as cell proliferation, collagen synthesis, vascular endothelial growth factor and prostaglandin synthesis — remain uncertain, more recent research has found evidence that it may also suppress the androgen-androgen receptor responsible for androgenetic alopecia. ((Hsu CL, Liu JS, Lin AC, Yang CH, Chung WH, Wu WG. Minoxidil may suppress androgen receptor-related functions. Oncotarget. 2014;5(8):2187-97.))

Understanding minoxidil’s exact mechanism of action remains today an important line of research both for the development of better hair loss treatments and for a better understanding of the biology of hair growth.

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