The purpose of taking hair loss medication is to stop your hair from falling out. So it is normal to be alarmed if your hair shedding intensifies instead of subsiding while taking Minoxidil. However, you can breathe easily knowing that the infamous Minoxidil dread shed is a mild and temporary side effect of this treatment [1].
As many as 85% of men [2] and 55% of women [3] experience hair loss during their lifetime and Minoxidil is among the most frequently prescribed treatments. However, while many anecdotal instances of Minoxidil dread shed are shared online, few cases have been reported in scientific literature and none of them were permanent. This article will give you all the information you need about this phenomenon, such as:
Minoxidil dread shed is the popular term for an increase in hair shedding which occurs in some people soon after the initiation of Minoxidil treatment (especially oral Minoxidil) [1].
This can be very distressing, since people seeking hair growth treatment often already face negative psychological effects, such as anxiety or depression [4]. Trying to treat their condition and instead seeing it suddenly worsen can intensify these conditions. As a result, many people dread this Minoxidil side effect, which is why it has been dubbed “Minoxidil dread shed”.
While the mechanisms behind Minoxidil dread shed are not yet fully understood, researchers believe it is caused by a temporary disruption to the hair growth cycle.
Minoxidil works by dilating the blood vessels in your scalp, which brings more oxygen and nutrients to your hair follicles, nourishing them and promoting hair growth [5]. This can make the hair resting phase shorter, so your hair moves into the shedding (and then, regrowth) phase faster. So strands that would have naturally fallen out over the following weeks or months are shed sooner.[1].
This process makes it seem like more of your hair is falling out, when, in fact, hair that was supposed to fall out soon anyway does so earlier than normal. Then, a new, longer growth phase begins, which brings improved hair density for many patients.
No, there is no reason to worry about Minoxidil hair shedding. It is temporary and only involves hair that was about to fall out naturally. It does not represent a worsening of your alopecia and there are no reported cases where this type of excessive hair shedding became permanent.
It is difficult to determine the exact incidence rate of Minoxidil dread shed, as most studies do not discuss this side effect [6][7]. Those that do report very different results, often as a consequence of variations in patient sample characteristics and research methodology.
Dread shed has been reported to occur in anywhere between 2.4% and 22% of patients using oral Minoxidil [8][6]. However, the patients in the study which reported the highest percentage of excessive hair shedding were women who were also treated with spironolactone for hair loss at the same time as Minoxidil, which may have influenced the nature and severity of these side effects.
Regardless of the proportion of patients who reported Minoxidil dread shed in these studies, most participants continued treatment and the studies showed promising results.
Typically, Minoxidil dread shed lasts between 3 and 6 weeks [1]. Since all patients are different, this can vary slightly.
However, if you are still experiencing excessive hair shedding 3 months after the start of your Minoxidil treatment, it is a good idea to see a trichologist. They can rule out any type of alopecia that does not respond to Minoxidil and, if needed, help you find a more effective hair loss treatment.
No, there is no need to discontinue Minoxidil use if you develop excessive hair shedding. This temporary effect will soon pass. Research shows that patients who experience dread shed normally still enjoy satisfactory results in terms of increased hair density and thickness over the course of their treatment [1].
However, if your hair gets so thin that you can see your scalp, if you suddenly develop new bald spots or the hair shedding does not improve after 3 months, it is best to see a trichologist.
Both men and women have been shown to develop Minoxidil dread shed [6]. However, people who use the oral medication form are most predisposed to this condition. And since men are more likely than women to be recommended oral instead of topical Minoxidil, male patients may be more frequently affected by this side effect.
More research is needed to determine whether other factors, such as age, hormonal activity or type of alopecia also put you at greater risk of developing Minoxidil dread shed.
Yes, oral Minoxidil is more frequently associated with dread shed. That is because it is delivered directly to your scalp capillaries through your bloodstream, which makes it more effective than topical Minoxidil. Topical solutions are applied to the scalp, but only a small quantity of the active substance is absorbed through the skin. The more effective your Minoxidil treatment is, the more dread shed you will experience. However, that is a good thing, as it is a sign that your medication is working and your hair is on its way to a new growth phase.
While anecdotal evidence suggests topical Minoxidil can also cause dread shed, only one clinical trial reported excessive hair loss as a side effect [9]. The study was performed on 50 women with female pattern baldness treated with Minoxidil 5% foam, 6 of whom reported dread shed. However, more evidence is needed to confirm this finding due to the study design.
Unfortunately, there is not much you can do to fully eliminate the risk of developing Minoxidil dread shed. It’s a potential side effect of your treatment working as intended, as it pushes your hair follicles out of the shedding phase and back into the growth stage more quickly.
However, if you are facing anxiety or discomfort around hair shedding, you can try to get around the dread shed by using topical Minoxidil instead of oral tablets. But be aware that Minoxidil foam or liquid can also produce this side effect.
Be sure to discuss your Minoxidil form and concentration with your hair doctor and let them know of your concerns. Most specialists will be sympathetic to your worries about dread shed and can explore alternative or complementary treatments. But if your hair loss is already advanced, topical Minoxidil may not be sufficient to curb or reverse your alopecia
There are several things you can do to keep your hair thinning hidden during the Minoxidil dread shed. Here are some of the most common.
Putting on a classy hat, a trendy cap or a cool bandana can refresh your look and disguise your hair shedding. Choose your favourite type of headgear and wear it confidently when going outside until the Minoxidil dread shed subsides.
Hair thickening spray contains microfibres that stick to your hair strands, making your tresses seem fuller and more voluminous. Using hair fibres during your Minoxidil hair shedding can help you conceal temporarily thinner hair.
Sometimes, all you have to do to make hair shedding less conspicuous is to style your tresses strategically. Take a look at some of the best hairstyles for men with thin hair (or the best female hairstyles for thinning hair on the crown) and choose the option that suits you best.
No treatment is needed for Minoxidil dread shed, as it will subside on its own within a few weeks. Furthermore, there is no known treatment that will prolong your hair shedding phase. (Nor would you want that to happen, as your goal is to get to the hair growth phase sooner.)
Keep in mind that this excessive hair shedding is a natural part of your treatment, and usually indicates you’re responding well to Minoxidil. This side effect is expected to pass within just a few weeks. And you are likely to start seeing Minoxidil results such as increased hair density, improved thickness and reduced hair miniaturization within 3-4 months of starting treatment.
While Minoxidil dread shed is temporary, unfortunately so is this medication’s effect on your hair loss. Non-surgical hair restoration treatments such as Minoxidil only work for as long as you are actively using them. However, a permanent hair transplant improves your hair density forever. And while this surgery is also followed by a hair shedding period, it will be worth it as you enjoy the results of your hair transplant after 10 years and more.
If you are interested in getting your hair surgically restored, book a no-obligation consultation with one of our hair transplant surgeons. They will determine whether you are a good candidate for this procedure and walk you through every aspect of it.
The award-winning Wimpole Clinic has a 50-year legacy of providing hair transplant excellence, with success rates of over 97% for both FUE and FUT procedures. See our results for yourself in our before and after hair transplant gallery.
If you are curious to learn more about Minoxidil dread shed, read the answers to these frequently asked questions.
While more evidence is needed to prove this, one study [1] found no significant differences in the amount of dread shedding reported by patients who took various doses of Minoxidil, ranging between 0.625 mg and 2.5 mg per day. That is because even smaller oral doses are quite effective at activating all resting hair follicles, so they will trigger Minoxidil hair shedding the same way larger doses would.
It is true that after surgery, most people experience hair transplant shedding, also known as hair transplant shock loss. This side effect is a form of telogen effluvium that occurs due to stress on the hair follicles, which need some time to recover from the procedure. Normal hair growth usually resumes within 3-4 months [10].
While Minoxidil dread shed and hair transplant shock loss may appear similar in manifestations, they have very different underlying mechanisms. Transplanted hair follicles are cut off from their blood supply and forced into the resting phase until this supply is restored. Hair follicles treated with Minoxidil have the opposite experience – they gain better access to blood supply, so they are forced out of the resting phase, towards shedding and regrowth. That is also why the post-transplant telogen effluvium lasts significantly longer than the Minoxidil dread shed.
There is anecdotal evidence of excessive hair thinning similar to Minoxidil dread shed after starting Finasteride treatment. However, at this time, no clinical trials have reported this side effect, which indicates that if it exists, it is likely mild and short-lived.
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