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How Does Minoxidil Help Hair Growth?

Thank you for your question! You stated in your question that you’re using 15% minoxidil and you’re asking if minoxidil can actually damage or kill transplanted hair. And you’re noticing that after the course of one year, that you have fewer transplanted hair. Well, I can give you some guidance on this question. I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years. Hair transplant has been a big part of my practice for this time. And in addition, I’m the founder of Trichostem™ Hair Regeneration centers, a non-surgical treatment alternative for hair loss using a wound healing technology that we developed in our practice. So I can certainly speak with a lot of experience about situations like yours. Now of course, in your question, unfortunately, I don’t have the complete story as to the timing of when you had the transplant, when you started using the 15% minoxidil and what that may mean when you observed fewer transplanted hairs but let’s start first of all with the question why be on 15% minoxidil. I realize that there are a certain percentage of our colleagues who believe on these custom formulations and certainly, in our practice, we have tried these various formulations. The idea is that if we can’t get something which is like over-the-counter like a 5% minoxidil, we believe that there is value in using a higher percentage, then you get these custom or compounded pharmaceuticals created and provide them to patients. So I’m not necessarily denying any potential benefit but let’s say we’re talking about the transplanted hair one year after transplantation. You’re always looking at a slice of time and it may not be that the minoxidil is causing the hair grafts to shed and not come back but it might be that you caught the transplanted hair in a particular stage in the growth cycle. To understand this, let’s just go over the basic hair growth cycles. There’s the anagen phase which is the active growing phase. There’s catagen phase, the intermediate phase where the hair is still present but it’s no longer actively growing and there’s the telogen phase where the hair sheds. During the telogen phase, there are 3-4 months of lag at a minimum before new hair growth occurs. So in our practice, when we do these surgeries but as of late, we have actually been doing a lot more of a treatment called Hair Regeneration. I’m just going to give you the context of how minoxidil fits into this equation. As far as I’m concerned, minoxidil does help people with hair thinning because it appears to prolong the growth cycle of thinning hair which means that the hairs that are thinning progressively at least stay a little bit longer. It’s important to understand, going back to the growth cycle, the anagen or the active growth phase decreases with hair thinning and the telogen actually increases which means you shed a hair and then you don’t have the hair to replace that hair for a longer period of time and when that hair comes in, it’s thinner. When we do this treatment called Hair Regeneration, we figured out that essentially for people with thinning hair, once they have the treatment, essentially the hair has stopped thinning. In other words, we no longer need the benefit of minoxidil. And I’ve been doing this for many years and so I have a lot of clinical data in fact we have patients who come to us from all over the world and we really rigorously collect a lot of information with every visit when we see our patients for microscopy photos, standardized position photos of the top of the head and various views and digital photography. And I’ve made observations because a lot of times, people have been using, with thinning hair, minoxidil for a long time and sometimes it becomes a security blanket. What I have observed that for a lot of our patients, I’ll actually stop the minoxidil about a month or so after the procedure if the patient wants to. Sometimes, people just want to stay on their regimens until their hair starts to regrow and they see it and they’ll stick with the regimen they were doing before the treatment. So I think that, in that respect, transplanted hair by definition is not hair that should be thinning. Now, of course, we can have a long discussion about the source of hair in procedures such as FUE grafts but let’s say you had a standardized FUT or strip surgery or even an FUE. Those hairs are genetically resistant to shedding. Therefore those hairs should actually be fairly resilient and be able to grow but something that not everyone fully appreciates is that a certain percentage of the hair grafts don’t actually make it. They don’t continue to grow. There’s a certain loss. We’ve seen patients who come to us for surgery who had megasession procedures and they lost 90% if their grafts done elsewhere and we were left with much less hair to work with to do surgery. So it is a potential. In the case of FUEs, approximately 30% of hairs are actually transected which means that those hairs don’t actually have the root when they’re placed so they can actually shed and go away. So I think you need to speak to the doctor who performed your surgery and the doctor who is prescribing the 15% minoxidil and get an orientation of what’s going and why you should continue using minoxidil. If it’s to maintain your existing hair, well it might be that the minoxidil itself maybe inflammatory or irritating to the scalp and it might be causing some breakage or some potential shedding of the hairs but not knowing what the vehicle is or method in which the minoxidil is being delivered in terms of the formulation, I can’t just say that that’s certain. So you have a reason to be concerned and I think that discussing this with your doctor, reviewing your photos. You know, when we do surgeries, we do a plan, we take pictures immediately after surgery, we take pictures throughout the follow-up period. It’s just what we do just to track progress and if there was hair in a certain hair and there isn’t hair now, it might not really be a minoxidil issue or an inflammatory issue but at least be able to document what it looks like 3 months from now, 6 months from now, 9 months from now. It may be that these hairs are just temporarily not growing but again, without more detailed information, I can’t give you a more definitive answer. So I hope that was helpful, I wish you the best of luck and thank you for your question!

Minoxidil appears to work by affecting the length of the hair growth cycle. The hair growth cycle is comprised of specific stages: the anagen, catagen and telogen phases. The anagen phase is the active growing phase; the catagen phase is the resting phase when the hair is present but is not actively growing; and the telogen phase is when the hair sheds. During the telogen phase, there is a usually a 3-4 month time period before hair growth resumes.

Scalp hair goes through growth, shedding, resting, and regrowth phases.
Hair cycles include phases of active growth, shedding, resting, or regrowth

When your hair is thinning or you’re experiencing hair loss, the length of time in the anagen phase decreases, and time in the telogen phase increases. This means you are losing hair faster than the rate of regrowth. When hair is thinning and the hair does grow back, it often grows back thinner.

Minoxidil
Minoxidil is an over-the-counter topical medication available under different brands names. Some medical practices offer higher concentrations of minoxidil in custom formulations.

Minoxidil appears to help hair loss by prolonging the active growth period or the anagen phase, which means that the hairs that are progressively thinning grow for a longer period of time, and delays the hair from shedding or entering the telogen phase. This results in the hair remaining on the scalp longer before shedding. This effect of delaying hair shedding, and prolonging hair growth improves scalp coverage. Minoxidil does not block dihydrotestosterone or DHT which is often an important variable contributing to hair thinning in men who are sensitive to DHT. The benefits of minoxidil on the hair growth and shedding cycle decreases as hair loss continues.

Hair Regeneration combined with finasteride works best for young men with high DHT-sensitivity
Hair Regeneration can improve scalp coverage over finasteride alone, while finasteride can extend the effectiveness of the Hair Regeneration treatment in men with high DHT-sensitivity

In our practice, we treat hair loss with a treatment system I developed, called TrichoStem Hair Regeneration. TrichoStem Hair Regeneration is a customized system I created by treating hundreds of patients from around the world with male and female pattern hair loss. I create customized treatment plans combining PRP (platelet rich plasma) with acellular matrix produced by ACell. Many of our patients who were previously using minoxidil are weaned off to avoid short term hair shedding. Since the first treatments performed in 2011, the benefits of TrichoStem Hair Regeneration have been sustained for 3-5 years with only 1 treatment session. Some patients with more advanced hair loss have a second treatment at 15-24 months. This second treatment which we refer to as “the booster” has been effective in thickening a large number of the thin hairs which were not visible and were reactivated by the first treatment

6 months after hair regeneration treatment
The TrichoStem Hair Regeneration treatment can thicken thinning hair and stimulate the growth of dormant hair follicles, without the need for minoxidil

During hair transplant surgery, hair is harvested from the genetically resistant zone or donor area. Typically, a certain percentage of hair grafts don’t grow. In addition, in an FUE (follicular unit extraction) procedure, there’s a loss involved due to transection which occurs when the graft is harvested but the root is left behind. In FUE surgery, approximately 30% of hairs become transected, which means that those hairs don’t have a root and cannot grow.

Hair Regeneration treatment can also help people who’ve had hair transplants
TrichoStem Hair Regeneration can improve scalp coverage by thickening native hair, and improve coverage for people who previously had hair transplant surgery.

Minoxidil can provide some benefit in helping men and women experiencing hair thinning. For men, finasteride is more effective as it decreases DHT (dihydrotestosterone) which allows more effective prolongation of the hair growth cycle. Finasteride is not generally effective for women with hair loss. TrichoStem Hair Regeneration treatment has been effective for both men and women with hair loss.

Hair Regeneration treatment’s effect on female pattern hair loss
The effects of TrichoStem Hair Regeneration treatment on female pattern hair loss after a single treatment session, and without minoxidil

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