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For many past generations, the onset of hereditary baldness, usually starting in the middle-aged years, was the embarrassing curse of being a man. A means to either prevent it or reverse it was one of the holy grails of the cosmetic pharmaceutical industry. In the late 1980s, a drug called minoxidil was introduced with considerable fanfare for its effectiveness in halting and reversing the progression of hair loss. Sold as the brand names Regaine® and Rogaine®, the topical minoxidil was a clear cream applied and massaged for direct absorption through the skin of a balding scalp.
Male pattern baldness, a medical condition called androgenic alopecia, affects an estimated 60% of men. Though less common and typically less pronounced, it can also affect women. Hair loss can start as early in age as the mid-teens, but more commonly begins in the late 20s or early 30s. The condition in men can progress to complete hair loss in one of several distinct patterns, but almost never results in complete baldness of the entire scalp. Though medical research continues, the cause of hair loss is widely believed to be changes in hormone production triggered by specific genes.
While many men are not concerned by what they perceive to be a natural function of maturity, many other men are discomforted by their changing appearance. In past years, men went to great lengths and expense to mediate the condition. Custom wigs, called toupees, were created. Surgical procedures included “plugging” individual strands of hair, as well as “transplanting” patches of still hairy skin onto balding areas.
In the early 1980s, an American pharmaceutical company called Upjohn Corporation noted the side effect of hair growth when testing the drug minoxidil for treatment of high blood pressure. It is a vasodilator, enlarging blood vessels to improve blood flow. It is believed that this is one of the factors that promote hair follicles, or roots, to sprout new hair. The company produced convincing evidence of significant new growth and thickening of existing hair in nearly 50% of tested men with early stages of androgenic alopecia.
Not only did the U.S. Food and Drug Administration (FDA) approve the drug for hair growth and hair loss prevention, in 1989 the agency issued new guidelines that eliminated all other hair loss medications then sold as ineffective and deceptive “snake oil” tonics. Topical minoxidil is prepared in either 2% or extra strength 5% concentrations suspended in an inactive liquid gel called propylene glycol. In 1996, Upjohn Corporation’s monopoly patent on minoxidil expired. Since then, many generic brands of topical minoxidil such as Ronoxidil® and Avacor® have come to be commercialized worldwide. In addition, by this time, proper usage directions, potential interaction with other medication, and minoxidil’s side effects had been sufficiently investigated for the FDA to approve its sale over the counter, without a doctor’s prescription.
The most common side effects of topical minoxidil are scalp irritations, including itching and drying. Another common side effect, which can alarm first-time users, is initial hair loss, believed to be a process of “shedding” the old hair to make room for the growth of new, healthier hair. Uncommon allergic reactions require immediate medical attention. They tend to be unmistakably severe, such as breathing difficulty, heart palpitation, or swelling of facial features. Users allergic to propylene glycol gel should use topical minoxidil in foam form.
The importance of strict adherence to the instructions on using a topical minoxidil cannot be overemphasized. When applied, proper hair and hand washing will prevent unwanted hair growth somewhere else on the body. Advanced stage androgenic alopecia, particularly if affecting the front forehead, might not be treatable at all. The typical dosage is the equivalent of 1 milliliter of solution applied twice a day. Duration before any effect becomes noticeable is four to six months; and if treatment is terminated, any new hair growth will be shed and lost.