Understanding Minoxidil

Minoxidil: Benefits, Side‑Effects and How It Compares to KESHAH

July 07, 2025

Minoxidil is one of the few FDA‑approved treatments for androgenetic alopecia (AGA). Its track record is backed by decades of clinical use, and many people have seen improvements from consistent application¹. At the same time, minoxidil doesn’t address the underlying scalp tension and vascular issues that contribute to hair loss, and both topical and oral formulations carry side effects. Here’s a balanced look at minoxidil’s benefits and drawbacks, and why KESHAH takes a different approach.

What Minoxidil Does Well

Proven ability to stimulate growth: Minoxidil prolongs the anagen phase (growth period) and shortens the telogen phase, increasing the time follicles spend growing hair¹. Large post‑marketing surveys of the 5 % topical solution found that about 63 % of users rated it as “effective” or “very effective” after a year².
Flexibility of formulation: Topical minoxidil is available over the counter in 2 % and 5 % strengths. Oral minoxidil, prescribed off‑label at low doses, has shown hair‑growth benefits comparable to topical therapy in randomized trials³.
Regulatory endorsement: Together with finasteride, minoxidil remains the only FDA‑approved pharmacologic treatment for AGA¹⁰.

The Downsides: Side Effects and Limitations

Despite its efficacy, minoxidil is not a cure, and it only works while you keep using it. When you stop, hair loss resumes. Side effects also deserve serious consideration.

Topical irritation: Itching, flaking and redness are common complaints. The propylene glycol and alcohol in many topical solutions can trigger scalp irritation or dermatitis³. Some users experience an early “shedding phase” that can be alarming.
Unwanted hair growth: If the solution drips onto the forehead or is absorbed systemically, it may cause fine facial hair in unwanted areas³.
Systemic risks with oral dosing: Low‑dose oral minoxidil can stimulate hair growth across the body, leading to hypertrichosis⁴. Fluid retention, swelling, headaches, dizziness and rapid heartbeat are also reported⁴. In rare cases, minoxidil has been linked to serious complications such as pericardial effusion (fluid around the heart)⁵⁶; these idiosyncratic reactions can occur even at lower doses, especially in individuals with kidney problems.
Continuous commitment: Minoxidil must be applied indefinitely to maintain results. Many users stop because of cost, inconvenience or side effects.

Why We Developed KESHAH

KESHAH is built on emerging research into scalp mechanics. Studies show that scalp skin overlying the galea aponeurotica (the fibrous sheet that covers the top of the head) is tightly bound and experiences elevated mechanical stress. This region corresponds to common balding areas⁷. A finite‑element analysis demonstrated a strong negative correlation between scalp tension and hair density (r = –0.885, P < 0.001)⁸. Chronic tension can restrict blood flow, cause inflammation and promote follicle miniaturization.

Our program focuses on relieving this mechanical stress via mechanotherapy and targeted scalp massages. Unlike pharmacologic treatments, KESHAH aims to restore a healthy scalp environment from the ground up. We also offer an app‑guided microneedling pen to enhance blood flow and nutrient delivery, using carefully controlled needle depths and patterns to minimize complications. While mechanotherapy is supported by observational studies and theoretical modelling, we acknowledge that it lacks large randomized trials and shouldn’t be considered a magic cure. However, it offers a drug‑free alternative or complement for those who prefer to avoid pharmacologic agents or cannot tolerate minoxidil.

Striking a Balance

We recognize that minoxidil has helped many individuals and remains an important option. Our stance isn’t to vilify it but to highlight that it’s not without drawbacks and doesn’t correct the underlying causes of hair loss. For people seeking a natural approach—especially those who have experienced side effects or discontinued minoxidil—KESHAH provides a different pathway grounded in scalp health and mechanotherapy. As always, consult a healthcare professional to determine the best regimen for your specific condition.

References

Oral Minoxidil Meta‑analysis (2025) – Reports that minoxidil prolongs the anagen (growth) phase, shortens telogen and may inhibit 5‑α‑reductase; used to describe how minoxidil modulates the hair cycle.
International Society of Hair Restoration Surgery Post‑Marketing Study – Survey of 5 % topical minoxidil users; about 63 % rated it “effective” or “very effective” after one year of continuous use.
StatPearls: Androgenetic Alopecia – Discusses topical minoxidil’s mechanism as a potassium‑channel opener and notes common side effects such as scalp itching, flaking, irritation and unintended facial hair growth.
Oral Minoxidil Meta‑analysis (2025) – Provides data on adverse events for low‑dose oral minoxidil; hypertrichosis, fluid retention, tachycardia, headache and dizziness are noted as common side effects.
Case Report on Minoxidil‑Induced Pericardial Effusion – Observed that antihypertensive doses (10–40 mg) of minoxidil were associated with pericardial effusion in ~3 % of patients; risk described as idiosyncratic and not strictly dose‑dependent.
Same Case Report – Describes a patient developing pericardial and pleural effusions and generalized edema after three weeks of low‑dose oral minoxidil; clinicians concluded minoxidil was the cause and recommended caution.
Finite‑Element Study on Scalp Mechanics – Explains that the scalp skin overlying the galea aponeurotica is tightly bound and corresponds to balding areas.
Same Study – Finite‑element analysis found a strong negative correlation between mechanical stress on the galea and hair density (r = –0.885, P < 0.001).
High‑Frequency Ultrasound Study – Demonstrated that balding areas have thinner scalp and subcutaneous tissue, fewer and narrower hair follicles and reduced blood flow compared with controls.
StatPearls: Androgenetic Alopecia – Notes that topical minoxidil and finasteride are currently the only FDA‑approved pharmacologic treatments for pattern hair loss.

References

Oral Minoxidil Meta‑analysis (2025) – Reports that minoxidil prolongs the anagen (growth) phase, shortens telogen and may inhibit 5‑α‑reductase; used to describe how minoxidil modulates the hair cycle.
International Society of Hair Restoration Surgery Post‑Marketing Study – Survey of 5 % topical minoxidil users; about 63 % rated it “effective” or “very effective” after one year of continuous use.
StatPearls: Androgenetic Alopecia – Discusses topical minoxidil’s mechanism as a potassium‑channel opener and notes common side effects such as scalp itching, flaking, irritation and unintended facial hair growth.
Oral Minoxidil Meta‑analysis (2025) – Provides data on adverse events for low‑dose oral minoxidil; hypertrichosis, fluid retention, tachycardia, headache and dizziness are noted as common side effects.
Case Report on Minoxidil‑Induced Pericardial Effusion – Observed that antihypertensive doses (10–40 mg) of minoxidil were associated with pericardial effusion in ~3 % of patients; risk described as idiosyncratic and not strictly dose‑dependent.
Same Case Report – Describes a patient developing pericardial and pleural effusions and generalized edema after three weeks of low‑dose oral minoxidil; clinicians concluded minoxidil was the cause and recommended caution.
Finite‑Element Study on Scalp Mechanics – Explains that the scalp skin overlying the galea aponeurotica is tightly bound and corresponds to balding areas.
Same Study – Finite‑element analysis found a strong negative correlation between mechanical stress on the galea and hair density (r = –0.885, P < 0.001).
High‑Frequency Ultrasound Study – Demonstrated that balding areas have thinner scalp and subcutaneous tissue, fewer and narrower hair follicles and reduced blood flow compared with controls.
StatPearls: Androgenetic Alopecia – Notes that topical minoxidil and finasteride are currently the only FDA‑approved pharmacologic treatments for pattern hair loss.

HAIR WELLNESS

Research & Resources

About Us

Before & Afters

ARTICLES

Understanding Minoxidil

Microneedling for Hair Loss

DHT & Hair Loss

LEGAL

KESHAH is a holistic hair health program built on emerging research into scalp mechanics, vascular biology and botanically derived anti‑androgens. Our approach focuses on scalp health rather than just symptom relief.

© 2025 KESHAH Inc. All Rights Reserved.
These statements have not been evaluated by the Food and Drug Administration.
These products are not intended to diagnose, treat, cure, or prevent any disease.

HAIR WELLNESS

Research & Resources

About Us

Before & Afters

ARTICLES

Understanding Minoxidil

Microneedling for Hair Loss

DHT & Hair Loss

LEGAL

HAIR WELLNESS

Research & Resources

About Us

Before & Afters

ARTICLES

Understanding Minoxidil

Microneedling for Hair Loss

DHT & Hair Loss

LEGAL

Minoxidil: Benefits, Side‑Effects and How It Compares to KESHAH

References

Oral Minoxidil Meta‑analysis (2025) – Reports that minoxidil prolongs the anagen (growth) phase, shortens telogen and may inhibit 5‑α‑reductase; used to describe how minoxidil modulates the hair cycle.

International Society of Hair Restoration Surgery Post‑Marketing Study – Survey of 5 % topical minoxidil users; about 63 % rated it “effective” or “very effective” after one year of continuous use.

StatPearls: Androgenetic Alopecia – Discusses topical minoxidil’s mechanism as a potassium‑channel opener and notes common side effects such as scalp itching, flaking, irritation and unintended facial hair growth.

Oral Minoxidil Meta‑analysis (2025) – Provides data on adverse events for low‑dose oral minoxidil; hypertrichosis, fluid retention, tachycardia, headache and dizziness are noted as common side effects.

Case Report on Minoxidil‑Induced Pericardial Effusion – Observed that antihypertensive doses (10–40 mg) of minoxidil were associated with pericardial effusion in ~3 % of patients; risk described as idiosyncratic and not strictly dose‑dependent.

Same Case Report – Describes a patient developing pericardial and pleural effusions and generalized edema after three weeks of low‑dose oral minoxidil; clinicians concluded minoxidil was the cause and recommended caution.

Finite‑Element Study on Scalp Mechanics – Explains that the scalp skin overlying the galea aponeurotica is tightly bound and corresponds to balding areas.

Same Study – Finite‑element analysis found a strong negative correlation between mechanical stress on the galea and hair density (r = –0.885, P < 0.001).

High‑Frequency Ultrasound Study – Demonstrated that balding areas have thinner scalp and subcutaneous tissue, fewer and narrower hair follicles and reduced blood flow compared with controls.

StatPearls: Androgenetic Alopecia – Notes that topical minoxidil and finasteride are currently the only FDA‑approved pharmacologic treatments for pattern hair loss.

References

Oral Minoxidil Meta‑analysis (2025) – Reports that minoxidil prolongs the anagen (growth) phase, shortens telogen and may inhibit 5‑α‑reductase; used to describe how minoxidil modulates the hair cycle.

International Society of Hair Restoration Surgery Post‑Marketing Study – Survey of 5 % topical minoxidil users; about 63 % rated it “effective” or “very effective” after one year of continuous use.

StatPearls: Androgenetic Alopecia – Discusses topical minoxidil’s mechanism as a potassium‑channel opener and notes common side effects such as scalp itching, flaking, irritation and unintended facial hair growth.

Oral Minoxidil Meta‑analysis (2025) – Provides data on adverse events for low‑dose oral minoxidil; hypertrichosis, fluid retention, tachycardia, headache and dizziness are noted as common side effects.

Case Report on Minoxidil‑Induced Pericardial Effusion – Observed that antihypertensive doses (10–40 mg) of minoxidil were associated with pericardial effusion in ~3 % of patients; risk described as idiosyncratic and not strictly dose‑dependent.

Same Case Report – Describes a patient developing pericardial and pleural effusions and generalized edema after three weeks of low‑dose oral minoxidil; clinicians concluded minoxidil was the cause and recommended caution.

Finite‑Element Study on Scalp Mechanics – Explains that the scalp skin overlying the galea aponeurotica is tightly bound and corresponds to balding areas.

Same Study – Finite‑element analysis found a strong negative correlation between mechanical stress on the galea and hair density (r = –0.885, P < 0.001).

High‑Frequency Ultrasound Study – Demonstrated that balding areas have thinner scalp and subcutaneous tissue, fewer and narrower hair follicles and reduced blood flow compared with controls.

StatPearls: Androgenetic Alopecia – Notes that topical minoxidil and finasteride are currently the only FDA‑approved pharmacologic treatments for pattern hair loss.