The dread shed: Minoxidil hair shedding

Hair growth occurs in cycles and involves four main phases [4]:

• Anagen Phase: The active growth phase where hair grows approximately 1 cm every 28 days.
• Catagen Phase: A short transition phase that lasts about 2-3 weeks.
• Telogen Phase: The resting phase where the hair follicle is inactive.
• Exogen Phase: The shedding phase where old hair falls out to make room for new hair growth.

At any given time, each hair follicle is at a different stage of this hair growth cycle, which is why normal hair shedding happens daily.

Several factors can disrupt the normal hair cycle, leading to increased hair shedding [5]:

• Genetics: Conditions like male androgenetic alopecia (male pattern hair loss) are hereditary.
• Hormonal Changes: Pregnancy, menopause, or thyroid issues can affect hair growth.
• Medical Conditions: Alopecia areata, scalp infections, or autoimmune diseases.
• Medications: Certain drugs can cause telogen effluvium, a type of hair shedding.
• Stress and Poor Nutrition: Both physical and emotional stress, as well as nutritional deficiencies, can impact hair health.

Topical minoxidil is a treatment approved for hair loss disorders [3]. Originally developed as an oral medication for high blood pressure, minoxidil was found to have the side effect of promoting hair growth. Today, it is widely used in both topical minoxidil and low-dose oral minoxidil forms to treat hair loss.

Minoxidil stimulates hair follicles by prolonging the anagen phase and increasing blood flow to the scalp [6]. This encourages thicker, stronger hair growth over time. Studies have shown that individuals using 5% topical minoxidil experienced 45% more hair regrowth compared to those using the 2% formulation after 48 weeks [7].

In addition to topical treatments, there are hair regrowth prescription medications available that address hair loss by targeting hormonal factors contributing to androgenetic alopecia. These treatments are effective for both male and female pattern hair loss and work by inhibiting the formation of dihydrotestosterone (DHT), a hormone linked to hair thinning and loss [8].

The "dread shed" refers to the temporary increase in hair shedding that some minoxidil and hair loss medication users experience when they first start treatment for hair loss [2]. While it may seem counterintuitive, this shedding is a sign that the treatment is working.

The Shedding Process

Both topical minoxidil and certain prescription medications can cause an initial increase in hair shedding, known as the dread shed. This occurs because these treatments accelerate the hair growth cycle, pushing hairs from the telogen phase into the exogen phase sooner than usual. This makes way for new, healthier hairs to grow during the anagen phase [9].

When minoxidil is applied to the scalp, it sends a signal to all the hairs waiting in line to shed [9]. The message is that they no longer need to wait the usual 2-3 months. Any hair that is in line to shed is now encouraged to shed immediately. The typical waiting period has been temporarily lifted. As a result, the person experiences an increased amount of hairs falling out on a daily basis after starting minoxidil. What is being shed are hairs that were destined to come out anyway:

• Instead of shedding tomorrow, a hair sheds today.
• Instead of shedding in two weeks, a hair sheds tomorrow.
• Instead of shedding in four weeks, a hair sheds in one week.
• Instead of shedding in six weeks, a hair sheds in two weeks.

The shedding timeline typically occurs within the first 2 to 8 weeks of starting minoxidil treatment for hair loss (or other treatments) and should subside as the hair follicles adjust, although for some who experience a temporary increase in hair shed, shedding may continue for a little longer [10]. It's important to continue maintaining the use of your treatment as directed by your practitioner, as stopping could reverse any progress made [11]. If you continue to experience increased shedding beyond four months, consult a healthcare professional to rule out other causes.

Increased Shedding: A Sign of Progress

While experiencing increased shedding can be unsettling, it's actually a sign that the minoxidil treatment or your prescribed hair treatment is working. The old hairs are being shed to allow for the growth of new, healthier hair. The hair you lose during the shedding process always grows back [11]. 

Shedding May Vary

All formulations of minoxidil have the potential to cause shedding, though not all people may experience this short-term issue [11]. The amount of hair shedding may vary from person to person. Some individuals might experience only minimal shedding when starting minoxidil or their hair loss treatment, while others might notice more significant excess shedding. It's essential to understand that this variation is normal and part of the process.

Shedding Happens: Stay the Course

Many patients experienced dread shed as a common side effect when starting minoxidil treatment, but it's imperative you don't stop using minoxidil immediately if you've just started. Knowing that others have gone through the same process can be reassuring. Remember that shedding happens as a natural part of the hair growth cycle and is expected when using minoxidil. Staying consistent with your treatment use is crucial for achieving the desired results in hair regrowth.

Understanding the type of hair loss you're experiencing can help in selecting the most effective treatment.

Telogen Effluvium

A form of temporary hair shedding often triggered by stress, illness, or hormonal changes [12].

Androgenetic Alopecia (Male and Female Pattern Hair Loss)

A genetic condition characterised by a receding hairline and thinning at the crown in men (male pattern baldness), and overall thinning in women (female pattern hair loss) [13].

Alopecia Areata

An autoimmune disorder causing patchy hair loss on the scalp, face, and body [14]. Sometimes, alopecia areata sufferers experience spontaneous regrowth of their hair in patches since the follicles are not completely destroyed. Some extreme cases may even cause total shedding all over.

Scarring Alopecia

Inflammation destroys hair follicles, leading to permanent hair loss [15].

For those who are experiencing minoxidil shedding, it's important to:

• Be Patient: Understand that increased shedding is a normal part of starting a new treatment.
• Continue Treatment: Stopping use can lead to further hair loss.
• Consult a Professional: Speak with your healthcare provider to rule out other causes of hair shedding.
• Maintain a Healthy Lifestyle: Proper nutrition and stress management can support hair health.

• Australian-Based Doctors: Consult with experts who understand your needs.
• Science-Backed Treatments: We offer evidence-based solutions for hair loss, including minoxidil treatments.
• Money-Back Guarantee: Try our products risk-free with a 30-day full refund policy.
• Ongoing Support: If our treatments aren't right for you, you have unlimited consultations with your practitioner to discuss your experience and alternative options.

Experiencing the dread shed can be unsettling, but understanding why it happens can alleviate concerns. Shedding is a temporary increase in hair loss—a normal part of the hair growth cycle when starting treatments like topical minoxidil or prescription medications. With the right support and treatment plan from Mosh, you can navigate this shedding phase confidently and look forward to new hair growth.