Why I Stopped Recommending Minoxidil to Everyone

Colin Hayes, MD

03 Feb 2023 • 4 min read

"Just use Rogaine!"

For years, that was my reflexive response to anyone with hair loss. Male, female, young, old, crown, hairline – didn't matter. Minoxidil was my hammer, and every scalp looked like a nail.

Then came the week that changed everything: three emergency calls, two ER visits, and one very angry cat.

The Protocol I Followed Blindly

From 2008-2018, my standard operating procedure:

Patient mentions hair loss
Recommend minoxidil 5%
"Use it twice daily forever"
See you in 6 months
Next patient

Simple. Effective (usually). FDA-approved. What could go wrong?

Everything, as it turns out.

The Week From Hell That Opened My Eyes

Monday: Sarah, 34, called with heart palpitations. Resting rate: 110. Had been using minoxidil for 3 weeks.

Wednesday: Tom, 55, in the ER with chest pain and dizziness. His wife mentioned he'd started "that hair stuff" recently.

Friday: Janet, 42, sobbing on the phone. Her cat was in emergency surgery. Kidney failure from grooming her minoxidil-treated hair.

Saturday: I stopped sleeping well.

What They Don't Put in Big Letters on the Box

Minoxidil was developed as a blood pressure medication. Rogaine is literally a blood pressure drug you rub on your head. The "rare" side effects I'd been dismissing:

Cardiovascular:

Palpitations
Chest pain
Rapid heartbeat
Dizziness
Fluid retention
Sudden weight gain

Dermatological:

Facial hair growth (especially in women)
Accelerated aging of face
Dark circles
Skin irritation
Allergic reactions

The Cat Thing:

Minoxidil is EXTREMELY toxic to cats
One lick can be fatal
No antidote exists
Most vets don't know to ask

The Patients Who Taught Me Nuance

Lisa, 28: Anxiety disorder

Minoxidil triggered panic attacks
Heart palpitations fed anxiety
Anxiety worsened hair loss
Vicious cycle of misery

Robert, 45: Perfect candidate

No health issues
Followed instructions perfectly
Developed severe facial bloating
Looked 10 years older after 6 months
"I'd rather be bald than look like this"

Amanda, 38: The success story

Dramatic regrowth
No side effects for 2 years
Stopped for vacation
Lost ALL gains in 6 weeks
More devastated than before treatment

The Dependency Nobody Talks About

Here's the cruel truth about minoxidil: it's a lifetime commitment. Not a "use until your hair grows back" solution.

Stop using it? You lose:

All minoxidil-dependent hair
Often more than you started with
In about 3-6 months
Sometimes faster

It's like a hair loss subscription service that charges in side effects instead of money.

My New Decision Tree

Now, before recommending minoxidil:

Health screening:

Blood pressure check
Heart rate baseline
History of cardiovascular issues
Anxiety/panic disorders
Pet ownership (yes, really)

Lifestyle assessment:

Can you commit to 2x daily forever?
Travel frequently? (TSA hassles)
Sensitive to medications?
Partner with sensitive skin? (transfer risk)
Financial stability? ($30-50/month forever)

Alternative check:

Have we tried everything else?
Is the hair loss severe enough?
Are expectations realistic?
Backup plan if it fails?

Who Should Actually Use Minoxidil

After my wake-up call, I still prescribe it, but selectively:

Ideal candidates:

Healthy cardiovascular system
No anxiety disorders
Committed to lifetime use
Realistic expectations
No cats (or careful protocols)
Failed other treatments
Significant quality of life impact from hair loss

Who should think twice:

History of heart issues
Prone to anxiety
Can't commit to daily use
Mild thinning only
Cat owners
Sensitive to medications
Expecting miracles

For mild-moderate loss:

Address underlying causes (iron, thyroid, stress)
Microneedling + topical solutions
Red light therapy
Ketoconazole shampoo
Natural DHT blockers
Lifestyle modifications

For women specifically:

Iron optimization (ferritin >70)
Hormone evaluation
Spironolactone (if appropriate)
Topical solutions without minoxidil
Stress management (huge factor)

For commitment-phobes:

Treatments that don't require daily use
Procedures over products
Address root causes
Accept what you can't change

The Conversation I Have Now

"Minoxidil can work well, but let me be completely honest about what you're signing up for:

Twice daily application forever
Possible initial shedding
4-6 months to see results
Potential side effects
You'll lose everything if you stop
Monthly cost indefinitely

Still interested? Let's discuss. Not interested? Here are six other options."

The Cat Tragedy That Haunts Me

Janet's cat survived – barely. $4,000 in vet bills. Three days in intensive care.

She'd been careful, or so she thought:

Applied in bathroom
Washed hands
Kept cat out during application

But:

Residue on pillowcase
Cat slept on her pillow
Groomed itself
Kidney failure within days

Now I explicitly warn every patient. Some think I'm crazy. I'd rather be the crazy cat doctor than attend another pet funeral.

What Pisses Me Off About Minoxidil Marketing

"Clinically proven!" "FDA approved!" "Number 1 dermatologist recommended!"

What they don't advertise:

Lifetime dependency
Cardiovascular effects
Pet toxicity
Facial aging
The devastating shed if you stop
Transfer risks to partners/children

It's not that minoxidil is bad. It's that informed consent requires actual information.

My Current Minoxidil Protocol

If we decide it's right for you:

Start slow: Once daily for 2 weeks
Monitor everything: BP, heart rate, photos
Use foam: Less systemic absorption
Night application: Reduce transfer risk
Pet protocols: If applicable
3-month check-in: Assess tolerance
Exit strategy: Plan for if/when stopping

The Bottom Line

Minoxidil isn't the devil. It's helped millions. But it's not candy either. It's a serious medication with real risks and lifetime implications.

Would I still recommend it? Sometimes. Is it my first suggestion? Never. Do I respect people who refuse it? Absolutely.

Medicine isn't one-size-fits-all. Neither is hair loss treatment.

Your scalp, your choice. But make it an informed one.

P.S. - Sarah's palpitations resolved after stopping. Tom had underlying heart issues minoxidil exposed. Janet's cat made a full recovery. All three found alternative treatments that worked better for their situations. Sometimes the "gold standard" isn't golden for everyone.