The way in which your topical minoxidil is delivered through the skin and targeted to the hair follicle is of great importance. In order to be clinically effective and minimise side effects, it is crucial that the medication absorbs well through the skin, reaches its target destination in the hair follicle and remains there with minimal systemic absorption into the bloodstream.

Dr Ball has researched various formulations of topical minoxidil that are available through specialist compounding pharmacies and has identified a product that is very well tolerated, contains no propylene glycol and has a pleasant aroma and feel on the hair. It is delivered to the scalp in a solution known as TrichoSol™.

TrichoSol™ is applied to the scalp in drops from a pipette and massaged into the scalp.

You can read more about Dr Ball’s recommended delivery system in our TrichoSol™ blog here.

Adverse effects of topical minoxidil may include:

• Local redness, itching, and flaking. However, skin reactions are largely due to the presence of propylene glycol in minoxidil solution and propylene glycol is not present in our recommended TrichoSol formula. Treatment should be discontinued if there is persistent redness or irritation of the scalp.
• Increased hair shedding, which generally occurs 2–6 weeks after initiating treatment. It is temporary and subsides within a few weeks. Treatment should be discontinued if shedding persists for more than 2 weeks.
• Hypertrichosis (unwanted non-scalp hair, including facial hair growth). This is caused by the transfer of the product to areas other than the scalp. We advise that care should be taken to apply the product to just the scalp. Applying a head covering can limit unwanted spreading of the product.
• Hypotension (low blood pressure) has been rarely reported, although there is no clear increased risk of cardiovascular complications with the use of topical minoxidil (because systemic absorption through normal skin is very low). Treatment should be discontinued if hypotension is detected.

It is also recommended to discontinue treatment if any of the following occur:

• Chest pain.
• Tachycardia.
• Syncope.
• Dizziness.
• Sudden unexplained weight gain.
• Swollen hands or feet.
• Persistent redness or irritation of the scalp.
• Other unexpected new symptoms.

There is a potential for toxicity to pets. To minimise the risk, please:

• Apply minoxidil in a pet-free area: Use the medication in a bathroom or enclosed space away from your pets.
• Allow full absorption before contact: Ensure the product has dried completely before interacting with your pet.
• Wash hands thoroughly after application: Always clean your hands before handling your pet.
• Store products securely: Keep minoxidil and related items like applicators and tissues out of reach.
• Avoid contaminated surfaces: Prevent pets from accessing bedding, clothing, or furniture that may have been exposed to minoxidil.

If keeping pets away is difficult

For households where close contact with pets is unavoidable, particularly cats who sleep on pillows or sit near their owners, we can discuss alternative hair loss treatments.

Options include:

• Low-dose oral minoxidil (does not pose the same contact exposure risk)
• Topical formulations without minoxidil
• Other evidence-based non-minoxidil therapies

Please contact The Maitland Clinic if you would like personalised advice or to discuss switching treatment.

Apply 1ml twice a day to the areas of thinning.

Please always follow the instructions on your prescription.

Clinical studies have suggested that adding topical tretinoin 0.01% to minoxidil therapy may enhance the penetration and efficacy of minoxidil, leading to improved hair growth outcomes in certain patients.

Studies have shown that patients using minoxidil with added tretinoin may expect:

• Up to 30–40% more hair regrowth compared to minoxidil alone.
• A significantly higher chance of improvement in visible density.
• Enhanced retention of hair in the growth (anagen) phase.
• Greater overall satisfaction and response, especially in early to moderate stages of hair loss.

Important considerations:

• Skin sensitivity: Tretinoin can cause dryness, irritation, or redness in some individuals, especially at the start of treatment.
• Application timing: To minimize irritation, it may be used on alternating nights or layered at different times of day.
• Not for everyone: This option may not be suitable for patients with very sensitive scalps or certain dermatologic conditions.