Doctor Tristan van Dongen (Erasmus MC).
wrote last week Metro about a possible ‘miracle cure’ for baldness. Tristan van Dongen works as a dermatology doctor at Erasmus MC and is one of the few in the Netherlands who sometimes prescribes these ‘wonderful’ minoxidil tablets to people who suffer from certain forms of alopecia. Yet he tempers the enthusiasm surrounding the medicine. “We must prevent people from seeing this as a rosy Walhalla pill, because if you take the side effects list, you scratch your ears three times.”
Before getting into the minoxidil tablets, about which The New York Times wrote last week that it can be a ‘miracle cure’ against hair loss, he first wants to make it clear that hair loss or baldness is a broad concept. “Alopecia is actually a group of hair diseases and not one diagnosis, because there can be many different causes. And the same treatment does not always help against that.”
The tablets with minoxidil are not effective for all forms of hair loss or baldness, the doctor first wants to clarify. “Will Smith’s wife has been in the news a lot lately,” he cites as an example. An enraged Will Smith hit Chris Rock several months ago after he joked about his wife suffering from hair loss. “She suffers from alopecia areata. But minoxidil in pill form, for example, does nothing against this specific form. So the diagnosis must first be correct.”
‘Miracle cure’ only works against certain forms of baldness
So what does minoxidil in pill form do something about? “Then it concerns the male form of baldness. That is hair loss caused by male hormones. You see that more often in the streets: people who are bald on top of the head. Minoxidil works because it improves blood flow to the hair follicles and stimulates hair growth,” explains doctor Van Dongen.
But that specifically applies to patients with ‘male pattern baldness’, also referred to as androgenetic alopecia. That is hair loss in both men and women, which is caused by the male hormones in the hair follicle and a decrease in blood flow to the scalp. In some people, the hair follicles are extra sensitive to these hormones. And that causes baldness.
Dermatologist starts with other treatments first
Tristan van Dongen often sees people suffering from alopecia in his outpatient clinic at Erasmus MC. But directly prescribe the minoxidil tablets to people for whom the tablets can work? He does not do that. “After establishing the diagnosis, I start with other treatments first,” he explains. This is partly due to the side effects of the pills containing minoxidil. According to him, they should not be underestimated.
“For example, I first start with minoxidil in a spreadable form, such as a lotion or foam, as has been prescribed by dermatologists for years. The main reason is because of the lifelong use of the drug. You don’t do anything against the underlying reason, but you treat the symptoms. And with the spreadable form of minoxidil, the costs outweigh the long-term risks.”
Lubrication can ‘work very well’ against hair loss
And that lubrication works ‘for some people already very well’, according to the doctor at Erasmus MC. “The advantage of lubrication is that there are almost no side effects internally in your body. The side effects are sometimes there, but especially around the area where you apply.” Very occasionally people do get palpitations, headaches or hair growth in other places, the doctor admits, but that happens less often than when swallowing the tablets.
There are also disadvantages to lubrication. For example, the lotion or foam is not reimbursed. “And spreadable minoxidil is not immediately effective once you put it on the skin. After it has been absorbed by the skin, it must first convert it into an active form. Only: not everyone has enough of the substance in your skin that is responsible for this.”
Only a third of people have enough of that substance on their skin to stimulate hair growth via minoxidil. Two-thirds of people lack enough substance to stimulate hair growth. Will it still lead to less hair loss for some, for a third the lotions do nothing at all. “Unfortunately, there are no tests available to divide you into groups in advance. You can only find out which group you belong to by applying it for half a year and looking at the effect.”
Dermatologist sometimes prescribes pill against baldness
Does the lotion not do much in your case and is there a form of alopecia against which minoxidil tablets work? “Then at some point you come to a point to prescribe it,” explains Van Dongen. But then all signals must be green. “It may not be desirable, for example, due to illness, medication or because there is still another potentially less harmful substance.”
The doctor always checks off an important list before prescribing the tablets. “I take heart problems into account and see if there are any other diseases in the patient at all. Or perhaps the patient is already taking medicines that do not combine too well with minoxidil.” The slightest thing can be a reason for the doctor not to prescribe the tablets. “They can potentially cause damage to health or make things worse.”
This has to do with the effect of minoxidil, originally a drug to lower blood pressure. Although the dosage of the drug for hair problems is much lower, there are still possible side effects. And ‘these may not always outweigh the disease gain’. He sums it up: “Do the lotions not work? Then the pill could be considered. Otherwise I would always go for the lotion, because of the smaller chance of side effects.”
Side Effects of Minoxidil in Pill Form
The most common side effect has to do with how the tablets work: hair growth. “This growth does not only occur on the head, but all over the body. This is often less serious for men than for women. They can get a lot of hair on their arms, legs or face. Think mustache growth or hair on the chin. It may not be the worst health problem, but for many women it is already an important reason not to take the drug.”
The doctor continues. “Minoxidil has a blood pressure lowering effect, because the drug reduces the ability of the blood vessels to squeeze. Normally, the blood vessels in the arms and legs are not constantly wide open. That is what the body regulates. But the mechanism of action is confused by minoxidil. The blood vessels are therefore more open, so that more fluid can escape in the legs or arms or, to a more extreme extent, even in the face. So you can gain weight in the sense of moisture. You notice this more in warm weather, although it is different for everyone. Some don’t notice.”
Baldness remedy affects the heart
Each side effect depends on the dosage. Because the dosage is relatively low, the chances of side effects are also relatively small. “But they do occur. Think of an inflammation of the pericardium, or fluid in the pericardium. The drug can also affect the heart, because it has to pump faster and more. That has to do with the effect on the blood vessels that open more.”
The dermatologist explains that the long-term consequences are not yet clear. “You have to take minoxidil for life to maintain the effect on the hair. For some, that means a higher heart rate for life.”
With use you can ‘definitely expect improvement’
The doctor does want to emphasize that the minoxidil in pill form is certainly beneficial for hair growth, also in his patients. “That is why the pill form has quickly gained popularity in the research world. The research results certainly show that a good effect can be achieved with this.” But is it a magic pill like The New York Times seemed to claim? “No,” he is clear.
Because fighting the real problem, that’s not what the pill does. “You don’t permanently address the underlying problem, the effect of the male hormones and the decrease in blood flow to the scalp,” he says. Moreover, the use of the product is already too late for many people, if they have been struggling with hair loss for a long time.
“The longer you have to deal with bald spots, such as the coves or the bald crown, the less likely it is that minoxidil can still stimulate the hair follicles sufficiently. I therefore only start with people whose hair loss is somewhat limited and the problem has not existed for too long. Then you can certainly expect improvement.”
Doctors find ‘miracle cure’ for baldness: ‘And it costs nothing’
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Doctor Tristan van Dongen finds ‘miracle cure’ for baldness ‘not so magical’