Minoxidil is one of the most used hair loss treatments globally. Three-quarters of hair loss specialists recommend topical minoxidil to their patients, with more than half recommending it often or always [1].
However, you might be reluctant to follow this advice if you’re worried about the risk of Minoxidil’s sexual side effects. In this article, we’ll explore:
Minoxidil is a hair loss treatment that comes in two forms: topical minoxidil and oral minoxidil.
Topical minoxidil is more widely used than oral minoxidil. Both are vasodilators: they widen the blood vessels so more nutrients and oxygen can reach the hair follicles.
While topical minoxidil only affects the blood vessels in the area it’s applied (i.e. the scalp), oral minoxidil can affect blood vessels throughout the body. So it may cause more significant side effects — but are any of these side effects related to sexual function?
Minoxidil isn’t generally linked with sexual side effects, though there have been a few reported cases. One review reported the following number of cases out of a total of 92 male patients [2]:
These results are higher than those reported by other researchers, so there’s still some uncertainty around the true prevalence of Minoxidil sexual side effects. However, if these results are accurate, they indicate that it’s very unlikely that you’ll experience sexual side effects when using minoxidil.
There are no reported sexual side effects among female minoxidil users, though a small percentage (1.01%) have reported irregular periods following minoxidil use [2].
Some people worry about the sexual side effects of minoxidil because there are links between sexual side effects and another first line hair loss treatment, finasteride. Finasteride is generally used as a treatment for male pattern baldness and for other conditions unrelated to hair loss, such as an enlarged prostate.
But unlike minoxidil, finasteride works on a hormonal level, which means it’s more likely to cause sexual side effects like erectile dysfunction. Even though findings differ on the prevalence of sexual side effects of minoxidil, researchers generally agree that minoxidil is safer than finasteride.
Minoxidil may also be more likely to cause side effects such as headaches and fainting episodes when combined with Viagra, a common medication for erectile dysfunction. For this reason, doctors generally advise not to use the two together, which could be an issue if you rely on Viagra for a healthy sex life. Learn more about this below.
Unlike finasteride, minoxidil doesn’t affect your hormones. While some research suggests it interacts with the androgen receptors in your hair follicles, it doesn’t actually change your hormone levels [3]. So it’s much less likely to cause sexual side effects.
Erectile dysfunction is the most commonly reported sexual side effect associated with minoxidil use. But in general, minoxidil is still very unlikely to cause erectile problems. In one case report, stopping minoxidil use reversed this sexual side effect [4].
Minoxidil doesn’t affect your testosterone levels to a significant degree. This is another key difference between minoxidil and finasteride, as finasteride can increase testosterone levels by blocking the conversion of testosterone to dihydrotestosterone (DHT).
Some studies have found a tentative link between minoxidil and the androgenic effect of male hormones [3]. Minoxidil may suppress the function of androgen receptors, which means that any androgens (such as testosterone or DHT) won’t trigger the same intensity of cellular response when they are bound to these receptors. This would weaken the androgenic effect of circulating male hormones, but more research is needed to establish this link.
There’s limited evidence exploring the link between minoxidil use and sperm count, particularly topical minoxidil.
One research paper suggests high doses of oral minoxidil may lead to conception issues [5]. But oral minoxidil is only rarely used to treat hair loss, especially in high doses, so this is an unlikely scenario for hair loss patients.
If you’re using minoxidil and you experience any of the following, speak to your doctor or prescription provider:
Your GP can help you determine whether minoxidil is causing these issues or if there’s another underlying cause. If minoxidil is found to be the cause, stopping treatment should reverse the symptoms.
While sexual side effects are rare among minoxidil users, there are some side effects to be aware of. minoxidil is licensed as a topical treatment for hair loss, and side effects tend to be less common when used topically. Here are the potential side effects of topical minoxidil [6]:
Oral minoxidil is sometimes used off-label for a hair loss treatment, meaning it is not licensed for this purpose. A 2023 review of low-dose oral minoxidil states that its most common side effects are hypertrichosis and cardiovascular symptoms (such as heart palpitations or a fast heart rate) [7].
Hypertrichosis is excessive hair growth on the body, beyond what is considered normal for your gender, age, and race. Women are more prone to experience hypertrichosis as a side effect of oral minoxidil than men [7].
Other possible side effects of oral minoxidil include [7]:
If you have male pattern baldness, you may be considering Finasteride, minoxidil, or a combination of the two. Let’s explore the sexual side effects of finasteride vs minoxidil.
Finasteride is more likely to have significant sexual side effects than minoxidil — according to research, anywhere between <2% to 15.8% of men taking finasteride may be affected by these [8-9]. Possible sexual side effects of finasteride in men include [10-11]:
Although minoxidil is also associated with these side effects, the risk of experiencing them is much lower than when taking finasteride.
Still worried about the side effects of minoxidil, sexually or otherwise? Here are some minoxidil alternatives for hair growth:
Bear in mind that these treatments may have side effects of their own, so always check the possible risks and safety issues before taking minoxidil alternatives.
If you’re worried about sexual side effects, topical minoxidil is one of the best hair loss treatment options. It’s less likely to cause sexual dysfunction than systemic treatments like finasteride and dutasteride.
It’s also well tolerated by both men and women, and has been proven to work for many types of hair loss. Minoxidil is available over-the-counter, so it’s a good first-line treatment option.
However, minoxidil is less likely to be effective if you have extensive hair loss. In this case, it’s a good idea to consult with a hair loss specialist who can help you find the right treatment.
If you’re experiencing minoxidil-related sexual side effects, these are likely to disappear when you stop using minoxidil. However, minoxidil’s benefits for hair loss will also gradually disappear too.
Within three to six months of discontinuing minoxidil, your hair shedding is likely to resume [12]. Exactly how much hair you will lose differs from person to person. One study found that for 40% of men, hair counts fell below baseline levels after stopping topical minoxidil [13].
This means it’s possible to lose more hair than you gained while taking minoxidil, which makes sense because pattern hair loss is progressive — it keeps getting worse without treatment.
If your hair loss is worrying you, it’s important to get an assessment from a trichologist. These hair doctors can diagnose the reason your hair is falling out using diagnostic trichology tests such as blood tests for hair loss or a hair pull test.
They also work closely with your dermatologist or doctor to make sure any hair loss medication you’re taking (like minoxidil) is safe and effective for you. Once you have a diagnosis, your trichologist will create a personalised treatment plan to help restore your hair.
If minoxidil isn’t providing the results you want, you may be eligible for a follicular unit extraction (FUE) or follicular unit transplantation (FUT) hair transplant. Hair transplants are permanent, so you could have healthy, thick locks for years to come. Book a consultation at one of our clinic locations to learn how to get the healthiest hair you’ve had in years.
Minoxidil is unlikely to affect male fertility. However, research has reported a small number of cases of erectile dysfunction, lower libido, ejaculation disorder and lower semen volume. If you are one of the few men impacted by minoxidil in these ways it could have an impact on fertility.
Minoxidil could potentially affect your mood when used long-term. Some research reports cases of anxiety and depression associated with long-term Minoxidil use in men [14].
However, severe hair loss can also cause depression and anxiety [15], so the use of minoxidil should be reviewed on a case by case basis in terms of how it affects mood.
Research suggests that minoxidil may be associated with difficulty sleeping in some cases [16]. However, this is not a common side effect of taking minoxidil.
Minoxidil is licensed for patients aged 18-65. However, you may still be able to use minoxidil if you’re over 65.
The effects of minoxidil have not been studied for over 65s, and it may not be suitable if you have conditions like ischemic heart disease [17]. If you’re over 65, you should consult with a dermatologist or hair transplant surgeon to make sure it’s safe to use.
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