Why am I still shedding on Oral minoxidil?

It’s understandable to feel discouraged when you notice shedding after switching to oral minoxidil, especially since you’ve been diligent with your treatment. What you’re describing is actually something I hear often.

When starting or switching forms of minoxidil, some patients experience what we call shedding or a “dread shed.” This happens because minoxidil works by stimulating hair follicles and pushing them into a new growth cycle. As part of this process, older hairs that were already on their way out can shed more quickly to make room for new, healthier growth.

For some people, this shedding phase can last a few months, and I know four months can feel like an eternity when it’s your own hair. That said, the timeline you shared about 6 months in is often when many patients finally begin to notice stabilization and regrowth if the medication is working for them.

Other factors, like stress, genetics, nutritional deficiencies, or scalp conditions, can also play a role in continued shedding, so it isn’t always only the medication at work.

The good news is that shedding on oral minoxidil doesn’t necessarily mean it isn’t working, often it’s a sign that the medication is actively cycling your hair follicles. Monitoring density and hairline over the next several months can give a clearer picture of the long-term benefit.

Although certainly topical minoxdiL will convert your hair follicles into a growth state most of the time patients need multimodal therapy. Low Light Laser therapy, +/- spironolactone women and +/e finasteride men typically what we see, can combine with prp as well. I would also do blood work Thyroid tests, iron, vitamin D, inflammatory markers, COVID testing to make sure nothing else is going on. It could also be you are undergoing stressful point causing telogen effluvium could be emotional stress, surgical, extreme diet changes.

I think it is important to rule out other causes such as telogen effluvium and alopecia areata incognita. For telogen effluvium, it could be caused by many things such as abnormal thyroid hormone, vitamin D deficiency, iron deficiency, stress, etc. Also, it's important to observe how many hairs you lose per day (you can check from the virtual scale - put "The Hair Shedding Visual Scale: A Quick Tool to Assess Hair Loss in Women" in Google). If the hair sheds more than 100 hairs/day on the day without shampoo, then it's abnormal. For the day you wash your hair, it would be abnormal if hair sheds more than 200 hairs/day.
I hope this help