Minoxidil Stopped Working? Why It Plateaus and the 3 Things to Add

Minoxidil is the first thing most men try when they start losing their hair. It's over the counter. It's been around for decades. And it works. Hair grows back thicker, thin spots fill in.

So why do so many men hit a wall on it? Why does it work for a while and then seem to stop?

Because minoxidil doesn't touch the thing causing the loss in the first place. Here's why it plateaus, how to tell if that's you, and what to add.

Why minoxidil stops working

Think of your hair like water in a bucket. DHT is poking holes in the bottom. Every growth cycle, DHT attaches to your follicles and shrinks them a bit more. The bucket is slowly draining.

Minoxidil is a tap. It pours water back in. It pushes resting follicles into a new growth phase and may keep them growing longer (Messenger 2004). Your hair gets thicker.

But the holes are still there. DHT is still shrinking your follicles. For a while the tap wins. You see results. Then the holes get bigger and the tap can't keep up. That's the plateau.

And because minoxidil only works while you use it, you're renting your hair. Stop paying rent and you lose it.

Signs you've plateaued

• You're 6 to 12 months in. Things got better, then stayed the same, now they're slipping.
• Your temples or hairline never really responded.
• Your day one photo and your latest photo look the same, or worse.
• You're seeing more scalp under bright lights than you were six months ago.

The only way to know for sure is photos. Same light, same angle, every month. The mirror lies. See how customers track theirs on our results page.

How well does each one work?

Before you add anything, see how well each option works. Here are the real numbers from the studies, each one linked so you can check it. Every study measured things a bit differently, so read each line on its own.

• Minoxidil 5%: good. 393 men, 48 weeks. 5% beat the dummy and grew 45% more hair than 2%. It doesn't touch DHT, so it works best next to a DHT blocker. (Olsen 2002)
• Oral minoxidil: good, but not better. A 5mg pill against 5% liquid for 24 weeks: no clear winner. 49% of men on the pill grew extra hair on their face and body. (Penha 2024)
• RU58841 on the scalp: strong. In bald monkeys, RU58841 5% raised growing follicles by 103% and turned 26% of thin hairs into thick ones. The finasteride pill got 88% and 12% in the same study, and RU did it with no hormone change. On real balding human scalp grown on mice, 28% of follicles started a new growth cycle with RU, against 7% without it. (Uno monkey study, not on PubMed; same team: Pan 1998, De Brouwer 1997)
• Finasteride pill: strong. 1,553 men. After two years, men on finasteride had 138 more hairs in a one inch circle on the crown than men on a dummy pill, who kept losing hair. It cuts the DHT in your blood by about 71%, which is why some men get side effects. (Kaufman 1998, Drake 1999)
• Dermastamp (microneedling): a big boost. 100 men, 12 weeks. Weekly microneedling plus minoxidil: hair count up 91.4. Minoxidil alone: up 22.2. 82% said their hair was more than 50% better, against 4.5% on minoxidil alone. (Dhurat 2013)
• Ketoconazole shampoo: small, but cheap. In one small study, 2% ketoconazole shampoo improved hair density and the share of growing hairs almost as much as 2% minoxidil. (Piérard Franchimont 1998)
• Scalp massage: small. 9 men, 4 minutes a day for 24 weeks. Each hair got a bit thicker: 0.085mm to 0.092mm. (Koyama 2016)

Short version: stop the DHT first, then grow the hair. That's a DHT blocker plus minoxidil, with a dermastamp once a week. RUstim+ does the first two in one bottle.

What to add

1. A DHT blocker

This is the big one. You need to plug the holes.

Doctors have long paired minoxidil with finasteride for exactly this reason. But finasteride is a pill that lowers DHT across your whole body, by about 71% in the blood (Drake 1999). Some men get side effects from that. I did, about six to eight weeks in.

RU58841 does it at the scalp. It sits on the receptor in the follicle and stops DHT attaching. In the animal studies it didn't lower blood testosterone or DHT (Ye 1997). In balding human scalp grafted onto mice, far more follicles restarted growth with it than without (De Brouwer 1997).

Now when minoxidil pushes growth, the new hair actually sticks around, because the thing shrinking it isn't getting through. Block the cause. Push the growth. Two jobs, one goal.

Read more: What Is RU58841?

2. A weekly dermastamp

This is the best add on for a minoxidil plateau. In a study of 100 men, weekly microneedling with 1.5mm needles plus minoxidil grew about 91 new hairs in the test patch in 12 weeks. Minoxidil alone grew 22. Some of those men had already tried minoxidil and finasteride with no luck, and still responded (Dhurat 2013).

Use a 1.5mm dermastamp. Once a week. Two minutes. Straight in, straight out. Then wait 24 to 36 hours before your next application.

3. Scalp massage

Small but real. Nine men who did four minutes of scalp massage a day for 24 weeks ended up with thicker hairs (Koyama 2016). It's a tiny study, so don't expect miracles. A scalp massager before you apply makes it easy.

What not to do

• Don't just pile on more minoxidil. More of the tap doesn't fix the holes.
• Don't stop minoxidil cold. You'll lose what it's holding. Add the DHT blocker first.
• Don't start everything in the same week. Add one thing at a time so you know what's doing what.
• Don't quit during a shed. Adding something new can bring a shed in the first 6 to 8 weeks. It passes.

The simple version and the manual version

Simple: swap your minoxidil for RUstim+. It's RU58841, 5% minoxidil, caffeine and peppermint oil in one bottle. 1ml, once a day, morning or night. Any time works, as long as it's every day. Both jobs in one go.

Manual: keep your own minoxidil and add RU58841 5%. Put them on at different times of day, one in the morning and one at night.

Either way, add the dermastamp once a week.

More on stacking the two: RU58841 and Minoxidil Together.

Frequently asked questions

Why has my minoxidil stopped working?

Usually because DHT is still shrinking your follicles. Minoxidil pushes growth but doesn't touch DHT. For a while it keeps up. Then it can't.

Can I add RU58841 to Rogaine foam?

Yes. Put them on at different times of day so each one dries properly. Or swap to RUstim+, which has both in one bottle.

Should I stop minoxidil when I start RU58841?

No. Keep the minoxidil going and add RU58841. Stopping minoxidil means losing the hair it's holding.

Will I shed again?

Maybe. Adding something new can bring a shed in the first 6 to 8 weeks. Keep going. Full timeline: How Long Does RU58841 Take to Work?

Is oral minoxidil the answer?

Some doctors prescribe it in small doses, usually starting at 2.5mg for men. The most common side effect is extra hair on the face and body, then dizziness or swollen ankles (Saceda Corralo 2022). It's still minoxidil. It still doesn't touch DHT.

The bottom line

Minoxidil is a great tool. But it's half the job. If you're not blocking DHT, you're fighting hair loss with one hand tied behind your back. Plug the holes first, then fill the bucket.

Sources

1. Messenger and Rundegren (2004). Br J Dermatol. How minoxidil works on hair growth. PubMed 14996087
2. Drake and colleagues (1999). J Am Acad Dermatol. Finasteride 1mg cut blood DHT by about 71%. PubMed 10495374
3. Ye and colleagues (1997). Skin Pharmacol. RU58841 on rat skin, no change in blood testosterone or DHT. PubMed 9449168
4. De Brouwer and colleagues (1997). Br J Dermatol. Balding human scalp on mice responded to RU58841. PubMed 9415227
5. Dhurat and colleagues (2013). Int J Trichology. Weekly 1.5mm microneedling plus minoxidil against minoxidil alone. PubMed 23960389
6. Koyama and colleagues (2016). Eplasty. Four minutes of daily scalp massage and hair thickness in nine men. PubMed 26904154
7. Saceda Corralo and colleagues (2022). Am J Clin Dermatol. Review including oral minoxidil. PubMed 36169916
8. Olsen and colleagues (2002). J Am Acad Dermatol. 5% minoxidil grew 45% more hair than 2%. PubMed 12196747
9. Penha and colleagues (2024). JAMA Dermatol. Oral minoxidil 5mg against 5% minoxidil liquid for 24 weeks. PubMed 38598226
10. Uno and colleagues. Conference abstract, Wisconsin Regional Primate Research Center. Follicular regrowth with 5α reductase inhibitor (finasteride) or androgen receptor blocker (RU58841) in the bald scalp of the stumptailed macaque. Not on PubMed. Same team's published RU58841 paper: Pan 1998, Endocrine
11. Kaufman and colleagues (1998). J Am Acad Dermatol. 1,553 men: finasteride 1mg gave 138 more hairs than a dummy pill after two years. PubMed 9777765
12. Piérard Franchimont and colleagues (1998). Dermatology. Ketoconazole shampoo and hair density. PubMed 9669136

I'm not a doctor and this isn't medical advice.