Rogaine is an FDA approved hair loss treatment and the most popular topical treatment in the world. However, results do not come overnight.
This post will introduce Rogaine, including:
- how it works
- what you can expect from its use
- how long it may take to see results
- how you may be able to speed up the process and enhance growth.
Who Is Rogaine For?
Both men and women with thinning or receding hair can use Rogaine. Male users will typically be suffering from Androgenetic Alopecia (AGA).
This is the term that describes hair loss affecting the temples and crown of the head. Another name for it is male-pattern baldness. It is caused by the action of DHT (a by-product of the hormone testosterone) on the hair follicles.
How Does Hair Grow?
In order to understand how minoxidil works, you will need to understand a) how hair grows normally and b) what is different in people with a genetic susceptibility to hair loss.
There are three different phases in the life cycle of every hair. These are the same regardless if the hair is growing on your toes or on the top of your head (1). These three phases are:
This is the phase your hair is in most of the time. It is the ‘growing’ phase, during which the hair on your head grows about half an inch a month. This growth is somewhat faster in the summer than in the winter.
This phase is the longest of all and can last three to five years. After that, the follicle enters the next phase.
This short phase occurs at the end of the anagen phase. It lasts approximately 10 days. It is the transition phase between anagen and telogen.
This is the phase where the hair falls out. Luckily, this happens at a different time for each follicle. It is for this reason that we don’t lose all our hair at once! The average person sheds 80 telogen hairs a day.
This period of telogen lasts three months. Afterward, the next anagen phase starts, repeating the cycle again.
Hair Loss & the Hair Growth Cycle
These three phases take place in regular cycles in healthy people. However, sometimes they can be disrupted. For example, in cases of extreme stress, like crash dieting or severe emotional distress, many hair follicles can enter the telogen phase at the same time. When this happens, lots of hairs are shed at the same time. This condition is called telogen effluvium.
If you have androgenetic alopecia, the hair loss cycle will also be affected. With each new cycle, the length of the anagen growth phase will shorten. On the other hand, each telogen phase will become longer and longer.
The result is hairs that are growing out for smaller and smaller periods of time. This is partly why hairs in androgenetic alopecia become progressively shorter, thinner, and weaker.
They will fall out more easily and will appear much finer. Eventually, you will lose your hair for good.
How Does Minoxidil Work?
Though no one is sure exactly how minoxidil works, it is thought that it allows more oxygen and nutrients to get to the follicles where the hair grows. This may be due to the fact that it is a known potassium channel opener. It is also a powerful vasodilator (2).
Minoxidil was originally developed as a vasodilator, namely a drug that widens the blood vessels. Early in its use, doctors and patients discovered that the drug also had hair growth properties (3). The drug allows the follicles to spend more time in the anagen growth phase. The result is that the hair grows back thicker and longer. This effect improves with each hair cycle of continued minoxidil use, but it plateaus after a few months (4).
A possibility is that minoxidil accomplishes this due to its vasodilating properties. By increasing blood flow to the scalp and, as a result, the flow of oxygen and nutrients, some scientists speculate that minoxidil stimulates the follicle to spend longer in anagen. The result is a halt of the follicle miniaturization process.
What Can I Expect If I Use Rogaine?
If you use Rogaine according to the manufacturer’s instructions, you will need to apply it to a dry scalp, twice per day. That is the case for both the foam and the solution versions.
One of the more startling effects of using Rogaine is that you will experience a phenomenon called ‘shedding’ in the first two weeks (5). This means you will experience a temporary increase in hair loss. The old anagen hair is falling out to make way for new, thicker hair.
It may take up to four months before you see the new hair growth. Even then, this new hair may be fine and relatively unpigmented. Minoxidil may take some time to get your hair back to its original state. It is expected that hair will get thicker as time goes on.
If you have not seen any new hair growth after four months, the manufacturer recommends you stop treatment.
How Much Hair Will I Grow?
A study published in 2014 looked at the impact of using 5% minoxidil (which is the concentration Rogaine comes in) on people with AGA (6). The study found that while 40 percent of users had some regrowth, this typically took three to six months to take effect.
Earlier studies published in American Family Physician showed that those who used the product for two years had significant terminal (thick and long) hair growth.
That review study also showed that it could, in fact, take up to six months to see any results. This is significantly longer than the four months suggested by the manufacturer.
The study also found that 50% of men who used minoxidil for 2.5 years could grow hair of moderate to dense thickness (8). Actually, 32% of these men needed that hair to be cut and 36% felt that it was worth the time and money to continue treatment (9).
However, you should note that the effectiveness of the product varied depending on the location of the thinning. The ideal candidate had been bald for fewer than five years, with a bald patch that was fewer than 4 inches (10cm) in diameter, and located on the vertex.
The chart below shows how the ideal candidate for Minoxidil treatment scores between III-V vertex on the Hamilton chart.
Men who have more advanced hair loss may still try to use Rogaine. Statistically, however, satisfaction with the results drops off for men greater than a V on the Hamilton chart.
Men who stopped using minoxidil rapidly lost the hair they gained during therapy. Three months after discontinuation of therapy, hair counts were at or below baseline hair counts (10).
This means that you need to use Rogaine indefinitely. Androgenetic alopecia is a chronic progressive condition. Even if you get good effects with Rogaine, you are not treating the root cause of your hair loss. This is why the hair loss will resume as soon as you stop treatment.
What Are the Side Effects?
All medicines have some risks associated with them. Rogaine is no different. While this product is relatively well-tolerated, it can cause dandruff and dryness of the scalp (11). Some even get contact dermatitis from it, which is a bit like eczema.
Dandruff can contribute to hair problems so if this is something you suffer from while using it, stop immediately.
Some people can be allergic to the chemical and end up with breathing difficulties and tachycardia. This is rare, but if it happens you should stop usage immediately.
Tricks To Make Rogaine More Effective/Work Faster
There are a few simple tricks to make minoxidil work more effectively. The first one is to use something called a dermaroller.
Use A Dermaroller
This is a small roller device covered in tiny metal pins. The pins penetrate the dermal layer just deep enough to produce superficial wounds to the skin. These increase collagen production, stimulate blood flow, and reduce calcification (12).
Studies have shown that using a dermaroller in combination with minoxidil is much more effective than minoxidil use alone (13).
The graph below shows the before and after hair counts of two different groups of men in a clinical study. One group used minoxidil on its own, and the other in combination with a dermaroller.
After 12 weeks the dermaroller + minoxidil combination went from a hair count of 226 to 317. This is an increase of 91 new hairs. The group to receive minoxidil by itself went from a hair count of 201 to 218. This is an increase of only 17 hairs.
You can use the dermaroller wherever you are experiencing hair loss. This can be at the frontal area, the crown, or both.
Be sure to clean your dermaroller after each use, and never share it with anyone else.
(Learn more about dermarolling here.)
Scalp Massage & Exercises
Scalp massages and exercises are an effective way to regrow hair! They even work without using any topical treatments like minoxidil.
The goal of the exercises/massages is to increase blood flow and make the scalp more flexible, elastic, and soft (15). These are all conditions that make new hair growth much more likely.
If you carefully observe someone with a bald head you will see how stiff, shiny, and thin the scalp is. Scalp massage helps reverse this.
You can learn some scalp massage techniques here.
Rogaine Reviews From REAL Users
You might still be undecided about starting Rogaine. If you have already started treatment, you may be wondering if the pros and cons you have experienced are common. Whatever the case, it is always helpful to consider the reviews offered by real users.
In summary, here are some PROS and CONS as offered up by REAL users of Rogaine products:
- Slowed down hair loss
- Regrew some lost hair (in newly-balding areas)
- Improved hair’s overall quality
- Be prepared to use for several months before you see results
- Shedding, aka “dread shed”, is a very common occurrence
- It can cause itching and general irritation, especially in the beginning of treatment
Of course, the results will vary from person to person. This means the only way to know if the solution will work for you is to try it yourself.
Does Generic Minoxidil Provide the Same Results?
Rogaine is the most popular brand product to contain minoxidil. However, many other hair loss products also contain minoxidil. These generic products are far cheaper, but they work as well as the branded Rogaine?
The answer is yes. Even though the inactive ingredients differ from brand to brand, the active ingredient is the most important part of the formula. As such, any two products with the same active ingredient should work similarly.
Of course, there may be some differences between the products. These include how it applies, as well as the possible side effects.
For example, some users claim that the Kirkland brand minoxidil is quite greasy. Others say that the Rogaine brand product dries out their scalp. This all comes down to inactive ingredients, especially in relation to the presence of alcohol.
Liquid or Foam?
A common question is whether to go with the liquid or foam formulation.
Rogaine topical solution was the first to be developed and approved by the FDA. It has been in use since 1988 (16). As far as symptoms go, Rogaine liquid solution was causing a number of irritations. These include itching, flaking, redness, and dryness. As research continued, scientists discovered that minoxidil was not the issue. Instead, an ingredient found in Rogaine liquid – propylene glycol – was the culprit.
In response, researchers worked to develop a Rogaine solution without propylene glycol. This is where Rogaine foam comes in (17). The foam does not contain propylene glycol. As a result, many users tolerate it better.
As a liquid, Rogaine topical might be absorbed into the scalp better. This can mean better hair growth results, which is why Rogaine topical solution is typically recommended to be used in smaller doses (especially for women).
On the other hand, Rogaine foam can stick to the hair shafts and not penetrate the scalp as deeply.
If you have a sensitive scalp, or you would like to work with a product that is easier to apply, choose the foam.
However, if you are interested in faster results, the liquid would be the way to go.
2% vs 5%
Rogaine and other minoxidil-containing products come in two concentrations: 2% and 5%. Which one is best?
Will a Higher Concentration Increase Results?
While a stronger dose may work for individuals who did not respond to minoxidil 2%, you will not necessarily see 2.5 times more growth when you switch from 2% to 5%.
This is because the response to the drug does not increase directly in line with dose increase (18). If you do experience improved results, these will probably be far less than 2.5 times what you would have experienced from using a 2% minoxidil formula.
Is There an Increased Risk of Side Effects?
Alongside dose-response is the concept of diminishing returns. That is, side effects increase without enough of a benefit return.
This may not necessarily happen with the 5% formula. After all, many individuals use it without ill effects. However, as dose increases, so too does risk of side effects. This is especially true in female users of the product, as studies show them to be more sensitive to minoxidil’s systemic effects (such as hirsutism).
Results and Expectations
One reason that some users of Rogaine find themselves less-than-pleased with the results is because they do not know what to expect. With any hair loss treatment, it is important to go in with a clear understanding.
First, you must know that Rogaine does not work for everyone.
Second, you should know that shedding is very common at the beginning of treatment. This is known as “dread shed.” This can be very unsettling but it is normal and should stop after a few weeks.
Third, Rogaine takes time. This is not an overnight cure, and it is not a product you can use inconsistently. To decide if Rogaine really works for you, you must use it consistently for at least 4-6 months.
There is no doubt that Rogaine can contribute to hair growth. However, this does not mean that Rogaine is the right treatment for everyone.
Some users will see minimal results, and others no results whatsoever. Even when users see results, the side effects and hassle of daily application can prompt some users to stop treatment.
The only way to know if Rogaine is right for you is to give it a try. But you may also want to combine it with the other techniques – including microneedling and scalp massages – mentioned above.