Minoxidil and finasteride are the only two FDA-approved hair loss treatments on the market. In this post, I’ll take a look at their well-known name brand products – Rogaine and Propecia – and how they compare to each other.
I’ll discuss the various differences between the two products – including mechanisms and side effects – and look closely at the scientific evidence that compares their use.
In the end, I’ll also share with you a plant-derived formula that I’ve used to stop hair loss and regrow hair.
About Rogaine (Minoxidil)
Rogaine was first approved by the FDA in 1988, though the active ingredient minoxidil was in use since 1979 as an anti-hypertensive medication.
How It Works
To understand how Rogaine works, it’s first important to understand the cause of Male-Pattern Baldness (MPB).
MPB occurs as a result of sensitivity to the androgen hormone DHT. This is produced when testosterone (the male sex hormone) and 5-alpha-reductase (an enzyme) interact.
With DHT produced, it is able to attach to the hair follicles (through the androgen receptor). When this occurs on sensitive hair follicles, this causes inflammation and irritation.
As the follicle inflames, a process known as hair miniaturization takes place. This means the hair has difficulty growing until, eventually, growth stops completely.
Additionally, the inflammation leads to poor circulation to the follicle, and the follicle withers (and, if left untreated, dies).
Unlike Propecia, which works by inhibiting DHT (more on that later), Rogaine works by dilating the blood vessels and improving circulation to the hair follicles.
Essentially, Rogaine makes it possible for your hair follicles to thrive in a hostile environment.
As circulation improves, the follicle is then able to receive oxygen and vital nutrients. This keeps the follicle healthy and can cut down on inflammation. This will also help to stop hair miniaturization and, if treated early, can even reverse it.
How to Use
Rogaine is a topical solution, and it’s applied twice per day (for men), and once or twice per day for women (depending on solution being used).
The application process will vary slightly depending on which formula you use (liquid or foam).
- Collect 1mL of liquid into the dropper.
- Part your hair (if necessary), and apply directly to the scalp.
- Use your fingertips to massage the foam into your areas of thinning (and be sure to wash them thoroughly).
- Let dry completely.
For best results, avoid applying other hair products for at least four hours. This will give the solution time to absorb fully.
For women, apply this treatment twice per day.
- Rinse your hands with cold water, and dry completely.
- Dispense one-half capful of the foam onto your fingertips.
- Part the hair (if necessary), and apply directly to the scalp.
- Use your fingers to massage the foam into your areas of thinning (and be sure to wash them thoroughly).
- Let dry completely.
For women, apply this treatment once per day.
As with any medication, there are some side effects to consider prior to treatment.
The majority of side effects associated with Rogaine use are topical in nature. These include itching, redness, flaking, and dryness.
Systemic side effects can occur – such as headache, dizziness, nausea, lightheadedness– though these are more rare. In women, the risk of excess facial hair growth is also a possibility.
If you experience symptoms of an allergic reaction, including hives, vomiting/diarrhea, or swelling of the lips, mouth, tongue, or throat, stop use immediately and see emergency medical attention.
About Propecia (Finasteride)
Unlike Rogaine, Propecia is a medication taken orally (in the form of a pill). It is taken once per day.
Initially, finasteride was FDA approved in 1992 (under the name Proscar) for the treatment of enlarged prostate. In 1997, it was finally approved under the name of Propecia for the treatment of male-pattern alopecia.
How It Works
As mentioned, Propecia works by inhibiting DHT. This means that hair miniaturization can be treated before it occurs, or reversed if it’s only in the earliest stages.
The main ingredient in Propecia, finasteride, works by inhibiting the enzyme 5-alpha-reductase. This means the drug works on a biochemical level, and this interrupts the usual balance of hormones within the body.
With less DHT, the hair follicle will no longer have a reason to be inflamed. This means that hair miniaturization will not take place, and any current miniaturization may be reversed depending on severity.
How to Use
The drug should be taken once per day and, for best absorption, taken on an empty stomach.
As Propecia has a short lifetime in the body, you should aim to take it at the same time everyday for best results. This may not always be possible, but it helps to add it to another habit of yours, such as brushing your teeth when you wake.
As DHT is a vital hormone within the body, its inhibition can lead to some less-than-pleasant side effects.
Common side effects of Propecia use include:
- Loss of libido
- Difficulty getting an erection
- Difficulty maintaining an erection
Warning! The sexual dysfunction side effects associated with Propecia – including loss of libido and inability to get an erection – may be long term. This means that side effects can continue long after treatment has ceased.
Rogaine vs. Propecia: The Scientific Evidence
In terms of effectiveness, let’s take a look at how the two hair loss treatments compare.
In 2003, researchers recruited 99 men (ages 18 – 45) with moderate mid-frontal and/or vertex balding to participate in a comparative study. The men were randomized into one of two groups.
The first group received once-daily oral finasteride (1 mg/d), while the second group received topical 2% minoxidil (1 mL twice daily). Each group continued treatment for 12 months.
At the 12 month mark, the participants were asked if they would like to continue treatment for another year. 83% of the finasteride-treated group and 81% of the minoxidil-treated group agreed to do so.
Researchers randomly counted hairs on the baldest area of each participant’s scalp, and thickness was also measured. This was done at baseline, and at 3, 6, 9, and 12 months.
For participants who chose to continue treatment past the initial one-year mark, measurements were also taken at 18 and 24 months.
At 3 months, 33% of the minoxidil group reported slight or moderate hair growth compared to 12% using finasteride. However, the difference between both groups at 12 months and 24 months was insignificant.
Which Drug is More Effective?
For men with male-pattern baldness, Propecia is the more effective treatment. This is because it targets the main cause of pattern alopecia (DHT). However, the side effects make it an unbearable treatment for a number of men.
For women with pattern hair loss, Propecia is not recommended or FDA approved. Instead, Rogaine has shown itself to be an effective treatment.
Can Rogaine and Propecia Be Used Together?
When hair loss sufferers want improved results, sometimes they combine treatment methods. Rogaine and Propecia are two such methods which are commonly used at the same time.
How to Use
As both drugs are taken in different ways (Rogaine is a topical application while Propecia is an oral pill), using them together isn’t difficult at all.
You can use both treatments as recommended, as the use of one will not interfere with the other.
Is There An Increased Risk of Side Effects?
There’s always a risk of side effects when you use over-the-counter treatments for your hair loss. However, combining two powerful methods can mean a higher risk of ill effects.
Are There Natural Alternatives?
Rogaine, Propecia, and other such over-the-counter treatments may provide positive results, but they don’t treat the underlying issue. That’s why I recommend you also consider other factors within your control.
A Change in Diet
While the minoxidil alternative above will offer you positive results, the best thing you can do for your hair is to pay special attention to what you’re putting into your body. After all, what you eat effects all body systems, including hair growth.
Unfortunately, the modern diet is full of unhealthy foods and beverages. These include red meat, alcohol, dairy, high-sugar grains, and carbonated beverages.
The consumption of such foods leads to an unhealthy environment throughout the body, and this can negatively impact the entirety of your health and trigger hair loss.
So, what can you do?
The easy answer is to increase your intake of leafy greens, fruits, lean meat, nuts and seeds, etc.
You can easily add these to your regular diet menu, or add a smoothie to your mornings for a healthy boost.
Rogaine and Propecia are the two most popular hair loss treatments on the market. They work in different ways to combat balding, though their results are similar in a lot of ways.
However, I recommend against the use of over-the-counter treatments and encourage the use of natural ones, instead.
This is because Rogaine and Propecia only work as long as you use them, and the risk of long-term side effects just isn’t worth it.
*This article was reviewed by Dr. Anil Simhadri