Is the original medication still the best option for hair loss, or are there better alternatives now?
As the very first FDA-approved medication for androgenic alopecia, Minoxidil (brand name: Rogaine) was an amazing innovation in the hair loss market.
However, you may be surprised to hear that Rogaine's formula has not changed in the 33 years since it was approved by the FDA in 1988.
Instead, Johnson & Johnson (the company that owns the Rogaine brand and formula), has primarily invested in marketing the product, instead of improving the formula or creating new and innovative products.
In the meantime, other startups and companies have been developing their own hair loss products that rival and even outperform Rogaine in key areas.
Before you opt for Rogaine, or any Minoxidil product, here are four things to consider:
How well does it work?
This is a very important question, and one we get A LOT. How well does minoxidil actually work?
Fortunately for us, since minoxidil / Rogaine (we'll use these terms interchangeably from now on) has been around for such a long time, there is a lot of research to draw on.
Let's first look at a clinical study from 2002, which compared a 5% solution of minoxidil to a 2% solution in 393 men with androgenic alopecia.
There was also a placebo group, and treatment lasted for 48 weeks.
The patients applied 1ml of solution (either 5%, 2%, or placebo) to their scalp twice per day. The total daily dose was 2ml.
After the initial visit, subjects returned every 4 weeks until week 32. They then returned every 8 weeks until the end of the 48-week trial.
The researchers performed safety and effectiveness evaluations on multiple points through the trial.
These were the results at week 48:
So, as we can see, Minoxidil does improve hair loss outcomes over the course of 48 weeks, and 5% minoxidil is better than 2% minoxidil.
However, the changes are underwhelming, as shown by a score of 62 in the 'Change in scalp coverage' assessment, which indicates only slightly better scalp coverage than before the start of trial.
So, yes minoxidil can regrow some hair but the results are relatively limited.
If given the choice, you should opt for 5% Minoxidil over 2% because the amount of hair regrowth is increased by nearly 50%.
We just saw how, on average, most men will get some regrowth over the course of 48 weeks.
But we know that people respond differently to medications. So what percentage of users won't see any regrowth at all?
To answer that, we can look at the results of a large study, published in 2007 in the Journal of the American Academy of Dermatology.
The study was randomized, placebo-controlled and double-blind.
This is a good study to look at because it had a large sample size, and since it it both double-blind and placebo controlled, the results are more likely to be fair and accurate.
The study compared the efficacy of 5% minoxidil versus a placebo in balding men who were between a 3 and 5 on the Norwood scale.
Treatment lasted for 16 weeks. At that point, a blind panel of 3 experienced medical doctors reviewed the before and after photos of the participants.
Ratings were given on a 7-point scale, from +3 to -3. So +3 stood for significant hair regrowth, +2 for moderate, and +1 for slight regrowth.
Zero was given to a more or less unchanged head of hair, and negative values were for new hair loss since the start of treatment.
52% of the men on minoxidil got a zero, meaning there was no observable change. And another 10% or so dropped out of the study.
Which left less than 40% of men with some regrowth after 16 weeks.
So in summary, we can see that around 50% of people who use minoxidil won't see any results from it, and those who do will only get mild regrowth, even after they've been using the medication for nearly an entire year.
2. Long Term Success
Is minoxidil a good long term solution?
We now know that after 48 weeks, around 50% of users will get some mild regrowth.
To be fair, this is better than doing nothing, in which case these users would likely continue to experience further hair loss.
However, it's important to consider whether the outcome achieved in the first year is sustainable long-term.
So, out of 100 men who try minoxidil for their hair loss, how many will still be using it after 5 years?
Again, this is a very important question to consider, because minoxidil is not a baldness cure.
What we mean by this is that Minoxidil is not solving the underlying the issue that is causing the hair loss in the first place.
If it did, then using Minoxidil would result in full regrowth.
Since it is not a cure, but just a temporary solution, users will need to continue taking the medication indefinitely in order to maintain their results.
It’s something you’re meant to continue taking for life.
That's why it's worth understanding whether people who start on Minoxidil are happy with it and continue using it indefinitely, meaning they can maintain their results long term.
If not, then it might not even be worth starting with the medication since you'll just need to find another solution in the not too distant future.
To answer this, there are 2 studies available that looked at minoxidil usage over a 5-year period.
The first one was a 1990 paper from a team of researchers out of North Carolina.
These doctors were interested in seeing how the hair responds to minoxidil in the long run. Does it keep on growing? Does it start falling out again? etc.
So they ran a 1-year study, which was completed in total by 126 men with hair loss.
But unlike most other studies, they followed up with these 126 patients for another 4 years, which meant a total of 5 years of observation.
At the end of the 5 years, only 31 of the 126 men were still on minoxidil. That’s just under 25%, which is a low percentage and quite disappointing.
Bear in mind also that these men were all involved in a research study.
So there’s likely going be a bit of a sense of obligation to the doctor to continue the treatment all the way to the 5-year mark since they’ve invested a lot of time and effort into the participants, and it’s only normal that they would feel like they owe something to the doctor.
Not to mention the participants would have also been receiving the medication for in exchange for taking part.
So perhaps the numbers are higher than they would otherwise be.
But what about real-life statistics? What about men who try minoxidil, with or without a prescription, and aren’t on a clinical trial or research study?
That’s basically everyone nowadays, potentially including you. The real-world users.
Well, minoxidil’s been on the market for over 30 years now. And surprisingly, there’s only been 1 study that looked into this, published in 2009.
The authors of this study selected a total of 1480 men who attended one of two private dermatology clinics in the city of Ahvaz in Iran.
No clinical trial, no extra assessments, nothing. Just ordinary, standard-of-care dermatology.
All men were between 20 to 40 years old, and had been suffering from hair loss for less than 5 years.
So these were deemed good candidates for hair loss treatment. Not too advanced, nor too old.
The men were examined by their doctor and prescribed 5% minoxidil, twice daily.
The researchers then simply made a record of who continued to take their minoxidil. This was either through clinic visits every couple of months or over the telephone.
By 6 months, over 50% of patients had stopped treatment.
And by 12 months, fully 95% of patients had stopped treatment.
After 5 years, out of the 1480 who had started it, there was just 1 patient who was still on treatment.
Which after you round it up, is basically 0% continuation at the 5-year mark.
The obvious question is why. Why does almost everyone stop?
Well, the Iranian researchers asked the patients why they stopped their minoxidil, and they learned that the basic reason was that the treatment just didn’t work on its own.
Two thirds of the men said minoxidil just wasn’t doing much for their hair.
Another 15% said they couldn’t be bothered, and around 13% said it was because of the side effects.
The remaining 5% said because it made their hair look and feel bad
To quote the doctors who wrote this study:
“…most scientific trials report to have seen an increase of terminal hair in about 30% or more of the patients. But despite many scientific trials, the results are quite different in daily clinical practice. The patients’ expectations are much more than the virtual effect of minoxidil. […].
The differences between the results of this study and those in scientific trials might be due to the different behaviours of patients under normal conditions with those in scientific studies”.
The takeaway if you’re considering minoxidil as a standalone treatment, you’re almost certainly not going stick to it.
If you’re anything like the average user, you will probably last 6 months, 12 months maximum.
You'll also have to ask yourself whether the potential side effects during that time are worth, which leads us onto the next section.
3. Side Effects
What are the possible downsides and how likely are they?
As we've just seen, one of the problems with Minoxidil, aside from the low efficacy, is that a fairly large percentage of men will experience side effects in one form or another if they continue to use the medication for long enough.
But what are the possible side effects, and how likely are they to happen to you?
To answer this, we can look to a study from 2019 in which 90 male participants applied 5% Minoxidil twice daily for 36-weeks in double-blinded, placebo-controlled trial.
In this study, the researchers asked participants whether they had experienced any side effects through the course of the trial, and if so what those were.
Below, we've listed the most commonly named side-effects that Minoxidil users experienced.
Red or inflamed skin
Hair growth in unwanted places
Dull or throbbing headache during or after application
Temporary hair shedding
Accelerated loss of hair when beginning treatment
View the full table by scrolling horizontally
Based on the numbers above, it's no wonder that hardly any users stay on the medication long term.
If over 1 in 5 men will experience some sort of skin irritation over the course of just 36 weeks, then it's easy to see how most men will discontinue using it, especially given that only mild regrowth appears to be the best outcome.
In light of the research that we've looked at, minoxidil is beginning to look like a less and less attractive option.
This leads us onto the next section where we'll explore the best alternatives available in light of the impressive advances in hair loss research over the last 3 decades.
Are there better alternatives available now?
It's been over 30 years since Rogaine hit the market, and in that time there's huge progress has been made in the hair loss space.
We now know so much more about the causes of hair loss, that the solutions have become more sophisticated and targeted.
For example, research has uncovered the way that Minoxidil works.
It's a vasodilator. This means that it stimulates hair growth by increasing blood flow to the hair follicles so that they have more oxygen and nutrients available to help with hair growth.
Vasodilation is a good way of stimulating hair growth. But there are many other methods for improving hair growth.
Below, we've listed the top 6 factors that contribute to hair loss.
You can see that minoxidil only targets one factor: poor blood flow.
This leaves a lot of room for improvement, which unfortunately Johnson & Johnson never did.
The ultimate hair loss product would be one that targets and alleviates all 6 factors. Unfortunately, as of yet, there is no single product that does treat all 6.
However, here at Hairguard we have been hard at work developing our own hair growth serum, and after years of development we've finally created a product that tackles 5 of the 6 factors.
This product is known as Biogaine and the formula includes a wide array of ingredients and it is designed to be more effective than minoxidil, but without the side effects.
For example, to improve blood flow, it uses Adenosine, Caffeine and Arginine, all of which are clinically-proven vasodilators.
It also includes a number of ingredients that help block the accumulation of DHT, such as Zinc and Azelaic Acid.
Blocking DHT was the basis for the invention of the drug finasteride, which was developed because blocking DHT has been shown to completely stop the progression of hair loss.
The problem with finasteride, however, is that it's a pill that's taken orally, and this means that it blocks DHT throughout the entire body.
Since DHT is a powerful male hormone, blocking it can result in nasty side effects. In fact, it's so powerful that women aren't legally allowed to use it, and men must get a prescription for it.
Hairguard solves this problem by including the DHT-blocking ingredients in the Biogaine formula, so that they get applied directly to the scalp, and thereby do not cause side effects in the rest of the body.
This multi-factorial approach makes the product particularly effective for both men and women with thinning hair. We're proud to say that we are yet to find anything nearly as advanced as Biogaine.
When Minoxidil was first brought to the market, it was a game-changer for hair loss, since there was literally nothing else on the market that was clinically-proven to work for hair regrowth.
However, in the 3 decades since, there have been many advances in hair loss research and innovation, and we now know that in order to be as effective as possible, the product should aim to tackle all 6 factors that contribute to hair loss.
In our opinion, Biogaine is the best hair loss product available, managing to tackle 5 of the 6 factors.
Below is a summary of Biogaine vs Rogaine.
Click on the image to make it full-size
As you can see, Biogaine beats Rogaine in every category except for price.
This is to be expected considering the far larger number of active ingredients and the sophistication of the product.
If you're interested to find out more, then click the button below.