Rogaine is the first of two medications FDA approved to treat hair loss. And while you may start using the drug with the expectation of seeing results immediately, that’s unfortunately not going to happen.
This post will introduce Rogaine, how it works, and how it can be used to treat pattern hair loss. It will also help to realign your expectations, including how long it can take to see regrowth and how much hair growth you can expect.
I’ll also share a few tips for potentially speeding up the results, or increasing overall satisfaction with the drug.
What Is Rogaine?
Rogaine is a brand name hair loss drug that was developed in the 80s and which became widely available in the 90s. This topical solution – first developed as an oral tablet for hypertension – contains the active ingredient minoxidil (1).
How Does It Work?
The main contributor to Rogaine’s success as a hair growth promoter is its vasodilative effects.
Rogaine – and more specifically, minoxidil – has been shown to increase lower blood pressure by dilating the blood vessels. And when applied topically, it can even increase cutaneous blood flow to the area (2).
The drug is also believed to open potassium channels and “upregulate the expression of vascular endothelial growth factor in human hair dermal papilla cells” (3, 4).
Who Is an Ideal Candidate for Use?
Rogaine and other minoxidil products are marketed towards both men and women who are experiencing pattern hair loss (which I’ll expand upon below).
But as with any drug, there are those individuals who will respond more favorably.
Pattern hair loss happens in stages. The most commonly accepted stages are those on the Hamilton chart below:
The users with the highest likelihood of regrowth will fall between stage III and stage V on the chart. This is because their follicles are miniaturized but still alive and, therefore, able to produce hair if the inflammation were to decrease.
That’s not to say that those with later stages won’t see some success. However, it’s very unlikely that they’ll ever regain their original hairline, which is why it’s best to start using Rogaine as soon as you can.
How to Use Rogaine to Treat Pattern Hair Loss
So, what do the mechanisms of Rogaine have to do with its treatment of hair loss?
First, it helps to understand the hair growth cycle.
The Hair Growth Cycle
There are three stages (or four, if you want to get technical) of the hair growth cycle.
They are anagen (active growth), catagen (transition), and telogen (resting). The fourth is exogen which is simply the period before active growth reoccurs.
For people without a hair loss condition, the vast majority (~80 percent) of hair follicles are in active phase at any given time. This stage lasts for years.
However, a hair loss condition such as Male-Pattern Baldness (MPB) can interrupt this natural process and lead to thinning and hairline recession.
Where Pattern Hair Loss Fits In
Androgenetic Alopecia (AGA), also referred to as pattern hair loss and MPB, is a genetic condition that causes hairline recession and eventual balding (5).
There are many factors that contribute to this condition, but sensitivity to the androgen hormone Dihydrotestosterone (DHT) is the one most often targeted by hair loss drugs.
DHT is a hormone that plays a role in the development of secondary sexual characteristics in boys (6). It is a product of testosterone and 5-alpha-reductase.
When DHT attaches to the follicle in those with AGA, it leads to inflammation of the follicle. This is more commonly referred to as hair follicle miniaturization.
Rogaine for the Treatment of Pattern Hair Loss
As you can imagine, the chronic inflammation attributed to DHT slowly cuts off the blood flow to the dermal papilla. By widening the vessels, minoxidil is able to ensure the delivery of nutrients and oxygen to miniaturized follicles.
The presence of minoxidil is also believed to upregulate growth factors in the dermal papilla cells. This means that it actively contributes to hair growth by stimulating cell division.
Results: What You Should Expect
There are many long-term users of Rogaine who are happy with the hair growth they see. But as a new user, the results may seem unimpressive.
This is why it’s important that you align your expectations with reality.
The first reality to face is that Rogaine takes time to work. I’ll discuss this more in-depth below, but it’s important to understand that you won’t see results overnight.
Second, there is a period in the beginning where you will likely experience an increase in shedding. This will also be discussed in more detail below.
All of this to say, it’s important to align your expectations with reality so as not to become discouraged.
How Long Does Rogaine Take to Work?
When you’re suffering from hair loss, you want a treatment that will provide you with immediate results. Unfortunately, that does not exist.
But that doesn’t mean you’ll need to wait years to see regrowth.
When reviewing the literature, it’s safe to say that the majority of users will see results by six months of usage.
That’s not to say that results before six months aren’t possible. After all, 26 percent of men reported moderate to dense regrowth after only four months of consistent use (7).
But what about long-term results of using the drug?
Rogaine, and minoxidil in particular, have been studied in-depth over the years. The majority of these studies are completed over a 12-month period.
One of these studies showed that moderate to dense hair growth was present in about 50 percent of the participants by the end of the trial (8). The majority of this hair growth was realized by month four, though some users did take up to six months to see results.
A second study performed in the same year found that 87 percent of participants (89 out of 102) experienced visible hair growth over the course of one year (9). And dense hair growth – enough to require a haircut or comb – was noted in 32 percent of the men (33 out of 102).
Best of all, both studies utilized 2 percent and 3 percent minoxidil solutions. This means drastic results were present with very little occurrence of side effects.
4 Ways to Speed Up the Effects of Rogaine
It’s not entirely possible to quicken the results, but a combination of hair growth techniques can contribute to the overall results. Here are just a few of those techniques.
Combine It With Other Medications
There are other drugs besides Rogaine that are used for treating hair loss.
The most common – and the second and last drug to be FDA approved for alopecia – is Propecia (finasteride).
Propecia is an oral tablet that was originally developed to treat prostate enlargement (10). It works by inhibiting the activity of 5-alpha-reductase and, as a result, lessening the amount of DHT present within the body (11).
Clinical studies on this drug have shown significant results in men with androgenetic alopecia (12).
A similar drug, dutasteride, also inhibits 5-alpha-reductase (13). However, this drug takes a more aggressive approach.
There are two types of 5-alpha-reductase. Propecia blocks just one type, while dutasteride blocks both.
And while it may seem logical that dutasteride would improve results, there is an increased risk of side effects (14).
But whichever of the above drugs you choose, you’ll be happy to know they can be combined with minoxidil.
Combine It With Microneedling
You don’t need to add more drugs to your daily routine to see improved (or quickened) results with Rogaine. Another approach is via microneedling.
In simplest terms, microneedling is a cosmetic procedure where tiny needles penetrate the skin (15). The needles cause minor trauma to the skin which trigger the healing process (16).
When used on the scalps of those with AGA, microneedling can stimulate the proliferation of collagen and hair cells. It can also break up calcification which happens after an extended period of untreated miniaturization (17).
And best of all, microneedling has been proven to be effective by itself or when combined with minoxidil (18).
Incorporate Other Scalp Stimulation Techniques
While I strongly recommend you consider adding microneedling to your hair care routine, there are other techniques with similar results.
Massage and Exercises
If you want to add a less “intense” technique to your repertoire, then give scalp massage and exercises a try.
As mentioned above, chronic miniaturization can lead to calcification of the scalp. This reduces blood flow to the follicle even further and, if left to harden completely, it can kill the follicles entirely.
The presence of DHT is a large contributor to calcification. However, mechanical tension can also play a role (19).
Scalp massage has been proven to reduce tension and even increase hair thickness (20). It can also stimulate blood flow and lessen inflammation (21, 22).
Exercises – which are just basic movements that gently stretch the skin and work the muscles in the area – can have similar results as massage.
And best of all, massage and exercises are low risk and easy to do on a daily basis.
Laser Therapy
Low-Light Laser Therapy (LLLT) is a fairly new treatment technique that’s helpful for a variety of conditions (and particularly those with chronic pain) (23).
But what is it?
LLLT is a technique that uses low-level lasers to interact with your body on a cellular level.
As the laser penetrates the skin, the light is absorbed by cells. This triggers the release of cellular energy (ATP) via the mitrochondria.
This energy is then able to make much needed repairs to the surrounding structures (such as the hair follicles), or even stimulate replication of cells.
There have been quite a few studies – at least 21, to be more exact – on LLLT for treating hair loss (24). And while not all of these trials have been carried out on human subjects, the research is still enlightening nonetheless.
These studies have shown that LLLT can be used to transition hair from telogen to anagen which likely contributes to its ability to increase hair density (25, 26).
If you do choose to use LLLT alongside minoxidil, it’s best to wait a few hours – at least 8 – between applying the solution and using the laser device.
Complications and Considerations
There’s always a risk of adverse effects when you start a new medication.
For most people, the side effects are mild (27).
The most common include irritation, flaking of the scalp, and itching. These are often attributed to the inactive ingredient propylene glycol and not minoxidil itself.
Systemic side effects are possible, including headache, lightheadedness, and dizziness. These are more common for those who use higher concentrations (e.g. five percent), but they can occur in two percent minoxidil users if they are particularly sensitive to the drug.
Minoxidil Shedding
At the very start of minoxidil use, you’re likely to experience something known as minoxidil shedding (28). This is not so much a side effect as it is a part of the regrowth process.
When minoxidil is first applied to the scalp of someone with AGA, it’s very likely that a good portion of their follicles are in telogen phase. But to see hair growth, these follicles must be pushed through to anagen.
To do this, the hair must first be shed. This occurs during the phase known as exogen.
When this happens, you will notice an increase in shedding. And while it’s alarming at first, it’s temporary and should stop within eight weeks (29).
Will a Higher Concentration Mean Faster Results?
As Rogaine (and the generic minoxidil) has grown in popularity, there have been a few different formulations made available to the public.
The most common dose of minoxidil is two percent. This is available in both liquid and foam formulations, and it’s the one that’s most often recommended by doctors.
However, a five percent formulation does exist. This does come with increased risk of side effects, of course (30).
So, does using a higher concentration guarantee faster results? No, not really.
You may see a slight improvement in hair growth if you choose to switch from two percent to five percent, but the improvement is not likely to be directly proportional to the increase in dosage.
As such, you may want to start with two percent to see how you respond.
Rogaine Liquid vs Foam: Which Is Better?
For years, the liquid formulation was the only one available. However, it was soon discovered that one ingredient in this solution – propylene glycol – was causing skin issues for some users.
Propylene glycol is a solvent that’s prone to drying out the skin.
In users who are sensitive to the ingredient, the liquid formulation can cause itching, dry patches, flaking, and irritation.
With this in mind, manufacturers wanted to create a formulation without propylene glycol. That’s where Rogaine Foam comes in.
Rogaine Foam is a foam version of the liquid solution that still contains the active ingredient minoxidil. The main difference between the liquid and foam, though, is the removal of propylene glycol.
But is the foam version just as effective as the liquid?
At this time, there is no comparative studies performed on humans. Though animal studies – such as the one performed on hamsters – does seem to indicate that the formulations have similar efficacy rates (31).
One thing to keep in mind is the foam formulation may not absorb as well as the liquid one which can mean slower results.
But it doesn’t hurt to give it a try if you’re suffering from dermatological symptoms such as those mentioned above.
Conclusion
The studies performed on the subject – and the many happy users of the drug – can testify to the fact that Rogaine is a viable treatment for hair thinning and loss. However, the real question is, is it the right one for you?
The truth is that Rogaine is not the right treatment for everyone. The side effects may be too much to handle, or the results may not be worth the effort.
However, the only way you can know if the drug will work for you is to try it for yourself.
The good news is that Rogaine and minoxidil products can often be combined with other hair growth methods, and this can speed up results or increase the growth you see.
