What is Rogaine?
Before answering the burning question of ‘does Rogaine work?’, it’s a good idea to be clear on what Rogaine is.
ROGAINE® (called Regaine outside the US and Canada) was the first drug approved by the FDA for the treatment of male pattern baldness. Rogaine’s main active ingredient is Minoxidil, a hair growth stimulant.
The terms minoxidil and Rogaine are sometimes (incorrectly) used interchangeably. Although there are many brands which use minoxidil as their main active ingredient to stimulate hair growth, Rogaine was the first and still most popular product containing Minoxidil for reversing male pattern baldness.
It is now also approved as an over-the-counter treatment for female pattern baldness in a 2% strength liquid solution. Stronger solutions for male pattern baldness (5%) are also available over-the-counter, in both a liquid and foam solution.
How Does Minoxidil Work?
As Minoxidil is the main active ingredient in Rogaine it makes sense to take a look at how minoxidil works.
Minoxidil belongs to a class of drugs known as vasodilators and was initially used as an oral medication to treat high blood pressure. (Vasodilation: widening of blood vessels through relaxation of the muscular walls).
Soon after its introduction, a unique side effect was noticed. It caused darkening and / or increased growth of body hair. In some cases, it lead to significant, although often unwanted, hair growth in both men and women.
Rogaine was subsequently developed as a topical solution for direct application to the scalp, containing 2% Minoxidil. Despite more than 20 years of research, scientists still have only a limited understanding of how Minoxidil stimulates hair growth.
Perhaps the most common theory, unsurprisingly, is that it dilates the blood vessels around the hair follicles, increasing the nutrient supply and encouraging hair growth. Given that other vasodilator drugs do not appear to promote hair growth there is reason to question this theory.
A second theory is that Minoxidil induces a significant increase in DNA synthesis in hair follicle cells.
Whatever the case, Minoxidil is one of only three FDA approved hair loss products and is undoubtedly effective in a significant number of cases in promoting hair growth. The stronger the solution, generally speaking, the more significant the results.
Does Rogaine Work?
Rogaine can help both arrest and reverse the progression of hereditary hair loss. As with any drug, results vary from person to person and ‘cosmetically significant’ results are generally only seen at 5% concentrations.
Ultimately, Rogaine is a treatment for hair loss. Not a cure. You need to take it for as long as you want to continue to maintain your results. If you stop, you will likely return to your previous pattern of hair loss within several months of discontinuing treatment.
Why? Minoxidil stimulates hair follicles and growth but does not reduce DHT or the enzyme responsible for its accumulation around the hair follicle, 5-alpha reductase. The current leading theory of pattern baldness indicates that 5-alpha reductase is the primary mediator of male pattern baldness in genetically susceptible individuals. Stopping treatment will therefore result in the hair loss resuming if DHT isn’t kept in check in some other way.
How Long Before I See Results?
The manufacturers of Rogaine claim that results can be seen in as little as 8 weeks using the extra strength (5%) solution and an average of 16 weeks for the 2% strength solution. Results will vary from person to person, although generally speaking the earlier (younger) you start the higher your chances of success.
You may notice a temporary increase in hair loss (shedding) in the first 2–6 weeks. This should subside within a few weeks and, in the normal course of events, should indicate that your hair is shifting from a dormant phase to an active growing phase. If shedding continues for more than 2-3 weeks I’d pay a visit to your doctor.
According to the manufacturers, if you don’t see results after 4 months of applying the Extra Strength Foam (or after 1 year of applying ROGAINE® Extra Strength Solution) twice a day to your scalp, you should discontinue the treatment.
In my experience, I would suggest that if you haven’t seen results using the extra strength solution (whether foam or liquid) after four months you’re unlikely to see any. Give the 2% version 6-8 months before reassessing effectiveness (providing the shedding stops within a few weeks).
If you experience any of the more serious side effects highlighted below, stop immediately and see your doctor.
Best Suited For
The perfect candidate for the 2% Rogaine solution is said to be a young male suffering from male pattern baldness who is just starting to bald in the vertex / crown area of the scalp.
That said, the manufacturers now claim that it can also be used for a receding hair line and it has also proven to be effective in women.
Rogaine should not be used for sudden / patchy hair loss, hair loss following birth, or otherwise unexplained hair loss. In short, it’s suited for male or female pattern baldness. Confirm the cause of your hair loss with a professional before you start the treatment.
Guidelines for Effective Use of Rogaine
The following guidelines should be followed to ensure best results. This is an abbreviated official list, my comments are provided in brackets after each bullet:
- Apply twice daily, once in the morning and once in the evening (once you’ve achieved the results you want you’ll probably find you can flex both frequency and volume and still maintain your results)
- To achieve maximum effect, the solution should be in contact with the scalp for at least 4 hours before allowing hair to get wet (abide by this one if at all possible)
- Allow the solution to dry on your scalp for 30 – 60 minutes before blow drying your hair, using other styling products, or going to bed (do what you can; it can be difficult to work into your routine if you get too hung up on this)
Tip: If you’re using the liquid solution, tap the end of your dropper against your head in multiple locations whilst lightly squeezing the dropper bulb. Massage with your fingers. This allows you to get the liquid directly to the scalp and aids in distribution (provided you move the dropper frequently as you tap).
Rogaine Side Effects
Topical Minoxidil was approved by the FDA for both efficacy and safety with no clinically significant systemic side effects reported.* According to the American Hair Loss Association, “the amount of Minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.”
That said, all drugs have side effects, the severity of which will differ from person to person. The most common for Minoxidil include a dry, itchy scalp. These symptoms should either diminish in a short time during use of Minoxidil or shortly after reducing use (or stopping altogether).
Higher doses will obviously increase the potential for side effects. More severe side effects are chest pain, irregular heartbeats, dizziness and fainting. I recommend familiarizing yourself with the complete list of side effects (here) before making a decision to commence treatment.
*Systemic effect refers to an adverse health effect that takes place at a location distant from the body’s initial point of contact and presupposes absorption has taken place. A Local effect refers to an adverse health effect that takes place at the point or area of contact i.e. scalp (source: Yale University).
- FDA approved for efficacy and safety
- Widely available over-the-counter in most pharmacies and on the internet (if you’re the shy type) for 2% and 5% concentrations. Higher concentrations can be prescribed by a medical practitioner
- Can be used in conjunction with other treatments
- Variable results widely reported (some are better candidates than others or will need to use stronger concentrations to see results)
- Stopping treatment will result in your hair loss resuming within a few months
- Requires discipline to incorporate into you routine on a daily basis (morning and evening)
- Expensive (when you add up the cost over a lifetime, truly exorbitant!)
Does Rogaine work? Yes, but be aware that it is a treatment, not a cure. To maintain results you need to keep administering.
Obviously, it’s far from being a natural solution; there are side effects. Don’t be fooled into thinking that because it’s an over-the-counter treatment that you shouldn’t do your research. There are alternatives and you may not necessarily be a good candidate.
The American Hair Loss Association (AHLA) sums up their review of Minoxidil, the active ingredient, with the following comments:
“While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair, most informed experts see it as a relatively marginally effective drug in the fight against hair loss. Since minoxidil has no effect on the hormonal process of hair loss its positive effects are at best temporary and usually yield somewhat disappointing long-term results.
With that said, the AHLA still recommends the drug for:
“[T}hose who have not responded favorably to finasteride treatment or for those who would like to add another product to their regimen. The AHLA does not recommend minoxidil as the first line of attack for men suffering with male pattern baldness, but does recognize it as an effective treatment for a small percentage of its users.”
Whilst the review does not bother to specify strength, I would agree with the above as far as 2% Rogaine is concerned. I tried the 2% solution for around 4 months, without result, about 5 years into my hair loss.
The 5% solution turned out to be a different story. I started using it at the end of my 8 year battle with hair loss after visiting a local hair loss clinic. The results have been impressive, although I now use the Regenepure 5% Minoxidil product (see the ‘What Treatment Worked For Me: 2016’ page on this site for further details).
I’ve since stopped using virtually all other elements of that treatment plan, with the exception of the 5% Minoxidil. I’ve also managed to reduce the volume applied by three quarters over the last three years. I was told I would potentially have to increase it over time.
In a nutshell, my advice would be: if you’re not ‘into drugs’, try the natural solutions being evaluated elsewhere on this site first. If you reach a point where you feel you’ve got no alternative but to pursue the pharmaceutical route, and you’re in the early stages of hair loss, it may be worth trying the 2% solution. If that doesn’t arrest or reverse your hair loss, the chances are that the 5% solution will. I wouldn’t try concentrations stronger than that, but each to his own.
Before you wander down this path remember that you’re effectively committing to a ‘lifetime’ (or until they find a cure) of disciplined use.