Does Rogaine Minoxidil Really Work in 2022? (explained by a dermatologist)

By the age of 30, 25% of men have visible hair loss, often due to male pattern baldness, and this percentage increases in proportion with age.

As balding and receding hairlines become a problem, the average hair loss patient’s first instinct is to go for the treatments they can instantly get started with.

One of these treatments is Minoxidil, a topical over-the-counter medication that has been on the market for decades.

It is a medication I’ve been prescribing my patients, both as a means to stop/slow down hair loss and as a supporting medication to hair restoration surgeries.

In this blog, I’ll go over the basics of Minoxidil, who should use it, its effectiveness, and the side effects that come with it:

Let’s start by understanding what exactly it is:

What is Minoxidil Rogaine?

Rogaine, also known as Minoxidil, is a popular FDA-approved medication used in treating male pattern baldness. It either comes in the form of an oral medication you can get with a prescription; or a topical foam or liquid solution that is sold over-the-counter, which means you can get it from your pharmacy or order online right now.

Minoxidil vs Rogaine – what’s the difference?

Minoxidil and Rogaine mostly refer to the same drug, but there is a small distinction you need to be aware of.

Rogaine is the brand name of the medication that contains minoxidil.

And minoxidil is the active ingredient inside Rogaine that is responsible for hair growth. Minoxidil is not exclusive to Rogaine, however, as there are other medication brands such as Loniten or Keeps that contain the compound.

Rogaine mostly contains around 5% or 2% minoxidil, depending on the product you’re getting.

Quick History of Minoxidil and Rogaine

Minoxidil was first developed as a medication for ulcers in the 1960s by the pharmaceutical firm Upjohn, but it didn’t prove successful in the trials.

Out of these trials, however, came an unexpected result. Minoxidil was a potent vasodilator, which refers to a substance or medication that dilates blood vessels and makes it easy for blood to flow through veins.

The U.S. Food and Drug Administration (FDA) approved the use of minoxidil in 1979, as oral tablets with the brand name “Loniten” to treat high blood pressure.

And in 1988, FDA approved Upjohn’s Rogaine as a medication to treat hair loss and pattern baldness.

• Over-the-counter selling of Rogaine without the need for prescriptions was approved in 1996.
• The 5% solution of Rogaine most patients use today was released in 1997, and was approved for over-the-counter selling in 1998.
• The foam version of the 5% Rogaine that is more widely available today was developed and approved for use in 2006.
• Many other brands also developed minoxidil solutions, which are currently direct competitors of Upjohn and Rogaine.

Does Rogaine Minoxidil Regrow Hair?

Rogaine Minoxidil can help with hair loss but is not the certain solution to every type of hair loss, it is actually far from that.

While there is proof it helps with hair growth and prevents further hair loss in some patients, there are also various studies that suggest it doesn’t work for everyone.

I know you’ve come here for a straight answer, but there is none.

So let me quickly explain how exactly minoxidil works, what different studies suggest, and who the drug is suitable for:

How does Minoxidil work?

There also isn’t a straight answer to how minoxidil causes hair growth, but there are two main theories based on the main functions of the medications.

First of which is based on minoxidil’s vasodilatory qualities:

1- Vasodilation (increasing blood flow to the scalp)

Minoxidil was initially used to treat high blood pressure when it was shown to improve blood flow by dilating blood vessels.

Its vasodilatory qualities are presumed to be the primary way it helps with hair growth.

When Rogaine Minoxidil is applied to the scalp, the blood vessels around the balding areas are widened, causing more blood containing oxygen and nutrients to flow into your scalp.

This feeds your follicles, promoting the quicker growth of new and healthier hair, which slows, stops, or even reduces excessive balding you’re going through.

2- Replacing Thinner Hair

Hair shedding is not the only way you can experience visible balding on your scalp.

In fact, because of male pattern baldness, most of your hair follicles shrink to a certain degree before falling out, causing your hair to look thinner even before you lose hair.

Minoxidil contains a certain type of nitric oxide moiety, which is a part of a molecule that can bind to nitric oxide and cause your hair follicles in the telogen phase to shed more quickly and stimulate your follicles to start replacing shed hair with thicker hair.

Minoxidil can’t grow new hair follicles ❌

Minoxidil doesn’t help you grow brand new hair on your scalp.

Actually, there is currently no way to grow new hair follicles, as all the hair follicles you have at the moment were produced in the womb before you were born.

Until we find a way to reproduce hair follicles in a lab, possibly through the use of stem cells, you’ll have the same hair follicles that will inevitably fall out as you age.

What minoxidil does is prevent the shedding of your existing hair follicles by supporting them with an increased blood flow and/or by replacing thinner hair grafts with new ones.

That’s why patients with large and complete hair loss on their scalps couldn’t see hair growth on these bald areas after using minoxidil.

What recent studies say about Minoxidil

So, yes, minoxidil can prevent hair loss and promote hair growth, but to what extent?

Let’s look at the studies conducted over the years to see the numbers and exact effectiveness of Rogaine Minoxidil:

A 12-month Study on 904 Patients in Germany (1)

▶ In 2003, dermatologists conducted an observational study on 904 patients with male pattern baldness to understand the efficacy of 5% minoxidil topical solutions.

▶ Patients applied 1ml of the minoxidil solution twice a day on their scalp to the areas with hair loss.

▶ After 12 months, areas with hair loss were observed to become smaller in 62% of the patients.

▶ The balding areas stayed the same for 35.1% of the patients and further hair loss was observed in 2.9% of the patients.

▶ 84.3% of the patients rated the minoxidil solution as “very effective”, “effective”, or “moderately effective”, while 15.7% of the patients rated it “ineffective.”

An 8-12 Month Study on 143 Male AGA Patients – including the placebo effect (2)

▶ In 2003, a Johnson & Johnson sponsored study was conducted on 143 patients with male pattern baldness.

▶ Patients applied either 1ml of the minoxidil solution or a placebo foam twice a day for 8-12 months on their scalp to the areas with hair loss.

▶ Evaluating both the change in non-vellus hair count and patient ratings, the 5% minoxidil solution provided improvements far superior to the placebo foam.

A Study Comparing the 5% vs 2% Minoxidil Solutions with 393 Male Patients (3)

▶ In 2002, a placebo-controlled multicenter clinical trial was conducted by a number of dermatologists to evaluate the effects of 2% and 5% minoxidil solutions on male pattern baldness.

▶ 393 male patients with androgenetic alopecia, aged 18-49, were randomly assigned a 2% minoxidil solution, a 5% minoxidil solution, or a placebo solution twice a day for 48 weeks.

▶ After 48 weeks, the 5% minoxidil solution proved significantly better results in terms of the change in the number of non-vellus hair, patient ratings, and investigator rating of scalp coverage.

▶ 5% minoxidil solution provided 45% more hair growth on average after 48 weeks and hair growth started significantly earlier than the 2% minoxidil solution.

▶ No systemic or side effects such as scalp irritation were observed during the study.

A 6-Month Study on 14 Male Patients (4)

▶ In 2016, an observational study on the efficacy and the safety of 5% minoxidil foam were conducted on 14 patients throughout 16 and 24 weeks.

▶ Patients were asked to apply 1ml of 5% minoxidil foam on their scalps daily for 6 months.

▶ Through assessments in hair counts, patient ratings, and photographic reviews; there was a significant improvement against hair loss for most patients after 24 weeks.

What most studies don’t say

Minoxidil is highly likely to promote hair growth for male patients with pattern baldness.

As the results of most studies suggest improvements in hair density and count alongside better coverage on bald areas, the hairline is not restored or frontal hair loss is not reversed.

Also, patients are expected to keep using minoxidil to avoid further hair loss for years, as men who stopped using minoxidil observed rapid hair loss after the discontinuation of the drug. In fact, for the majority of these patients, hair counts were below the numbers that were recorded when they started using minoxidil in the first place.

Minoxidil is not the perfect method to regrow your lost hair.

And when it comes to stopping hair loss, it’s not the best method for everyone:

Who should use Rogaine Minoxidil?

Experiencing hair loss, unfortunately, doesn’t make you the perfect candidate for using Rogaine. There are a few other variables to evaluate before deciding.

Studies suggested that minoxidil was more effective in patients with:

• Male Pattern Baldness/Androgenetic Alopecia
• Smaller areas with hair loss
• Progressing hair loss for under 5 years
• Central hair loss rather than frontal hair loss

So if you have been experiencing hair loss for a long time and have relatively large bald areas located more on the front of your scalp, you’re not going to get the desired improvements from using Rogaine minoxidil.

How should Minoxidil be used?

The topical solutions and foams of minoxidil are mostly preferred for treating hair loss.

The general directions of these medications suggest using 1ml of the liquid solution or half a cap of the foam to the scalp, twice a day, focusing on the areas with hair loss.

It can be used before/after a hair transplant, and there are various studies suggesting improved results after using oral finasteride and topical minoxidil together.

Side Effects of Minoxidil Rogaine

Rogaine has a number of side effects that can be experienced around the scalp or systemically.

Systemic effects include an increased high rate due to the vasodilatory qualities of the substance, but the chances of experiencing this side effect are extremely low as the topical minoxidil is mainly applied around the scalp.

Other side effects include:

• Sensitive scalp
• Irritation, redness, or burning around the applied areas
• Dry skin on the applied areas
• Flaky skin around the scalp

You might’ve heard or read about Rogaine causing erectile dysfunction or adversely affecting sexual performance.

While these side effects are common with other hair loss medications such as finasteride, there are no studies that connect minoxidil with these conditions.

Minoxidil not working for you?

Minoxidil is not a certain solution to hair loss.

Yes, it can help boost hair growth.

And yes, it can slow/stop hair loss.

But using Rogaine, you can’t get your natural look back with a restored hairline and full head of hair.

At least not alone:

Hair Transplant Surgeries at UnitedCare – more effective and certain solution to hair loss

At UnitedCare, we’ve adopted a holistic approach to a much better and more effective solution to hair loss, hair transplants.

From the first examination to long after your operation, we’re with you, providing you and your body with everything necessary to get your looks back.

You’re one click away from getting your hair back: 👇

References

1. Jan Rundegren, A one-year observational study with minoxidil 5% solution in Germany: results of independent efficacy evaluation by physicians and patients 1 1The author is employed by Pharmacia AB (part of the Pfizer Group), Journal of the American Academy of Dermatology, Volume 50, Issue 3, 2004, Page 91, https://doi.org/10.1016/j.jaad.2003.10.289
2. Bruce Kohut (2005). A Study to Evaluate the Effectiveness and Safety of 5 Percent Minoxidil Foam in the Treatment of Male Pattern Hair Loss. https://clinicaltrials.gov/ct2/show/study/NCT00151515
3. Olsen, E. A., Dunlap, F. E., Funicella, T., Koperski, J. A., Swinehart, J. M., Tschen, E. H., & Trancik, R. J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. Journal of the American Academy of Dermatology, 47(3), 377–385. https://doi.org/10.1067/mjd.2002.124088
4. Hasanzadeh, Hournaz & Ahmad Nasrollahi, Saman & Halavati, Nader & Saberi, Maryam & Firooz, Alireza. (2016). Efficacy and safety of 5% minoxidil topical foam in male pattern hair loss treatment and patient satisfaction. Acta dermatovenerologica Alpina, Pannonica, et Adriatica. 25. 41-44. 10.15570/actaapa.2016.12.