Propecia Versus Rogaine

before and after photo of man with hair loss

While hair loss medications Propecia and Rogaine can be effective hair loss treatments taken separately or as part of the same hair regrowth regimen, they do not work the same way.

When first announced as cures for hair loss, both Rogaine (minoxidil) and Propecia (finasteride) were hailed to be as important as the introduction of birth control pills and the Salk vaccine. Finally, going bald would be a choice, not an immutable verdict of nature.

Both have been available for a generation of use and proved to be helpful to men (both medications) and women (Rogaine only). But each comes with its own set of efficacy, side effects and costs. Following are the pros and cons of each, to help you decide if either is right for you.

Propecia & Rogaine: External versus internal application

Rogaine is applied topically to the scalp (foam or lotion), and Propecia is taken internally as a pill. Rogaine must be applied twice daily without interruption to remain effective, and uninterrupted use is required of Propecia as well.

For many people something you apply directly to the skin will always be preferred over an internal medication. This is because some medications that pass through the digestive system and the liver can be detrimental to certain internal organs. There are no known serious detrimental effects on the liver or other internal organs from taking Propecia.

Propecia & Rogaine: Effectiveness

Both Propecia and Rogaine are effective but in varying degrees with different types of individuals. Propecia, according to Merck & Co., its manufacturer, halts hair loss in a majority of those taking it (86 percent) and helps regrow hair in almost half (48 percent) of patients. The product is not available for women. Rogaine is 30 to 40 percent effective in its regular (2 percent) formulation and between 50 and 60 percent with its extra-strength (5 percent) version. Dense regrowth of hair, however, is uncommon (8 percent of users), and actual gains in hair count are less frequent as well (30 percent). It is more effective for women than for men.

With both Propecia and Rogaine, earlier use in patients under 40 will yield the greatest results. And the baldness that is prevented or reversed tends to be on the crown of the head, not at the hairline (which will continue to recede over time).

Propecia & Rogaine: Major and minor side effects

Rogaine can cause skin irritation, which includes burning, scaling, itchiness, dryness, and flaking, at the point of application (crown of the head). Users are advised to limit sun exposure for this reason. Other, rarer side effects include lightheadedness, rapid heart rate, chest pain, swelling (stomach, face, hands or ankles), breathing difficulty and weight gain. Women who are or who could become pregnant are advised against using Rogaine.

Propecia is particularly problematic for women who may be pregnant (and, in particular, their male fetuses). Mere exposure to a broken pill, in contact with the skin, can lead to genital abnormalities in the male fetus. Men taking Propecia experience — at a rate of about 3.8 percent — adverse effects, which may include erectile dysfunction, decreased volume of ejaculate and decreased libido, as well as itchiness, hives, swelling of the lips and face and testicular pain.

Propecia & Rogaine: Can they be combined?

The FDA (Food and Drug Administration) takes no official position on whether combination therapy, using both Rogaine and Propecia, is either dangerous or more effective, or both. Several online Web sites feature individuals who claim a synergistic effect of using both simultaneously.

Cost and prescription vs. over the counter

Rogaine in a 5% solution starts at about $19 for a three-month supply — generic brands are less expensive than the original brand, which can be priced at more than twice as much. It has been available without a prescription since 1998. Propecia ranges in cost via online suppliers from $28 to $71 for a monthly supply. It requires a prescription from a medical doctor.

So, has either Propecia or Rogaine lived up to its expectation? That seems to depend on the individual using them. Personal choices about cost, side effects, and daily maintenance schedules are generally what drives individuals to try and continue to use these medications (or not).