Understanding Minoxidil Is Vital to Making the Right Choice




Available first by prescription and subsequently over the counter, minoxidil (Rogaine is the predominant U.S. brand) has been in widespread use for a generation. It works in varying degrees, with some side effects, so it makes sense to study it before you decide to use it.

Q. Does minoxidil/Rogaine work?

A. Rogaine is sold in regular (2 percent) and extra-strength (5 percent) variations. The regular variation claims a success rate of 30 to 40 percent, while, unsurprisingly, extra-strength achieves its users’ objectives with a 50 to 60 percent success rate.

But success happens in degrees. Actual dense hair growth is experienced by 8 percent of those who use it, while moderate growth has been documented in about 30 percent of users. Studies strongly indicate that the product’s best result is in halting further hair loss.

It is most successfully applied by people under age 40 to the crown (apex/top) of the head in the early stages of thinning; it is relatively ineffective with receding frontal hairlines, above the forehead. Women have greater success with Rogaine than men do (with a 2 percent solution only).

One clinical study published in the Journal of the American Academy of Dermatologists (M. Duvic et al., “A Randomized Trial of Minoxidil in Chemotherapy-Induced Alopecia” [Department of Medical Specialties, University of Texas, 1996]) found that use of minoxidil “decreased the duration of alopecia caused by chemotherapy” with no significant side effects.

Q. What is minoxidil/Rogaine made of?

A. The commercial product, Rogaine, is minoxidil (2, 4-diamino-6-piperidino-pyrimidine-3-oxide) in a solution of alcohol, propylene glycol and water. It is sold as both a solution and a foam.

Q. How does minoxidil/Rogaine work?

A. As people begin to lose hair, in actuality their existing hair follicles shrink. Rogaine revitalizes those shrunken hair follicles, effectively making them larger. In some individuals, the follicles may grow longer as well.

Exactly what causes that is subject to some speculation, since scientists aren’t fully able to determine how it works. They’ve determined that the product increases blood flow in the scalp (i.e., it is a vasodilator). But less understood is whether it opens potassium channels in hair root cells, which would restore hair growth.

Q. Does minoxidil/Rogaine have side effects?

A. Side effects generally are related to skin irritation, such as itchiness, dryness, flakes, scaling, or burning. For that reason, people using Rogaine should avoid excessive sun exposure. In rare cases, it may cause weight gain, chest pain, swelling (hands, ankles, stomach or face), difficulty breathing, rapid heart rate and lightheadedness.

The Food and Drug Administration (FDA) considers it a category C medication, which means women who are pregnant, who could become pregnant or who are breast-feeding should not take it, as research does not definitively rule out whether the drug can have an effect on a fetus or an infant. Women also are advised to use only the 2 percent solution (regular Rogaine), because the extra-strength (5 percent) solution may cause decreased blood pressure, lightheadedness and excessive body hair growth.

Because higher concentrations of minoxidil are taken for hypertension (high blood pressure), people with known cardiovascular disease are advised to speak with their physician regarding use of Rogaine.

Q. Will minoxidil/Rogaine continue to work as a person ages?

A. The peak efficacy for Rogaine, a 35 percent increase in hair volume, is found to continue up to 96 weeks in the longest-term study available. Anecdotally, its hair-retention effects reportedly last longer but only on the crown of the head, not elsewhere.

Importantly, cessation of use of the product will result in hair loss, probably to where the individual would be if he or she had never used the product.

Q. Will the texture of the hair be the same?

A. In most cases the texture is diminished as compared with intact hair surrounding it. It tends to be shorter, curlier (fuzzy) and less dense. But that is a function of how early in the hair loss process the product is applied.

Q. Is there a difference in how minoxidil/Rogaine works for men versus women?

A. Yes. Women get a greater increase in hair volume (hair counts and hair weight) than men do and are advised to use only the lower percentage (2 percent)_solution because that effect can lead to unwanted body hair growth. In general, women have an increased sensitivity to both the intended and (adverse) side effects.

Q. Can Rogaine/minoxidil be used together with Propecia/finasteride?

A. There are no prohibitions from the FDA against using these drugs in combination, nor are there data tracking efficacy or safety issues. Many Web sites (run by commercial interests) advocate doing so, claiming synergistic effects in individuals.

Q. Is minoxidil available only under the brand name Rogaine?

A. In the United States only variants on the Rogaine brand (Men’s Rogaine, Rogaine for Men Extra Strength, Women’s Rogaine) are available, in addition to proprietary store brands. In Canada the product is sold under several other brand names: Apo-Gain, Gen-Minoxidol, Hair Gro, Hair Regrowth Treatment, Med Minoxidil and Minox.

Q. Does a person need to have a prescription?

A. Since 1998 the product in both solution strengths has been available over the counter (no prescription required).

Q. How was minoxidil discovered?

A. Minoxidil was originally developed as a treatment for hypertension (high blood pressure) by Upjohn Corporation in the 1980s. When hair growth was found to be an unanticipated side effect, the company successfully sought FDA approval for that use.

Q. Is minoxidil/Rogaine expensive?

A. Major U.S. retailers (Target, Walgreens, Walmart) sell generic 5 percent solution minoxidil for about $19 for a three-month supply. It needs to be applied twice daily without interruption.