What it is
Sold under the brand name “Rogaine”™, this topical lotion is the only medication approved by the FDA to stimulate the regrowth of hair for those men and women who have a hereditary tendency for pattern baldness or hair loss. Rogaine™ topical lotion is 2% and also 5% minoxidil in a solution of water, alcohol, and propylene glycol.
What it Does
Minoxidil topical lotion work on active hair follicles still capable of producing hair. For those with pattern hair loss, minoxidil can reduce and reverse the rate of hair follicle miniaturization, and can reverse the transformation of terminal follicles that produce full-size hairs from vellus follicles that only grow “peach fuzz”. With minoxidil, vellus follicles enlarge back to their full size.
As with any medication, the results vary from person to person.
Minoxidil is safe. When used as directed in lotion form applied to the scalp, only very small amounts of minoxidil reach the blood. The risk of serious side effects is very small. Change is gradual.
Now Available Without a Prescription
As a hair growth treatment, minoxidil is applied as a lotion on the scalp two times each day. This method of administering the drug causes the hair-growing effect to be on the scalp only, and not on other parts of the body. There is no effect on blood pressure when applied as directed. In 1995 the US FDA declared that minoxidil in a 2% topical lotion form no longer required a prescription from a Medical Doctor for purchase in the US.
Benefits of Minoxidil
Clinical studies were run during which some men and women with pattern hair loss applied Rogaine topical lotion to their scalps, and others with pattern hair loss applied the same mixture of water, alcohol, and propylene glycol used in Rogaine lotion, but without the minoxidil (a placebo). The men and women selected for the study had thin hair or baldness on the top of their heads, where minoxidil is most effective at promoting hair regrowth. The effectiveness of the minoxidil treatment was compared to the placebo lotion. The results of clinical studies involving thousands of men and women have shown Rogaine topical lotion is able to cause statistically significant increases in hair regrowth.
Risks and Disadvantages of Minoxidil
Minoxidil treatment does not work on everybody with thinning hair due to inherited pattern hair loss. It is less effective for hair loss at the hairline than on the top of the head. It is less effective on large bald spots than small ones. It is less effective on small bald spots than on diffuse thin areas. It is less effective on long-established baldness than recent hair loss.
Continuous use Required
Minoxidil treatment is not a permanent cure. It must be applied twice-daily for as long as the newly regrown hairs are desired to be retained. It requires commitment. Those treating their hair loss with minoxidil have to think about treating their hair loss every day.
Skipping a day or two occasionally is not likely to cause any measurable difference in the effectiveness of minoxidil treatment. However, after several months of discontinued use, the regrown hairs are likely to be shed. Also, the hairs that would have been shed if the minoxidil had not prevented follicle miniaturization will also be lost as those follicles begin to shrink. Regrown hairs may be shed within just a few months after discontinuing use of minoxidil.
In clinical studies involving 6,000 men and women about 7% of those using Rogaine lotion experienced some degree of scalp Itching, inflammation, dryness, or flaking.
Lotion on the Scalp
Although Rogaine topical lotion is a colorless, odorless, and non-greasy liquid that dries quickly and without any visible residue, some people simply do not like putting lotions on their scalp.
Minoxidil With Betamethazone Valerate
Betamethazone valerate is a cortisone medication that helps to prevent scalp inflammation. In addition to reducing possible scalp irritation, it may also enhance the hair restoration effect of minoxidil in two ways: First, it helps block the metabolism of testosterone in the cells of the hair follicle where the hormone signal to “stop producing new hairs” takes place. Blocking this signal may keep more hairs growing. Second, betamethazone valerate helps to disperse the white blood cells that are called up to push the hair shaft out of the hair follicle. This may keep more hairs in place longer. Dr. Panagotacos has published this information on his Website since 1993. A study done in 2001 demonstrated increased hair density in one year of use.
Minoxidil With Tretinoin (Retin-A)
Tretinoin is a prescription acne medication applied to the skin, and is also famous for helping to reduce facial wrinkles. Minoxidil lotion applied with low concentrations of tretinoin has been show to promote greater hair growth, and possibly faster results, than minoxidil used alone. Tretinoin may increase the absorption of minoxidil through the skin, as well as having additional hair growth promoting effects. In addition to the risks and advantages of minoxidil use, tretinoin adds additional risk of skin irritation and inflammation. These studies were done in the early 1980’s.
Minoxidil With finasteride
Finasteride is another medication that demonstrates significant hair restoration effects. Combining finasteride with minoxidil can produce better hair restoration results than using either medication alone.
Other medications are progesterone derivatives, and spironolactone-like compounds.
People respond differently to minoxidil. For some people with pattern hair loss it works very well, and for others there seem to be no results at all. The only sure way to determine if minoxidil will be effective is to try it twice-daily for at least 4 months.
Who can expect results?
Those likely to achieve the best results are in the early stages of pattern hair loss. On average, younger people get better results than older people. Those with thinning or baldness on the top of their heads generally get better results than those with hair loss at the hairline. People with diffuse hair loss, especially women, tend to get better results than those with clear bald spots. Those with smaller bald spots usually show more regrowth than those with large bald spots.
What if I stop?
If minoxidil treatment is discontinued for several months, the regrown hairs will probably be shed, and hair loss will resume.
Minoxidil Treatment Described
Easy to Use
Rogaine topical lotion is easy to use, and only takes a few minutes each day for application. It is applied to a clean and dry scalp twice each day using a dropper or sponge applicator.
In the Morning
The first application is usually done in the morning, after shampooing and towel drying. The lotion is applied directly to the scalp, and not to the hair.
It takes about 4 months of twice-daily treatment before initial results are noticeable, if at all. Initial results can include less hair shedding and some new hair growth. The newly regrown hairs may be finer and substantially less pigmented than other full size hairs, however many of these hairs will enlarge and darken as they grow out. The results may improve over the next several months with continuous twice-daily use. After about 12 months of minoxidil use, the maximum benefit is usually achieved, and hair regrowth tends to stabilize.
Other Hair Growth Drugs
Avodart, dutasteride, was released at the end of 2001 for treatment of benign prostate hypertrophy. It blocks both Type I and II 5-alpha-reductase and lowers DHT by over ninety-five percent in men, whereas Propecia lowers it only sixty-six percent. Type II is found in the prostate gland and Type I in skin and hair. Women only have type II, therefore women with thinning hair may benefit from Dutasteride. I routinely place my male patients on Dutasteride if they are part of the small group who continue to lose hair while on Propecia. Avodart (dutasteride 0.5 mg) daily lowers DHT 90% whereas finasteride only lowers DHT 65 – 70%. Although it has not been approved by the FDA for hair loss, I prescribe Avodart when Propecia is not strong enough.
Dutasteride is currently being studied for hair loss, but results have not yet been published.
Learn more about “Drugs That Grow Hair” by reading Chapter 9 of Dr. Panagotacos’ book, Hair Loss Answers