Does Rogaine really work?

More or less just what it says… is it a working hair loss treatment or a sham like so many other hair loss treatments?

No, Rogaine (minoxidil) really does work. And it was a side-effect of the medication’s original purpose: To lower blood pressure.

I have a few patients on it for blood pressure reduction. They don’t really consider the hair-restoring properties to be a boon, for a variety of reasons: When taken orally, it makes hair grow all over (at least in places where hair grows normally). Some of these guys have the hairiest ears and backs and noses I’ve ever seen. So have some of the gals, so that’s another drawback.

When used topically, the drug tends to just promote hair growth in the area it’s applied to. And one can almost always see some improved hair growth in the area. Sadly, in about a third of the cases, it’s inadequate to produce much of a visible difference.

But minoxidil does work as a hair restorer, to some extent, for most people using it.

Stop using it and the hair goes away…

Yes, there is absolutely no question that minoxidil produces clinically significant results when applied topically. The 5% solution works more effectively than the 2% solution. I’ve never seen any hardcore stats showing regrowth after one year in terms of mean and standard deviation of number of hairs/square inch of scalp, but from what I’ve read (which is quite a bit), a person using the 5% solution for a year or more should have at least a 65% chance or so of seeing some sort of result.

Also, don’t forget that oral finasteride arrests the progression of male pattern baldness in 83% of all clinical samples—it stops it dead, case closed, end of discussion. So this should really be your weapon of first choice, with minoxidil as an added booster. The bottom line is that using finasteride and minoxidil together should at least arrest the progression of MPB in 85 - 90% of all men, with a very substantial number showing at least some regrowth.

Finasteride is sold as Propecia for baldness, and it’s sold as Proscar for benign prostate hyperplasia (swollen prostate). A similar drug, durasteride, is sold as Flomax for BPH. Even though Flomax’s tests show slightly better results for baldness than Propecia, Flomax is not yet marketed as a baldness cure. Maybe it’s a coding dodge, in case insurance won’t pay for a baldness cure.

I remember looking at the Rogaine package years ago and it seemed to indicate it would help the bald spot, but not a receding hairline. Am I remembering correctly? Is this still considered true?

Cite for that 83% figure please? I was told by my doctor about 1/3 had no reponse, about 1/3 had slowed or stopped hairloss, and 1/3 had regrowth.

Though some may find your certitude and zeal (e.g. “weapon of choice”) refreshing, “end of discussion” is rarely the phrase of choice in medicine. While finasteride and minoxidil do indeed yield clinically significant results in large trials for the treatment of MPB, the more operative question is whether combination therapy yields cosmetically acceptable results and whether said results justify the possible, albeit still unknown, risks of longterm use.

Clinical trials are just beginning to explore this frontier and the full picture may not be known for 10-15 years. Left untold–and currently medically unknown–are the possible longterm consequences associated with oral finasteride’s effect of “stopping [male pattern baldness] dead, case closed, end of discussion,” as you put it.

For now, consider these very preliminary findings, all layperson accessible and none conclusive:

“While finasteride (Propecia/Proscar) decreases serum DHT, it also is thought to increase estrogen which suggests that men over 35 may want to consider using it in conjunction with a systemic aromatase inhibitor such as Chrysin/Piperine (Super Miraforte), Arimidex, or stinging nettle extract, to maximize its hair growth effects and minimize potential side effects (that are listed in the PDR) such as Gynocaemastia (breast enlargement in males), sexual side effects, and an increase in fat deposition. These compounds have been reliably shown to increase testosterone and reduce excess estrogen, resulting in a youthful hormone profile that optimizes immune function and to some degree, body composition”

Proscar for Prostate Cancer Prevention: Q&A - WebMD, 6/24/03 - “a drug called Proscar can also prevent or delay prostate cancer. It also shows that the drug may increase the risk of aggressive, high-grade prostate tumors. And while men taking Proscar have fewer urinary problems, they also have more sexual problems”

Analysis Shows Drug Could Save Lives From Prostate Cancer - Science Daily, 3/16/05 - “the commonly used drug finasteride reduced the incidence of prostate cancer by 24.8 percent compared to a placebo. However, a possible increase in the number of high-grade tumors in the trial prompted many to question whether any benefits of the drug would be offset by an increase in mortality related to the higher-grade tumors. No difference in mortality was seen during the 7 years of PCPT”

Bottom Line: Combination therapy with finasteride and doxazosin for at least four years reduces the risk of clinical progression of BPH. However, long-term use of finasteride also is associated with an increased risk of high-grade prostate cancer (Thompson IM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med July 17, 2003;349:215-24). Until this risk is better elucidated, combination therapy should be limited to patients who have a prostate volume greater than 40 mL, a PSA level greater than 4 ng per mL, and a clear understanding of the risks and benefits of therapy. (Common POEM) (Level of Evidence: 1b)

The second study analyzed data from the landmark Prostate Cancer Prevention Trial, involving more than 18,000 healthy men. Some received finasteride, while others got a placebo. The trial, scheduled to last seven years, was cut short early because researchers found a nearly 25 percent reduction in the incidence of prostate cancer in the men taking finasteride.

However, that good news was tempered by the fact that the overall incidence of aggressive cancers was doubled in the men who took finasteride compared to those did not. So while most participants benefited from the drug, a minority may actually have fared worse.

Because of that paradox, “there was controversy about whether or not it was worth giving finasteride to the general population,” said Joseph M. Unger, the Prostate Cancer Prevention Trial statistician who performed the new analysis.

As for oral minoxidil, the form prescribed for high blood pressure, patients should use minoxidil only under medical supervision to ensure that excessive amounts of the drug are not absorbed into their bodies. Large amounts of minoxidil may increase the severity of the symptoms and side effects of hypertension.

FWIW, the dermatologist I saw years ago said that Minoxidil followed the 4/4/40 rule. If your lost hair is less than 4" in size (skull-cap loss, I assumed), if you’ve been losing it for less than 4 years, and if you’re less than 40 years old, then Minoxidil has a good chance at being effective.

I lose on all counts.

I’ll see if I can find it. Most of my knowledge on the subject is several years old, and hasn’t been upgraded. The 83% percent figure is one I remember seeing over and over again in Usenet discussions on alt.baldspot, a group which has deteriorated in the past few years from a serious forum for the discussion of peer-reviewed literature to mostly a flame pit about the merits or lack of merits of non-recognized cures. The group is essentially worthless now. I have a couple of papers on the subject of MPB and FPB that I retrieved from Medlars which were written by a dermatologist/trichologist in the SF Bay area who was at that time one of the foremost authorities on the subject of male and female pattern baldness. Unfortunately, the papers are packed away in storage and I can’t find them. I can’t even remember her name now. I’m pretty sure that she also stated the 83% figure for finasteride, as did Merck’s published data from their FDA approval trials. Again, this 83% figure is one that I’ve heard over and over again in regards to finasteride. It’s very possible that subsequent studies have yielded different results. And some of the stuff that Carnac posted is really sending a chill up my spine—this info wasn’t around when I was seriously pursuing the subject a few years ago. I always thought that a nice side effect of finasteride was that it was going to keep me safe from prostate cancer, not give me a more aggressive form of it!

Vera Price

Get this article. It will give you a very thorough overview of the subject of hair loss treatments. Well worth the $10 retrieval fee.

Here’s a tentative cite for the 83% figure. I’ll see if I can come up with something better, though.

Minoxidil has only been really tested on the vertex of the scalp…but many folks use it on other areas of the scalp as well…it tends to not work as well for “receding hairlines” as it does for the top.

Currently Minoxidil and Propecia are the only hairloss treatments approved by the FDA.

There is a good, no nonsense, primer here.

FWIW, the other component that many dermatologists suggest is to use Nizoral shampoo a couple of times a week…it acts as an anti inflamatory and antiandrogen. (No it is not specifically tested for or marketed for MPB)

The scary stuff is far from definitive. BTW, I made a typo above and meant to say:

"Clinical trials are just beginning to explore this frontier and the full picture may not be known for 10-15 years. Left untold–and currently medically unknown–are the possible longterm consequences associated with oral finasteride’s effect of ‘stopping DHT production dead, case closed, end of discussion,’ as you put it.

History may show that finasteride’s researchers produced a blunt-force instrument that well controlled DHT production, but yielded unintended side effects that far outweighed its cosmetic benefits. Think Vioxx, Halcyon and many more.

That said, there’s always the cool laser. Works like a charm. :wink:

I read through the usage instructions and effects that came with a bottle of Rogaine once (my wife picked up a bottle for her cousin when she went to America and asked me to translate the instructions), and the stuff just didn’t seem that impressive.

As has been posted earlier, receding hairlines probably won’t see much change. Also (according to the info in the box) it takes a fairly long time of regular usage for results to start appearing, the hair you do get will be fairly thin, and once you stop using Rogaine you’ll go right back to how you were before. This last one was the biggest blow to my cousin-in-law, since there was no way we could keep going to the States each month to keep him stocked (the stuff has since become available in Japan, though).

Forgive my naiveté, but are you making a tongue-in-cheek joke, or are you talking about this thing? I’ve heard a little bit about it—supposedly it really does have some demonstrable effect.

Wow. A much more complicated issue than I had at first believed.

Thanks all!

Yes, it is a fairly complex issue. Although the biochemical basis of male pattern baldness is pretty well documented, there are still a lot of unanswered questions about female pattern baldness. To really address the crux of your question, the bottom line is that there currently five chemical compounds known to medical science which effectively treat pattern baldness: finasteride, minoxidil, tretinoin, spironolactone, and mifeprestone. Men can use the first three compounds, and women of childbearing age can use the last four. Post-menopausal women can use all five compounds. If you want a detailed explanation of how these compounds are used in the medical treatment of pattern baldness, get a copy of the paper I mentioned in post # 11.