If you’re noticing that you’re one of the 30 percent to 50 percent of men affected before the age of 50 by male pattern baldness, chances are, you’re here because you’ve started exploring your treatment options.
And that’s okay — welcome to the club!
Typically, this search will lead you to the only FDA approved medications for androgenetic alopecia — oral finasteride (brand name Propecia®) which requires a prescription before use, and topical minoxidil, a readily available over-the-counter medication for hair loss.
Now you may be wondering: when it comes to minoxidil vs. Rogaine, who really wins?
We’ll be answering these questions by making comparisons between the treatment options for male pattern hair loss, and examining how they fill out against other treatments.
We’ll answer this in a moment, but a little explainer on how minoxidil works will help to clarify just how hair loss comes about.
Unfortunately, the mechanism of action in minoxidil isn’t yet fully understood by the medical community. However, it’s believed that, as a vasodilator, minoxidil helps promote blood flow to the areas of your scalp that need nutrients the most.
When applied topically, it interacts with scalp sulfotransferase to convert minoxidil into minoxidil sulfate.
From there, it shortens your hair’s telogen phase (when your hair is resting and beginning the process of shedding), and kicks it into the anagen phase (the phase in which your hair grows).
Androgenetic alopecia is caused by the enzyme Dihydrotestosterone (DHT). This enzyme is the end product of the interaction between 5-alpha reductase and testosterone. The number of DHT receptors increases as hair loss progresses on the scalp.
A balding scalp is an androgen-sensitive scalp. When DHT comes into contact with the follicles of an androgen-sensitive person, follicle miniaturization (the thinning and shortening of hair) occurs, that’s bad for your hair.
Typically, hair follicles grow in three primary stages: anagen (the growth stage), catagen (when it stops growing) and telogen( the resting stage). The follicle remains in the telogen stage until another follicle is produced at anagen, pushing it out.
When male pattern baldness occurs, the anagen phase becomes more and more diminished with every cycle, while the telogen phase remains largely unchanged.
This means you have less hair growing, leaving your scalp open to follicle miniaturization and diminished hair growth.
And if that isn’t bad enough, during this process, the scalp receives reduced blood flow and oxygen pressure, which can also affect its growth.
Here’s where minoxidil comes in.
Originally intended as an oral medication for severe hypertension, minoxidil became a likely treatment option for hair loss when cases of hypertrichosis were reported in patients after use.
Topical minoxidil works as a hair growth stimulator. This medication shortens the telogen phase, causing the dormant hair follicles to enter into a premature anagen phase.
If you’ve ever heard of “minoxidil shedding,” it’s the result of the shortened telogen phase — old hairs falling out in large numbers to make room for new ones. But it doesn’t stop there, minoxidil also prolongs the anagen phase, allowing for increased hair length and diameter.
Adding to this is minoxidil’s function as a vasodilator, and its ability to open up the potassium channels of hair follicles.
It is believed that by widening the blood vessels and opening up the potassium channels, more nutrients, blood and oxygen will be permitted into the hair follicle.
This usually produces effects like stimulating circulation near the hair follicles. This stimulation may cause hair growth.
It may also prevent androgen effects on the already androgen-sensitive follicles. Minoxidil could also directly stimulate hair follicles and delay their aging in its form as a solution or foaming agent.
Even though the exact mechanism explaining how minoxidil works may be in question, there’s one thing that isn’t up for debate, is how effective this drug is in treating male pattern hair loss.
In a clinical trial carried out on 393 men, the effectiveness of 5% topical minoxidil, 2% minoxidil and placebo in treating AGA. Each participant was to use the product assigned to him, twice daily.
After 48 weeks of therapy, those on 5% minoxidil showed the most promising improvements, with earlier results when compared to those who used 2% topical minoxidil and the placebo.
In another study to test how effective minoxidil is treating hair loss along the hairline (the frontotemporal region) and around the highest point of the scalp toward the back of the head (the vertex), 70 men were given 5% minoxidil and a placebo treatment as control.
Twenty-four weeks after using either product twice daily, a significant increase in hair density and width was discovered in the patients that applied the 5% minoxidil formulations.
More recently, a study was conducted on 30 men who were experiencing androgenic alopecia. They were given 5 mg of oral minoxidil once daily, for 24 weeks. By week 12, a significant increase in total hair count was already recorded.
At the end of the study, it was concluded that oral minoxidil administered once daily increased hair growth.
Despite the benefits promised for hair regrowth, some caution is necessary when treating hair loss with minoxidil.
The topical options available for minoxidil — a liquid solution and foam, offer less severe side effects than its oral counterpart (which isn’t used as a hair loss treatment), and is for the most part considered safe.
Reports of irritant contact dermatitis, (and the symptoms of itching and scaling that come with it) have however been observed.
This reaction may occur either because of an allergic reaction to the inactive agent — propylene glycol — or to the minoxidil itself.This condition has been observed most frequently with the 5% minoxidil solution.
Another side effect is the already mentioned minoxidil shedding. This occurs after minoxidil use causes the telogen phase to end prematurely to give way for new hair.
Even though finasteride and minoxidil have similar missions to treat hair loss, they take very different approaches to achieve their objectives.
If you recall the little masterclass on the balding process early in this article, you'll recall that hair loss is caused by the actions of DHT.
Finasteride works to prevent the loss of hair by inhibiting the enzyme 5-alpha reductase, preventing it from converting testosterone into the DHT androgen. This reduces DHT levels in the body, helping to manage hair loss.
Minoxidil does things a little differently. It side-steps DHT, allowing it to run wild in the body.
Instead, it focuses on the hair follicles, using its abilities as a vasodilator to give these follicles all the oxygen and nutrients they require to thrive in the hostile, DHT-ridden environment.
By doing this, the follicles have everything they need to complete their stages of growth in good health.
Now before you ask, yes — finasteride is just as effective in reducing hair loss. A study from the Journal of the American Academy of Dermatology certified that this medication provides a noticeable increase in hair growth on the scalp.
Deciding between finasteride and minoxidil is dependent on personal needs. This choice should be made following consultation with a healthcare professional.
An interesting thing to note however, is that finasteride and minoxidil can be used together, as confirmed by many studies.
One of such studies tested out 450 Chinese men with male androgenetic alopecia with finasteride, minoxidil and the combined medication of finasteride and minoxidil respectively.
The end of the study reported the combined medication as having the best end results for patients.
If you're interested in learning more about finasteride, we've talked about everything you need to know in our blog, Is Finasteride the Right Hair Loss Remedy for You.
Here’s what you need to know about Rogaine: it is a popularly recommended treatment for hair regrowth. To carry out this function, it has an active ingredient which is called, wait for it — minoxidil.
Minoxidil is the generic form of the brand Rogaine. This is why attempting to make a distinction between generic minoxidil Vs Rogaine, could amount to splitting hairs.
However, differences can be noticed in the inactive ingredients brands choose to include in their hair loss product, to enable it stand out.
Rogaine, or its generic form, minoxidil, is a proven medication for hair regrowth. It is up there on the same level with other known treatments for male pattern hair loss, and is an easy choice if you're looking to get ahead on male pattern baldness.
Though largely safe, its use can come with certain side effects.
Remember to speak to a healthcare provider before making any decisions on your preferred treatment for hair loss.