For a (semi) complete list of scientific treatments and study results, see the Hair Loss Agents list at Regrowth! (http://www.regrowth.com/).***

Minoxidil (Rogaine)

Minoxidil, known as Rogaine in the US and Regain(e) in other parts of the world (the FDA wouldn't let Upjohn use the name Regain for obvious reasons!), is the only FDA (Food and Drug Administration) approved treatment for hair loss. In addition, the FDA has banned advertising substances as treatments for hair loss unless they are FDA approved. Although Minoxidil has been extensively studied, it is still not known EXACTLY how Minoxidil makes hair grow.

How is Rogaine used?

Rogaine is a clear, colorless solution to be used for external application only. Apply 1 mL of Rogaine two times a day to the scalp with the specially designed applicator supplied in the package. Do not use more than twice a day.****

Is Rogaine safe?

Rogaine, which has been marketed since 1988 and used by over three million people, has an excellent safety record. The most common side effect was itching of the scalp, reported by about seven percent of patients in the clinical trials.****

Is Rogaine for Women and Rogaine for Men different?

No. Only the packaging is.

Can I use hair sprays, mousses, gels, etc.?

Hair spray, spritz, or styling aids may be used on hair while using Rogaine. You should apply Rogaine first and wait for it to dry completely before applying styling aids.****

Can I have my hair colored or permed while using Rogaine?

We have no evidence that coloring or perming hair or use of hair relaxers interferes in any way with the effectiveness of Rogaine. However, to avoid possible scalp irritation, you should make sure all of the Rogaine has been washed off the hair and scalp before using these chemicals.****

Can I go swimming or get wet in the rain?

Yes, as long as you use good judgement. Avoid washing off the Rogaine. If possible, apply Rogaine to a dry scalp after swimming, or wait about 4 hours after application before going swimming. Do not let your scalp get wet from the rain sooner than 4 hours after applying Rogaine.****

Can I blow dry my hair after using Rogaine?

You can, however studies have shown some of the Rogaine gets evaporated if you blow dry, so the Rogaine will be less effective. In general, it is recommended you NOT blow dry your hair afterwards unless you absolutely have to.

Why can't I get my hair wet for four hours after using Rogaine / Can I use Rogaine after showering with my hair wet?

Wet scalp skin increases the penetration of topical drugs by several times (2x-5x more powerful). Because Rogaine does have side effects, they must attempt to keep you from increasing its potency and thereby side effects. However, if you apply Rogaine and do not experience any side effects, you might try applying it to wet scalp if you want to make it more potent. Be sure you have someone around if you do this since there is a change that you may not experience side effects on dry scalp, but may with wet scalp. If you experience side effects when applying Rogaine to dry hair, DEFINITELY *NEVER* apply it to your hair wet and be sure to follow Upjohn's instructions about not letting your hair get wet for 4 hours.

From personal experiences, I have heard many people who have said that Minoxidil did not work well for them, but after they started applying it to a wet scalp, it started working much better.

What side effects are there to using Rogaine?

The most common side effect of Rogaine is simple itching. In some people this can be a simple irritation, in others it can be an allergic reaction. A small percentage of people experience dizziness and/or shortness of breath. These are because Minoxidil lowers blood pressure, and too much is being absorbed and causing your blood pressure to drop. If you know you have low blood pressure already, be very careful using Minoxidil. Some people also get a bitter taste in their mouth after application.

What should I do if I experience side effects of Rogaine?

If you experience itching and scaling, try applying less Rogaine. If you are using the sprayer, try the applicator instead. Once the itching goes away, you can increase the doseage again to see if the reaction has gone away. If it continues you will need to just use less.
If you experience dizziness or shortness of breath, consult your doctor. Have your blood pressure checked to see if you have low blood pressure. If you have very low blood pressure normally, you probably should not use Minoxidil. If the side effect is not too strong, you may first try lowering the dosage you are applying and seeing if the effect disappears.

How effective is Rogaine?

59% of men reported growth after 4 months use of Rogaine. 26% reported moderate to dense regrowth (what most of us would consider acceptable), while 33% experienced minimal regrowth (a few hairs here and there, but not worth the effort). It should be noted that 42% of men using the placebo (containing no minoxidil) reported some growth. 11% reported moderate to dense regrowth (probably due to the propylene glycol, extra massaging, or just overoptimism), while 31% reported minimal regrowth (if you rub just about anything into your head twice a day, you're bound to see one or two hairs here and there).

5% Minoxidil is a non FDA approved version of Minoxidil containg a larger concentration of minoxidil. It is much more effective than the standard 2%. Many who do not respond to 2% will respond to 5%. Unfortunately, since it is not yet FDA approved, it has to be custom made by a pharmacy through a doctors prescription. Due to this, many doctors will not prescribe it. Also, many pharmacies can't or won't make it and most that do sell it at a high price. Many people swear by 5% minoxidil though.

Who is the ideal Rogaine candidate?

The ideal Rogaine candidate is a young male (20s) with little (thinning) hair loss on the crown/vertex, or a small bald spot 1-2" in diameter. The less you match this description the less likely Rogaine is to work for you.

What can I REASONABLY expect from Rogaine?

Rogaine seems to have a very individualist response. Some people respond, some don't. When deciding to use Rogaine, you have to prepare yourself for the chance that you just may not respond well to Rogaine. The more you fit the ideal candidate situation, the better it will work. If are an ideal candidate, or close, you can expect to replace hair lost within the last 1-2 years, but sometimes up to 5 years. Usually hair will NOT grow back from 'slick spots' where no hair exists at all. Mostly the hair will come back from the small, vellus hairs still existing on your scalp. Rogaine has only proven effective on vertex balding (the back top of your head). You should not expect new hairs along the front of your hair line. If you do get some, treat it as a bonus. Rogaine should also cause the hair you do still have on top to thicken and look healthier. Unless you are a young male whose hair has become thin within the last 1-2 years who does not have a slick spot, do not expect a complete reversal of loss.

When should I expect to see the results from Rogaine?

Rogaine response is different for every individual. Most individuals report that they can see 'fuzz' grow more within the first few months. Some report increased shedding of hairs (this is due to old hairs falling out so new ones can grow). Full hairs may be seen to grow as early as 4 months into treatment, although the full effect of Rogaine is usually achieved between 12 and 14 months. After that point, as long as Rogaine is used properly the hair can usually be maintained indefinitely. Since response is different in different people, you should not be disappointed if you don't see a bunch of new hair after four months. Sometimes it takes 6 or 8 to see good results. As long as you do not seem to be losing more hair after 4 months, the Rogaine is probably working and you should be patient.

Can I use Rogaine once a day instead of twice?

Not within the first year. For Rogaine to be used effectively, it MUST be used twice per day, preferably 12 hours apart. Some people find that after a year or two they can use Rogaine only once a day to maintain what they have, however, MOST people will still have to use it twice a day to keep from losing hair.

Can I skip a treatment or two of Rogaine?

Yes. You can skip treatments for one or several days without reducing Rogaine's effectiveness. You should not make a habit out of it, though.

How long can I stop using Rogaine without losing hair?

The general consensus is that you can stop using Rogaine for 1-2 weeks without losing (much) hair. Again, this is based on the individual. 3 weeks is pushing it. By 4 weeks you will definitely begin to see shedding.

Will I lose the hair I grew if I quit Rogaine?

Yes. Rogaine requires continual treatment to maintain the new growth. If you stop using Rogaine your hair will revert back to what it would have been had you never used Rogaine in about 2-3 months.

How much does Rogaine cost?

$29.95 for 60ml (one month) of brand name Rogaine by Upjohn. The lowest I have found for generic Rogaine is $14.99 for a two pack. Several companies make generic versions which are almost always cheaper than brand name Rogaine. Almost all Wal-Marts carry Equate brand minoxidil in a 3-pack for $24.95 ($8.32/bottle). Most places now sell generic single packs for $10-15.

Is Minoxidil 3% effective?

Studies have shown that Minoxidil 3% is less effective or as effective as Minoxidil 2%.

What about 5% Minoxidil?

Upjohn is trying to get a 5% version of Minoxidil approved. It has not been approved by the FDA yet, but is expected to be approved and issued by prescription. Doctors can prescribe 5% under FDA regulations allowing for exprimental medications at their discretion. A pharmacy then has to actually make the 5% minoxidil for you, which is not easy (the solution has to be changed to hold the higher concentration of minoxidil).

Where can I get a prescription for Rogaine 5% mixed with Retin-A?
Currently, the majority of doctors do not prescribe it because it is not yet approved by the FDA. Most doctors will not prescribe unapproved drugs (although they are allowed to) due to liability concerns. However, the Regrowth! web site has been building a list of doctors who prescribe such treatments and has a list of doctors for many of the states who commonly prescribe this and other treatments. You can go to that list by clicking here.

There are now a couple of overseas pharmacies selling 5% Regaine by Upjohn. They charge around $45-50 per bottle, but you can get it without a prescription. You can find a list of overseas pharmacies here.

What about 10% Minoxidil or 20% Minoxidil?

Minoxidil will not stay in a liquid solution at more than 5%, so 5% is as strong as you will get. If you see ads for 10% minoxidil or any strength above 5%, it is an illegal con and you should report it to the police/FDA. Applying 5% to a wet scalp or with penetration enhancers may increase absorption of the minoxidil to get more minoxidil than applying to a dry scalp.

Can I use Rogaine along with Retin-A?

Yes. Using Rogaine along with Retin-A increases the effectiveness of either alone in most people. Some doctors say 2% Minoxidil combined with Retin-A is about as effective as 5% Minoxidil. You can also get 5% Minoxidil combined with Retin-A some places.

Can I mix Rogaine with the Retin-A I purchased separately?

NO! Mixing separately purchased Rogaine and Retin-A will dilute both and make them both less effective. The reason is most of the liquid or cream you get is NOT Minoxidil or Retin-A, and when you combine them you get even less of the drug per application. You must apply them separately or buy them precombined.

How do I use Rogaine with Retin-A?

This can be tricky. As stated above, you can not just mix Rogaine in with Retin-A. If you have purchased precombined Rogaine and Retin-A, apply it as instructed. If you purchase them separately, they must be applied at separate times. Some people apply the Retin-A and then the Rogaine, some the Rogaine then the Retin-A. Some find if they apply one after the other it causes irritation. You have to find what works for you. The general theory is that you should apply one, wait until the solution has dried COMPLETELY (usually 15-30 minutes), then apply the other. You still have to apply Rogaine twice per day. Whether you apply Retin-A twice per day is up to you, however it is not recommended that you use Retin-A in sunlight. If you do not experience itching or scaling by applying twice per day, go for it. Most people apply Retin-A, then Minoxidil, under the theory that the Retin-A will increase absorption of the minoxidil.

Can I use Rogaine along with Proscar?

Yes. Studies have shown that using Rogaine and Proscar together is more effective than using either alone. Doctors who have expirimented with this combination have confirmed this to me.

How can I get Rogaine?

Rogaine is now available over the counter in the US. You can get it at grocery stores and drug stores. There are even online mail order services for it. If you do not live in the US, most countries allow purchases of drugs from other countries for personal use, so you can probably mail order it from the US. However, many countries have already given Minoxidil OTC status, too, so you may be able to get it over the counter where you are.

I am a 32 year old male. I have been using Rogaine for 8 years. It was effective for the first 2, but after that my hair loss resumed, and now there is a big difference. Is this normal? And should I continue to use it?
It depends on what you consider normal. Certainly, a certain percentage of men do experience this, so you are not alone. The most prevalent belief is that Rogaine stimulates hair to grow, but it does not prevent damage to the follicle. Eventually, damage may become so great that even Rogaine can not prevent the follicle from dieing. There are men who have used Rogaine for 10 years or more without having this effect, so apparently this does not happen in all men. Yes, you should continue to use it. Even though it is not AS effective, it is still probably having some effect. It is probably keeping more hairs from falling out than there would be if you weren't using it at all. With Minoxidil as cheaply available as it is now in generic form, there's no reason not to keep taking it. The two most researched and proven things you can do to stop the loss and improve results are start taking an antiandrogen such as Proscar/Propecia to prevent further damage to follicles and move up to a higher strength version of Minoxidil. Formulations up to 5% are available with prescription and are much more effective than 2% alone.

Also, I am experiencing hair growth at the top and backside of my shoulders only. Could this be a side effect of Rogaine?
It is possible. Minoxidil's hair growth effects were initially discovered when people taking it orally started growing hair all over their body, so this does happen. However, a large percentage of men with baldness seem to have a genetic predisposition to shoulder and back hair and get it even if they don't take Minoxidil. In my experience, the frequency and amount of hair increases as you get older, so this may not necessarily be related to Minoxidil. Certainly the Minoxidil doesn't help it to go away though :) There aren't very good options for getting rid of large amounts of unwanted body hair permanently, however new methods for removing unwanted hair are being tested now and may be available within the next few years. Certainly there is a large market in both men and women who would like to get rid of unwanted body hair and companies are aware of this and working on products which can do this. Methods vary from laser removal, sprays that damage the follicle, and substances that work in reverse of hair growth products which signal the hair to STOP growing.

I am a woman considering using Minoxidil. I have heard that a woman is sueing Upjohn for excess facial hair growth due to Minoxidil. Is this true and what can I expect?
It's impossible to say what effect Minoxidil may have on you. Minoxidil has a known side effect of unwanted hair growth no matter which sex you are. Most people do not experience this, but there is always that chance. It is important to also remember many men and women who experience androgenetic hair loss often experience unwanted body/facial hair growth anyway. For example, many men with balding end up growing hair on their backs and many women with hair loss have unwanted facial hair growth whether they are on Minoxidil or not.

Retin-A (Tretinoin)

Retin-A was first approved by the FDA for treatment of skin conditions such as acne. Since then it has been studied in hair loss and found to be a hair growth stimulator in the right dosages, particularly when combined with Minoxidil.

How can I get Retin-A?

Retin-A is only available by Prescription in the US. Therefore you must have a prescription to purchase it unless you order it from outside the US. The FDA allows importation of a three month supply of medications for personal use of drugs that are only available by prescription in the US. There are online web sites for ordering medications from overseas. In addition, Retin-A is available OTC in Mexico if you live within travelling distance.

What strength of Retin-A should I get?

Retin-A is available in many different strengths. The most common are 0.01%, 0.025%, 0.05%, and 0.1%. Most people using it use 0.025% or 0.05%. Since Retin-A can cause skin irritation depending on percent, many people use 0.025%. Also, some studies have shown that 0.1% is only MINIMALLY more effective than 0.025% or 0.05% but caused a lot more irritation. Retin-A that is too strong and irritating can cause hair to fall out and damage the follicle, so it is important not to use too strong of a strength.

What are the side effects of Retin-A?

Retin-A's main side effects are itchiness and scaling of the skin. This can sometimes be very extreme depending on the individual, and most people will experience some itching or scaling if too much is applied. Also, Retin-A can cause hair LOSS if TOO much is applied in too strong of a dose.

How should I apply Retin-A to avoid side effects?

Since Retin-A can be a skin irritant, it is important to apply it carefully at first to see how you will react. Apply a small amount to a small area of your scalp. This should give you an idea of how much irritation you can expect. If you don't experience too much irritation, you can try it on a larger area with more of the medication.

Some people have said that apply Iamin Gel or Aloe Vera after Retin-A soothes and removes the irritation. Iamin Gel also may help with improve or grow hair so if you are experiencing irritation this may be a good addition to your treatment.

Can I use Retin-A with Rogaine?

Yes. See sections 3.A.22, 3.A.23, and 3.A.24.

Is Retin-A effective without using Rogaine?
Yes, although this depends on the individual. Studies have shown that Retin-A does stimulate hair growth, however it is more effective in combination with Rogaine.

Retin-A is too irritating to my skin. What can I do?
There are basically three options:

1. Stop using the Retin-A - This is always an option.
2. Apply something to soothe the irritation - Many people choose to do this. Aloe Vera gels or other soothing gels or lotions may soothe the irritation. Some people have said Iamin Gel has completely removed any irritation they experienced.
3. Get a Retin-A substitute - This is probably better than option 1, but not as good as option 2. There are a few new Retin-A substitutes, the most well known is Retinol. Studies indicate these work like Retin-A but require lower doses and have less irritation. Unfortunately, these studies aren't concerning hair loss, so there's no way to know whether they will work exactly like Retin-A or not. Also, I've never heard of anyplace providing Minoxidil precombined with Retinol any other analogues.

Propecia / Proscar (Finasteride)

Proscar was first developed as a treatment for enlarged prostates. Proscar works by preventing testosterone from being converted into the male hormone responsible for prostate enlargement (which is the same one primarily responsible for hair loss). It was FDA approved for treatment of prostate enlargement, but is also prescribed for hair loss.

How can I get Proscar?

Proscar, like Retin-A, is a prescription drug. It is also a fairly recent drug so it is not available without prescription in most other countries. However, under FDA regulations you can order up to a three month supply from other countries for your own personal use. Proscar is mostly used in the treatment of enlarged prostates, so some doctors may not prescribe it for hair loss.

How is Proscar taken?

Unlike Retin-A and Minoxidil, Proscar is taken orally in pill form. This means side effects are more likely to occur because it is absorbed throughout your body.

What are the side effects of Proscar?

There's good news and bad news. The good news is, Proscar's most common side effect isn't threatening to your health. The bad news is, it's most common side effect is threatening to your sex life! At hair loss doses, less than 2% of individuals using Proscar experience sexual problems such as impotency when they first use Proscar. Usually even in this small percentage, the problems are temporary and go away after a while, however, they will stop is treatment is stopped. The cause of this problem is that the way Proscar works is by reducing certain male hormones in your body which enlarge the prostate and also cause hair loss. The fluctuation in male hormones when first taking Proscar can cause sexual problems since male hormones are what controls sex drive. However, the primary sex hormone that is reduced is not a primary hormone for sex drive, so permanent and long term sex problems should not occur. Another side effect may be a reduction of male hormone related hair, such as hair on the chest, back, and shoulders. This hair can also sometimes increase when first taking Proscar because of the fluctuation of hormones. Proscar sometimes increases overall testosterone levels (since it's being prevented from being converted into DHT), which may also be a cause in an increase of body hair. Increased breast tissue is a possible but very unlikely side effect, possibly including some soreness. If this side effect occurs, discontinue proscar to prevent the problem from getting worse. This can happen with any treatment that decreases male hormones.

What can I reasonably expect by using Proscar?

Proscar's primary function is reducing the male hormone that initiates and continues hair loss. In most men, Proscar will stop or severely slow the balding process. Most men also experience a 10% increase in hairs after one year. Since Proscar does not stimulate hair growth but keeps hairs from being influenced by male hormones, hair takes a while to grow back and only the most recent hairs lost grow back. Proscar's main role is in halting the balding process, not reversing it.

Like Minoxidil, Proscar's results may be highly individualized. Some men have been known to grow large amounts of hair from Proscar. Others have grown little or none. Almost all will prevent further hair loss. The more recently the hair was lost, the more likely the hair is to grow back.

The Propecia FDA study results indicate the effectiveness of Proscar/Propecia.

Can I use Proscar with Rogaine and/or Retin-A?

Yes. Proscar when used with Rogaine and/or Retin-A is much more effective than using Rogaine alone. Several people who have been long time users of Minoxidil 2% with little or no effect have reported almost an immediate start of hair growth after starting Proscar. Since Proscar works against the cause of hair loss, it allows Minoxidil to work better. This combination is the fastest way to get results.

Isn't there a way to apply Proscar topically so that I can avoid side effects?

This is unknown. Proscar is soluble in alcohol and dissolves well in Minoxidil solutions. Doctors have used it and it has seemed to improve the result over minoxidil alone. A direct study hasn't been done comparing topical or oral. Doctors who have used it topically have told me there are fewer side effects, however at these lower doses there may be fewer side effects anyway. A clinical study was done showing that Proscar is absorbed topically but the effects are seen throughout the body, so it may not remove side effects by applying topically. No topical form is expected to be released. Merck is concentrating on an oral pill for hair loss, since the topical form was absorbed throughout the body anyway. Apparently orally is better or Merck would have tried to get a topical form approved.

When will Propecia be approved? Will Propecia be prescription? How much will it cost?
There is no way to predict when the FDA will approve Propecia. Some people have said generally the drug would be approved within a year of applying for approval. This would mean the FDA may approve Propecia around the end of this year, but there's no way to say for sure. Propecia will be prescription due to side effects and the fact that women shouldn't be taking it unless they are postmenopausal. Merck has not said anything about cost, but given the fact that this is a new drug (meaning Merck will say it needs to recover research costs) and it is prescription (meaning fewer people will buy it than if it was OTC), my guess is that Propecia will be priced similarly to Rogaine when it was prescription, or around $50 per month. I would not guess that they would charge less than $30 per month. If you took Proscar and cut it into even 1mg pills, the cost would only be around $10 per month at current prices, but it is unlikely that Merck will charge this little for the drug since it is new.

***Source: Shameless plug by me
****Source: Is Rogaine for You? pamphlet from Upjohn, (c) 1996 The Upjohn Company

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