Does Rogaine (minoxidil) work?

Take some porcupine hair, boil it in water and then apply it to the scalp for four days. As an alternative, you could sauté the leg of a female greyhound in oil along with a donkey's hoof and spread the resulting goo all over your thinning pate. These are just some of the ancient baldness "cures" people used centuries ago. 

Nowadays, people use remedies with a little more scientific backing—like Rogaine (minoxidil). But does Rogaine work to prevent hair loss? Read on to find out. 

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Minoxidil (brand name Rogaine) is a hair loss treatment that has been used for decades. It comes as an over-the-counter liquid (solution) or foam in 2% and 5% strengths. Minoxidil is FDA-approved for use in women in two forms: a 2% topical solution and a 5% topical foam. Men can use the 5% topical solution or foam; the 5% topical solution is not approved for women.  

Minoxidil is applied directly to the scalp twice a day to slow or stop the progression of androgenic alopecia, also called male pattern baldness, and thinning hair. You need to use it continuously to maintain results—if you stop applying the medication, the new hair growth will reverse, and your hair loss will resume. 

Women can also experience androgenic alopecia, called female pattern hair loss. Unlike men, women tend to get general hair thinning, especially on the top of the scalp, with a widening of the part. Rarely does female pattern baldness progress to complete baldness. Minoxidil is also FDA-approved to help women treat their hair loss and encourage hair growth (Ho, 2021).

Minoxidil's exact mechanism of action in the body isn't completely understood. It was initially developed in the 1950s as an oral medication to treat high blood pressure, and researchers discovered that it led to hair growth in some patients.

Minoxidil seems to work as a peripheral vasodilator—that means it helps widen blood vessels to increase blood flow. 

Researchers believe that minoxidil might increase the flow of blood and nutrients to the hair follicles, stimulating hair growth. The drug encourages hair follicles to enter the growth phase of the hair cycle (called the anagen phase) and stay there longer, resulting in both longer and thicker hair. Unlike finasteride (another hair loss medication), minoxidil has no effect on hormones (like dihydrotestosterone or DHT) (Badri, 2021). 

Minoxidil is effective at slowing hair loss and encouraging new and thicker hair growth. Studies show that 5% minoxidil seems to work better than the 2% formulation for treating hair loss (Suchonwanit, 2019).

Rogaine tends to be more effective in younger men (meaning those under 40) who have been balding for less than five years. Minoxidil is less likely to produce benefits once hair loss spreads over a large area and has persisted for a long time. Basically, the younger you are, and the sooner you start minoxidil, the better the results tend to be (Badri, 2021). 

Studies show that using minoxidil and finasteride together are more effective than using either one alone. However, women cannot use finasteride, and pregnant women should not even touch finasteride tablets (this medication can cause serious harm to a fetus) (Chen, 2020).

A small clinical trial found that men who used 5% minoxidil in combination with low-level laser therapy (or LLLT, an FDA-cleared red light device held to the scalp) were more satisfied with their results than men who used minoxidil by itself (Faghihi, 2018).

This is not as well understood. Minoxidil is FDA-approved for use on the "vertex," or the top of the scalp, because that is what the original trials evaluated. It hasn't necessarily been shown to be effective for a receding hairline because there have not been as many studies looking at that part of the scalp.

It turns out that the scalp hair follicles from the top of your head are molecularly different from those at the front edge of your hairline (where the hairline typically recedes). Despite this, one small study showed that minoxidil helped improve receding hairlines just as much as vertex thinning. However, more data is needed before definitively saying that minoxidil improves hairline recession (Mirmirani, 2015).

What are researchers waiting for? Your guess is as good as ours. But for now, don't count on seeing results from using minoxidil on your receding hairline. However, finasteride has been shown to be somewhat effective there—another good reason to use the two medications together (York, 2020).

Minoxidil is also unlikely to regrow hair on a completely bald scalp. Once male-pattern baldness has progressed to the point of complete baldness, that suggests that your hair follicles are no longer functional and hair regrowth is not likely. Remember, minoxidil works by encouraging your hair follicle to grow—if the follicle is not functional anymore, there is not much for minoxidil to work with (Badri, 2021).

Minoxidil is typically used twice a day, and the 5% formulation may work more quickly than the 2% strength. You may initially start to see effects after around eight weeks of treatment—but for maximum effect, you will likely need to wait four months (Badri, 2021).

Some people may experience additional hair loss or shedding when they first start using minoxidil. This may make you think your baldness is getting worse. In actuality, this effect can be normal and is usually due to the hair follicles shifting growth phases; fortunately, the hair shedding resolves as you continue to use the medication (Badri, 2021).

If your hair loss hasn't slowed after several months of using minoxidil, it's a good idea to stop applying it and get medical advice from your healthcare provider. Something else might be contributing to or causing your hair loss. As you use minoxidil, remember that results are different for everyone—you might see results that surpass your expectations, or minoxidil might not work for you at all.

As mentioned, shedding hair in the first few weeks after treatment is a normal response to using minoxidil. Given that less than 2% of minoxidil is absorbed by the body when applied topically, serious side effects are rare. Side effects of minoxidil include (Suchonwanit, 2019): 

• Scalp irritation

• Itching

• Allergic contact dermatitis at the site of drug application

• Hair growth in untreated places (hypertrichosis)

• Headaches

Side effects, especially hypertrichosis, are more common with the higher 5% dose than the 2% formulation (Suchonwanit, 2019). 

To minimize these side effects, don't use minoxidil more than directed, and wash your hands after using the product so you don't transfer it to other areas of your body. If you do develop scalp irritation or unwanted facial hair growth, give your healthcare provider a call.

Before starting minoxidil, talk to your healthcare provider—especially if you have issues with your heart or high blood pressure. If you experience chest pain, rapid heartbeat, faintness, dizziness, sudden unexplained weight gain, or hand or foot swelling while using minoxidil, seek emergency medical attention. 

The 5% minoxidil topical solution is not FDA-approved for women. Also, women should not use any form of the medication while they're pregnant or breastfeeding. Minoxidil is not approved for anyone younger than 18.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

September 14, 2021

Written by

Michael Martin

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.