Does Rogaine Make Hair Loss Worse Before It Gets Better?
Yes, hair loss often gets worse before improvement is seen.
I am taking Rogaine for the first time in my life and I feel like it is just making my hair loss worse. Is this a common occurrence and will it get better?
Rogaine (minoxidil) is a topical hair re-growth product available for both men and women. Specifically, it is indicated for the treatment of both male and female androgenetic alopecia. It is available as a 2% solution, 5% foam or 5% solution.
Several studies have published positive results regarding the efficacy of Rogaine for re-growing hair and is the only FDA approved topical therapy (1, 2). While effective, Rogaine is associated with a temporary worsening of hair loss before improvement is seen.
Initial Hair Loss With Rogaine
While Rogaine can be effective in promoting hair growth, or at the very least, halting the worsening of hair loss, initial use of Rogaine is well associated with hair loss (7).
In fact, the prescribing/package information for Rogaine states the following:
"When you first begin to use ROGAINE® Extra Strength Solution, your hair loss may increase temporarily for up to 2 weeks. This is likely a sign that you are getting rid of old hairs in order to regrow more new hairs. This temporary increase in hair loss is expected and is a part of the process for how ROGAINE® Extra Strength Solution regrows hair. Remember, this increased hair loss is temporary. However, if it continues after two weeks, see your doctor."
In addition to the initial hair loss with Rogaine, other commonly reported adverse effects include:
- Hypertrichosis (excessive hair growth, especially on cheeks and forehead)
- Skin irritation (most common with the 5% foam/solution)
- Dry/flaking skin
Why Does Hair Loss Get Worse With Rogaine?
Rogaine, in many individuals, will increase hair loss (sometimes referred to as hair shedding) for up to two weeks (although up to 6 weeks has been reported). This occurs because Rogaine decreases the latent period of the hair cycle.
The latent period in the hair growth cycle is defined as the time between the telogen phase and the anagen phase.
During the 'telogen' phase of the hair cycle (also known as the resting or shedding phase), hair follicles are dormant/inactive and may fall out. Extended telogen phases are very often the cause of noticeable hair thinning/loss (3).
The 'anagen' phase of the hair cycle is the growth phase, with hair typically growing around 0.3 to 0.4 inches per month (4).
As Rogaine application accelerates hairs shifting from the resting telogen phase to the growing anagen phase, you may visibly notice hair shedding in the first few weeks of use.
How Does Rogaine Work?
As described above, Rogaine works by decreasing the latent period of the hair cycle. The precise mechanism of action isn't well known but may also work via:
- Decreasing the entrance of calcium into hair cells. When calcium is present, it is thought to affect epidermal growth factors (EGF), inhibiting hair growth. Rogaine can reduce calcium entry into the hair cell, reducing EGF-induced inhibition of hair growth (5).
- Vasodilation (increased blood flow).
- Altering the metabolism of androgens in the scalp (6).
How Do You Use Rogaine?
Rogaine should be applied consistently (starting at the center of the affected area) twice daily for the best results when the hair and scalp are thoroughly dry.
- If using Rogaine solution, 1 mL should be used for each application, regardless of the total application area.
- If using Rogaine foam, approximately one-half capful should be applied to the total affected hair loss areas of the scalp each application.
If using your hands to apply Rogaine, be sure to wash them thoroughly after each application.
Rogaine needs to be used consistently for best results. If Rogaine use is stopped, hair loss can be expected to re-occur.
It can often be disconcerting to experience initial hair loss with Rogaine, especially since it is used to prevent it! Nevertheless, as described above, initial hair loss is extremely common with Rogaine, and can persist anywhere from 2 to 6 weeks. After the initial hair loss, you should begin to see positive results.
If you continue to see shedding after 2 weeks, you should stop Rogaine and discuss your options with your doctor. They may recommend continuing for up to 6 weeks to evaluate if shedding has stopped. If shedding continues after 6 weeks, you may need to evaluate alternative treatments.