The history of hair loss remedies shows that people have struggled with balding for thousands of years. Records show unusual treatments involving herbs, animal parts, and maybe a few incantations from the Greeks to the Egyptians.
But as the scientific method and modern medicine emerged, institutions like the FDA have helped sort the good from the bad in the hair loss world. Finasteride and minoxidil have been the only two treatments approved so far, and widespread popularity has followed.
These two drugs, known better by their brand names Propecia and Rogaine, have dominated the hair loss field for years, and debates continue about which is best.
Let’s get to the truth about Propecia and Rogaine, then give you the final verdict on the most effective hair loss treatment currently available.
Propecia has one of the more interesting stories in the pharmaceutical sphere. What started as a series of unusual experiments later became one of the top-selling hair loss medicines of all time. It’s also one of the few drugs that address the root issue of male pattern balding.
Here are the key facts about the generic drug finasteride and how it became Propecia, along with the benefits users can expect for hair preservation and regrowth.
The story of finasteride began with an unexpected origin: the 1970s in the Dominican Republic.
Researchers had caught wind of a phenomenon in a small Dominican village where young women expressed atypical male sex characteristics when reaching puberty, without balding or prostate development.
This was the first clue that hair loss, prostate health, and male hormones like testosterone were all somehow linked. As research progressed, scientists discovered the role of the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone, or DHT.
With the discovery of DHT, a new chapter of hair loss science opened up, as studies revealed close links between DHT and the progression of Norwood scale pattern balding. Much of the scientific focus on hair loss revolves around these topics, and finasteride was one of the first breakthroughs to go mainstream.
Following the discovery of 5-AR and its impact on DHT, pharmaceutical leaders scrambled to turn these findings into a marketable and effective product. Merck was the first to identify the opportunity, realizing that hair loss could be reduced by inhibiting the action of 5-AR.
The bulk of the 1980s was spent developing safe and effective medications based on these findings. Propecia was soon introduced as the first in a new class of drugs known as 5-AR inhibitors and got FDA approval for hair loss in 1997.
Propecia was the first product brought to market by Merck and was a hit from the start, with clinical and anecdotal support throughout the medical and patient community.
Finasteride is now known as a trusted, accessible form of hair loss prevention, particularly for men in the early stages of hair loss. The drug is commended for its direct interaction with DHT in the scalp, whereas other competing medications — such as minoxidil — do not act similarly.
Doctors also tend to side with finasteride for its ease of use and the ability for patients to stay consistent with the medicine for long periods. The once-daily tablet format is simple and easy to add to a morning regimen of vitamins alongside breakfast.
As an added bonus, the brand name Propecia is no longer dominant in the pharmaceutical industry. Generic forms of finasteride are now widely available, even through online pharmacies and other avenues.
Finasteride is a favorite among hair loss specialists like Dr. Jae Pak, but it’s not an instant or complete fix. The drug is most effective as a preventive method and in combination with other treatments that target the root of pattern balding.
Some side effects, including issues with sexual function and prostate health, have also been identified in certain finasteride patients. For this reason, patients should always take finasteride with proper medical supervision and closely track all effects, good or bad.
Finally, patients should be aware that finasteride only works as long as they take it, meaning that discontinuation can reverse any results or gains. Therefore, patients may consider taking finasteride for life or as long as it works in their favor.
Rogaine, or minoxidil, is the other FDA-approved medication with a completely different mechanism of action and research background. Here are the facts about minoxidil and why it doesn’t stack up to finasteride as a long-term solution.
While finasteride research started with DHT and 5-AR, minoxidil came about in clinical trials for blood pressure and related cardiovascular issues. The compound was discovered to be an effective vasodilator, expanding blood vessels and allowing for greater uptake of oxygen and nutrients in the target area.
Clinical trials for minoxidil were seemingly successful from the start, tracking back to the early 1960s. The original formula was refined and introduced in a 2% solution in 1997, and the patent was subsumed by Johnson and Johnson in the 2000s.
Rogaine went through more iterations and improvements through the years and remains the number one topical hair loss solution to this day.
As the clear winner in its class of topical medications for hair loss, Rogaine has the advantage of first mover and little competition. Clinical trials have been promising, and many patients have reported somewhat positive results with continued minoxidil use.
The issue with Rogaine, however, is that vasodilation is not the primary pathway by which hair loss can be stopped. While additional blood flow may not hinder your ability to grow hair, the drug does nothing to address the root cause of pattern balding in men, known as DHT.
This is not to say minoxidil is entirely ineffective. For example, a five percent concentration in women has been shown to help slow the trend of thinning in the center of the scalp, especially around menopause.
However, men who want to combat hair loss with the most effective and target methods will want to look beyond Rogaine, particularly as thinning and receding progress.
In addition to the questionable efficacy of minoxidil, doctors point out several other issues with the drug’s format and side effects.
Firstly, administering liquid or foam minoxidil twice daily is far from a streamlined experience. The solution is potent, astringent, and can easily stain clothes and irritate the skin. For busy individuals short on time, the continued use of minoxidil may simply not be worth the effort.
The more potent forms of minoxidil have also been associated with side effects, including redness, breakouts, and even blood pressure issues. When all these factors add up, it may be hard to justify using minoxidil for an extended period.
Propecia and Rogaine are bundled in the same category, but they could not be more different. Even so, these medications are just the tip of the iceberg in hair restoration, with so much more that can be done.
Here’s what today’s doctors outline as the best hair loss treatment program, with plenty of room for customization based on your goals.
As always, medicines are no substitute for a balanced and healthy lifestyle. Even the most powerful treatments fall short without a strong foundation of health established.
Before reaching for medicines like Rogaine or Propecia, take stock of your general health and work to optimize daily habits like diet, exercise, and sleep.
While Rogaine and Propecia get most of the marketing and press in the hair loss world, there’s much more to discover. Recent advancements in collagen induction therapy, including microchanneling, show promise for hair restoration with significant clinical support.
Alternative treatments like low-level light therapy and plasma treatments are on the rise as well. Consult a forward-thinking hair doctor to see what’s new and effective in an always-evolving industry.
No medicine or treatment compares to hair transplantation’s expedient, permanent results. Modern FUE surgeries are subtle and minimally invasive, allowing nearly 1000 precise grafts to reconstruct depleted hairlines.
FUT strip surgery procedures are still popular as well for higher graft volumes. Look into the hair transplant galleries from industry leaders to see these life-changing results for yourself.
With so much discussion on topics like Propecia vs. Rogaine and other debates, it’s easy to forget that hair restoration is more than just medicine. Many deeper, complex factors are at play, many of which have yet to be discovered and put into practice by modern medicine.
Knowing this, we suggest that patients think bigger when achieving their desired look, whether it’s scalp hair, facial hair, brows, or any combo.
In truth, a single medicine won’t give you the transformation you seek. A more committed and intentional approach is required. Working with Dr. Jae Pak will put you ahead of the curve with targeted, custom treatments that bring you closer to your ideal appearance without the risk or wasted time.
Sources:
Long-Term Efficacy of Finasteride | Open Access Text
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