Hey Doctor, What Happens When You Stop Using Rogaine?

Hair loss is a common health problem encountered by men and women as they age. Hair loss is caused by several reasons - hereditary, autoimmune disorders, malnutrition, and hormonal imbalances. Male pattern baldness is a common form of hair loss characterized by abnormal levels of androgens in the blood.

These hormones disrupt the normal growth of hair and result in excessive shedding of hair. Rogaine or minoxidil is a topical medication used to treat hair loss and stimulate the growth of new hair. So, what happens when you stop using Rogaine? Let's find out!

What is Rogaine?

Rogaine is the brand name of a famous drug, minoxidil. It was initially formulated to treat hypertension but with reported cases of accompanied hair growth, topical minoxidil was derived to treat hair loss. This over-the-counter medication can be obtained without a prescription.

The 2% and 5% minoxidil foam and solution are widely available in pharmacies to cater to an individual's requirements. Rogaine is effective for people who suffer from androgenetic alopecia or pattern baldness and are under the age of 40.

Apart from scalp hair, Rogaine is also beneficial for beard and eyebrows. The US Food and Drug Administration approves Rogaine for treating both male and female pattern baldness.

How Does Rogaine Work?

The hair follicles contain an enzyme called sulfotransferase. Rogaine or minoxidil is converted to minoxidil sulfate by this enzyme, which is the biologically active form of this drug. Minoxidil sulfate causes vasodilation and open potassium channels.

The opening of potassium channels is linked to the increased proliferation of cells. Improved blood flow as a result of vasodilation delivers adequate nutrients and oxygen to the hair follicles, thus promoting healthy hair growth.

How Rogaine Affects the Hair Growth Cycle?

The human hair growth cycle consists of four phases.

Anagen Phase

This phase reflects the growth of hair strands from the hair follicles. Almost 90% of the scalp hair is in the anagen phase at a given time, which usually lasts for three to seven years.

Catagen Phase

This phase indicates the transition of hair from a growing to a resting state. The hair stops growing, hair follicles shrink, and the production of melanin ceases. This phase lasts for about two to three weeks.

Telogen Phase

When the hair neither grows nor sheds, they are in a phase known as the telogen or resting phase. This phase lasts for two to three months.

Exogen Phase 

This is the phase during which the hair sheds, facilitated further by combing and washing the hair. The duration of this phase is two to five months, and almost 50 to 100 hair strands are shed each day as per the normal hair growth cycle. 

Rogaine increases hair growth by increasing the duration of the anagen phase, thus promoting hair growth to the maximum potential. Furthermore, Rogaine shortens the telogen phase, which results in decreased hair fall.  

What is Minoxidil Shedding?

Minoxidil shedding is the term used for describing increased hair fall at the start of Rogaine treatment. As Rogaine shortens the telogen or resting state of the hair growth cycle, the hair quickly moves on to the exogen phase where they fall out from the hair follicles.

This hair loss may trigger stress and anxiety among many individuals; however, this is a common phenomenon and lasts for about three to four months. Doctors may recommend a lower concentration of minoxidil foam or solution to reduce hair loss in some cases.

How Long Does Rogaine Take to Work?

Rogaine or minoxidil starts working as soon as it is applied to the scalp. However, visible results are delayed owing to the minoxidil shedding. Visible hair growth is observed after approximately four months of use as the hair loss subsides. Hair growth peaks at about one year of Rogaine treatment for hair loss. 

Who Should Not Use Rogaine?

1. People younger than 18 years of age should refrain from using Rogaine.
2. Pregnant and breastfeeding women shall not use Rogaine for hair loss owing to the lack of studies regarding the safety and efficacy of the drug in these conditions. 
3. Rogaine is contraindicated in individuals suffering from cardiac disorders including hypertension.
4. People with skin conditions on the scalp such as irritation and sunburn should avoid using Rogaine. Interruption of the skin barrier in these conditions causes the Rogaine to penetrate deeper into the scalp and gives rise to severe side effects. 
5. Individuals should discontinue alcohol and tobacco before using Rogaine owing to the risk of adverse drug interactions. Alcohol makes the skin dry and may cause scalp irritation upon using Rogaine. 
6. One should always consult a doctor before using Rogaine, albeit being an over-the-counter drug. 
7. People who are allergic to topical Rogaine should consult their doctor for oral dosage or an alternate medication. 

What are the Side Effects of Rogaine?

Following are the common side effects of using Rogaine:

1. Hair texture and color may change upon Rogaine's application. 
2. Itchiness, burning, or rash if an individual is sensitive to Rogaine.
3. Development of acne where Rogaine was applied. 
4. Increased hair loss or minoxidil shedding in the initial phases of the treatment.
5. Swelling and increased hair growth on the face.
6. Inflammation of the hair follicles may also develop in some individuals.

Excessive use of Rogaine or damaged protective barrier of the skin causes the Rogaine to infiltrate the blood and cause adverse side effects:

1. Abnormalities of vision.
2. Widespread edema, particularly involving the face, feet, and hands. This may lead to rapid weight gain.
3. Tingling of the face, feet, and hands. 
4. Excessive use of Rogaine leads to irregular heartbeat and chest pain. 
5. The patient may complain of neurological symptoms such as dizziness and headache.
6. As Rogaine dilates the blood vessels, higher amounts of this drug in the blood lead to flushing.

One should immediately seek medical attention upon observing these symptoms while using Rogaine. 

Side Effects of Discontinuing Rogaine 

Minoxidil is safe and can be used for the long term to maintain hair growth. The question arises - what happens when an individual stops using Rogaine?  

Followed by discontinuing Rogaine intake, the hair returns to the original state that was before initiating Rogaine treatment. Following are the effects of quitting Rogaine:

Reduced Blood Flow

Rogaine is a vasodilator drug that increases blood flow towards hair follicles to provide nourishment for hair growth. Increased blood volume has a higher content of essential nutrients. Discontinuing Rogaine will suppress the vasodilating effects of the drug on blood vessels supplying the hair follicles.

This deprives the hair follicles of adequate oxygen and nutrients. The hair follicles shrink owing to reduced cellular proliferation and lead to reduced hair growth. Hence, stopping the treatment will return the hair to its pre-Rogaine state. 

Hair Loss

Rogaine exerts its growth-promoting effects by prolonging the anagen or the growth phase and shortening the telogen or the resting phase of the human hair growth cycle. This may lead to hair loss at the beginning of treatment; however, the hair growth in the anagen phase overcomes this hair loss within three to four months.

Termination of Rogaine treatment will reverse its effects on the hair growth cycle. The anagen phase shortens and significantly reduces the growth of existing as well as new hair. Spending less time in the anagen phase, the hair proceeds to the telogen phase quickly and eventually falls out. In the absence of Rogaine, the telogen phase prolongs and further aggravates hair loss.

Similar to the fact that Rogaine takes four to six months to show visible hair growth, quitting Rogaine also takes several months to manifest as hair loss. 

How to Combat Hair Loss Caused by Discontinuing Rogaine?

Individuals who use Rogaine often have a common misconception that Rogaine is the only medication for hair loss. Following are the possible alternatives to increase blood flow and promote hair growth after quitting Rogaine:

1. Scalp massage increases blood flow towards the hair follicles and increases hair growth. This is better accompanied by a serum that helps hair growth.
2. Inversion method facilitates blood flow towards the scalp under the influence of gravity.
3. Vitamin and mineral supplements are essential for maintaining hair health and increasing hair growth. 
4. Finasteride, available by the brand name Propecia, is an FDA-approved alternative to Rogaine for hair loss treatment. Finasteride decreases the production of dihydrotestosterone (DHT) by inhibiting the enzyme that catalyzes its conversion, 5-alpha reductase. DHT disrupts the hair growth cycle and shrinks the hair follicles. This leads to reduced hair growth and increased hair loss. However, finasteride affects libido and causes sexual and erectile dysfunction. The side effects of topical finasteride are significantly lower than the ones caused by oral finasteride.
5. Natural DHT blockers include pumpkin seed oil and reishi mushroom or Ganoderma lucidum.

Conclusion

Hair loss is a common problem encountered by individuals with increasing age. Rogaine is an over-the-counter drug, which increases hair growth and counters hair loss. This is caused by improving blood flow and modifying the hair growth cycle.

While long-term use of Rogaine is safe and effective for almost all Rogaine users, discontinuing Rogaine leads to adverse side effects. Severe hair loss and reduced hair growth are seen in individuals who stop Rogaine treatment. Various options can be considered to reduce hair loss. Finasteride is a 5-alpha reductase that makes it to the top of this list.

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Read more:

• Microneedling For Hair Loss: Should You Do It At Home?
• Finasteride Side Effects After Stopping: PFS & What Are They?
• How To Reduce Hair Loss With DHT Blocking Foods?

References

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2. Badri T, Nessel TA, Kumar D D. Minoxidil. [Updated 2021 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482378/
3. Bernard B.A. (2017) The Hair Growth Cycle. In: Humbert P., Fanian F., Maibach H., Agache P. (eds) Agache's Measuring the Skin. Springer, Cham. https://doi.org/10.1007/978-3-319-32383-1_103
4. Motofei IG, Rowland DL, Tampa M, Sarbu MI, Mitran MI, Mitran CI, Stoian AP, Diaconu CC, Paunica S, Georgescu SR. Finasteride and androgenic alopecia; from therapeutic options to medical implications. J Dermatolog Treat. 2020 Jun;31(4):415-421. doi: 10.1080/09546634.2019.1595507. Epub 2019 Apr 2. PMID: 30897009.