When Howard Hintz looks in the mirror every morning, he sees a guy with a full head of hair. Maybe it's not quite as thick on top as it was when he was 18, but neither is it as thin as it was a few years ago--and Hintz has a morning and evening ritual to keep it that way.
"I'll continue to use it until something else comes along. Or until I get to a point where I'm too old to be bothered," said the 31-year-old Los Angeles chef.
The secret to Hintz's rebound from baldness is minoxidil, rubbed in the scalp twice a day. Under the brand name Rogaine, the drug has been touted over the last year as "the first and only product that's proven to grow hair."
It's a product to meet a health need that is more mental than physical, and American men have been slow to accept it. But there has been a slow, steady increase of Rogaine users, including some women who were losing their hair because of genetics or medical treatments.
From its beginnings in sober medical propriety 1 1/2 years ago, Upjohn Co.'s marketing campaign for Rogaine has moved from aiming at doctors to directly appealing to consumers.
On the sports pages and on posters at the barbershop or hair salon, American men are seeing explicit ads about what Rogaine can do for them.
In a twis t on supermarket coupons for cereal and cat food, the ads even contain a coupon worth $10 toward the cost of visiting a doctor for a Rogaine prescription.
And the recent Los Angeles Marathon featured a 5-K run sponsored by Rogaine: its first move into sports sponsorship to get name recognition for a cosmetic that can be sold by prescription only.
A product that was seen as a sure-fire hit before it received FDA approval in August, 1988, Rogaine began looking like a pharmaceutical Edsel in the first few months after Upjohn made it available in November of that year. Sales that some market analysts had predicted would hit $200 million in the first year totaled less than a third of that in 1989.
In short, it has taken some work to persuade American men to spend at least $600 a year for a vanity product they must use for their lifetimes. Most pharmacies fill only a handful of Rogaine prescriptions each month.
One of the notable exceptions is--where else?--in the center of Southern California's good-looks industry, Beverly Hills.
Mickey Fine Pharmacy, 433 N. Roxbury Drive, Beverly Hills, sells at least 144 bottles of Rogaine every month, said owner Ted Buchalter. He estimates that 10% of those bottles go to women.
The men, who don't like to admit they're using Rogaine, "are mostly yuppies, young executives, people who are in a position where they have to make the good appearance. If they get bald, they look a little older," Buchalter said.
Nearby, at the hair transplant center of the Bosley Medical Group, 8447 Wilshire Blvd., patients use about 100 bottles of minoxidil a week, said clinic administrator Charles Ihling. The drug is thought to promote hair growth that the trauma of the transplant operation might temporarily disrupt.
Seven other centers in California and three other states bring the Bosley Medical Group's monthly consumption to about 1,000 bottles, Ihling said.
"We've been told by Upjohn that we're the No. 2 purchaser of Rogaine in California and among the top 10 in the United States," Ihling said.
Upjohn will not release sales figures, saying only that 2 million men worldwide have tried Rogaine.
What that doesn't say is how many men quit using the drug because it didn't seem to work or because--once confronted by having to rub it on twice a day, forever, and at a cost of about $50 a month--men decide they'd rather go bald. Dr. Rhonda Rand, a Beverly Hills dermatologist, said about half of her patients who try Rogaine stick with it.
Minoxidil has been used in the United States since 1980 to lower blood pressure. When doctors testing the drug in the early 1970s noticed that some men taking the pills started growing hair on their heads and upper cheeks, Upjohn began researching it as a baldness remedy.
The tests found the drug useful against male pattern baldness, the hereditary type that begins at the top of the head and can eventually leave a man with only a horseshoe-shaped fringe of hair around his head. About 30 million American men have some degree of male pattern baldness.
The study concluded that 39% of men experienced moderate to dense hair regrowth; 37% had minimal regrowth; 13% grew only small, soft, colorless hair, and 11% had no regrowth.
The studies also showed that minoxidil requires a four- to six-month commitment of twice-daily applications before early results can be seen. And, although early hairs often resemble "peach fuzz," sometimes they are replaced later by more normal-appearing hairs.
The earlier in the balding process a man is, the better the results seem to be. And, even when hair doesn't become denser, some men find that minoxidil "holds the line" against further hair loss. Once minoxidil treatment is stopped, though, balding will begin again.
The current formulation is a 2% solution of minoxidil, but Upjohn recently launched a study of whether increasing the concentration to 5% would improve the results, said Kaye Bennett, spokeswoman for the firm.
Some doctors also tell their patients to use minoxidil in conjunction with Retin A, the "anti-aging" drug.
The major side effect from Rogaine is skin irritation, which occurs in about 5% of men. Because minoxidil is absorbed through the skin, close monitoring is needed if Rogaine is used by a man with hypertension, coronary heart disease or a predisposition to heart failure. Its use should be avoided by pregnant or nursing women.
Before Rogaine was approved, American men were spending about $200 million a year on various remedies for hair loss, Upjohn says. In January, the FDA banned the promotion of various long-standing over-the-counter remedies for baldness, calling them ineffective--and leaving Rogaine as the only approved nonsurgical alternative.
Surgical options include transplanting small plugs of hair from the back of the head to the top, moving flaps of hair over balding areas, and scalp reduction surgery that decreases the bare area.
Although Upjohn and others are researching the mechanism of minoxidil's action, no one is sure how it works. Male pattern baldness is known, however, to result from hair follicles reacting abnormally to the presence of androgens, male sex hormones.
Another drug currently being tested for its hair restoration properties, Cyoctol, acts against androgens. A very small study for a Los Angeles firm showed that Cyoctol blocked the action of testosterone on the scalp, preserving the hair, but further studies are needed.
Women could present the market of the future for Rogaine because they are more concerned when hair loss occurs and more likely than men to consult doctors, drug market analysts believe.
"It would more than double the market," said Richard Stover, who analyzes the drug market for Alex Brown & Sons Inc. in New York.
Early results of Upjohn tests indicate that hair growth in women with thinning hair was 50% better with minoxidil than with a placebo.
Actually, women already play an important role in the market, even when they aren't using Rogaine themselves, some say.
Many inquiries about the drug come from women who are asking on behalf of husbands who are too embarrassed to call attention to their baldness, said Dianne Narron, a Raleigh, N.C., hairdresser. Narron chairs an education committee for the National Cosmetology Assn.
"It tickles me. A lot of mothers whose sons are college-age or older ask about Rogaine," Narron said. "One lady noticed her son was getting some hair loss and offered to pay for it if he would go to the doctor. She thought he had such a wonderful head of hair and, if something could help it, then she wanted him to do it."
Upjohn gives hairdressers posters and other information about Rogaine as a way to help them advise customers about the drug.
But, even as advertising tries to convince men that their baldness is something to treat medically, UCLA health researcher Michael S. Goldstein suggests that men's slowness to accept Rogaine is one of the few positive byproducts of men's reluctance to consult doctors.
"Most of the research on men's health habits tends to make men look bad, because they don't respond to (medical) symptoms," Goldstein said. "But hair loss isn't a genuine symptom in the way it's commonly thought about. It's a created symptom and a need that's being artificially created. So if men aren't responding, it's a sign of their mental health, not ill health."
Upjohn's latest effort to woo male customers is a new television commercial being tested this month in Youngstown, Ohio; Rochester, N.Y., and New Orleans. It is the first time Rogaine's name is being mentioned in a broadcast advertisement, said Upjohn spokeswoman Bennett.
Previous attempts talked about a new medical remedy for baldness but did not name the drug. The new ads talk about Rogaine but aren't specific about what it's for.
The FDA requires that if both the name of the product and the condition it treats are mentioned, the ad must also contain details about the drug's effectiveness and side effects. In print ads, this is solved with masses of fine print, but that option is not practical for TV.
The ultimate solution to this advertising dilemma--and a boon for men worried about baldness--would come if the FDA approves making topical minoxidil an over-the-counter medication. Market analyst Stover says there is a "high probability" of this happening by 1995.
In that case, many companies could market anti-baldness minoxidil solutions, but Rogaine would have the name recognition that Bayer has for aspirin or Tylenol has for acetaminophen, he said.
Meanwhile, men will have to consult a doctor before they can obtain Rogaine to see if it works for them. Because the results vary from man to man, Howard Hintz advises men to come to terms with the idea of being bald before trying Rogaine:
"You shouldn't do something when you're crazed about it, but when you're more or less comfortable with going bald. Then if it works, it works, and if it doesn't, it doesn't."