Many people start on topical Minoxidil only to find out months later that it doesn't work for them. In some cases, they may even experience a worsening of hair loss. We explore why this may be the case. 

 

1. Minoxidil is a Pro-drug 

Minoxidil is a pro-drug and only becomes active once it comes into contact with an enzyme present in the hair follicle called Sulfotransferase. A study found that approximately 50% of the population do not make enough of this enzyme to see appreciable improvements with Minoxidil.

 

2. Hormone Imbalance 

Hair loss is accelerated by high levels of dihydrotestrone (DHT). Minoxidil does not have any effect on DHT levels.

 

3. The Formulation

 The effects of Minoxidil can be enhanced by combining minoxidil with other ingredients or by combining Minoxidil and micro-needling.

Traditional formulations of topical Minoxidil contain 30% to 75% alcohol. Regular use can cause scalp dryness and irritation and hair to become brittle and break easily.

 

4. Concentration

Meta-analysis of several clinical studies show female responders to 2% minoxidil is as low as 13-20%. 

 

5. Follicle Miniaturation

High levels of DHT causes follicles to miniaturise with each new cycle. Minoxidil works by stimulating blood flow to the scalp area to stimulate new growth. Therefore, you may experience new growth with Minoxidil but they can still look sparse.

Studies have also shown micro-needling can improve hair thickness as well as hair count. When used in conjunction with Minoxidil, the results are superior compared to either therapy alone.

 

Final thoughts:

The response rate to Minoxidil can vary greatly between individuals. For the best possible outcome, speak to your doctor or pharmacist for a customised formula tailored to your unique goals.

 

 

Author: Dan Atkinson  B Pharm

 

References: 

1.  American Academy of Dermatology. “What is Male Pattern Hair Loss and can it be Treated?” News release Updated December 13, 2022. Last accessed June 5, 2023.
2. Olsen, E et al. (2002). "A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men." Journal of the American Academy of Dermatology, 47(3), 377 385.
3. Roberts, J et al (2014). "Response to Topical Minoxidil in Female Androgenic Alopecia." Journal of Dermatologic Therapy. Jul-Aug;27(4):252-4