Can we pre-determine who minoxidil is going to help?

Will minoxidil help?

Minoxidil is FDA approved for the treatment of androgenetic alopecia. In fact, it was the first treatment formally approved by the FDA for hair loss. The drug does not help everyone with hair loss. In fact, studies suggest it helps only 30 % - 40% of users.

Is it possible to predict if minoxidil will help me?

At present, the only way to determine if minoxidil will help is to try it out. And that phase of "trying it" phase needs to last about 6 months in order to determine if minoxidil will help or not.

The sulfotransferase enzyme

Recent research has turned to focusing on whether the activity of an enzyme in hair follicles called the sulfotransferase enzyme can predict who minoxidil will and will not help. 

In order for minoxidil to do it’s job, it needs to be converted to minoxidil sulphate. Hair follicles have the machinery to help with this but some people’s hair follicles are not really that good at it. Scientifically, we say that some people’s hair follicles lack high levels of an enzyme known as “sulfotransferase” and so they cannot convert minoxidil into the active form that actually does all the work.  (The public does not yet have minoxidil sulfotransferase testing kits available to them but this technology may be coming at some point in the near future.)

Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. In a new study, researchers confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA.

Comments

This is a powerful step in the right direct for a safe and somewhat effective medication. I've seen countless numbers of patients helped by minoxidil, and countless more who have not been helped.  If we can now figure out who shouldn't use mionxidil - this is a huge step in the right direction. I'm excited to follow where this sulfotransferase enzyme testing will lead- I am confident we'll hear more soon. This is good science put to good work. 

This test is not yet available but I will certainly update when it becomes available.

 

Reference

Goren et al. Clinical utility and validity of minoxidil response testing in androgenetic alopecia. Dermatol Ther. 2014 Aug 12. doi: 10.1111/dth.12164. [Epub ahead of print]