Can we predict if it will help?
In short the answer is NO - not yet. However, we can state if one person has a higher chance that minoxidil will work than another person. Soon we may be able to test whether minoxidil will work by testing patient's minoxidil sulfotransferase enzyme activity . But those tests aren't available yet.
For now we gave several general predictors of who will benefit from minoxidil.
Minoxidil tends to work better if:
NO INFLAMMATION ON SCALP BIOPSY. We don't biopsy everyone to figure out if there is inflammation present or not, but Dr Whiting in 1996 showed that individuals without inflammation responded better!
ONE YEAR DURATION OF HAIR LOSS. Individuals who have had their hair loss for a shorter period of time respond better. There is no rule about one year but one study showed that patients with hair loss less than one year responded better than if hair loss had been present 10 years or more.
YOUNGER. Younger patients respond better to minoxidil than older (in general). This was true in both males and females
FIVE YEARS or LESS. One study showed individuals with balding less than 5 years had better results than those with balding more than 21.
MORE HAIR. Patients with more hair follicles per unit area had a response than those with less hair. These studies were conducted by counting the number of hairs in biopsy specimens. Those with more hair responded better to minoxidil.
FIVE CM OR LESS. One study looked at crown (vertex) balding in men and showed that balding crowns with a diameter less than 5 cm respond better than crowns with a diameter more than 15 cm.
Now if you continued reading this post right to the end you'll learn a simple phrase that I teach clinicians who are trying to learn this information. Repeat to yourself this silly phrase : "No one younger than 5 years needs more hair or five cents". This helps us remember the patients who minoxidil works best.
One= one year
Younger = younger patients
5 yrs = 5 yr duration (vs 21)
more hair = more hair on biopsy
5 cents= 5 cm vertex diameter
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299