Does Rogaine® actually work?

In short, yes. Rogaine® is the brand name for the generic drug minoxidil. Minoxidil was originally developed to treat high blood pressure due to its vasodilator properties.1 Vasodilation is the mechanism of opening blood vessels. However, the opening of the blood vessels also increased the flow of nutrients to hair follicles and began to show hair growth in patients experiencing baldness. 2 After noticing these side effects, researchers found that 2% and 5% formulations of minoxidil could be applied to the head to stimulate hair growth. Rogaine® today is still marketed at both strengths, with the 5% being the most popular in men.

Though it is one of the most popular hair loss treatments, there is a downside as with most medications. Drugs are not one size fits all and minoxidil is no exception. Minoxidil is considered a prodrug, which means it must be activated to work properly. Prodrugs can be thought about like computers; computers now can do almost anything but are useless when turned off. The difference is computers have power buttons whereas prodrugs have enzymes to activate them. These activation steps ensure no wasted energy and protection until the time is tight. For minoxidil, “the power button” is an enzyme called sulfotransferase, which turns minoxidil into minoxidil sulfate. Minoxidil sulfate is the actual compound responsible for stimulating hair growth. Without the sulfotransferase enzyme, minoxidil cannot be activated into minoxidil sulfate and therefore will have no action.

How can I tell if minoxidil is right for me?

The gene, SULT1A1, codes for the sulfotransferase enzyme that activates minoxidil. Genes are segments of DNA that code for proteins that make up our unique characteristics. Nucleotides, the basic building blocks of DNA, make up these genes and are commonly represented by a sequence of the letters A, T, C, and G. Mutations or differences in the sequence of nucleotides have the potential to cause certain conditions or abnormalities. The most common genetic mutations are what we call single nucleotide polymorphisms (SNPs). These occur when a single nucleotide (letter in the sequence) is changed and can cause multiple variations of that particular gene. In short, even one letter switch has the potential to alter your appearance.

Certain SNPs can expose if a medication will work or not. In the case of minoxidil, there is a SNP that turns the base C into a T. This mutation decreases the activity of sulfotransferase and consequently the levels of minoxidil sulfate. The lower levels of minoxidil sulfate cause the use of minoxidil to no longer be beneficial as the drug will not be activated to perform its function. This is the premise of what genetic results can do; they allow for personalized medicine by finding what will and will not work for you.

What treatment options are available?

As with most conditions, there are many different medications out there that can help. Fortunately, we can now have a more accurate opportunity to use what is best for your own body rather than what works for everyone else. Minoxidil has long been the front runner in hair loss treatment especially since it remains the only FDA-approved topical medication for the condition. Thanks to new studies and genetic testing availability, we can now utilize a wider variety of drugs in both topical or oral formulations.

With a normal functioning sulfotransferase enzyme (aka no evidence of the above mentioned SULT1A1 mutation), minoxidil would be a good candidate in your treatment plan. If results come back with a lower functioning sulfotransferase due to the above mentioned mutation in SULT1A1 gene, minoxidil may not be an option as it will not be able to become activated. Instead other medications can be used such as finasteride, or dutasteride, (depending on SR5DA results) are other options to stimulate hair growth. Additionally, many vitamins can be added to your compound to help your body utilize these medications. For example, vitamin A which has been known to promote healthy hair may also increase the activity and presence of minoxidil sulfotransferase. 3 New studies continue to be published and expose new treatments or ways current treatments can be used.

Why is a genetic based compound better than other products?

Personalized medicine is the new way to treat YOUR conditions. Genetic results are able to reduce unwanted side effects, avoid taking unnecessary drugs, and ensure whatever is taken can actually work in your body. These are key features that the popular tried and true prescriptions cannot offer. Most compounds are also available in oral or topical formulations. This can be affected by certain drugs and genetic results, but can be decided based on preference. Does applying a foam into your hair in the morning make you feel safer with the medicine? Or does taking a pill fit better into your schedule? These are all considerations that will take part in the development of every treatment plan.

References

1Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug design, development and therapy, 13, 2777–2786. https://doi-org.ezproxy.lib.utexas.edu/10.2147/DDDT.S214907

2Alfredo Rossi, Carmen Cantisani, Luca Melis, Alessandra Iorio, Elisabetta Scali and Stefano Calvieri, “Minoxidil Use in Dermatology, Side Effects and Recent Patents”, Recent Patents on Inflammation & Allergy Drug Discovery 2012; 6(2) . https://doi-org.ezproxy.lib.utexas.edu/10.2174/187221312800166859

3Sharma, A, Goren, A, Dhurat, R, et al. Tretinoin enhances minoxidil response in androgenetic alopecia patients by upregulating follicular sulfotransferase enzymes. Dermatologic Therapy. 2019; 32:e12915. https://doi-org.ezproxy.lib.utexas.edu/10.1111/dth.12915

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