Does Rogaine Always Work?

If you’ve talked with me about hair loss, you know I’m a huge fan of Rogaine (topical minoxidil).  I’ve used it myself for years now and I recommend it every day to patients.  I continue to be surprised by the resistance about using it.  The only thing that I get more pushback on is RetinA.  And if there are two things in dermatology that have an excellent record, it’s Rogaine and Retin A.  But I digress…

Every once in awhile I encounter a patient who tells me that they have been diligent in using their Rogaine for over 6 months with no response.  These cases are rare.  Usually, patients have just been lackluster about actually applying it every day.  But if a patient uses Rogaine for a whole year with no response,  I often tell them to stop using it.  At that point, one of two things happens.  Number one, a lot of hair falls out and they find out that the Rogaine  was actually working.  Or, number two, nothing happens at all meaning the Rogaine truly wasn’t working.  

To be honest, I’m perplexed with what to do next for patients that Rogaine is not working well, especially if we have diagnosed and eliminated as many underlying conditions as possible.  These patients often have very normal looking healthy scalps.  So, why is the Rogaine not working?

I was at a conference this summer and I learned something new!  

One lab has now identified an enzyme that is essential for Rogaine to work.  Turns out, some people may lack this enzyme. 

Topical minoxidil needs the enzyme sulfotransferase (specifically the SULT1A1 isoform) located in the hair follicles to work. This enzyme converts inactive topical minoxidil into its active form, minoxidil sulfate, which actually stimulates hair growth.

I learned that there is a mail in test by a lab called Daniel Alain Labs that tests hairs for the enzyme.  According to that lab and their site and their published articles, their test is 80-95% accurate.  They also claim that only 30-40% of people are good responders to minoxidil.  This particular lab and group of scientists are the only ones who have done any of the research on this enzyme and this test. 

In my practice, I tell patients they have a 95% chance of regrowing some hair within 6 months IF using the 5% minoxidil DAILY.  When I went back this week and reviewed some of the early studies of topical 5% minoxidil, in those studies about 70% of patients had some significant regrowth of hair. So, maybe I am being a little overzealous with my 95%, but that is what I see in practice.  Most people grow hair IF they use it correctly every single day.  

Out of curiosity I visited the Daniel Alain website.  Here is what I found.  Ugh.  Well that stinks.  Again, this particular lab and group of scientists are the only ones who have done any of the research on this enzyme and this test. When you go to their site now, they focus on selling wigs.  Hmm.  These kinds of things make me wonder. 

I realize I sound like a conspiracy theorist but given that ALL the scientific data trying to sway patients from using topical minoxidil comes from a group that focuses on selling wigs is of concern.

So, back to the drawing board… I still recommend Rogaine foam once a day, every day for six months as the first and most effective step for patients with hair loss.  I still am not a fan of oral minoxidil, although it’s very trendy right now.  I wrote a previous article on that linked below and I’ll do a follow up on that article soon with information from my conference.