Minoxidil (Rogaine ®) is a commonly used topical agent for male pattern balding and female pattern hair loss. Clinical studies have proven that it is effective for some patients (unlike most other topicals, for which virtually all have no real proof). However, it is not effective for everyone and it would be great if we had a test that could determine if the effort involved in applying Rogaine ® twice daily was worth it. At present, the only way to determine if it works is to try it for at least 6-9 months.
The importance of sulfotransferase for minoxidil responsiveness
It seems that there is an enzyme that may be involved in the efficacy of Rogaine ® and several studies have analyzed this enzyme in responders and non-responders. The enzyme is called sulfotransferase and the activity of this enzyme in plucked hair follicles appears to predict the responsiveness of patients to Rogaine ®.
According to an analysis of current and ongoing minoxidil response testing, this assay is able to successfully rule out 95.9% of non-responders. Not 100% but pretty close. If this test becomes commercially available, it could save some people a lot of time and effort. (more…)
We will occasionally request blood tests in women suffering from hair loss if the diagnosis is unclear. One of the tests we do is a testosterone (T) level as elevated levels of testosterone can be associated with hair loss and we want to rule out this possibility. Many times, however, the test result will reveal that the level is actually low. The question that arises is whether or not anything should be done about this. Dr. Nakatsui usually requests that the patient discuss this with her family physician to see if testosterone supplementation is reasonable. Over the years, some of the patients who went on supplementation have reported to us that their hair loss actually improved!
Should a woman with low T go on supplementation?
Whether or not to go on supplementation depends on a number of factors. Firstly, does the patient have any other symptoms of low testosterone, such as insomnia, fatigue, depressed mood, hot flashes, and vaginal dryness? If so, perhaps a case could be made to go on supplementation.
The other issue is that of side effects as one of the possible side effects is increased facial hair. Is the patient willing to deal with this?
The last question is whether or not supplementation will actually improve the hair loss. (more…)
For many years, we have used finasteride (Propecia) for male pattern hair loss and for many men, it has worked very well. However, in those men who are non-responders, another option may be dutasteride, a cousin to finasteride. Whereas finasteride is approved by the FDA for hair loss, dutasteride is not but has been used off-label for several years.
Both of these medications are 5-alpha-reductase inhibitors, which help improve hair loss by preventing the formation of dihydrotestosterone (DHT). The difference between them is that finasteride (FIN) inhibits 5-alpha reductase type 2, whereas dutasteride (DUT) inhibits 5-alpha reductase type 2 and type 1.
Which is stronger?
DUT is more potent and decreases DHT to a greater extent than FIN (90% versus 70%). However, the flip side is that side effects are potentially greater so many patients are reluctant to go on this medication for this reason. (more…)