New Mechanism for Minoxidil’s Efficacy

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Minoxidil has always been a very powerful medication for hair loss. Topically traditionally at five percent for men and two percent for women and then since 2014 5% also for women. More recently, oral minoxidil has been shown to be very effective in helping with hair loss for both men and women. And I use both oral and topical and occasionally both simultaneously to get maximal gains on limiting further progression of hair loss. The interesting thing about when I’ve been asked, how does minoxidil actually work? The answer I usually give it’s a potassium channel Agonist. It’s a vascular. It helps with vascular in growth and to be honest with you, I think those two are still true today, but there’s actually been some recent studies looking at exactly does it work differently besides how we traditionally claim that to work? And it actually found that Minoxidil can work as a DHT blocker. So, as everyone knows Dihydrotestosterone or DHT is the offending agent for male pattern baldness and often times for female pattern baldness where there’s a conversion of testosterone to DHT and with the Propecia or finasteride and blocks, one of the enzymes called 5-alpha reductase type 2, where asteroid blocks, both 5-alpha reductase type 1 and 2 blocking a larger percentage of the offending hormones. And they’ve actually found that that minoxidil sulfate, which is one of the metabolites can actually lengthen anagen phase, which is growth phase and also caused a DHT blockade. And but what’s interesting with Minoxidil is that I think because it has so many pathways through which it works now recognize that it lengthens antigen works through DHT mechanism of blocking 5-alpha reductase type 2, as well as perhaps some of the general concepts of vascular improvement and blocking this potassium channel, that could be causing hair loss. That it is something that maybe we now know that through all these mechanisms, there’s so many, it’s very, very powerful and finding out how Minoxidil can work is to me it’s fascinating that there actually is a DHT Channel. It is processed to the liver and it is processed through the kidney even. So even though it is or excreted through the kidneys and metabolite of salt 2, 1 a 1. So, the ultimate thing to understand is that just like anything, even though it’s over the counter, I do recommend your yearly physical exam by your internist is just to check your blood work. Look at your liver function tests. Look at your kidney function tests, just to make sure everything is going, that your body is doing well with it. Just like any other drug that’s out there. But it is over the counter. Now with oral minoxidil that’s not over-the-counter. That’s something that needs a prescription for and I’ll be happy if you’re the right patient for that. Which I have described in my podcast and all Minoxidil. I’ll help you with that, to prescribe that as well. But I ultimately think it’s always better to be having your treatment through an internist who can actually monitor all your blood levels to make sure everything’s going well in the long end.


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