Category Archives: Minoxidil

Minoxidil Sulfotransferase Booster out in 2023

With oral Minoxidil becoming the most discussed hair loss treatment over the past year, now is a good time to discuss the Minoxidil Sulfotransferase (SULT1A1) enzyme.

The below diagram is from a Polish study published in 2022 covering Sulfotransferase activity in hair follicles and the response to Minoxidil treatment. Sulfotransferase 1A1 is encoded by the SULT1A1 gene.

Minoxidil Sulfotransferase (SULT1A1).
Minoxidil Sulfotransferase (SULT1A1) chemical structure.

The Minoxidil Sulfotransferase Enzyme

When Minoxidil is used topically on the scalp, it is converted into its active form (Minoxidil sulfate) by SULT1A1 enzymes, which are located in the follicular outer root sheath. However, many people’s hair follicles lack high levels of sulfotransferase. So these men (and women) are unable to convert even extra strength Minoxidil into its active form that stimulates hair growth.

Note that Retin-A (Tretinoin) enhances the response to Minoxidil in androgenetic alopecia patients by upregulating follicular sulfotransferase enzymes. No wonder so many blog readers have recommended the use of both products together.

Benefits for Oral Minoxidil too?

When it comes to oral Minoxidil, the body’s liver does the job of converting Minoxidil into Minoxidil sulfate (also spelled sulphate). Several articles that I read seem to suggest that the hair follicle does not need to do the conversion anymore. However, Dr. John Cole said the following to me:

“If you can’t sulfate it, Minoxidil will not work. Peripherally sulfated Minoxidil cannot enter the cell.”

Also, in this 2020 letter from Ramos et al (full version here), a key quote:

“Increasing the activity of SULT1A1 can improve the efficacy of topical and low dose oral minoxidil for the treatment of AGA.”

Moreover, the following quote in last year’s important article from the AAD in regards to LDOM suggests some uncertainty via the use of the word “may”:

“It has been suggested that oral minoxidil may also be converted by liver and platelet sulfotransferase, thereby reaching a higher follicular accumulation.”

It would be interesting to know if beard growth with topical Minoxidil is also impacted by SULT1A1.

Boosting SULT1A1

In recent years, there have been some significant efforts made to  develop products to boost the Sulfotransferase enzyme in order to improve the efficacy of Minoxidil. Leading the way is Dr. Andy Goren, who started a company called Applied Biology that created a Minoxidil Booster product.

However, in June 2021, Applied Biology was acquired by Jupiter Wellness. Luckily, while researching for this post, I came across Jupiter’s hair loss product page. Lo and behold, some interesting news on their Minoxidil Booster topical product:

  • It has been clinically shown to increase the sulfotransferase enzymes needed for minoxidil to work by up to 7x over a two-week period. I assume this 2021 study pertains to those findings. Co-authors include the well known hair researchers Dr. Rodney Sinclair and Dr. Rachita Dhurat.
  • The product has already been licensed to Taisho, which is Japan’s leading seller of Minoxidil products. They expect to launch the product commercially in 2023.
  • Licensed to Cosmofix Technovation and Sanpellegrino Cosmetics, both from India.

Note that in the study that I listed above, 75% of patients in the SULT1A1 group demonstrated a positive increase in hair growth; compared with only 33% of patients in the placebo group. However, the study limitations include its small sample and limited duration of follow up.

Update: Right after writing this post, I found out that compounded Minoxidil Sulfate (MXS) based topical formulations are available for medical use in some parts of the world such as Brazil.

Dutasteride and Minoxidil Before and After Photos

When I originally wrote this post, I focused on topical Minoxidil and oral Dutasteride combination hair loss treatments. Nowadays, it seems like oral Minoxidil plus oral Dutasteride has become the gold standard combination treatment among some doctors. Some also add injection Dutasteride into the mix.

Make sure to also read my post on before and after hair growth photos from Finasteride and Minoxidil.

Oral Dutasteride plus Oral Minoxidil

In March 2021, Dr. Sergio Vano (Spain) and Dr. Bevin Bhoyrul (Australia) posted interesting before and after success story photos on Twitter. Both doctors made use of oral Minoxidil and oral Dutasteride (aka Avodart).

Dr. Vano tends to offer both oral and injection Dutasteride in the beginning, with the patient deciding on one or both after a year.

Oral Dutasteride and Oral Minoxidil Hair Growth
Oral Dutasteride and Oral Minoxidil Hair Growth Results. Dr. Bhoyrul and Dr. Vano.

Jan 3, 2019

In my previous post on Dutasteride injections for hair loss, I showed an incredible before and after photo. That male patient was taking taking Dutasteride (oral and injection) in combination with oral Minoxidil. This person was treated by Dr. Sergio Vañó-Galván from Spain. The doctor later sent me a number of other before and after photos of his hair loss patients. All of them saw significant hair growth while on some variation of this Dutasteride (oral and/or injection) and Minoxidil (topical or oral) combination treatment.

I was debating on whether these new photos were worthy of a new post, and concluded in the affirmative. Sometimes people forget about the excellent existing hair loss treatment medications out there that have been proven to work really well for many patients.

Of course one must be willing to risk potential side effects of these medications. Most published studies suggest very few people get major permanent side effects from Dutasteride, but it is up to you to do your own research and reach your own conclusions. Note that Dutasteride is only approved in several countries to treat hair loss as of 2019. However, it is approved as an enlarged prostate treatment all across the world.

Dr. Sergio Vañó-Galván was on the organizing committee of the 11th World Congress for Hair Research that took place in Barcelona in 2019. He is also on the Board of Directors of the EHRS.

Oral Dutasteride plus Topical Minoxidil Hair Growth

For those getting side effects from oral Minoxidil or fearful of taking it, topical Minoxidil is always a good alternative. Below are some great hair regrowth results of men who took topical Minoxidil 5% and Dutasteride.

Patient 1: Dutasteride injections plus oral Dutasteride plus 5%  topical Minoxidil at 12-months.

Dutasteride and Topical Minoxidil -- 12 Month Hair Growth

Patient 2: Dutasteride injections plus oral Dutasteride plus 5% topical Minoxidil at 12-months.

Dutasteride plus Topical Minoxidil Hair Growth at 12 Months

Patient 3: Dutasteride injections plus oral Dutasteride plus 5% topical Minoxidil at 12-months.

Dutasteride and Topical Minoxidil Hair Growth Before After

Oral and Injection Dutasteride

One can also ignore Minoxidil entirely and just focus on Dutasteride (oral and injection combination treatment) if desired. Note that Dutasteride injections are sometimes termed as mesotherapy.

Patient 4: Oral Dutasteride plus mesotherapy with Dutasteride 0.05% once every three months.

Dutasteride Mesotherapy Before and After

Female Hair Loss Treated with Oral Minoxidil

Women are not given Dutasteride if trying to get pregnant. However, females are allowed to take oral Minoxidil at any time if healthy. However, women should note that oral Minoxidil can cause excessive body hair (hirsutism) as a side effect.

Patient 5: Oral Minoxidil 1 mg/day at 12-Months in a female.

Oral Minoxidil Hair Growth in a Female: Before and After