Written By: N. Lothungbeni Humtsoe | Updated : June 4, 2026 10:13 AM IST
Medically Verified By: Dr Debraj Shome
Hair Growth. (Image: AI Genrated)
Minoxidil is the most widely used hair loss treatment in the world available over the counter in pharmacies across India. It is recommended as a first-line intervention by dermatologists globally but many are reporting inconsistent effective treatments. Some patients may notice clear improvement while others see modest results. A subset sees almost nothing despite months of consistent use which is why it is crucial to understand what minoxidil actually does and where it falls short.
Minoxidil is a vasodilator that was originally developed as an oral antihypertensive. According to Dr. Debraj Shome, Clinician Scientist and Research Mentor, QR678 its effect on hair growth was discovered as a side effect.
She said, "The topical formulation works primarily by widening blood vessels in the scalp, increasing blood flow and nutrient delivery to the follicle and extending the anagen phase. It also appears to open potassium channels in follicle cells which may contribute to its growth-promoting effect."
The Clinician Scientist notes that minoxidil must be converted by an enzyme called sulphotransferase specifically SULT1A1 into its active form called minoxidil sulphate before it can exert any biological effect on the follicle.
This is the most extensive post on minoxidil's mechanism of action ever written
Most people think minoxidil regrows hair by increasing blood flow which is dead wrong. It actually works by opening cellular potassium (K+) channels. Specifically, human hair follicles contain pic.twitter.com/Hq6pJ9qJxH Anagen (@anagenxyz) May 14, 2026
This conversion step is where the variability begins as sulphotransferase activity in the scalp differs significantly between individuals. The doctor says, "It is genetically determined that a proportion of the Indian population has low or negligible SULT1A1 activity."
According to Dr. Shome individuals who have low SULT1A1 may find difficulty in converting topical minoxidil into its active form regardless of how consistently it is applied or what concentration is used.
She said, "The treatment is not failing because they are doing something wrong but because their scalp biochemistry is not equipped to activate it. A scalp biopsy or enzyme activity test can identify these individuals before months of ineffective treatment are invested. This step is rarely taken in standard clinical practice because minoxidil is so routinely prescribed as the default first intervention."
Minoxidil is the most studied hair-loss drug on earth, with 35+ years of evidence behind it.
But two things almost nobody explains: why it does nothing for a large share of people, and why it causes side effects. Both trace to the same fact: minoxidil is a prodrug. It does https://t.co/7Jkb78nlgm Anagen (@anagenxyz) May 31, 2026
The medical professional told TheHealthsite.Com that for patients who do not respond to topical minoxidil they can try oral minoxidil which bypasses the scalp conversion step entirely for an increasingly used alternative with a growing evidence base.
Dr. Shome further continued, "Beyond minoxidil the more important clinical point is that hair loss driven by oxidative follicular damage, microenvironment dysregulation or nutritional deficiency will not respond to a vasodilator regardless of how the patient metabolises it. Minoxidil addresses blood flow but it does not address the stem cell exhaustion, extracellular matrix stiffening or growth factor deficits that characterise many of the hair loss patterns seen in clinical practice today."
Disclaimer: This content is for informational purposes only and is not a medical advice. Hair loss treatments including minoxidil may affect individuals differently so consult a dermatologist.
