Derek (More Plates More Dates)

Ketoconazole does help.

There's studies showing it's equivalent to the hair growth results of 2% minoxidil via a totally different mechanism, which is like very significant for something that's like an over-the-counter shampoo that also you can get that.

attenuate dandruff to some extent seborrheic dermatitis um can improve the scalp environment to your your scalp environment to some extent depending on i don't know if you're prone to like i don't know fungal overgrowth for example but in general it's like a mild five alpha reductase inhibitor and topical antiandrogen that's just like a good shampoo that doesn't require like the risk profile of a finasteride dutasteride but it's like

Typically for most people, not going to be sufficient to offset it unless you're like mildly, very lightly prone.

That's where you need to like layer up with the 5-alpha reductase inhibition pharmaceutically.

And then minoxidil is the growth stimulant that is FDA approved and works reliably and

it's just hit or miss if it works based on your own enzymatic conversion capacity.

So it needs to convert into minoxidil sulfate in the scalp to actually work.

And if you have inadequate sulfo-transferase enzyme activity, it will not, you could be a total non-responder, even though you're using the full drug dose every day.

Those individuals either have a

Issue with the scalp environment, like they're not getting it into where it needs because with topicals, some of the problem often is just like your scalp either is unhealthy, the environment or it's not clean enough or like you're not using a high enough dose of the drug.

It all depends on the person and the formulation that you're using.

But in general, if you're using it properly and at a high enough dose.

you will be limited by this enzymatic pathway.

And there are ways to upregulate it.

One is compounding the minoxidil with tretinoin, which can upregulate the sulfotransferase enzyme and allow more of that conversion to take place.

And then there's microneedling, which also seems to be pretty dramatic, turning some non-responders into like significant responders or magnifying the results like multiple fold for people who are responding, just not as well as they could be, either driven through lack of adequate absorption,

and or lack of adequate sulfotransferase enzyme activity that also seems to be upregulated via this like manual like micro damage essentially like there's some crazy studies with individuals who've like burned their scalps that had balding and then they ended up like a regrowing hair after which is pretty weird via like the recruitment of growth factors that like you wouldn't have gotten if it wasn't for that like dramatic event now obviously no one's gonna light their head on fire hopefully but that's a thing

So it's like a very terrible blood pressure drug.

So it was originally prescribed for high blood pressure as a lonatin.