The Tretinoin Trick: How 43% of Non-Responders Became Responders

If minoxidil isn't working for you, tretinoin (retinoic acid) might be the missing piece. A 2019 study showed it can convert nearly half of non-responders into responders.

How It Works

Tretinoin increases expression of the SULT1A1 enzyme in scalp tissue. This is the enzyme needed to convert minoxidil to its active form. More enzyme activity = more minoxidil activation = better results.

Additionally, tretinoin may enhance minoxidil absorption through the skin by increasing cell turnover and permeability.

How to Use It

• Concentration: Typically 0.01-0.025% tretinoin
• Application: Usually combined with minoxidil in same solution, or applied before minoxidil
• Frequency: Once daily, usually at night
• Patience required: Still need 4-6 months to see results

Where to Get It

Tretinoin requires a prescription. Options include:

• Happy Head: Offers minoxidil + tretinoin + finasteride compounded solutions ($79-99/mo)
• Strut: Custom compounded topicals with tretinoin
• Dermatologist: Can prescribe tretinoin separately to add to your routine

Cautions

• Can cause initial scalp irritation, dryness, peeling
• Increases sun sensitivity—use sunscreen
• Start with lower concentration and work up
• May cause initial shedding (this is normal)

The Bottom Line

If you've given minoxidil a fair trial (6+ months) with no results, adding tretinoin gives you nearly a 50% chance of becoming a responder. It's worth trying before giving up on topical treatment entirely.