Male Pattern Baldness: A Review of Available Treatments

Male pattern baldness (androgenetic alopecia) is an embarassing issue that affects most men at some point in life. Although more commonly appearing after the age of 50, it can strike at any time due to factors like genetics and stress. The immune system and vitamin D level are implicated in the epigenetics of turning the genes responsible ‘on’ or ‘off.’ The root cause (no pun intended) of the condition is poorly understood, but it is associated with a high level of the hormone DHT (dihydrotestosterone) in the scalp and hair follicles. Maintream treatments involve topical and internal pharmaceuticals to help decrease circulating DHT and improve blood flow to the scalp.

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Traditional medicine sees this disorder as an imbalance of sorts, and treats each person’s case individually. In Ayurveda, the pitta archetype is likely to suffer from excess heat, causing hair to literally be ‘burned’ off a ‘hot’ scalp. Heat in this case can refer to anger, high stress, or a control-freak type-A personality. Chinese medicine attributes hair loss to a decrease in vitality, and treatment involves nourishing the deep life essence, or Kidney Jing, with diet and herbs. Acupuncture can also help restore proper flow within the meridians.

There’s a trendy new website being advertised everywhere now, ForHims. Despite the great marketing however, the products they offer for male-patterned baldness leave me wondering if they are really serving the community. Their kits consist of oral and topical products that are simply private-label versions of standard pharmaceutical medications with the indication for male-pattern baldness. Let’s examine them one by one:

  1. Finasteride: the low-dose (1 mg) of this prescription medication (that’s another issue, you need to have a prescription to buy this from the site, which they provide is some web-consulation, presumably with a doctor?) is indicated for male-patterned baldness. It works by inhibiting 5-alpha reductase, the enzyme that converts testosterone to DHT. Since DHT is presumed to be the main culprit behind alopecia, lowering it does seem to prevent further hair loss. It may also help regrow some hair, but upon discontinuing the medication the effects are short-lived. In addition, it may cause sexual dysfunction in some men. It should not be handled by pregnant women as it can cross the skin barrier and cause damage to the fetus (by interfering with male hormone production).
  2. Hair gummy vitamins: these seem harmless enough, containing vitamins C, D and some B’s (B6, B12 and biotin). However, the number one ingredient listed is corn syrup, and who really knows what ‘natural flavor’ entails...the FDA has very loose guidelines under that heading. The only therapeutic dose seems to be that of biotin, and hyper-therapeutic at that. Although biotin is a very important hair vitamin, it’s best absorbed from food sources (eggs, almonds, mushrooms, spinach, etc.) in the presence of cofactors. The source of the vitamins is not specified on the label, and most of them (all except for D are water soluble), which means that anything your body can’t absorb will be excreted in urine. So although you probably won’t overdose on these, the effects will most likely be limited and temporary
  3. DHT blocker shampoo:  the theory seems consistent with current scientific data on hair loss, but the active ingredients seem to be extracts or essential oils of plants, as well as some vitamins and yeasts. The whole concoction is held together by some chemical additives, thickeners and preservatives (parabens). All in all, I’d suggest using the plant ingredients without all the chemistry.
  4. Minoxidil: this topical over-the-counter treatment acts as a vasodilator, which increases blood flow to the hair follicles and thus prevents hair loss, and may even stimulate regrowth. It doesn’t work for everyone and takes a while to kick in. It must be applied to the scalp twice a day and as soon as it’s stopped, the hair pattern will revert back. It also has some undesirable chemicals in the formulation that may cause sensitivity or allergies in some people.

To sum it up, the ForHims company makes it very simple to obtain oral and topical treatment for male-pattern baldness according to the latest FDA-approved indications. It saves a trip to the pharmacy and the hassle or possible embarrassment of an in-person explanation and transaction. It even saves a trip to the doctor in the case of a prescription-based medication (finasteride)! The verdict? These products will keep hair on your head as long as you continue to use them on a regular basis. On the other hand, the root cause of the issue is not addressed, and as soon as products are stopped, hair loss will resume and all the positive results will have been erased. Some side effects may be unpleasant, from sensitivity to sexual dysfunction. In addition, the products are far from organic or natural, if you’re into that type of thing. Which I assume you are if you’re on this website.

So, what’s a person with male-pattern alopecia to do? If you’re seeking a natural and holistic remedy, let’s go back to the traditional definition and explanation of this type of hair loss. Ayurveda and ancient Chinese Medicine say that people with ‘hot temperament’ are prone to this malady, and therefore cooling remedies are sought. Here are some herbal treatments that may help naturally restore, or at least prevent, further hair loss:

  1. Stinging nettle (Urtica dioica): this vitamin- and mineral-rich “weed” has been traditionally used as a hair tonic both internally and topically. Anecdotal evidence is strong in many cultures, and many hair products on the market use this ingredient. According to contemporary herbalist Matthew Wood, nettles rules the proteins of the body and can reverse greying as well as alopecia.  There’s emerging scientific data to support its claim to fame, some studies showing that it potentially acts like finasteride via blocking 5-alpha reductase. Other benefits include antioxidant and anti-inflammatory properties, as well as nourishing to the scalp via nutrient content (vitamins C, E, B, K; silica; iron; potassium). Potentially consuming the whole plant (leaves, stem and root) can help achieve the best results, while topical applications traditionally involve only the leaves. Nettles is also delicious as a food, just be careful to use gloves when handling the fresh plant. Once cooked, the stingers are deactivated and safe to eat. You can sautee or stir-fry fresh nettles, or add the dried powder to soups, stews and smoothies. The Hair Loss Revolution website has some more information and recipes for nettle teas and hair oils.
  2. Saw palmetto (Serenoa repens) : speaking of 5-alpha reductase, saw palmetto used internally seem to block this enzyme and elicit benefits for BPH (benign prostatic hyperplasia) and alopecia in men. The plant part used is the berry, and because the taste is rather ‘soapy’ and unpleasant, it’s best taken as a tincture or capsule.
  3. He shou wu (Polygonum multiflorum): also called ‘Fo-ti’ in America, this root has been traditionally used in Chinese Medicine as a rejuvenative tonic to treat and prevent hair loss in both men and women. Its Chinese name translates to “Mr. He’s black hair” which refers to a mythical character who lived to 160 years old and took this herb to restore his youth. As the name suggests, it’s also been used to prevent greying and in particular for men, as a sexual tonic. It is thought to nourish the deep Kidney Essence (Jing), which is tied to our life force, vitality and the waters of our body (consistent with sexual function in the Western model). It also encourages detox and circulation, which benefits hair follicles. He shou wu should not be consumed raw, but cured in black bean stew. It’s usually sold on the market already cured, as a root or powder. The root needs to decocted (boiled and simmered for about 20 minutes) and the powder can be consumed in food or drinks. Other available preparations are tinctures, capsules or tablets. Consult with a practitioner for dosing.
  4. Rosemary (Rosmarinus officianalis): used topically to stimulate hair follicles, it’s thought to behave like the drug minoxidil (with less side effects). Rosemary stimulates blood circulation and nourishment to the scalp when applied as a strong infusion as a hair rinse. Alternatively, the essential oil can be added to hair products. See this article for some tips and research behind it.
  5. Green tea (Camellia sinensis): rich in compounds thought to reverse hair loss, such as polyphenols (such as epigallocatechin gallate or EGCG), carotenoids, zinc, selenium, and vitamins C and E. Research shows it may act as a DHT blocker internally and topically, and that its antioxidant and anti-inflammatory properties may help hair regrow. It must be brewed at the proper temperature for maximum benefit. Ground green tea leves, known as matcha powder, can also be used.
  6. Henna (Lawsonia inermis): in India, henna has been used both to strengthen hair and as as a natural dye (for hair and temporary skin art). Traditonally, a hair oil mask is made with henna leaf infused into mustard seed oil, and then mixed with coconut oil. Coconut oil has additional soothing anti-inflammatory and antifungal/dandruff properties that benefit the scalp.
  7. Horsetail (Equisetum arvense): naturally rich in silica, cysteine and selenium, which help to strengthen hair shafts. It also acts to increase urine output and helps detox the body (interestingly it’s a diuretic, but useful in overactive bladder). Horsetail may help decrease buildup of oils on scalp and thus promote hair growth. It’s also used for skin and nail health, but breaks in therapy are recommended to avoid silica overload. 
  8. Amla berry (Phyllanthus emblica): aka “Indian gooseberry”, is one of the richest sources of vitamin C, hands down - and because it’s food based, it’s the most readily absorbed by the body. Ground amla berry powder mixed with water to form a paste, or with oil, makes an excellent hair mask for topical use. Consuming it internally supports all collagen-rich tisues of the body, including integumentary system and hair health.
  9. Gingko (Gingko biloba): like rosemary, gingko leaf (not to be confused with the nut) is thought to increase circulation to the growing hair follicles, and has shown clinical improvement as compared to minoxidil in studies.
  10. Pumpkin seed (Cucurbita pepo): the oil has been shown to block 5-alpha reductase in rats, presumably via its phytosterol content. One study found a significant increase in male hairgrowth after consuming 400mg of pumpkin seed oil capsules daily for 24 weeks.
  11. Brown seaweed (Ecklonia cava): edible brown alga species native to Japan and Korea with loads of polyphenols, thought to help proliferate hair while reducing loss via DHT mechanism. Several rat and human studies showed efficacy via topical application.
  12. Onion juice (Allium cepa): freshly squeezed or juiced onion applied to scalp has been a long-used folk remedy for hair loss. It may hep by providing sulfur, which supports keratin structure in hair, and contains antimicrobial and antioxidant phytochemicals. Although my research didn’t correlate onions to successful treatment of andogenetic alopecia, one study showed success in treating alopecia arreata (patchy hair loss). Garlic (Allium sativum) is in the same plant family and can be used as an alternative. Because these juices may not be the most pleasant to the senses, combining them with honey and/or lemon juice seems to make them more tolerable with good results.
  13. Fenugreek seed (Trigonella foenum-graecum): has traditionally been used in India as a nutrition-powerhouse as a spice in dishes, for blood glucose regulation, lactation support, metabolism and topically for hair health. To make a hair mask, soak fenugreek seeds overnight and grind in the morning with some more water or coconut milk to make a paste. Apply directly to scalp or mix some honey, coconut oil or yogurt for extra benefits. 

 As with anything, hair health starts with lifestyle and diet first and foremost. Here are some tips for stress management and nutrients you should be sure to consume to maintain gorgeous locks.

  • Stress reduction: if you can’t reduce stress load, you can try to work on lowering your response to it. Like with anything else, stress is at the root cause of many ailments, at least indirectly. Stress or environmental factors play a huge role in epigenetics, and may turn on the genes responsible for male-pattern baldness. Therefore mindfulness practices, such as breathing and meditation, can help tremendously by rewiring our brains to be able to cope with stress better. Tai chi or yoga practices can help align body and mind to rise above stress (and be in great shape too!).
  • Nutrition: get a variety of whole, preferably organic, foods in your diet, with a focus on plants. Make sure to have plenty of vegetables daily of the entire ‘rainbow’ spectrum: the brighter the colors, the more rich they are in antioxidants and other beneficial nutrients. Include green leafy vegetables and the brassica family (brussel sprouts, cabbage, broccoli) for vitamin K and sulfur compounds (onions and garlic are high in sulfur as well - precursor to cysteine amino acid, itself a precursor to a powerful antioxidant) to help detox the body. Healthy fats such as avocado, coconut, raw (soaked) nuts, cod liver and cold-pressed vegetable oils (olive, hemp, sesame, pumpkin seed) will provide fat-soluble vitamins for your skin, hair and nails. For protein, try to source grass-fed pastured animal products (beef, chicken/eggs, butter/ghee) or wild-caught fish from reputable companies. Soak your grains, nuts and legumes to assist in digestion and free the nutrients from their lectin binders. Specific foods shown to benefit hair growth include: royal jelly (a bee product), seaweed (mind the sodium), pumpkin and sesame seeds, watercress and parsley. Most importantly, avoid inflammatory foods and xenoestrogens (packaged processed foods and additives, dairy, hormone/antibiotic treated foods, unfermented soy, artificial flavors and scents such as perfume or candle fumes).
  • Self care: stimulating the hair follicles with manual massage can be very hepful in removing dead skin cells and debree, as well as allow nutrients to come to the surface of the scalp. Applying oils, especially ones infused with herbs or essential oils, can be extra therapeutic as part of the massage or as a hair mask. At the very least, an herbal infusion (tea) can be used as a hair rinse at the end of a shower for some benefit. Topical treatment with nutrient-rich herbs have been used traditionally and are evidence-based according to current research.

 What has or hasn’t worked for you? Please share so we can learn from one another!

 

Works Cited (in order of appearance)

  1. He Shou Wu for Hair Loss & Grey Hair in Chinese Medicine. Nootriment.com. 2018. Accessed 2 May 2018.  https://nootriment.com/he-shou-wu-for-hair-loss/
  2. “Benefits of Stinging Nettle For Hair Loss.” Hair Loss Revolution. Dec 2016. Accessed 5 May 2018. https://www.hairlossrevolution.com/stinging-nettle-for-hair-loss-results/ 
  3. Nahata, A. and Dixit, V. K. (2012), Ameliorative effects of stinging nettle (Urtica dioica) on testosterone‐induced prostatic hyperplasia in rats. Andrologia, 44: 396-409. doi:10.1111/j.1439-0272.2011.01197.x 
  4. Prager, Nelson, Karen Bickett, Nita French, and Geno Marcovici. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-α-reductase in the treatment of androgenetic alopecia. The Journal of Alternative & Complementary Medicine 8, no. 2 (2002): 143-152.
  5. Hills, Jenny. How to Use Rosemary for Treating Hair Loss. Healthy And Natural World. 2018. Accessed 6 May 2018. https://www.healthyandnaturalworld.com/hair-loss-treatment-using-essential-oils/ 
  6. Panahi Y, Taghizadeh M, Marzony ET, Sahebkar A. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial. Skinmed. 2015 Jan-Feb;13(1):15-21. https://www.ncbi.nlm.nih.gov/pubmed/25842469
  7. “5 Herbs that Help Hair Loss.” Progressive Health. 2018. Accessed 8 May 2018. http://www.progressivehealth.com/hair-loss-herbs.htm 
  8. Esfandiari A, Kelly AP. The effects of tea polyphenolic compounds on hair loss among rodents. Journal of the National Medical Association. 2005;97(8):1165-1169.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576011/ 
  9. Jain PK et al. Prospect of Herbs as Hair Growth Potential: A Review. Innovare Journal of Medical Science. 2017;5(1):25-33. https://innovareacademics.in/journals/index.php/ijms/article/download/16471/9335
  10. Cho YH, et al. Effect of Pumpkin Seed Oil on Hair Growth in Men with Androgenetic Alopecia: A Randomized, Double-Blind, Placebo-Controlled Trial. Evid Based Complement Alternat Med. 2014; 2014: 549721. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017725/ 
  11. Shin H et al. Enhancement of Human Hair Growth Using Ecklonia cava Polyphenols. Ann Dermatol. 2016 Feb;28(1):15-21. English. Published online Jan 28, 2016.  https://doi.org/10.5021/ad.2016.28.1.15 
  12. Sharquie, K. E. and Al‐Obaidi, H. K. (2002), Onion Juice (Allium cepa L.), A New Topical Treatment for Alopecia Areata. The Journal of Dermatology, 29: 343-346. doi:10.1111/j.1346-8138.2002.tb00277.x 
  13. Moers-Carpi, M. Influence of Nutritive Factors on Hair Growth. Aktuelle Dermatologie 37, no. 5 (2011): 171. 
  14. “Hair Loss and Herbal Remedies.” Chinese Herbs. 2018. Accessed 17 May 2018.  http://www.chinese-herbs.org/hair-loss/