Surprise! The only cure for male pattern baldness is removing a man’s testicles at an early age (i.e., castration).
Without male hormones (testosterone and a more potent form of testosterone known as dihydrotestosterone, commonly abbreviated as DHT), genetic characteristics affecting the scalp, such as hair loss, can’t be fully expressed (turned on).
Of course, when a man’s testosterone level drastically plummets (whether from a surgical procedure, drug, or just over time), his risk of experiencing all those things women can go through when they hit menopause (such as rapid bone loss, fatigue, hot flashes, loss of sex drive, and weight gain) almost immediately increases. So, I imagine most men would rather lose their hair than go through “manopause.”
A more realistic option for men experiencing hair loss is to take a prescription drug or supplement, which works primarily by reducing DHT to almost zero or altering testosterone metabolism (drugs can do this, but supplements haven’t been as successful with this strategy).
However, side effects include reduced sex drive and fertility and an increased risk of erectile dysfunction and possibly even depression. So, the pros need to be weighed against the substantial cons here. It’s incredibly ironic that the supplements and prescriptions used by men to keep their hair, which is a cosmetic or superficial feature of manhood, can do so much potential damage (in the short and long term) to real, or physiologic, manhood!
What is Hair Loss?
Androgenetic alopecia is also known as male pattern baldness (women can experience a version of it as well, commonly known as female androgenetic alopecia or female pattern hair loss). Pattern refers to the way hair falls out, which tends to be different in men versus women: Men tend to lose hair at the front “corners” of the scalp (called bitemporal recession) and at the crown (back of the head). Women tend to lose it on the central portion of the scalp, sparing the frontal hairline.
Up to 70 percent of men and 40 percent of women experience this kind of hair loss, and it typically comes down to hormones and genetics (there’s usually a family history). In men, hormones turn on the genetic switch that triggers hair loss. In women, it can be due to either hormones, genetics, or a combination of issues. (Other causes of hair loss, such as thyroid dysfunction or infections, are a separate category, which I’m not going to discuss.)
Alopecia areata is a different type of hair loss; in this case, hair falls out in patches, and the condition remits and relapses. It’s really classified as “inflammatory hair loss of unknown origin,” and it can be due to a family history, an autoimmune disorder, or emotional stress. By reducing some of this inflammation, hair growth can be stimulated. The reason I am mentioning this condition is that some companies will test a product on these individuals and then show a photo of how they got better, but this condition can resolve on its own (in other words, caveat emptor!). In this section, I’ll primarily discuss androgenetic alopecia, which will not improve without treatment.
Two drugs have been approved in my lifetime for androgenetic alopecia. The first is topical minoxidil (also FDA approved for women), which is applied daily to the scalp; it’s available over the counter now and as a generic. Finasteride (Propecia) is the other drug, available only through a prescription (it’s not FDA approved for women but some do use it). This drug works by blocking the enzyme 5-alpha-reductase, which helps convert testosterone into its turbocharged form, DHT. This hyped-up testosterone is what triggers hair loss. So if you cut off or reduce the supply of the hormone responsible for hair loss, you keep more hair!
When started as early as possible in the hair-loss process, minoxidil and finasteride (which can be used together) can be effective at stopping it, but they usually won’t help dramatically regrow hair or fill in a bald spot; at best, some fine, thin hair might spring up. Another drug, dutaste-ride, can also help with male and female pattern hair loss, but it is much more expensive than finasteride and is not FDA approved for this condition. (It’s approved for noncancerous prostate enlargement, so a lot of folks get it off-label from doctors.)
The role of androgens (a male hormone) in hair loss is not as well known in women as it is in men, and the majority of women impacted by hair loss have normal blood levels of androgens. In women, genetics are the primary cause, but higher testosterone levels can exacerbate the condition.
Home Remedies For Hair Loss
1. Saw palmetto 320 to 960 milligrams a day for treatment of minimal hair loss as soon as it begins to happen
This is only number one because something has to come first, but it does not mean that this is the best supplement for hair loss. Almost all (99.9 percent) of the supplements that have ever been promoted for hair loss do not work; the ones that might have an effect would essentially have to work in the same way finasteride does—by altering hormones. If they did that, the unavoidable side effects that I mentioned earlier would grab the attention of attorneys and the FDA, and these products would be gone in less than a year.
There are some small studies of saw palmetto or multiple fatty acid components of saw palmetto showing it may minimally help hair growth in the same way finasteride does, but it’s far less potent. In other words, instead of reducing DHT by 80 to 90 percent or more, like conventional drugs do, saw palmetto might reduce it by 25 percent, if that. And remember, these were just small studies.
Many saw palmetto supplements contain the following fatty acids (in approximation).
- 30 percent lauric acid
- 28 percent oleic acid (the same monounsaturated fat in olive oil)
- 12 percent myristic acid
- 10 percent palmitic acid
- 5 percent linoleic acid (an omega-6 fatty acid) and some stearic acid
Researchers have concluded that all of these fatty acids have the ability to partially block the enzyme 5-alpha-reductase that contributes to hair loss. Some research teams suggest it is the lauric acid and myristic acid (both commonly found in coconut oil) that mostly block this enzyme, as well as oleic acid in small amounts.
Several herbal supplements or ingredients for prostate enlargement— including pygeum, beta-sitosterol, and zinc (see the Benign Prostatic Hyperplasia section—have shown the potential to block 5-alpha-reductase, but not nearly as well as saw palmetto. One oft-cited but small clinical trial is a 5- month study of 26 men with androgenetic alopecia who took either a placebo or 200 milligrams of saw palmetto extract combined with 50 milligrams of beta- sitosterol daily. Sixty percent of the men taking the supplement saw improvements versus 11 percent with the placebo.
A recent small study of 100 men taking either 320 milligrams of saw palmetto or 1 milligram of finasteride daily for 2 years showed finasteride was more effective. More than half of the participants with severe hair loss reported improvements with finasteride, and it helped keep and grow hair (fine and thin) in the front and back of the scalp. Saw palmetto apparently benefited some men who had baldness in the back of the head only (there was no placebo).
So, what can I say? Trying 320 milligrams of saw palmetto (up to 960 milligrams per day) is probably safer than taking finasteride, but whether it works much better than a placebo is unknown. (Look for saw palmetto with at least 85 percent total fatty acids and 0.3 percent sterols; it can be taken with or without other supplements for prostate enlargement, such as pygeum and beta-sitosterol.) I recommend trying it for 3 to 6 months to see if there’s a difference.
Keep in mind that none of these male prostate supplements, such as saw palmetto or beta-sitosterol, have been tested in women. (Finasteride is only approved for men, but a lot of dermatologists use it for women and it clearly helps a minority of them, so it’s worth talking to your doctor about trying saw palmetto.)
2. FOR WOMEN ONLY: Iron dosage varies depending on blood test results
In some women (premenopausal), iron can help hair thinning and loss. Doctors often test for iron deficiency in women who complain of hair loss, especially if they are still menstruating, are vegetarian, or have a history of anemia. There’s no guarantee obviously, and iron supplements should never be taken unless a deficiency is diagnosed with a blood test. Some women report improvements in the quality or quantity of their hair with iron, but others don’t.
The doctor may also test thyroid function because abnormal thyroid levels can cause hair loss, and some will also check testosterone and other hormone levels (DHEA-S and prolactin) to see if there’s an excess of testosterone or another hormone issue that might explain the hair loss.
What Supplement is Useless For Hair Loss?
Recently in the United States, there was an incident where more than 200 people took a liquid selenium supplement that, unknown to them, contained 200 times the dose reported on the label. More than 70 percent of these people reported hair loss, and 18 percent reported complete loss of scalp hair.
Numerous companies promote a variety of B-complex supplements for “healthy hair.” However, I cannot emphasize enough that you should not use B vitamins in excess amounts (beyond what is found in a multivitamin) for genetic hair loss because they have no evidence. Biotin is another popular hair and nail supplement, but it will not grow hair or reduce the risk of hair loss from androgenetic alopecia (see the Brittle Nail Syndrome section). As I alluded to above, these vitamins are often tested with patients who have rare causes of hair loss, like alopecia areata or extreme Third World deficiencies, and you can’t apply those results to regular pattern hair loss.
There is some minimal, weak research on vitamin D supplements to prevent hair loss (either by itself or with a prescription drug), but these studies mostly come from the laboratory and show that vitamin D is necessary to put hair follicles in the growth stage, to prevent hair from toxicity, or just for normal hair growth cycles. There is very little chance that vitamin D impacts hair growth though, except in rare cases of an extreme deficiency. Obese women, however, can have lower levels of vitamin D (the vitamin gets stored in fat cells instead of in the blood) and abnormal changes in hormone levels, including testosterone, which could be the real reason behind the hair loss.
Vitamins A, E, and C
There is no human research to suggest that these vitamins help with hair loss or making hair healthier, unless there is a rare deficiency.
Estrogen-boosting or testosterone suppressive (finasteride-mimicking) compounds
Estrogen production may prevent testosterone from impacting receptors that could accelerate hair loss; it simply decreases testosterone use. For this reason, in rare cases some women are given antiandrogen drugs or contraceptive pills to increase estrogen levels. It’s a good rationale, but they just don’t work for most men and women for hair loss. Some herbs you might see promoted for this purpose are black cohosh, chasteberry, dong quai, false unicorn, flaxseed or soy extracts, and red clover.
There aren’t many of these that actually work, but dietary supplements that claim to increase testosterone can only make hair loss worse if you’re a man; the extra testosterone can get converted to DHT, which turns on the genetic hair-loss switch.
What Lifestyle Changes Can Help With Hair Loss?
Heart healthy = hair healthy?
I wish! However, there is some research to suggest that men who have early hair loss (or premature graying, like me) could have an increased risk of heart disease.
Evaluate your lifestyle. All of the following could cause some hair loss, either temporarily or long term.
- Medications (prescriptions and supplements)
- Crash dieting and eating disorders
- Emotional disorders
- Chronic illness
- Excessive daily exercise for long periods of time, such as training for ultra- endurance races
Wash away the bald
Shampoos to make the hair appear more dense and full can have some minor to moderate impact. I like to put them in the “why not try it” category for both men and women. Shampoos containing ingredients such as ketoconazole (2 percent) or pyrithione zinc (1 percent) have been used for years, and they’re basically extra-strength anti-dandruff shampoos that may also impact hormone levels in a small way. These shampoos do have the potential to increase hair density and size, and they can increase the number of hair follicles that go into the growth stage. Rotate them with your regular shampoo.
Let there be light
Laser light therapy combs (like something out of Star Wars) are selling well in various countries around the world. You run the bulky comblike device through your hair several times a week for 10 to 15 minutes, and you can also use it as a sword to fight the dark side (just kidding). Sounds crazy—and it very well may be—but there is some minimal research to suggest these products may increase bloodflow to the scalp and promote slight hair growth for men and women. In one study, participants used a comb with a wavelength of 655 nanometers (HairMax LaserComb) for 15 minutes three times a week (on nonconcurrent days) for 6 months. About 64 percent of the subjects reported no growth (compared to 58 percent with a placebo comb), 25 percent saw minimal growth, 10 percent had moderate growth, and 1 percent hit the jackpot with dense growth. Overall, it did a little better than a placebo comb. So I’m not sure if these results are clinically significant (I’m skeptical overall), even though some of the results were statistically significant.
Consider waving the white flag
My primary recommendation for many men is to just shave their heads and not worry about it. Of course, I realize that with all the pressure today to look younger, this is not an easy decision. Unfortunately, drug manufacturers have made this condition seem like it’s a disease when, in reality, it’s mostly just a natural genetic expression, like eye color. Still, men with hair loss can save time and tons of money by opting for a close shave, and it may improve their sex lives because they won’t be messing up their hormones with pills. Going bald is proof that you have a decent amount of testosterone flowing in your body. Giving in and shaving what remains of your hair also seems to be associated with the most long-term satisfaction, in my experience.
What Else to Know About Hair Loss?
There are still only two FDA-approved drugs for hair loss (topical minoxidil and finasteride), which gives you an idea how hard it is to come up with any drug or supplement in this billion-dollar industry. Other antiandrogen drugs—such as oral contraceptives, cyproterone, and spironolactone—might help some women with hair loss.
The prescription drug Latisse (bimatoprost ophthalmic solution, 0.03 percent) is FDA-approved to make eyelashes grow longer, fuller, or darker. It was originally used to treat ocular hypertension and glaucoma, and a notable side effect was increased eyelash growth. In some small clinical studies of men and women with pattern baldness, it seemed to be beneficial. Stay tuned! What I like is that it grows hair via a new and different mechanism that does not apparently impact hormones; it has more of a localized effect—a little similar to minoxidil.
The only permanent solution for hair loss for men and women is hair transplants, but keep in mind that once you get one, you’re probably a customer for life! You will have to use minoxidil or finasteride to keep the rest of your hair from falling out. So, to say this option is costly long term is stating the obvious.