It is widely believed that Dihydrotestosterone (DHT) is responsible for the pattern of hair loss associated with Androgenetic Alopecia (AGA), or male-pattern baldness.
A popular way to treat the condition, then, is to reduce DHT levels within the body. One way to do this is with the FDA-approved drug Propecia (finasteride). The problem with this approach is not only is it difficult to reduce overall DHT levels in the body, but there can be side effects.
By blocking DHT directly in the scalp you can reduce hair loss, and increase hair growth. As a method, this can work more effectively than trying to block DHT in the body.
What is DHT?
DHT, or Dihydrotestosterone, is an androgen sex hormone and steroid (1).
The hormone is a by-product of testosterone, and it is created when testosterone and the enzyme 5-alpha-reductase interact:
The main role that DHT plays is male sexual development. More specifically, this hormone and steroid is responsible for the development of secondary sexual characteristics. This includes maturation of the penis and scrotum, facial, body, and pubic hair growth, and maintenance of the prostate gland.
DHT and Hair Loss
As DHT plays such a critical role in male sexual development and male characteristics, it seems odd that DHT may actually be the cause of hair loss. The relationship between DHT and male-pattern baldness is an interesting one. Let us discuss.
There are two major theories of hair loss: The DHT Theory, and the Scalp Tension Theory.
According to the DHT Theory of Hair Loss, a predisposed sensitivity to DHT at the hair follicles is the primary cause of pattern balding. The Scalp Tension Theory, on the other hand, sees DHT as a secondary cause of pattern baldness which is first triggered by chronic scalp tension (2).
No matter which theory you believe, the fact is that DHT is a major contributor to hairline recession and hair loss.
When DHT attaches to the androgen receptors at the scalp, it triggers the expression of Transforming growth factor beta 1, or TGF-β1 (3). This cytokine (an anti-inflammatory) is responsible for controlling cell growth, cell proliferation, and cell differentiation.
The increased levels of TGF-β1 make it difficult for the stem cells within the base of the hair follicle (or bulb) to grow and differentiate as usual. As such, hair growth is stunted. This process is often referred to as hair follicle miniaturization.
How Does Minoxidil Work?
You may be surprised to learn that minoxidil does not have an effect on DHT levels whatsoever. Minoxidil works, instead, to promote hair growth on the scalp in spite of the presence of DHT (4).
The active ingredient minoxidil, now known more commonly by the brand name Rogaine, was initially developed as an anti-hypertensive medication. This means it reduced blood pressure in patients by dilating the blood vessels so as to relieve pressure on vascular walls.
An interesting side effect was seen in many male patients during the trials, and that was hair growth. In men diagnosed with pattern hair loss, it seemed the drug actually reversed the effects of pattern baldness.
There are a few theories surrounding the exact mechanism of minoxidil in hair loss. It is likely that the reasons are a combination of those listed here:
- It increases blood flow to the area when applied topically, which ensures proper delivery of oxygen and nutrients.
- It opens the potassium channels which enables the flow of potassium ions (5). This is known to reduce hypertension and relax smooth muscle activity.
- It upregulates the expression of certain growth factors, one of which is Vascular Endothelial Growth Factor (VEGF). VEGF plays a significant role in the anagen (active) phase of the hair growth cycle.
The fact is that minoxidil does not prevent DHT from attaching to the hair follicles, so miniaturization is still possible. But it is proven effects within the body (increases blood flow, opens potassium channels, upregulates VEGF expression) can help to reverse the symptoms of pattern baldness for as long as it is used.
Are There Natural Alternatives to Minoxidil?
This question is difficult to answer in that there is not a natural ingredient that mimics all of minoxidil’s effects. There are ingredients, though, that can promote the different positive effects of the drug such as improved blood circulation.
A few common blood flow stimulators include peppermint and spearmint oils and caffeine. There are also manual techniques, such as scalp massage and dry brushing.
There may be a more comprehensive approach, though, and that is topical DHT blockers.
As the name suggests, topical DHT blockers prevent DHT from attaching to the hair follicles. This means the negative effects on DHT-sensitive hair follicles are mitigated. While topical DHT blockers are not a one-to-one replacement of minoxidil, their use may provide you with the results you seek.
Why Use a Topical DHT Blocker?
If you are suffering from pattern hair loss, it would make sense to block DHT. There are two ways to do so: internally, and externally.
The popular oral drug, finasteride, works by inhibiting the activity of 5-alpha-reductase which results in lower DHT levels. The problem with this approach is that it is a systemic one. This means that DHT levels are lowered throughout the body.
As we know, DHT plays a critical role in many male sexual characteristics. So lowering DHT throughout the body is not good if you want to maintain those characteristics and sexual functions.
The use of an internal DHT blocker, like finasteride, can trigger side effects such as:
- Loss of libido
- Inability to get an erection
- Inability to maintain an erection
- Inability to ejaculate
- Loss of ejaculatory volume
…and the list goes on.
The good news is you can still block DHT and decrease your risk of side effects. How? With a topical DHT blocker.
A topical DHT blocker works to inhibit DHT externally. This means it only triggers DHT levels at the site of application. In this way, you can reap the benefits of blocking DHT with a significantly reduced risk of negative effects.
Topical DHT Blockers: Pharmaceutical vs. Natural
At the moment, there are no pharmaceutical DHT blockers which have been approved for topical use.
There have been research studies on the use of topical finasteride and it certainly looks promising, but further studies are needed (6).
So if pharmaceutical options are off the table (for now), what other options are there?
There are actually quite a few “natural” ingredients that have been shown to reduce DHT when applied topically. Here is a brief overview of each ingredient.
Saw palmetto is likely the most popular DHT blocking ingredient used in both topical and internal formulations. There is quite a bit of evidence suggesting its efficacy and safety when used to treat pattern baldness in men with the condition (7).
Like many other ingredients on this list (and similar to finasteride), saw palmetto does not target DHT directly. It instead inhibits the activity of 5-alpha-reductase so as to reduce DHT production.
Due to its popularity in the hair loss community, this is one of the easier ingredients to find online and in health food stores.
Pyguem bark is taken from the African cherry tree. It is an ingredient which has been used medicinally for centuries, and more recently it was found to be an effective treatment for Benign Prostatic Hyperplasia (BPH), or an enlarged prostate (8).
DHT is known to play a role in BPH. When DHT is lowered, the prostate will decrease in size and reverse the symptoms of the condition. So too can this ingredient lower DHT at the scalp so as to reduce follicle miniaturization.
Stinging nettle is a plant most widely known for its ‘stinging’ effects when touched. But stinging nettle extract is a proven way to treat BPH (just like pygeum bark) by inhibiting the activity of 5-alpha-reductase and decreasing DHT levels (9).
Reishi mushroom has been used in China for years, and a 2005 study showed reishi to be the most effective mushroom species at inhibiting 5-alpha-reductase (10). This suggests reishi may have at least a mild impact on DHT levels when used topically.
You can find reishi mushroom most often as a powder or in a capsule. You may also find whole, dried reishi at health food and specialty stores.
How to Use Topical DHT Blockers
When it comes to using topical DHT blockers, there are two main forms they come in.
If you are looking for a quick and low-risk way to add topical DHT blockers to your hair care routine, then consider DHT blocker shampoos.
There are many DHT-blocking shampoo options available on the market today. They include a range of ingredients, from saw palmetto to ketoconazole to caffeine. Their goal is often two-fold: to lower DHT levels and to stimulate blood flow to the scalp.
Another option for topical DHT blockers is in the form of a liquid solution.
You can purchase a liquid solution that contains DHT blockers online, or you can make them yourself at home.
The process of making your own topical solution can be daunting. It can also be difficult to obtain the right ingredients. That is why I suggest a ready-made option over a homemade one.
Is There Risk Associated with Topical DHT Blockers?
When speaking of DHT blockers, it is important to discuss the potential for side effects.
There are numerous potential side effects associated with internal DHT blockers, like finasteride. These same side effects may be seen even when you use ingredients like saw palmetto and reishi.
But what about the risks associated with topical DHT blockers?
The risk of side effects when using topical DHT blockers is small when compared to internal DHT blockers, but it is not non-existent.
When a topical DHT blocker is applied to the scalp, it is absorbed by the skin. In this way it can enter the bloodstream and interact with the hair follicle.
Since trace amounts of these DHT blockers will be entering your bloodstream, there is the possibility to experience mild systemic side effects. It is very likely that you may experience no noticeable side effects at all, though.
You can reduce the risk of developing side effects by using a topical DHT blocker with a low concentration of DHT-blocking ingredients. This will dampen the positive effects, of course, but it will also reduce risk.
Carefully follow the manufacturer’s directions, and buy products from reliable sources.
Herbal products are not monitored by the FDA. Products brought in from other countries may be contaminated, or they may not contain what the packaging claims.
Other Methods to Address Hair Loss
Perhaps you are interested in blocking DHT, but you also want to treat the cause of the hair loss at its source. This is the best way to address pattern baldness, and it is the only way to ensure that your hairline does not recede again once your hair has regrown.
But what other methods can you use to address hair loss?
Blood Flow Stimulators
It is true that hair follicle miniaturization cannot be reversed when DHT is still present at the scalp. This may make you want to target DHT first. But a better long-term solution is to create a healthy environment for hair growth to occur, even as you work to reduce DHT at the scalp.
The best way to do this is with blood flow stimulators.
The goal of blood flow stimulators is to increase blood circulation to the immediate area. This will ensure the hair follicles are receiving what they need (e.g. oxygen, nutrients) and that waste (including DHT) is being removed regularly.
Minoxidil, the only topical hair loss treatment that has been approved by the FDA at the time of this writing, is a blood flow stimulator. It increases blood flow to the scalp to promote hair growth even in spite of DHT’s presence.
There are natural topical ingredients which can also increase blood circulation. Peppermint oil is perhaps the most popular. It contains the active ingredient menthol which has been proven to increase cutaneous blood flow (11).
Caffeine is another option, and it is quickly becoming a popular addition to shampoos, elixirs, and other hair products (12).
Scalp massage and exercises are also a great way to increase blood flow to the area.
Scalp Massage and Tension Relief
By reducing scalp tension, you reduce inflammation. This will lower levels of DHT at the hair follicle, which will reverse the effects of hair follicle miniaturization.
There are two main ways to reduce scalp tension: with scalp massage, or by using a scalp tension relief device.
Scalp massage is a manual process that involves the use of your hands or a specialized massage tool. The goal is to loosen the skin on the scalp and relax the muscles.
For best results, you should practice scalp massage for at least 10 minutes every day.
There are plenty of different massage routines you can use. Check out our scalp massage demonstrations here.
Are you not interested in a manual process? Or maybe you want to perform scalp massage but you also want to add a bit more to your routine. A scalp tension relief device can help.
A scalp tension relief device is a device that is placed directly on the head. It will have a band which wraps around the scalp, and pump which can be used to fill the band with air.
As the pump fills the band, the device lifts the scalp so as to relieve pressure.
There are many benefits to this technique, especially if you subscribe to the Scalp Tension Theory of hair loss.
The main benefit is the reduction in scalp tension which can reverse the chronic effects (including inflammation and follicle miniaturization). The device can also help to increase blood flow as pressure will be removed from the scalp’s underlying blood vessels.
When you are struggling with pattern hair loss, it is important to address the problem quickly. An easy way to do this is with FDA-approved treatment options such as minoxidil.
You may be surprised to learn that minoxidil does not treat the underlying issue, though. That is, it does not block DHT.
This is why you should consider adding a topical DHT blocker into your hair care routine. A topical DHT blocker will block DHT at the follicles with minimal to no risk of side effects. It can help you to maintain your current hairline and even regrow hair that you previously lost.