It is well known that dihydrotestosterone (DHT) is the hormone that is mostly responsible for male pattern baldness. Luckily, there is quite a lot you can do to lower your DHT levels, but it is probably not what you expect.
Why Would You Want to Reduce DHT Anyway?
DHT is an androgen hormone that is a product of testosterone, and it is converted by the enzyme known as 5-alpha-reductase (1). Of course, we do not want to block DHT and lower our testosterone levels as a result, so a more effective approach is to inhibit (slow down) the action of the enzyme.
An important point to understand is that men who suffer from male pattern baldness do not have particularly high levels of DHT. That is not the problem.
The Two Main Ways to Reduce DHT: Blockers and Inhibitors
When it comes to lowering DHT levels, though, there are two main ways to do so:
- Using DHT (androgen) blockers
- Using DHT (androgen) inhibitors
DHT blockers prevent DHT from binding to androgen receptors. These are found throughout the body, including the prostate, liver, brain, skin, and hair follicles. With the inability to bind to androgen receptors, the processes triggered by DHT will not occur.
DHT inhibitors prevent DHT from being produced. They do so by inhibiting the activity of 5-alpha-reductase, the enzyme that facilitates the conversion of testosterone to DHT as mentioned above.
When speaking of hair loss, the drug most often recommended is finasteride. Finasteride, also known by the brand name Propecia, is an androgen inhibitor. It lowers DHT levels throughout the body by reducing 5-alpha-reductase activity.
There are no true DHT blockers that are currently approved by the FDA for hair loss. These drugs are most often used for more serious medical conditions, including prostate cancer, precocious puberty and, Benign Prostatic Hyperplasia (BPH).
If you suffer from androgenetic alopecia, the above processes sound beneficial. They do carry some side effects, though.
How to Lower DHT Levels In the Scalp
If you want a clinically-proven approach to lowering scalp DHT, then finasteride is just what you are looking for.
Finasteride, more commonly known by its brand name Propecia, is a hair loss drug. It was initially developed for the treatment of Benign Prostastic Hyperplasia (BPH), but studies soon showed that it also contributed to hair growth (9).
The reason for this is clear – both BPH and AGA are triggered by a sensitivity to DHT. The first condition affects the prostate, and the second affects the hair.
It does not block DHT or even reduce DHT levels directly. Instead, it inhibits the activities of 5-alpha-reductase and therefore reduces the by-product of this enzyme’s interaction with testosterone (10).
A 1999 study on the topic found that a 1mg dose of finasteride reduced scalp DHT by 64 percent while a 5mg dose reduced scalp DHT by 69 percent (11). These results were seen after 42 days of treatment.
This makes finasteride one of the most effective ways to combat AGA.
Utilize Natural DHT Blockers
While there is still much room for research as it relates to the use of natural DHT blockers, there are a few that preliminary studies show may play a role in lowering scalp DHT. Here are just a few.
There are a few research studies that highlight the anti-androgen activities of saw palmetto. One of the most in-depth was one that showed a combination of gelatin-cystine and saw palmetto was effective in reducing free radical levels and inducing hair growth (12).
This study followed 48 volunteers (24 male and 24 female) as they applied the lotion (either active or placebo) over a period of 50 weeks. Some participants (12) also took an oral supplement (which did not contain saw palmetto, but did contain gelatin-cystine). All of the patients were previously diagnosed with AGA (ranking anywhere from a stage III to IV on the Norwood-Hamilton scale).
The 48 volunteers were split into five groups:
- Group 1: Active lotion A;
- Group 2: Inactive (placebo) lotion B;
- Group 3: Active diet supplement C;
- Group 4: Inactive (placebo) diet supplement D; and
- Group 5: Active lotion A and active diet supplement C
The lotion was applied twice per day (morning and evening), and the participants were also provided a mild shampoo. They were instructed to use this shampoo throughout the study.
So, how did researchers assess hair growth? They used the mean percentage variation of hair number per squared centimeter of scalp.
The three active groups (lotion, diet, and lotion + diet) performed significantly better than the two placebo groups (lotion and diet). The most effective was the lotion + diet group, followed by diet, and then lotion.
While this does not definitively prove saw palmetto’s efficacy, it does give provide hope.
Since the study was performed to test both saw palmetto and gelatin-cystine, there is no way to say which of the two worked best.
However, as mentioned, other studies have been performed which show saw palmetto’s benefits in relation to hair growth.
Stinging nettle is another herb that has been shown to have anti-androgenic effects.
One study, performed in 2011, showed stinging nettle’s effects on Benign Prostatic Hyperplasia (BPH) in human patients (14).
This studied consisted of 620 patients, and it was performed over six months. The results were collected using various techniques, including:
- International Prostate Symptom Score (IPSS);
- Maximum urinary flow rate (Qmax);
- Postvoid Residual Urine Volume (PVR);
- Serum Pros-tatic-Specific Antigen (PSA);
- Testosterone levels; and
- Prostate size
The techniques above were used throughout the study, and the six-month results proved stinging nettle’s efficacy.
Most notably, both the IPSS and Qmax decreased significantly when compared to the placebo group.
The fact that stinging nettle was useful in the treatment of BPH proves its ability to inhibit 5AR’s activities. So while it is not a direct DHT blocker, it may still contribute to healthy hair growth.
Reishi mushroom is another unlikely ingredient for lowering DHT levels in the scalp according to a 2005 study (15).
The study was created to test 19 different mushroom species and determine whether any of them were an effective DHT blocker.
Researchers prepared ethanol extracts of each mushroom species, and then added the extracts to a suspension containing rat liver and prostate microsomes. This was carried out to see which species, if any, could inhibit 5AR:
As you can see above, reishi (G. lucidum) performed the best.
It actually had an inhibitory percentage of over 70 percent, which was significantly better than the other mushrooms in the study.
This shows that reishi mushroom can be considered comparable to finasteride, since both inhibit 5AR and, as a result, reduce the amount of DHT that attaches to the hair follicles.
The Potential Risks and Side Effects of Blocking DHT
If you think that DHT blockers and inhibitors are the answer to your hair loss woes, you may want to learn a bit more about the risks associated with their use.
As DHT is an androgen sex hormone, it plays a key role in male secondary sexual characteristics. These include the various effects of puberty, such as a deepening voice, pubic hair growth, facial hair growth, and muscle development. DHT’s role does not end with puberty, though.
As study after study has indicated, a reduced level of DHT can have adverse sexual effects. These include:
- Loss of libido
- Inability to get an erection
- Inability to maintain an erection
- Inability to ejaculate
- Difficulty in reaching climax
- Reduced ejaculatory volume
- Premature ejaculation
These side effects can be mentally devastating.
There is a risk of more serious side effects, including:
- Water retention and swelling of the hands and feet
- Tenderness or swelling of the breasts
- General weakness
At this time, DHT blockers are only indicated for use in men. Women are strongly cautioned against the use or handling of antiandrogen medications, such as Propecia, due to the potential risk to a developing male fetus.
For some men, the benefit of using DHT blockers and inhibitors will outweigh the risks. But if you have another option, why not consider it?
Other Ways to Treat Hair Loss
If you are wary of the side effects of DHT blockers, you should know that there are other options.
Use an Alternate FDA-Approved Treatment for Hair Loss
There are two medications currently approved by the Federal Drug Administration (FDA) for the treatment of hair loss: finasteride (Propecia) and minoxidil (Rogaine).
Minoxidil, known by the brand name Rogaine, is a topical vasodilator applied directly to the scalp. It works by dilating the blood vessels.
It is thought that minoxidil has various mechanisms when it comes to treating hair loss. For example, minoxidil can:
- Increase blood flow which ensures oxygen and nutrient delivery to the hair follicles.
- Open potassium channels to facilitate the hair growth process.
- Upregulate growth factors to promote anagen (active) phase of hair growth.
That is not to say that minoxidil does not have risks of its own.
One of minoxidil’s original uses was as an anti-hypertensive. This means it treats high blood pressure (hypertension). The most common side effects of vasodilators are water retention and swelling (edema), headache, lightheadedness, and flushing (warmth, redness, and/or tingling).
Eat a Balanced Diet
It may seem silly to suggest diet as a treatment for hair loss. This is especially true of androgenetic alopecia which is caused by DHT and not malnutrition or nutrient deficiencies. You may be surprised at what a well-balanced diet can do for you, though.
There are certain vitamins and minerals which have been shown to contribute to healthy hair growth. These include niacin, iron, biotin, Vitamin D, and Vitamin E.
You can take supplements as a way to ensure you are meeting your minimum daily required values, but the best way to increase vitamin and mineral intake is with a balanced diet.
A balanced diet is just as it sounds — a diet that contains a varied array of foods from the various food groups. The categories of foods that contribute to a well-balanced diet include:
- Lean meats
- Leafy greens
- Nuts and seeds
- Whole grains
While this may seem like a small change, it can make a significant difference to your overall health and the state of your scalp and hair.
Practice Scalp Massage and Stimulation
Scalp massage and scalp stimulation are a great natural way to promote blood circulation to the scalp. They do have additional benefits, though, that may help you in your hair regrowth journey.
While it is known that DHT plays a major role in hair loss, the question for many is why?
There are various theories of hair loss that attempt to answer this question. One such theory is the Scalp Tension Theory of Hair Loss.
According to the Scalp Tension Theory, the trigger may be chronic scalp tension.
As the muscles within the scalp tighten, the potential for inflammation increases. This triggers the recruitment of anti-inflammatory substances within the body, including DHT. For those with a genetic predisposition to DHT sensitivity, though, the increased presence of DHT at the follicles can trigger follicle miniaturization.
The Scalp Tension Theory of Hair Loss answers many questions about pattern baldness, including why hair loss presents in the typical M-shaped pattern and why DHT levels appear to be higher in balding versus non-balding scalp tissues.
If scalp tension is the problem, then what is the solution?
One way to combat scalp tension is with routine scalp massages and stimulation.
The purpose of scalp massages is two-fold:
- Reduce the chronic tension of the galea layer of the scalp
- Increase blood circulation and promote healthy blood flow
The great thing about scalp massage is it is easy and it is free. You can practice it anytime, anywhere. Here are a few scalp massage demonstration videos to get you started.
Other Reasons You May Be Experiencing Hair Loss
There are plenty of reasons that one may suffer from hair loss, and not all of them are related to DHT. Some of these are temporary, while some of these are permanent. Here is a look at some other reasons you may be experiencing hair loss, as well as how to address them.
Does your hair loss appear to be patchy? Does the hair loss come on suddenly, and does it seem to resolve on its own too? The cause for this may be alopecia areata.
Alopecia areata is believed to be an autoimmune disorder in which the immune system attacks the hair follicles. The hair in that area will often shed entirely and leave you with a bald patch of irregular size and shape.
The hair loss will often resolve as mysteriously as it appeared, though there are treatment options available for sufferers, too.
The most common treatment is a corticosteroid. A topical corticosteroid is often the first round of treatment, though oral steroids (like prednisone) may be prescribed in persistent cases.
At this time, there is no known cure for alopecia areata.
Dandruff and Seborrheic Dermatitis
You may have thought that dandruff and seborrheic dermatitis were two distinct scalp conditions. These conditions are actually triggered by the same issue, but they fall on opposite ends of the spectrum.
Dandruff is the less severe of the two conditions. It is characterized by itching, flaking, and
Seborrheic dermatitis is a more severe form of dandruff.
The good news is that both conditions can be treated, though the treatment will depend on many factors.
When formulating a treatment plan for dandruff or seborrheic dermatitis, your doctor will consider the severity of your condition. They will also consider the treatments you have tried in the past (both successfully and unsuccessfully) and your current lifestyle.
The most common treatments for dandruff and seborrheic dermatitis include salicylic acid, selenium sulfide, tar-based shampoos, ketoconazole-containing shampoos, and zinc. Your doctor may also suggest lifestyle changes and changes to your hair care routine.
An imbalance of hormones can wreak havoc on the body. And depending on the hormone, it may even be a cause of hair loss.
What causes hormonal imbalance?
The most common cause is thyroid malfunction, where the thyroid either produces too much or too little of essential hormones. The conditions which can most often trigger thyroid malfunction include Hashimoto’s disease, Graves’ disease, goiter, and thyroid nodules. You can experience both hypothyroidism and hyperthyroidism as standalone conditions, however.
The hair loss caused by a hormonal imbalance can often be treated by treating the underlying condition.
Illness and Medications
Your body operates like a well-oiled machine, that is until something goes “wrong.” Then the body may only operate at a limited capacity, and this means certain non-essential functions, such as hair growth, will suffer.
If the illness is prolonged, or if it is particularly intense, you may suffer from diffuse (all over) hair loss as a result.
The most common type of hair loss triggered by illness is telogen effluvium. This means that hair loss occurs during the telogen phase of hair growth. It is during telogen phase that your hair will begin to shed so as to make room for new anagen phase hairs. If you shed too much during this stage, though, you may not be able to replace what you have lost. The hair loss will become more apparent as the cycles continue.
The treatment for your illness may sometimes trigger hair loss, too.
Medications can cause two types of hair loss: telogen effluvium, and anagen effluvium.
Chemotherapy, for example, can trigger anagen effluvium which is diffuse hair loss that occurs due to an interruption in the anagen phase of hair growth. This can result in widespread balding, and its effects are often more severe than telogen effluvium.
In most cases, hair regrowth is possible once the illness has passed or once you have stopped taking the medication. It may take several months for the hair growth process to get back into sync, but once it does you should notice steady hair growth.
While poor nutrition does not often lead to significant hair loss, it can cause just enough increased shedding and loss of volume to concern you.
If you suffer from certain gastrointestinal conditions, such as Chron’s and Ulcerative Colitis, you may suffer from malnutrition as a result of poor nutrient absorption in the gut.
The good news? Hair loss caused by poor nutrition can often be treated with vitamin and nutrient supplements, as well as changes in your diet.
You should get an entire blood panel from your physician so you can know what nutrients and minerals your body is lacking.
The nutrients and minerals that are most often linked to hair loss/growth include zinc, selenium, biotin, Vitamin D, and niacin. You can increase your dietary consumption of these vitamins and minerals, though a supplement can also help you to bridge the gap.
While using a DHT blocker seems to be the most obvious technique for combatting pattern hair loss, you should also consider techniques that enable you to lower DHT sensitivity.
Of course, there are also ways to lower DHT levels, including topical DHT blockers. But if you are set on seeing results, then the drug finasteride is likely your best bet.