What Is DHT’s Role In Male Baldness?
Androgenetic alopecia is a common and treatable and sometimes reversible form of hair loss. Its cause is thought to be a genetic sensitivity of the hair follicles to dihydrotestosterone (DHT), a hormone essential for male sexual development that is also thought to cause miniaturization of the hair follicles. DHT is a contributing factor to both male and female pattern hair loss.
An extremely common condition, androgenetic alopecia affects about 50 million men and 30 million women in the U.S. Its highest prevalence is between ages 30 and 65, but it can occur as early as adolescence. A survey of men aged 18 to 49 years found that 42% had moderate to extensive hair loss.1 About 50% of men over age 50 have hair loss. Hair loss is more common in women after menopause.2 This pattern of hair loss causes a receding hairline, hair thinning, and hair loss at the crown in men, and overall hair thinning and widening of the hair part in women.
DHT is essential for sexual hair growth, including axillary, pubic, and facial hair, but it negatively impacts scalp hair. When researchers plucked hair follicles and skin from balding and non-balding scalp, there were higher levels of androgen receptors on balding scalp hair follicles.3
In people with a genetic predisposition to DHT sensitivity, the growth phase of hair follicles is reduced from years to weeks or months, and the hair follicles decrease in size. A shortened growth phase means more hairs enter their resting phase and fall out. A smaller hair follicle results in hairs that are thinner and less coarse.
Testosterone and DHT are androgens that play an important role in males developing male sexual characteristics before birth and adolescence. An enzyme, 5α-reductase, converts up to 10% of testosterone to DHT in adults. DHT is a stronger, more powerful androgen than testosterone.
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How To Reduce DHT Levels And Promote Hair Growth
Everyone sheds about 50 to 100 hairs each day. There are three phases of hair growth: anagen, which is the growth phase; catagen, a transitional phase; and telogen, the resting phase. The length of these phases and the percentage of hairs in each phase vary throughout your lifetime. This is why hair loss increases with age.
Read more about What Age do Males Turn Gray and Lose Hair
But, just because hair loss, and graying for that matter, increase with age, that does not mean you need to accept the inevitable. There are highly effective medications that reduce DHT and some lifestyle changes and natural remedies that may also help.
Finasteride is a competitive inhibitor for type II 5α-reductase, the form of 5α-reductase that is more common in the hair follicles. Finasteride is a competitive inhibitor that blocks 5α-reductase from binding to its receptor and converting testosterone to DHT. It decreases the amount of circulating DHT in the body by about two-thirds and slightly increases testosterone levels.4
In two clinical trials, 1,553 men between the ages of 18 and 41 received oral finasteride or placebo for one year, and 1,215 men continued treatment for a second year. The men experienced increased hair count, slower hair loss, increased hair growth, and improved hair appearance.5
Finasteride is FDA-approved for treating male pattern hair loss and is used off-label to treat female-pattern hair loss.4
Read more about Finasteride for Hair Loss: An Overview
Some foods and herbs may also reduce DHT and help reduce male and female pattern hair loss. Try these to see if they reduce hair loss:6
- Green tea contains epigallocatechin gallate (EGCG), which may support hair growth by blocking DHT. However, more research is needed because studies have been small and short in duration.7 Green tea extracts containing standardized amounts of EGCG have not shown an ability to reduce DHT and have been linked to liver damage in some people.8-10 Green tea has anti-inflammatory and antioxidant properties.
- Saw palmetto is extracted from palm tree berries. The extract is rich in fatty acids and carotenoids. Saw palmetto inhibits 5α-reductase, which reduces DHT and slightly increases testosterone.
- Pumpkin seeds contain fatty acids, sterols, and phytoestrogens. Pumpkin seed oil and extract may inhibit 5‐alpha‐reductase activity with a dose of 400 mg/d for 24 weeks.
- Rosemary leaves and flowering buds contain natural antioxidants and esters. Rosemary works similarly to minoxidil in that it increases blood flow to the hair follicles.
- Grape seed contains anthocyanins, vitamin E, flavonoids, quercetin, and polyphenols. In mice studies, grape seed increased hair follicle cell proliferation and conversion from the telogen resting phase to the anagen growth phase.
- Licorice contains glycyrrhizin and is rich in flavonoids that may reduce testosterone effects.
There are not many studies that investigate lifestyle factors and DHT levels. However, lifestyle factors that improve overall health will affect your immune system and blood circulation and, therefore, may improve hair follicle health.
Optimize your overall health by prioritizing:
- Eat a well-balanced diet with healthy sources of fat
- Manage stress
- Maintain a healthy weight
- Spend time outside to boost vitamin D
- Get plenty of high-quality sleep
- Quit smoking
- Cut back on alcohol use
- Avoid endocrine disruptors
Hair transplants are performed by taking hair from one part of the scalp and surgically placing it into areas of baldness. Hair is taken from places on the scalp where hair follicles are resistant to DHT effects. Scalp on the back of the head and lower portions of the sides and back of the scalp are less sensitive to DHT.
Hair transplant methods:
- Follicular Unit Transplantation (FUT): A strip of hair is harvested and separated into follicular units. The tiny grafts are then transplanted into scalp with thinning hair.
- Follicular Unit Extraction (FUE): Instead of removing a strip of hair, individual follicular units are removed and transplanted.
Men with androgenetic alopecia are the most common population to receive hair transplants. In one study, satisfaction with the outcome ranged from 90% to 97%, and graft survival rates ranged from 85% to 93%. Hair transplantation does not increase the overall amount of hair. It only evens it out over the scalp.11
Side Effects Of Reducing And Blocking DHT
Finasteride and other medications that block DHT have side effects, including:
- Erectile dysfunction: E.D. occurs in about 1.5% of men treated with finasteride. Erectile function typically returns after being off the medication for three months. Several treatment options for E.D. are available, including Passion +, which combines oxytocin, tadalafil, and PT-141 to provide a comprehensive solution to E.D. treatment.
- Loss of libido: decreased sex drive is a reversible side effect that also occurs in just over 1% of men taking finasteride. Medications that can enhance sexual health and function can improve libido.
- Breast enlargement and tenderness (gynecomastia)
- Stomach pain
Other Causes Of Hair Loss
There are many potential causes of hair loss. In many cases, if the underlying problem is treated, hair loss may resolve. Talk to your healthcare provider to rule out other potential causes if you notice increased hair loss or balding. Some potential causes of hair loss include:
- Age: Getting older is the single biggest risk factor for hair loss. Invigor Medical offers several treatment plans for age management that address hair loss and other conditions associated with aging.
- Genetics: If you have a family history of male or female hair loss, you may be at increased risk for several types of hair loss. In many cases, earlier treatment leads to a better treatment outcome.
- Stress: Stress can increase hair loss and cause changes to the skin, including fine lines and wrinkles. Read more about what causes skin wrinkles and how to treat them.
- Hormonal imbalances: In addition to changes in testosterone and DHT levels, hormonal imbalances between estrogen and testosterone can affect hair growth and blood supply.
- Medical conditions: Immune disorders, skin infections, severe illnesses, and other medical conditions can cause hair loss.
- Nutritional deficiencies: B vitamins, iron, zinc, niacin, and biotin deficiencies can increase hair loss.
- Rhodes T, Girman CJ, Savin RC, et al. Prevalence of male pattern hair loss in 18-49 year old men. Dermatol Surg. Dec 1998;24(12):1330-2. doi:10.1111/j.1524-4725.1998.tb00009.x
- Hibberts NA, Howell AE, Randall VA. Balding hair follicle dermal papilla cells contain higher levels of androgen receptors than those from non-balding scalp. J Endocrinol. Jan 1998;156(1):59-65. doi:10.1677/joe.0.1560059
- Lebwohl MG, Heymann, W. R., Berth-Jones, J., & Coulson, I. Treatment of skin disease: Comprehensive therapeutic strategies. Elsevier Health Sciences.; 2018.
- Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. Oct 1998;39(4 Pt 1):578-89. doi:10.1016/s0190-9622(98)70007-6
- Dhariwala MY, Ravikumar P. An overview of herbal alternatives in androgenetic alopecia. J Cosmet Dermatol. Aug 2019;18(4):966-975. doi:10.1111/jocd.12930
- Kwon OS, Han JH, Yoo HG, et al. Human hair growth enhancement in vitro by green tea epigallocatechin-3-gallate (EGCG). Phytomedicine. Aug 2007;14(7-8):551-5. doi:10.1016/j.phymed.2006.09.009
- Dostal AM, Samavat H, Bedell S, et al. The safety of green tea extract supplementation in postmenopausal women at risk for breast cancer: results of the Minnesota Green Tea Trial. Food Chem Toxicol. Sep 2015;83:26-35. doi:10.1016/j.fct.2015.05.019
- Hu J, Webster D, Cao J, Shao A. The safety of green tea and green tea extract consumption in adults – Results of a systematic review. Regul Toxicol Pharmacol. Jun 2018;95:412-433. doi:10.1016/j.yrtph.2018.03.019
- Sarma DN, Barrett ML, Chavez ML, et al. Safety of green tea extracts : a systematic review by the U.S. Pharmacopeia. Drug Saf. 2008;31(6):469-84. doi:10.2165/00002018-200831060-00003
- Jimenez F, Alam M, Vogel JE, Avram M. Hair transplantation: Basic overview. J Am Acad Dermatol. Oct 2021;85(4):803-814. doi:10.1016/j.jaad.2021.03.124