Hair loss supplements and vitamins - do they work?
Natural Options for Hair Loss or Thinning Hair
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Ray Sahelian, M.D.

Hair originates in the dermis, the skin layer just below the surface layer (epidermis). Baldness (alopecia), or severe hair loss, is much more common in men than in women. Hair loss can result from genetic factors, aging, local skin conditions, and diseases that affect the body generally (systemic diseases). Some medications, such as those used to treat cancer, also cause hair loss. Perhaps a poor diet with lots of junk food over a period of years and decades is involved in hair loss but scientists still don't have a good understanding regarding the relationship of food and hair loss.

Standard Hair loss treatment
Most types of hair loss have no cure.
A person with male-pattern or female-pattern baldness may undergo hair transplantation, in which hair follicles are removed from one part of the body and transplanted. Some medications or hair loss products, such as topical minoxidil, may promote hair growth in a small percentage of people. The oral drug finasteride may also promote hair growth. Finsateride is available as the product name Propecia 1 mg, or as Proscar 5 mg (used for enlarged prostate). It is cheaper to buy Proscar 5 mg and bite off about a fifth a day instead of buying Propecia since Proscar is only slightly more expensive than Propecia but it has 5 times as much finasteride.
   Minoxidil, used topically may also be helpful at minoxidil 2% for women and minoxidil 5% for men.

Natural Hair Loss Remedy -- may be helpful for healthy hair growth
The role of diet in hair loss is not well understood, but it is possible that a diet with lots of junk food could promote inflammation and be harmful to hair growth, whereas a very healthy diet, over many years, may reduce hair loss. I'm not sure whether eating soy products, lots of vegetables, fish or taking fish oil capsules would help slow down hair loss. Perhaps they may since they thin the blood and improve circulation. I'm not aware of a hair loss vitamin that would be useful since most Americans are not severely deficient in any particular vitamin.
   A molecule produced in the intestine when soy is digested stops a hormone which can fuel prostate growth or cause hair loss. Writing in the journal Biology of Reproduction, researchers said the finding could explain why Japanese men, who eat more soy, rarely have prostate cancer. They said the molecule could be used as a treatment for cancer and hair loss. The team found that the molecule, equol, "handcuffs" the male hormone DHT - a by-product of testosterone. Equol is a metabolic product of the flavonoid daidzein. The researchers say this could be particularly important for men who have been diagnosed with either an enlarged prostate (benign prostatic hyperplasia), or cancer of the prostate. DHT has also been implicated in research into the causes of male pattern hair loss.
  
Saw palmetto extract is also involved blocking DHT in prostate tissue, whether it does so in hair tissue is not clear. One small study indicates the combination of saw palmetto and beta sitosterol could be helpful (see below). Hopefully, over the next few years we will have a clearer understanding of the role of long term dietary intake or supplement use and hair health.

   Dr. Sahelian has formulated a product for prostate tissue health which contains saw palmetto isoflavones such as genistein and daidzein along with beta sitosterol. Whether this product helps those with hair loss has not been evaluated. Interestingly, Prostate Power Rx users report a noticeable sexual enhancement.

Prostate Power Rx
Formulated by Ray Sahelian, M.D.

With Saw Palmetto, Beta Sitosterol, Pygeum, Stinging Nettle, Quercetin, & 9 Key Ingredients. Prostate Power Rx is carefully formulated with important herbs and nutrients to provide optimal prostate health.

Saw Palmetto extract (standardized to contain 45% fatty acids - serenoa repens fruit)
Stinging Nettle 4:1 extract (urtica diocia root)
Quercetin which is a flavonoid
Rosemary 4:1 extract (Rosemarinus officinales leaf)
Beta Sitosterol which is a phytoestrogen
Pygeum 4:1 bark extract (Pygeum Africanum)
Daidzein (standardized to contain 40% isoflavones)
Genistein (standardized to contain 40% isoflavones)
Lycopene (Lycoperscion escatatum fruit)

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Male-pattern baldness is the most common type of hair loss affecting men. It's rare in women and children because it depends on the presence of male hormones (androgens), and levels of these hormones are high in males after puberty. Hair loss runs in families. Hair loss usually begins on the sides, near the front, or on the top of the head toward the back. Hair loss can begin at any age, even in the middle teen years. Some people lose only some hair and develop a bald spot in the back or a receding hairline; others, especially people whose hair loss begins at a young age, may go completely bald.
   Researchers have found that variations in a gene related to male sex hormones may be at the root of male-pattern baldness, the most common form of hair loss. The culprit is the androgen receptor gene, and it dwells on the X chromosome, which all men inherit from their mothers. Other, yet-unidentified genes are likely involved in male-pattern baldness, possibly including ones handed down by fathers. But the new findings highlight the importance of mom's side of the family when it comes to a man's hairline.

Female-pattern baldness or female hair loss is less common than male-pattern baldness. Usually, this condition causes the hair to thin in the front, on the sides, or on the crown. It rarely progresses to total hair loss.

Gray Hair
Hair goes gray when melanocytes become depleted. The scalp contains a reservoir of adult stem cells that provide a continuous supply of these color-making cells. But as the body ages these cells become depleted and sometimes begin to develop in the wrong part of the hair follicle. I have not yet come across any credible research regarding the reversal of gray hair with vitamins or supplements.

Natural Hair growth research studies
A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia.
J Altern Complement Med. 2002 Apr;8(2):143-52. Prager N, Bickett K, French N, Marcovici G.
Clinical Research and Development Network, Aurora, CO, USA.
One contributing factor to androgenic alopecia is the conversion of testosterone (T) to dihydrotestosterone (DHT) via the enzyme 5-alpha reductase (5AR). This metabolism is also key to the onset and progression of benign prostatic hyperplasia (BPH). Here, we report the first example of a placebo-controlled, double-blind study undertaken in order to examine the benefit of these botanical substances in the treatment of androgenetic alopecia. The goal of this study was to test botanically derived 5AR inhibitors, specifically the liposterolic extract of saw palmetto and Beta-Sitosterol, in the treatment of androgenic alopecia. Included in this study were males between the ages of 23 and 64 years of age, in good health, with mild to moderate androgenetic alopecia. The results of this pilot study showed a highly positive response to treatment. The blinded investigative staff assessment report showed that 60% of (6/10) study subjects dosed with the active study formulation of beta sitosterol and Saw-Palmetto were rated as improved at the final visit.

Melatonin topical application and hair growth
Melatonin increases anagen hair rate in women with androgenetic alopecia or diffuse alopecia: results of a pilot randomized controlled trial.

Br J Dermatol. 2004 Feb;150(2):341-5.
In addition to the well-known hormonal influences of testosterone and dihydrotestosterone on the hair cycle, melatonin has been reported to have a beneficial effect on hair growth in animals. The effect of melatonin on hair growth in humans has not been investigated so far. To examine whether topically applied melatonin influences anagen and telogen hair rate in women with androgenetic or diffuse hair loss. A double-blind, randomized, placebo-controlled study was conducted in 40 women suffering from diffuse alopecia or androgenetic alopecia. A 0.1% melatonin or a placebo solution was applied on the scalp once daily for 6 months and trichograms were performed to assess anagen and telogen hair rate. To monitor effects of treatment on physiological melatonin levels, blood samples were taken over the whole study period. Melatonin led to a significantly increased anagen hair rate in occipital hair in women with androgenetic hair loss compared with placebo. For frontal hair, melatonin gave a significant increase in the group with diffuse alopecia. The occipital hair samples of patients with diffuse alopecia and the frontal hair counts of those with androgenetic alopecia also showed an increase of anagen hair, but differences were not significant. Plasma melatonin levels increased under treatment with melatonin, but did not exceed the physiological night peak. To the authors' knowledge, this pilot study is the first to show that topically applied melatonin might influence hair growth in humans in vivo. The mode of action is not known, but the effect might result from an induction of anagen phase.

Q. I just read your article about the study done on woman using melatonin solution on their hair. I am a woman in her 50s and have already lost hair in the front and upper sides. I was wondering where I can get this melatonin solution for hair loss. Can you direct me to someone who can help me?

Q. I understand 0.1% melatonin hair formula can help with growing hair back for women. Where can I purchase this and would I need a prescription? I saw a website that said, "ASATEX Swiss Melatonin Hair Formula is the first topical hair product with Melatonin in a special carrier system protected by world wide patents. It is recommended for men and women experiencing short-term hair loss caused by various factors such as stress, nutritional problems and seasonal influences.
ASATEX improves the texture and appearance of hair in long-term hair loss mainly due to hereditary factors. The product has been developed for use in early stages of hair loss and hair thinning.
   A. I am not familiar with this company and do not know if their product works or whether there is an adequate amount of melatonin in the hair formula.

Emails regarding hair loss
Q. I read you article on Serenoa repens ( saw palmetto ) and hair loss.... What is your opinion ( I know research is lacking ) on combining finasteride with Serenoa repens ( saw palmetto ) ---given the former is a type 2 inhibitor whereas the Serenoa repens ( saw palmetto ) is a dual inhibitor would you speculate there may be a beneficial effect on hair loss or an adverse one involving hormonal feedback loops ?
   A. You ask a good question. i don't see any obvious harm adding saw palmetto to finasteride, but I honestly don't know whether there would be a synergistic effect. I still am not convinced daily use of finasteride for hair loss or prostate enlargement is safe in the long run. Finasteride may blunt sexuality, but more research is needed.

Q. I know you probably won't be able to answer me, but I am desparate. I am a 43 year old woman and took a 25 mg. DHEA supplement recommended by my doctor. He was not really clear about how long I should take it, nor did he give me any warnings about possible side effects. Unfortunately I took it for 6 months and now am experiencing pretty severe hair loss.
I have lost 50% of my hair in the last 2 months. I really had NO IDEA what I was taking and feel very stupid for not researching this before I took it. My levels were tested on June 23rd and were high (260 in a scale of 14-244). I have stopped the supplement as of 3 weeks ago. Can you give me any hope (at all!) about regaining my hair once the DHEA level drops? I know you won't recommend treatments but if you could direct me to some information I would be grateful. This is causing me unbelievable anxiety.
   A. Unfortunately we have had many emails regarding hair loss associated with misuse of DHEA. There is hope that some of the hair, maybe most or all could grow back, but it is impossible to predict. Perhaps some of the herbs as mentioned above could be tried or your doctor could prescribe finasteride for hair regrowth, at least for a few weeks or months.

Q.  Is there a way to test if you are an equol producer? ie.. I'm an average joe taking red clover twice a day (for hair loss) but also for prostate health. I would like to know if it's beneficial to me to keep taking this. Also, after reading a couple of the daizden articles, I believe I have experienced my first "hot flash" the other night. It felt as though I was going to be sick, I got real hot then sweat on my forehead. I just thought I had caught a touch of the flu. Anyhow, I'm now thinking that I had a hot flash, becasue I'm taking too much daizden? hard to say, there aren't any guidelines for how much to take. Are the "herbal" drug companies any closer to creating an over the counter equol supplement so us thinning hair people can combad male pattern baldness?
   A. You ask good questions and we just don't have enough knowledge at this time to make any firm recommendations.

Q. I receive your Supplement Research Update. Thank you for this free information. Another drug to add to the list of harmful pharmaceuticals is Propecia (Merck) for hair loss. More and more people, myself included, are suffering from the long-term, potentially permanent side-effects of this hair restoring drug. The finasteride side-effects include impotence, loss of libido, hormonal imbalance, and problems with mental clarity. In my opinion, this is the next drug that the public will "blow the lid off of." I hope that Dr. Sahelian would comment on this further in upcoming newsletters. Furthermore, I was wondering if Dr. Sahelian has any recommendations for people who've been affected by Propecia. Is there a way to correct the hormonal imbalance that this drug has caused? Has he helped others with this issue? Is there hope? I belong to a web forum called finasteride-side-effects.com. A brief look at the messages posted here show that hundreds of people (on this site alone) have been affected.
Thanks again for your resource. Any help that you can provide would be a great blessing to many who are dealing with this devastating problem.
   A. Even though long term ( 5 year ) studies thus far do not clearly indicate significant side effects from finasteride, I suspect that we will encounter some problems as you mention. A couple of options for improving libido include Passion Rx or Tongkat Ali. For mental clarity, Mind Power Rx is an option.

Q. I am 38 and searched the internet for info on herbal remedies to prevent hair loss. I found anecdotal references on benefits of saw palmetto, zinc, and vitamin B6 p-5-p (pyrodoxal, not pyrodoxine). All three were indicated to fight the effects of DHT's reaction with 5-alpha reductase which can have a harmful effect on hair follicles and cause hair loss. Have you heard anything more "official" on these three supplements for stopping hair loss?
   A. As far as I know, there are, as of now, no proven herbal or nutritional therapies for androgenetic hair loss. Some over the counter hormones, such as DHEA, androstenedione, and pregnenolone may cause hair loss or hair thinning in some individuals. I am hoping that future research will indicate that certain herbs or supplements are helpful. Saw palmetto apparently blocks DHT in prostate tissue, it is not clear whether it does so in hair tissue.
Fish oils can improve circulation, but I'm not sure if they would be helpful.

Q. What are your thoughts on finasteride for hair growth. Does it have any side effects?
   A.
Finasteride is a 5alpha-reductase inhibitor approved for the treatment of male pattern hair loss. It was originally approved in 1992 for the treatment of benign prostatic hypertrophy. Finasteride's approval was expanded in 1997 to include the treatment of androgenetic alopecia in men at a dose of 1 mg/day. Finasteride inhibits 5alpha-reductase, thereby prohibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that in high amounts accelerates hair loss in some men. Reduction in DHT results in a significant improvement in hair growth and density. Finasteride is usually well-tolerated. The most common side effects are reduced libido, decreased ejaculate volume and gynaecomastia (enlargement of breast tissue). For those who feel they need to rely on finasteride for hair regrowth or to prevent further hair loss, but wish to minimize the side effects, you could consider taking half a 1 mg pill daily as opposed to a full pill. To boost libido, try Passion Rx (see link at top for ray sahelian)

Q. I believe that hair loss can occur due to increased DHT when a male is using testosterone replacement cream. If a person is unable to tolerate finasteride due to the side effects, what would you suggest is the next best solution to this type of hair loss?
   A. We're not aware of any good natural options at this time for hair loss.

Q. I am a 56 year old woman. I have come through menopause but lately noticed that my hair is thinning in the front crown area of my head. Do you sell anything that might help it to thicken my hair again?
   A. I have  been looking into a good hair raising formula and thus far I have not yet found a product that I feel works effectively. But I actively looking, and if I do come across a hair raising formula, I will mention it in the newsletter.

Q. I read your newsletter with great interest. Something puzzles me: you do not mention the effect of biotin on hair growth. I am seventy, a woman, and afflicted with male pattern baldness. A dermatologist recommended 5mg (milligrams) of biotin three times a day. I confirmed this with my internist, was told it was all right, but am still a bit uncomfortable with such a high dose. I would appreciate your thought.
   A. We have not come across any reliable research regarding biotin supplementation leading to hair growth for those with age related hair loss. If your doctors have such information, we would be glad to review it.

Q. Hair experience - I have some personal experience with taking DHEA in 25 mg doses and also later taking finasteride (Propecia 1mg) for hair loss. There are pros and cons to each. I am a normal 44 year old Caucasian male Navy carrier pilot.
     DHEA: I took this at three different times over a few years as part of a workout supplementation program. I found that it increased my energy, libido, ability to lift heavy weight in the gym, and my overall feeling of strength and well being. It also significantly increased the volume and fluidity of my ejaculate and reduced sexual recovery time, letting me "stud out." It reduced joint pain due to lifting weights and trimmed me down somewhat by reducing belly fat. But it very definitely increased the rate of my male-pattern baldness and hair thinning, so I stopped taking it. It also made me irritable, impatient, intolerant, and aggressive as you would imagine with increased testosterone.
     Finasteride / Propecia: I just stopped taking this after only 13 days because it made me feel as though my prostate was drying up. It was already visibly changing my hair by increasing the area of growth, but this is not worth the negative side effects. I found it reduced my libido (which I thought would be good but felt unnatural, almost like being neutered), greatly reduced the volume of my ejaculate, induced low back pain and a sense of dryness/pain in my whole prostrate / genital region, increased my belly fat, and made me a bit lethargic.
     I never took these two hormones / drugs together. They have opposite effects in my body. DHEA was better except for the hair loss and increased aggression, as well as possible long-term contribution to prostate cancer. The only benefit to finasteride was hair improvement - everything else was very negative. I have normal to high levels of DHEA and testosterone naturally in my body.
     Do you plan to do further research on the link between these two drugs? It would be useful to know how one may counteract the effects of the other. I plan to take a little
DHEA to get back to neutral after quitting finasteride, then not take either one and letting my body do its own natural thing.
   A. We're impressed on how observant you are about the effects of dhea and finasteride. Our own experiences confirm your findings. One option is to take a sexual enhancement product without dhea, and thus get the sexual benefits without the hair loss effects of dhea. We have found in many propecia users that
Passion-Rx reverses the sexual side effects.

Q. I have been suffering from extreme hair loss ever since puberty. I am 30 years old and I recently got a saliva test for my hormones. My progesterone was very low(46 pg/ml) during the luteal phase, and my DHEAS was very high (15.7 ng/ml). I have been also suffering from acne, itchy scalp, horizontal ridges on my nails. I hardly have any hair left on my scalp. My doctor told me to use natural progesterone cream because my body is unable to make progesterone. I have been using the cream for 12 days a month (30 mg/day) for 3 months now and still there is no improvement.
   A. We cannot make individual recommendations, but the information on this hair web page and the page on acne should be helpful to you. The prescription of hormones bases on saliva tests is no always reliable.

Q. Can a person take Passion Rx if they are taking finasteride Propecia or Avodart for hair loss? I find Propecia reduces sensation and makes me lose interest in sex.
   A. Yes, we have found that Passion Rx reverses the sexual side effects from Propecia and you may take Passion Rx if your doctor approves. Avodart is also known to reduce libido and sexual drive.

Q. I saw an advertisement on the internet for a product called Advecia which is supposed to help with hair loss. Do you have an Advecia review? Does Advecia really work for hair loss?
   A. We don't have an Advecia review but can comment on the ingredients in Advecia as mentioned on their website. The Advecia website claims this product is a restorative formula for bald or thinning hair. There is a question on the website that asks, "Can Advecia assist in your individual pursuit for slowing hair loss? And they answer, "Yes." I cannot find any clinical trials with Advecia mentioned on their website. The ingredients in Advecia are saw palmetto, beta sitosterol, green tea extract, lysine, arginine, and grape seed extract. These are good nutrients and herbs, but I seriously doubt whether Advecia has a significant impact on hair loss or hair growth. The burden of proof lies with the advecia sellers and they have not provided this proof before making these claims. There is not good evdience that saw palmetto can block 5 alpha reductase is a sufficient manner in hair follicles to prevent hair loss or restore hair loss. Therefore, at this time, Advecia appears like another one of those "me too" natural hair loss product heavily advertised with no proof of effectiveness. You can find the invidivual herbs sold separately for much cheaper. There seems to be a negligible amount of saw palmetto in Advecia and a high amount of green tea extract. Until Advecia sellers present a couple of human studies proving that Advecia administration reversed hair loss, your money is better spent somewhere else. There is also a possibility of Advecia side effects with too much green tea, especially when the Advecia web site recommends taking two Advecia capsules in the evening. This could cause an Advecia side effect of insomnia.

Q. I read recently that too much of a particular supplement could cause hair loss. I have noticed lately that more hair than usual is falling out. I basically take Juice Plus as my daily supplement but also take Alpha Lipoic Acid and Wild Salmon (Omega 6) oil supplement. I read that I should not take ALA and Omega 6 together and have stopped. I also read in your newsletter that I should only take 30 to 50 mg a day of ALA, I was taking 300 for several years, but recently stopped and now only take 50 mg every other day or so. I also stopped taking my calcium supplement with enzymes because I thought they were making me constipated. I read that lack of calcium could cause hair loss. I just want to nip this in the bud before too much hair falls out. I also started using nioxin hoping that would help. So please tell me if too much of what I take could cause hair loss. PS. Your newsletters are a life saver. I have gained so much more knowledge by reading them and thank you for your wisdom. I started taking ALA because Dr. Nicholas Perricone said it was great for the skin and helped aging of the skin but appreciated reading in your newsletter that less is more.
   A. I hope this web page can help you with some suggestions. High doses of vitamin A can cause hair thinning. DHEA, pregnenolone, and androstenedione can cause hair loss.

Q. In the research you mentioned about use of melatonin for hair loss in women, a "melatonin solution" was applied to the scalp once daily for 6 months. How would one go about making a melatonin solution for hair loss?
   A. We have not looked into this matter in any detail at this time.

Q. I am writing an article for a health magazine on a natural approach to prevent hair loss. Are there any natural supplements you recommend to stop hair loss?
   A.
Hair loss in men is mostly due to genetics. We all know people who eat a terrible diet with tons of fast foods and soft drinks, yet they have a full head of hair while others watch their meal selection carefully and choose healthy foods on a regular basis but still can's stop their hair loss. Although genetics has most of the influence, it is possible that a low inflammatory diet over the long run could be of benefit. This low inflammatory diet would have a high intake of fish and fish oils, a high intake of all sorts of vegetables and whole grains, and a low intake of sugar and simple carbohydrates. By reducing inflammation, there would be less damage to the microcirculation that supplies nutrients to hair follicles. Furthermore, flavonoids in vegetables dilate blood vessels, and the fish oil thin the blood. As to herbs or nutrients that may help hair growth, there has been very little study in this area. I have seen one study where the combination of saw palmetto and beta-sitosterol was helpful, but many more are needed before we determine the appropriate dosage and long term benefits and risks.

Q.  I took Pregnenolone hormone for several years, one 50 mg capsule each day. For the last couple of years, I have noticed that my hair is much thinner than it used to be and I was puzzled until I read that pregnenolone could have that effect on hair. Immediately I discontinued taking pregnenolone. That was about six months ago but I have not seen any difference in my hair. If this hormone is responsible for my hair thinning, can its effect be reversed by discontinuing the use of this hormone? While, I am female, have always had thick hair, and am now 70 years old ... my family history shows no sign of hair thinning or balding in either sex ... quite the reverse ... a good head of hair into old age.
   A. The use of pregnenolone hormone or DHEA is associated with hair thinning or hair loss. In some cases the hair regrowth occurs after discontinuation of the hormones, and in other cases it may not. We are not sure if finasteride use for a few weeks would be helpful or not but that is something you could discuss with your doctor.

Q. I have been reading your information and wasn’t quite clear about what supplements to take for a female for hair loss. My hair has been thinning for a couple of years but here lately (6-8 months) I have been going through a lot of stress but also some alternative health choices. One of the choices was taking DHEA and some other supplement and my hair has really thinned.
   A. DHEA is a hormone that can contribute to hair loss. I am not aware of any good research that has shown natural supplements to reverse hair loss but I continue to seek such studies.

Q. I am a man, I have thinning hair and would like to do something to prevent it. I don't really want to use something like minoxidil because of the side effects. In the searching I have done on the internet I was thinking about trying saw palmetto but then I came across something called beta sitosterol. I was wondering if Dr. Sahelian had a preference between the two and why. I was also going to try saw palmetto shampoo as I've heard the shampoo can remove DHT from the scalp. Is this true and is there a particular brand of shampoo that he recommends?
   A. I have not seen any research that saw palmetto shampoo can remove DHT from scalp hair follicles or reverse hair loss. Research with beta sitosterol and saw palmetto regarding hair growth is quite limited and at this time, November 2008, I have only come across one small study that showed a potential benefit with the combination of saw palmetto and beta sitosterol.

 

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