At the moment, there are only two medicinal treatments that have been approved by the FDA (Food and Drug Administration) in the US for treating hair loss - topical minoxidil (trade name Rogaine) and oral finasteride (Propecia).
Topical minoxidil is suitable for both sexes, whereas finasteride can only be prescribed to male patients. Minoxidil is a vasodilator, originally used to treat high blood pressure, which was later found to stimulate hair growth when applied topically to the scalp.
Finasteride is an antiandrogen that was first used to treat benign prostatic hyperplasia (BPH), also known as prostate enlargement. It acts by inhibiting conversion of the male hormone testosterone to the follicle-harming dihydrotestosterone (DHT).
The discovery of finasteride's positive effects on hair growth led to finding the true cause of hereditary baldness, which is the harmful attacks of DHT on our hair follicles. Since making this discovery, a quest for other alternative DHT blockers has begun, especially amongst antiandrogen drugs and herbs that have, in the past, been used to treat urinary problems.
Dutasteride (trade name Avodart) is an antiandrogen drug similar to finasteride in its chemical structure and mode of action and has been studied extensively for treating hair loss.
It has recently completed phase III clinical testing for efficacy and safety in the treatment of male pattern baldness and the study results are pending. Like finasteride it is also used for treating BPH.
Dutasteride is believed by many to be a more powerful hair loss drug than finasteride but also with more severe side effects.
Flutamide (trade name Eulexin) is a very strong antiandrogen used to treat prostate cancer. It works by binding to the androgen receptors and thus competing with DHT. Oral use of flutamide can cause serious side effects but it is believed that topical applications might have less adverse side effects and could be, in the future, used to treat hereditary hair loss. More research is needed to verify such claims.
Spironolactone (trade name Aldactone) is another antiandrogen that works by binding to androgen receptors, competing with DHT.
It is used in women to treat acne, hair loss and excess body hair and although there are some generic topical applications for the treatment of male pattern baldness which contain spironolactone, it has never been approved to treat hair loss in men and should be avoided.
For women, spironolactone can be considered as a reasonable alternative to the men’s best hair-loss pill, finasteride, which cannot be used in women.
As has been mentioned earlier, following the discovery of DHT attacks on hair follicles being the true cause of hereditary baldness, herbalists started looking for possible natural alternatives to finasteride among plants that have been traditionally used to treat urinary problems and, more specifically, enlarged prostates.
Saw palmetto has been used for decades to treat prostate enlargement and it is one of the few plants used in natural remedies that have been subjected to some sort of scientific research in regards to their potential for treating BPH.
Its supporters assume that it works by inhibiting the conversion of testosterone into prostate and follicle-harming DHT but no study has yet confirmed this assumption.
No clinical research has ever been conducted on saw palmetto's effects on hair loss. Despite that, saw palmetto is widely used by thousands of hair loss sufferers around the world as a safe natural alternative to finasteride.
Extract from the bark of the evergreen tree pygeum africanum is another popular herbal ingredient found in natural hair-loss treatments and many herbalists believe it is more potent in treating hair loss than saw palmetto.
Its rise to fame also comes from the general assumption that this plant, thought to be beneficial for treating prostate enlargement, must be also effective in treating hair loss. Pygeum africanum has been less well studied than saw palmetto and it has never been used in any clinical hair-loss study.
The third most popular herbal ingredient used in natural hair-loss cures is nettle root extract. This herbal drug is derived from the root of the stinging nettle, a popular healing plant found in temperate and subtropical zones of the northern hemisphere.
Its use in natural hair-loss remedies also stems from the fact that it is supposed to help shrink enlarged prostates and is thus believed to inhibit the conversion of testosterone to DHT. Like the two aforementioned herbal extracts, nettle has never been used in any clinical hair-loss study.
This list of hair-loss drugs and herbal extracts that are believed to mimic the actions of finasteride, the only approved pill for hair loss, is not exhaustive. There are many other ingredients, mostly of natural origin, that claim the ability to block DHT and thus reverse hair loss.
However, no clinical proof exists that any herb contained in the natural remedies promotes new hair growth. Whether you decide to try a commercial herbal remedy or just one or two herbs on their own, keep in mind that, besides there being no guarantee of their effectiveness, no daily dosage has been established and side effects might occur, despite the general belief that herbal hair-loss remedies are safe and free of them.
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