DHT Blockers: What Actually Works?

Dr. Andrea Suarez explains the options, with their pros and cons:

Many ways to do it

First, what DHT is: dihydrotestosterone is a potent androgen made from testosterone by 5-alpha-reductase. It is normal and important in the body, but genetically susceptible hair follicles can be highly sensitive to it.

DHT progressively miniaturizes susceptible follicles, producing hairs that become thinner, finer, and shorter. This is the most common type of hair loss (androgenetic alopecia, or “pattern hair less”) and occurs in both men and women.

So, what to do about it? There are options, including:

• Finasteride: blocks type two 5-alpha-reductase, reducing conversion of testosterone to DHT. It has decades of evidence for male androgenetic alopecia and can slow hair loss and improve density, but it does not cure the underlying follicle sensitivity. Hair loss can resume after stopping treatment.
  • Studies in women are few and far between, because it comes with the warning that it must not be taken (or, depending on the pharmacy, even that it must not be touched) by women. However, that’s only because it may have an adverse affect on fetal development during pregnancy. So if you’re very sure that pregnancy is not a risk to you, then that is not a real issue and should not have been framed as applying to all women. Medical misogyny strikes again.
• Dutasteride: blocks both type one and type two 5-alpha-reductase, producing a greater reduction in DHT than finasteride. It can produce more substantial results, and is generally used off-label for androgenetic alopecia in the US.
• Spironolactone: this is a general testosterone-blocker rather than a DHT blocker specifically. It’s commonly used for androgenetic hair loss in women. Systemic use in men can cause unwanted effects such as breast development. It also messes with electrolyte balance (regardless of your sex hormones), so it might be better to avoid it if you have or are at risk of kidney disease.
• Topical anti-androgens: topical spironolactone is being investigated, while clascoterone, an androgen-receptor blocker currently used topically for acne, is being studied as a potential treatment for androgenetic alopecia in both men and women.
• Saw palmetto: a non-selective 5-alpha-reductase inhibitor. Studies suggest similar performance to finasteride, but its evidence is much less robust and predictable than established medications.
• Pumpkin seed oil: limited human evidence suggests it may improve hair growth, but the supporting randomized trial was small and has not been adequately reproduced. Evidence is considerably weaker than for finasteride.
• Alfatradiol: an 5-alpha-reductase inhibitor that may influence the hair-growth cycle, but clinical evidence is mixed and substantially less convincing than for finasteride.
• Green tea extract: EGCG may inhibit 5-alpha-reductase and protect follicle cells in laboratory studies, but convincing human evidence that drinking green tea or taking supplements improves hair growth is lacking. Green tea extract supplements have also been associated with liver injury.
• Horsetail: laboratory research suggests weak 5-alpha-reductase inhibition, but clinical evidence for treating hair loss is very limited.

For more on all of this, enjoy:

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Take care!