A more realistic option for men experiencing hair loss is to take a prescription drug or supplement, which works primarily by reducing DHT to almost zero or altering testosterone metabolism (drugs can do this, but supplements haven’t been as successful with this strategy).
However, side effects include reduced sex drive and fertility and an increased risk of erectile dysfunction and possibly even depression. So, the pros need to be weighed against the substantial cons here. It’s incredibly ironic that the supplements and prescriptions used by men to keep their hair, which is a cosmetic or superficial feature of manhood, can do so much potential damage (in the short and long term) to real, or physiologic, manhood!
1. Saw palmetto 320 to 960 milligrams a day for treatment of minimal hair loss as soon as it begins to happen
This is only number one because something has to come first, but it does not mean that this is the best supplement for hair loss. Almost all (99.9 percent) of the supplements that have ever been promoted for hair loss do not work; the ones that might have an effect would essentially have to work in the same way finasteride does—by altering hormones. If they did that, the unavoidable side effects that I mentioned earlier would grab the attention of attorneys and the FDA, and these products would be gone in less than a year.
There are some small studies of saw palmetto or multiple fatty acid components of saw palmetto showing it may minimally help hair growth in the same way finasteride does, but it’s far less potent. In other words, instead of reducing DHT by 80 to 90 percent or more, like conventional drugs do, saw palmetto might reduce it by 25 percent, if that. And remember, these were just small studies.
Many saw palmetto supplements contain the following fatty acids (in approximation).
• 30 percent lauric acid
• 28 percent oleic acid (the same monounsaturated fat in olive oil)
• 12 percent myristic acid
• 10 percent palmitic acid
• 5 percent linoleic acid (an omega-6 fatty acid) and some stearic acid
Researchers have concluded that all of these fatty acids have the ability to partially block the enzyme 5-alpha-reductase that contributes to hair loss. Some research teams suggest it is the lauric acid and myristic acid (both commonly found in coconut oil) that mostly block this enzyme, as well as oleic acid in small amounts.
Several herbal supplements or ingredients for prostate enlargement—including pygeum, beta-sitosterol, and zinc (see the Benign Prostatic Hyperplasia section—have shown the potential to block 5-alpha-reductase, but not nearly as well as saw palmetto. One oft-cited but small clinical trial is a 5-month study of 26 men with androgenetic alopecia who took either a placebo or 200 milligrams of saw palmetto extract combined with 50 milligrams of beta-sitosterol daily. Sixty percent of the men taking the supplement saw improvements versus 11 percent with the placebo.
A recent small study of 100 men taking either 320 milligrams of saw palmetto or 1 milligram of finasteride daily for 2 years showed finasteride was more effective. More than half of the participants with severe hair loss reported improvements with finasteride, and it helped keep and grow hair (fine and thin) in the front and back of the scalp. Saw palmetto apparently benefited some men who had baldness in the back of the head only (there was no placebo). So, what can I say? Trying 320 milligrams of saw palmetto (up to 960 milligrams per day) is probably safer than taking finasteride, but whether it works much better than a placebo is unknown. (Look for saw palmetto with at least 85 percent total fatty acids and 0.3 percent sterols; it can be taken with or without other supplements for prostate enlargement, such as pygeum and beta-sitosterol.) I recommend trying it for 3 to 6 months to see if there’s a difference. Keep in mind that none of these male prostate supplements, such as saw palmetto or beta-sitosterol, have been tested in women. (Finasteride is only approved for men, but a lot of dermatologists use it for women and it clearly helps a minority of them, so it’s worth talking to your doctor about trying saw palmetto.)
2. FOR WOMEN ONLY: Iron dosage varies depending on blood test results
In some women (premenopausal), iron can help hair thinning and loss. Doctors often test for iron deficiency in women who complain of hair loss, especially if they are still menstruating, are vegetarian, or have a history of anemia. There’s no guarantee obviously, and iron supplements should never be taken unless a deficiency is diagnosed with a blood test. Some women report improvements in the quality or quantity of their hair with iron, but others don’t.
The doctor may also test thyroid function because abnormal thyroid levels can cause hair loss, and some will also check testosterone and other hormone levels (DHEA-S and prolactin) to see if there’s an excess of testosterone or another hormone issue that might explain the hair loss.
WHAT’S WORTHLESS
Selenium (megadoses). Recently in the United States, there was an incident where more than 200 people took a liquid selenium supplement that, unknown to them, contained 200 times the dose reported on the label. More than 70 percent of these people reported hair loss, and 18 percent reported complete loss of scalp hair.
B vitamins. Numerous companies promote a variety of B-complex supplements for “healthy hair.” However, I cannot emphasize enough that you should not use B vitamins in excess amounts (beyond what is found in a multivitamin) for genetic hair loss because they have no evidence. Biotin is another popular hair and nail supplement, but it will not grow hair or reduce the risk of hair loss from androgenetic alopecia (see the Brittle Nail Syndrome section). As I alluded to above, these vitamins are often tested with patients who have rare causes of hair loss, like alopecia areata or extreme Third World deficiencies, and you can’t apply those results to regular pattern hair loss.
Vitamin D. There is some minimal, weak research on vitamin D supplements to prevent hair loss (either by itself or with a prescription drug), but these studies mostly come from the laboratory and show that vitamin D is necessary to put hair follicles in the growth stage, to prevent hair from toxicity, or just for normal hair growth cycles. There is very little chance that vitamin D impacts hair growth though, except in rare cases of an extreme deficiency. Obese women, however, can have lower levels of vitamin D (the vitamin gets stored in fat cells instead of in the blood) and abnormal changes in hormone levels, including testosterone, which could be the real reason behind the hair loss.
Vitamins A, E, and C. There is no human research to suggest that these vitamins help with hair loss or making hair healthier, unless there is a rare deficiency.
Estrogen-boosting or testosteronesuppressive (finasteride-mimicking) compounds. Estrogen production may prevent testosterone from impacting receptors that could accelerate hair loss; it simply decreases testosterone use. For this reason, in rare cases some women are given antiandrogen drugs or contraceptive pills to increase estrogen levels. It’s a good rationale, but they just don’t work for most men and women for hair loss. Some herbs you might see promoted for this purpose are black cohosh, chasteberry, dong quai, false unicorn, flaxseed or soy extracts, and red clover.
Testosterone-enhancing supplements. There aren’t many of these that actually work, but dietary supplements that claim to increase testosterone can only make hair loss worse if you’re a man; the extra testosterone can get converted to DHT, which turns on the genetic hair-loss switch.
