Natural DHT Reducers Vs. Propecia: They All Cause Sexual Side Effects

Propecia And The Fear Of Sexual Side Effects

When it comes to treating hair loss, many men feel trapped between two terrible choices:

Choice #1: Start taking a drug forever that will help fight hair loss – but at the risk of developing sexual side effects (that are sometimes reported as permanent).

Choice #2: Don’t take that drug… and instead, accept that you will continue to lose your hair.

This is exactly how I felt when, at 17-years old, my doctor diagnosed me with pattern hair loss and then prescribed to me Propecia.

Propecia – an FDA-approved drug – helps slow, stop, and even partially reverse hair loss by reducing the amount of DHT in our bodies (a hormone that may trigger pattern hair loss).

Unfortunately, the hormone DHT (dihydrotestosterone) isn’t just implicated in hair loss… It’s also critical for male sexual development. In fact, men who have never been able to produce normal amounts DHT tend to suffer from low libido and poor genital development. So it’s no surprise that the drug Propecia (Finasteride) – a DHT reducer – is often maligned online as causing similar side effects: lower sex drive, poorer quality erections, and in rare cases, impotence. For an unlucky few, these sexual side effects might persist even after they stop taking the drug (although the evidence here is still debated).

As a high schooler with thinning hair, I didn’t want to risk impotence – no matter how small the chance. So I decided against taking Propecia.

But here’s something I never understood…

Many People Are Afraid To Take Finasteride To Reduce DHT, So They Instead Take “Natural” Supplements To Reduce DHT. What Difference Does It Make?

Many hair loss sufferers who fear Propecia’s sexual side effects instead take what they call “natural” DHT reducers… supplements like saw palmetto or pumpkin seed oil.

Their rationale? They say that “natural” DHT blockers reduce DHT… but without the same sexual side effects as Propecia.

At first glance, that makes no sense. Propecia, saw palmetto, and pumpkin seed oil do the same thing: they decrease DHT. But DHT is required for proper sexual development. So how come Propecia has a history of sexual side effects… while, according to some supplement advocates, “natural” DHT blockers don’t?

Or maybe these supplement takers are wrong about their “natural” DHT reducers. Maybe these supplements do cause sexual side effects, but no one has ever looked deep enough in the literature.

This article uncovers the answers. By the end, you will learn:

  1. Why the word “natural” is subjective, confusing, and misleading
  2. Do natural DHT blockers cause sexual side effects? The answer may surprise you
  3. How natural DHT blockers may reduce DHT differently than Propecia – and how this relates to your sex drive
  4. If we stop taking DHT blockers – natural or synthetic – are we worse off than if we never started?
  5. Should we use natural DHT blockers to fight pattern hair loss? And if so, how?

Warning: this article gets technical. But if you’re considering taking any kind of natural DHT blocker – then you might want to read this content.

Let’s start by reviewing how DHT is connected to pattern hair loss, how reducing DHT might help fight thinning hair, and where Finasteride comes into play.

The DHT-Pattern Hair Loss Connection

When I was first diagnosed with pattern hair loss, I asked my doctor why my hair was falling out. His answer:

DHT (a hormone made from testosterone) is higher in the scalps of balding men. For reasons not entirely understood, our hair follicles start to become more sensitive to DHT, and then begin to shrink over a series of hair cycles. The end result: pattern hair loss (and eventually baldness).

DHT shrinks hair

Beyond this relationship, the DHT-hair loss connection is cemented by two major findings:

  1. Boys who are castrated before puberty produce 95% less DHT for the rest of their lives. Interestingly, castrated prepubertal boys never go bald later in life.
  2. Some men have a rare genetic mutation that prevents DHT from binding to their scalp tissues. These men also never lose their hair to pattern baldness later in life.

While researchers still can’t explain why DHT causes hair loss, the evidence is clear: (1) men who can’t produce DHT don’t go bald; and (2) balding men have elevated DHT levels in their balding regions. So goes the DHT-hair loss connection…

These findings were the basis for pharmaceutical companies to develop drugs that could reduce DHT, and hopefully reverse pattern hair loss.

Enter Propecia… A Drug That Reduces DHT

Finasteride (branded as Propecia) reduces DHT. How? By inhibiting an enzyme known as type II 5-alpha reductase.

5-Alpha Reductase, DHT & Pattern Hair Loss: What You Need To Know

Remember how DHT is made from testosterone? Well, this conversion doesn’t just happen on its own. In order for testosterone to convert into DHT, it needs the help of an enzyme called 5-alpha reductase.

5-alpha reductase is an enzyme required for our bodies to convert free (unbound) testosterone into DHT. Without 5-alpha reductase, this conversion doesn’t happen.

The 5-alpha reductase enzyme comes in a few types, but the one that is of highest interest to hair loss researchers is type II 5-alpha reductase. Why? Because type II 5-alpha reductase is the exact enzyme needed to convert testosterone into DHT in our prostate tissues and scalp skin.

5-alpha reductase converts testosterone into DHT

Do you recall that rare genetic mutation which prevents some men from going bald? That mutation is actually a type II 5-alpha reductase deficiency. The reason why men with that mutation don’t go bald is because they don’t have any scalp DHT, and the reason why they don’t have any scalp DHT is because their bodies can’t produce the type II 5 alpha reductase enzyme.

Finasteride’s goal: to do the same thing.

Finasteride Reduces DHT By Inhibiting Type II 5-Alpha Reductase

The logic behind Finasteride is as follows: if we can stop type II 5-alpha reductase from forming, then we can stop DHT from binding to our scalps.

Finasteride (Propecia) does exactly this. It inhibits type II 5-alpha reductase, and in doing so, reduces DHT levels in our prostates, scalps, and other tissues.

Is Finasteride Effective?

Yes. While studies show that Finasteride (Propecia) isn’t great at regrowing all lost hair, the drug can significantly slow, stop, or even partially reverse the progression of pattern hair loss.

But for a select few, this may come at the cost of sexual side effects.

The Evidence: Sexual Side Effects of Finasteride

Depending on the dose, Finasteride can reduce serum levels of DHT by ~70%.

While this may help regrow hair, a DHT reduction this severe sometimes coincides with the following side effects:

  • Impotence
  • Depression
  • Lacking sexual appetite
  • Difficulty orgasming
  • Low volumes of ejaculation
  • Gynecomastia (or the more familiar term: man boobs)

Propecia’s manufacturers say these effects are rare and only impact up to 2% of drug users. But some studies suggests that incidence is much higher.

In one study, men taking 5mg daily of Finasteride saw a 15% incidence in sexual side effects within one year. And while this isn’t a perfect apples-to-oranges comparison (when it comes to hair loss, most Finasteride users take up to 1mg daily instead of 5mg), it’s an indicting example of how 5-alpha reductase inhibiting drugs may curb our sexual performance.

The Good News: Finasteride (Propecia) And Dutasteride Aren’t The Only Things That Can Reduce DHT

There are many foods (and food derivatives) that also reduce 5-alpha reductase activity, and thereby DHT levels.

For example, studies show that the extract from saw palmetto fruit is a 5-alpha reductase inhibitor. And some studies suggest the fatty acids in pumpkin seed oil also reduce DHT levels.

There’s also evidence that a seaweed extract called ecklonia cava may have DHT-reducing capabilities. And even the volatile oils inside rosemary and peppermint extracts show some ability to reduce 5-alpha reductase activity.

Many hair loss sufferers refer to these extracts and concentrations as “natural” DHT reducers. And as a result, most people also consider these safer.

But are these food derivatives actually safer than Finasteride? The research is more complicated than you’d expect…

And even more complicated? People’s definitions of the term, “natural”… And why, for some reason, these DHT blockers are considered “natural” while Finasteride isn’t.

DHT Reducers: Why “Natural” Is A Ridiculous Term

When we define things as natural or unnatural, what do we mean?

Some people say that “natural” is anything that can’t kill you. According to these people, substances like cyanide or arsenic are unnatural.

Unfortunately, both cyanide and arsenic are naturally-occurring substances found all over the world. And they can kill us fairly easily.

Other people loosen their definition of “natural” to anything that isn’t harmful to our health – like water. But if we think about this critically, too much of anything can harm us. In fact, too much water can kill us.

Then we’ve got a group of “natural” thinkers who are sort of scientifically literate. They say that anything made in nature = natural. Anything made in a lab = unnatural.

I decided to poll ten people who agreed with this definition. When I asked if they considered steroids unnatural, 100% said yes.

Then I explained that synthetic estrogens (a lab-made steroid) are made from concentrations of the “natural” food source wild yams. And so came another tightening of their natural definition…

My point is this: people have wildly different takes on what is natural, and what isn’t. So before you go throwing out the term, make sure you know where your definition of “natural” starts and stops.

For purposes of this article, we’re going to draw a hard line too.

“Natural” DHT Reducers: Our Definition

I think a fair definition of a “natural DHT inhibitor” is one that is…

  1. Food-based
  2. Chemically unaltered

For example: pumpkin seed oil and saw palmetto extract fit my definition of natural DHT inhibitors. Why?

For one, both are derived from foods. Pumpkin seed oil is made by cold pressing the seeds of pumpkins. Saw palmetto extract is made by extracting the polyphenols, phytosterols, and fatty acids from the saw palmetto fruit.

And aside from being highly concentrated, these extracts aren’t chemically altered. In other words, they’re not molecularly modified to look and act like a hormone in our bodies.

Now contrast this with Finasteride (Propecia).

Finasteride is synthetic. It’s made in a laboratory by modifying the chemical bonds of progesterone – an endogenous sex steroid released by the ovaries and the placenta during pregnancy.

And based on our research, Finasteride is not made from food. It’s a chemically altered derivative of progesterone that binds to a cofactor required for type II 5-alpha reductase expression, and as a result, stops that expression from happening.

As a result, I consider saw palmetto and pumpkin seed oil natural, and Finasteride as unnatural (at least if I had to put definitions on them).

  • Natural = food-derived, chemically unaltered.
  • Unnatural = not from food, chemically synthesized.

Now that we know just how pure and “natural” saw palmetto and pumpkin seed oil are, surely they must be devoid of sexual side effects… I mean, they shouldn’t boast any sexual problems like the “unnatural” drug Finasteride… Right?

Wrong. (Sort of).

The Evidence: Sexual Side Effects of “Natural” DHT Inhibitors For Hair Loss

Saw Palmetto

While the evidence is mixed, there are some reports that saw palmetto is sometimes associated with sexual dysfunction such as decreased libido.

The good news? These side effects seem less common with saw palmetto versus Finasteride. Moreover, the adverse effects of saw palmetto (if any) appear to be mild and infrequent. Lastly, a recent large multi-center study found no evidence of significant adverse effects (including sexual dysfunction) after 18 months of treatment with saw palmetto… at three times the typical dose.

We can’t say the same about mega-dosing with Finasteride, as that earlier study showed that 5mg daily dose resulted in a 15% incidence of male sexual side effects in just one year. At the same time, I’m making a crude apples-to-oranges comparison. If we really wanted to answer this question, we’d need to compare Finasteride against saw palmetto within the same clinical trial… and ask the participants detailed questions about rates of sexual side effects.

That research currently doesn’t exist. So we’re left drawing crude comparisons and taking our best guesses.

The bottom line: there’s some evidence that saw palmetto may cause some sexual side effects. But these effects are probably much milder versus Finasteride.

So, what about other “natural” DHT reducers – like pumpkin seed oil?

Pumpkin Seed Oil And Other “Natural” DHT Reducers: Any Sexual Side Effects?

There are reports that pumpkin seed oil may cause ejaculation problems. However, several recent studies on patients receiving pumpkin seed oil over 6-12 months have shown no significant sexual side effects.

We also haven’t observed any sexual side effects with topical rosemary oil use – another anti-androgenic extract. And ironically, the seaweed extract ecklonia cava may reduce DHT levels in men while simultaneously improving their sexual function.

The Takeaway: Natural 5-Alpha Reductase Inhibitors Reduce DHT, And Probably With Fewer Sexual Side Effects Than Propecia

And this brings us back to our main question…

How can both natural 5-alpha reductase inhibitors and Finasteride reduce DHT… but only Finasteride is associated with higher rates of sexual dysfunction?

There are at least four possibilities.

Hypothesis #1: Natural DHT Blockers Don’t Cause Side Effects, Because People Don’t Perceive They Should Cause Side Effects

This is called the nocebo effect, and it happens all the time in research.

For example, one study on Finasteride showed that simply by warning patients of the potential for side effects, reports of side effects rose by over 500%. The implication? Maybe many of the side effects reported by Finasteride users are psychosomatic.

When we follow this logic further, things get even more interesting. For instance, the effects of certain drugs – both positive and negative – seems to vary by cultural group. For instance, while saw palmetto is sometimes associated with sexual side effects in the U.S., it was also celebrated as an aphrodisiac for some indigenous groups.

Same plant, same ingredients, but two opposing effects.

Moreover, some studies on minoxidil have shown that men have regrown significant amounts of hair… in the placebo group! Similarly, studies on finasteride have shown men have lowered their DHT levels… by taking sugar pills!

The mind is a powerful thing.

So, maybe these “natural” DHT reducers don’t cause nearly as many side effects… simply because we don’t think they should.

Hypothesis #2: Natural DHT Blockers May Cause Sexual Side Effects, But We Don’t Yet Have The Studies To Prove It

There are an overwhelming number of studies on Finasteride and its sexual side effects. On the contrary, there are fewer studies on saw palmetto, pumpkin seed oil, and other natural DHT reducers. By volume alone, the literature skews heavily against Finasteride. As a result, we might be making misleading conclusions about these “natural” DHT reducers.

But for a moment, let’s assume this isn’t true.

Instead, let’s take the current body of evidence at face value: despite the fact that Propecia and food-based extracts reduce DHT, Propecia causes significantly more sexual side effects than saw palmetto or pumpkin seed oil.

The question is… why?

Well, there are two remaining possibilities.

First, that natural DHT reducers aren’t as effective at reducing DHT as a drug like Propecia, and as a result, produce fewer sexual problems.

And secondly, that natural DHT blockers reduce DHT through a completely different set of mechanisms, and that only certain DHT-reducing mechanisms are to blame for Finasteride’s negative side effects

Let’s take these one-by-one.

Hypothesis #3: Natural DHT Blockers are Worse at Reducing DHT than Finasteride, And Thus Cause Fewer Sexual Side Effects

This is an uncomfortable truth for most “natural” DHT reducer advocates: these natural compounds are probably less effective at reducing DHT versus Finasteride.

Finasteride And Dutasteride Drastically Reduce Serum, Prostate, And Scalp DHT

Studies have shown that Finasteride decreases serum DHT levels by 71% after 24 weeks of use. Similarly, Dutasteride has been shown to lower serum DHT by 95 % after 24 weeks.

Finasteride and Dutasteride also reduce scalp DHT by 64% and 51%, respectively. Finasteride reduces prostatic DHT levels by 85%, and Dutasteride reduces prostatic DHT levels by 97% over 6-10 weeks.

Those are some serious reductions. So how do food-based 5-alpha reductase inhibitors compare?

Sadly, we don’t really know. But based on the evidence so far, these food-based DHT reducers are much less effective.

Natural DHT Reducers Only Reduce DHT By A Fraction Of Finasteride

In a randomized trial, saw palmetto reduced prostate tissue DHT levels by 32%.

Another study showed that saw palmetto inhibits the activity of type II 5-alpha reductase by 76%, and Finasteride by 82%. Unfortunately, there was no evaluation in actual DHT levels. And to make matters worse, when we compare half-lives and metabolism rates of saw palmetto versus Finasteride, the 5-alpha reductase reduction from saw palmetto appears much shorter-lived.

Even worse news: there are no studies evaluating “natural” DHT blockers and their reduction in DHT levels in the prostate or scalp. And when it comes to pattern hair loss, the scalp is where DHT reduction really counts.

Based on the limited evidence – if we control for dosage sizes, half-lives, and the studies above – our best guess is that natural DHT blockers reduce DHT levels by just 1/3rd of what a synthetic DHT blocker can achieve.

This would also explain why saw palmetto isn’t as effective as finasteride: it’s just not as powerful.

The take home note? With less of a reduction in DHT, fewer sexual side effects will arise. So it’s no wonder that food-based DHT reducers are associated with fewer sexual problems.

But this might not be the “big” reason why natural DHT reducers boast fewer sexual side effects. In fact, it might be due to the actual structure of these synthetically-made drugs.

Hypothesis #4: Natural DHT Blockers Indirectly Reduce 5-Alpha Reductase, Whereas Finasteride Directly Reduces 5-Alpha Reductase… Which May Explain Why Finasteride Has More Sexual Side Effects

5-Alpha Reductase Inhibitors: Steroidal Versus Non-Steroidal

Remember how we defined “natural” versus “unnatural”? Natural is food-based and chemically unaltered; unnatural is not from food and chemically synthesized.

Well, chemists also divide 5-alpha reductase inhibitors into two categories:

  1. Steroidal 5-AR Inhibitors: 5-alpha reductase inhibitors made from steroids
  2. Non-steroidal 5-AR Inhibitors: 5-alpha reductase inhibitors not made from steroids

Examples of steroidal 5-AR inhibitors: Finasteride and Dutasteride. Why? Because these drugs are chemically synthesized from the sex steroid progesterone.

Examples of non-steroidal 5-AR inhibitors: saw palmetto extract and pumpkin seed oil. Why? Because these compounds are simply food concentrations.

Why The Difference Between Steroidal And Non-Steroidal 5-AR Inhibitors Matters

Interestingly, steroidal 5-alpha reductase inhibitors may reduce DHT differently than non-steroidal 5-alpha reductase inhibitors.

Steroidal 5-AR Inhibitors Directly Reduce 5-Alpha Reductase

Remember our chart from earlier? Free testosterone is converted into DHT by the enzyme 5-alpha reductase…

But in reality, this process isn’t that straightforward.

Why? Because 5-alpha reductase doesn’t just pop up out of nowhere. It actually needs the help of a cofactor to form and mediate the DHT conversion process. And what is that cofactor? A coenzyme known as nicotinamide adenine dinucleotide phosphate… or to put it simply, NADPH.

Finasteride works on a molecular level by binding to and altering the structure of NADPH. It changes NADPH it into a different cofactor – one that doesn’t allow 5-alpha reductase to form.

The end-result: a direct decrease in 5-alpha reductase expression.

This is an example of direct 5-alpha reductase inhibition. And based on the evidence, this is exclusively how steroidal 5-AR inhibitors reduce DHT.

But non-steroidal 5-AR inhibitors behave differently in the body. And these differences might explain the lacking sexual side effects.

Non-Steroidal 5-Alpha Reductase Inhibitors – How Are They Different?

Before we go any further – let’s be clear: non-steroidal 5-AR inhibitors like saw palmetto, pumpkin seed oil, rosemary extract, and ecklonia cava still directly reduce 5-alpha reductase.

For example…

Non-Steroidal 5-AR Inhibitors: Direct Mechanisms

Pumpkin seed oil is high in polyunsaturated fatty acids (linoleic acid) and zinc. And interestingly, linoleic acid and zinc are non-steroidal elements which directly inhibit 5-alpha reductase. Here’s how:

Linoleic acid reduces 5-alpha reductase by altering the lipid bilayer in cell membranes. Conversely, zinc inhibits 5-alpha reductase by decreasing the expression of NADPH – the same cofactor needed for 5-alpha reductase to form.

These non-steroidal elements direct reduce 5-alpha reductase (5-AR). Why? Because they act on a molecular level to directly shut down 5-AR activity.

We see these same direct mechanisms are play with other natural DHT reducers – like saw palmetto and rosemary oil.

Saw palmetto extract inhibits 5-alpha reductase directly by competing with free testosterone to bind to androgen receptors. The more saw palmetto present, the less free testosterone can be converted to DHT. And just like saw palmetto, rosemary oil also appears inhibit 5-alpha reductase through direct actions on cell function.

But this isn’t the only way non-steroidal compounds reduce DHT levels. In fact, they also act on DHT indirectly… And evidence suggests that this type of DHT reduction – indirect – is probably much safer when it comes to sexual side effects.

Non-Steroidal 5-AR Inhibitors & Indirect DHT Reduction

Unlike Finasteride, non-steroidal 5-AR inhibitors like saw palmetto and pumpkin seed oil reduce DHT through both direct and indirect means.

As a refresher:

  1. Direct – inhibit 5-alpha reductase directly (suppress 5-AR expression at molecular level).
    1. Steroidal examples: Finasteride alters the chemical structure of NADPH so 5-alpha reductase cannot form
    2. Non-steroidal examples: linoleic acid alters lipid bilayers so 5-alpha reductase cannot form; zinc decreases NADPH so 5-AR cannot form
  2. Indirect – inhibit 5-alpha reductase indirectly (by reducing inflammation)
    1. Steroidal examples: none.
    2. Non-steroidal examples: compounds in saw palmetto, pumpkin seed oil, and rosemary oil help reduce chronic inflammation, and as a consequence, reduce the amount of DHT in inflamed tissues

The definition of Indirect DHT Reduction is important – so let’s reinforce it.

Indirect DHT Reduction = Reducing Inflammation

When it comes to the causes of pattern hair loss, one question worth asking is…

If DHT levels are higher in balding scalps, then what causes DHT to rise in the first place?

Doctors have a simple answer for this: genetics. But the full story is a lot more complicated. For example, DHT may not just increase out of genetic sensitivity; DHT may increase, in part, as a response to chronic inflammation.

It’s far more likely that elevated scalp DHT in isn’t just due to genetic sensitivity, but rather, that this DHT is a response to inflammation in men’s scalp skin.

The causes of scalp inflammation are still debated, as is inflammation’s role in pattern hair loss. But one thing is clear: where there’s chronic inflammation, there’s also often an increase to DHT levels.

The net: higher DHT levels are a response to chronic inflammation. And if we take away the inflammation, we may indirectly take away some DHT.

And that is how we might indirectly reduce DHT levels. We take away the sources of inflammation.

Interestingly, non-steroidal 5-alpha reductase inhibitors might partially do this…

Examples Of Indirect DHT Reduction: Non-Steroidal 5-Alpha Reductase Inhibitors

There are hundreds of studies showing how substances inside pumpkin seed oil, saw palmetto, rosemary, and ecklonia cava can reduce inflammation (and thereby DHT levels).

Covering all of them would turn this 5,000-word article in 100,000. So instead, we’ll just give a highlight reel.

Indirect DHT Reducing Mechanisms Of Non-Steroidal 5-AR Inhibitors

The following parts of pumpkin seed oil help reduce chronic inflammation:

  1. Pumpkin Seed Oil
    1. Antioxidants (tocopherols): decrease oxidation, decrease expression of transforming growth factor beta
    2. Linoleic acid: reduces COX-2 enzyme
  2. Rosemary Oil
    1. Polyphenols: reduce COX-2 enzyme
    2. Volatile oils: reduce COX-2 enzyme, pro-inflammatory interleukins, and tumor necrosis factor

This list could go on for pages. But you get the idea: natural DHT reducers don’t just reduce 5-alpha reductase… They also reduce the signaling proteins and enzymes that are linked to chronic inflammation in our scalp tissues. As a result, they directly reduce inflammation, and thereby indirectly reduce DHT levels.

And that might be the difference between Finasteride and natural DHT reducers: one does more to directly reduce DHT levels; the other does more to indirectly reduce them. This, maybe the natural DHT reducers cause fewer sexual side effects… simply because these compounds are indirectly reducing DHT by lowering inflammation.

Again, these are just hypotheses. Nobody really knows.

Are There Hidden Costs Of Finasteride? A Note On Dependency And Potentially Irreversible Remodeling Of Androgen Receptors

When it comes to Finasteride, there is one study that has (slightly) worried me, and that I can’t fully explain.

Finasteride, when combined with Letrozole (a drug that lowers estrogen levels), appears to increase androgen receptor activity in the prostate of gerbils. That’s not necessarily a big deal… but it’s also not the whole story. In that study, the change in androgen receptor activity didn’t go away… even after stopping Finasteride + Letrozole treatment.

Why is this a problem? Well, if this research translates to humans, that would imply that when you get off Finasteride (Propecia), your prostate may have remodeled to have an even higher amount of androgen receptors. DHT has a higher affinity for androgen receptors than many other testosterone derivatives. Because of this, there’s a chance that if you increase your androgen receptors, the more likely DHT will arrive to those sites.

In other words, if your prostate remodels and you get off Finasteride, your prostate is likely going to flood with more DHT than if you never took Finasteride to start. This may, in part, explain things like the development of androgen-independent prostate cancer.

Does Androgen Receptor Remodeling And DHT Flooding Carry Over Into Pattern Hair Loss?

We don’t know, but hypothetically it’s possible. Maybe it’s even plausible.

In fact, this would explain why men lose hair so rapidly after dropping Propecia. More DHT floods the scalp and the hair rapidly miniaturizes… potentially sending people lower than their baseline (i.e., had they never started treatment in the first place).

Again, we just don’t know if these findings in gerbil prostates apply to humans with pattern hair loss, or if androgen remodeling with Finasteride + Letrozole is similar to that which  might occur with Finasteride alone. Moreover, those gerbils were taking 10mg/kg of Finasteride – the equivalent of 720mg of Finasteride daily for humans. That feels like a supraphysiological amount for humans, and so it’s very possible that these study results do not apply to humans.

In any case, they do warrant more investigation, and maybe slightly more cause for concern among people considering the drug.

Do “Natural” DHT Blockers Like Saw Palmetto Or Pumpkin Seed Oil Remodel Androgen Receptors?

The answer to this question is that we don’t know.

While saw palmetto has been shown to not influence androgen receptor activity, there are no other studies (to my knowledge) that have evaluated this issue. But what’s assuring is that food-based DHT blockers…

  1. Are less potent than Finasteride, and…
  2. Seem to reduce DHT through direct and indirect means

Both of these likely lower the risk of irreversible tissue remodeling.

Moreover, natural DHT reducers have other health benefits besides promoting hair growth – like reducing oxidation and chronic inflammation – processes not only detrimental to our hair, but to our entire body. And if you’ve been keeping up with these articles, you’ll know how just how closely these processes are associated with nearly all disease development.

Should You Include “Natural” DHT Reducers In Your Hair Loss Regimen?

They’re not very effective. But if going all-natural is very important to you, than you can certainly try them.

Based on the evidence, “natural” DHT blockers – saw palmetto, pumpkin seed oil, rosemary oil, and ecklonia cava – seem to be somewhat effective at reducing DHT. They’re also derived from food substances as opposed to chemically altered steroids – which might make them safer (again, we just don’t know for sure).

For instance, drugs like Propecia appear to have no other benefits to cardiovascular health or longevity. Conversely, studies show that the substances inside “natural” DHT reducers may have anti-inflammatory properties that confer to longer-term health benefits: a reduction of reactive oxygen species, lower levels of inflammation, and more.

Final Thoughts

You have hundreds of “natural” DHT reducing supplements from which to choose. So, which are the best? We don’t yet know. What we do know is that these things aren’t as powerful as Finasteride… at least in their current formulations.

You could try saw palmetto, pumpkin seed oil, rosemary extract, peppermint oil, castor oil, olive oil, and just about every essential oil out there. All of these appear to have some anti-androgenic effects. At the same time, just because something is natural doesn’t make it safe.

If you do decide to try a “natural” DHT reducer – commit to it for at least six months before determining if it’s helping your hair loss. Better yet, do it in conjunction with mechanical stimulation exercises. Chances are the two will create a synergistic hair regrowth effect (read the case study in our saw palmetto article).

Questions? Comments? Please reach out in the discussion section.

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    108 thoughts on “Natural DHT Reducers Vs. Propecia: They All Cause Sexual Side Effects”

    1. Hi Rob,

      Great, thorough and scholarly article as usual! 2 comments:

      1) Many sources actually mention Saw palmetto and pumpkin seed oil as actually BETTER for sexual dysfunction. couple such links: https://draxe.com/saw-palmetto-benefits/ https://www.organicfacts.net/health-benefits/herbs-and-spices/saw-palmetto.html

      2) If you are taking the natural ones for BPH (to avoid BPH drugs for folks like me >50), then the hair benefit is just gravy.

      Untreated BPH itself causes sexual dysfunction if untreated.

      Was curious about your take on this.


      • Thanks Manish. To answer your questions — I checked out the links and the primary sources each link cites. The first link actually warned of the sexual side effects from saw palmetto. The second link referenced saw palmetto as an aphrodisiac, but upon further examination, the primary source that link cites doesn’t actually make that claim. Instead, the primary source is an overview of how people use saw palmetto in Florida – and that some Floridans consider the fruit arousing.

        Unfortunately, study findings often get misconstrued when certain articles summarize them. This appears to be the case with that article from Organic Facts.

        I agree with you about the untreated BPH claims! For me, I think that elevated DHT isn’t the cause, but rather a symptom. If we want to treat BPH successfully, we can’t just treat its symptoms (high DHT) – we have to figure out what’s increasing DHT in the first place. The good news is that these herbal / food-based DHT reducers tend to provide far more benefits than just direct DHT reduction – on top of resolving the symptoms of BPH. So if you aren’t experiencing any sexual dysfunction from taking them, then keep at it!

    2. As always, an exceptionally well-written and researched article. A few points:

      1) I’m highly skeptical that DHT causes (or even contributes to) hair loss.

      First, the DHT theory was not accepted by the mainstream medical community until Big Pharma had a synthetic drug to sell to hair loss suffererers. So the obvious profit motive behind the theory raises major concerns.

      Second, the study showing that castrated boys do not lose their hair in adulthood was conducted back in the 40’s or 50’s upon indigenous tribesman in some far away land. This study was not “clinical” but observational and, as far as I know, has not been repeated in modern times in American laboratories. It’s safe to assume that castration would cause a host of biological changes in a developing organism, including impact on skull expansion and galea muscle tension that are the more likely causes of male pattern baldness. Given these alternative explanations, we can never really know whether the attachment of DHT to androgen receptors in only certain parts of scalp is what causes hair follicles to cease production.

      Third, the idea that hormones affect certain parts of scalp, but not others, just doesn’t hold weight. If DHT was the cause of hair loss, then the entire scalp (including sides and back) would go bald. Also, if DHT / testosterone were the real culprit, then why does hair loss increase over age while testosterone levels decrease? The entire theory is counter-intuitive.

      Finally, the fact that more DHT is found in balding areas could simply be a symptom of hair loss rather than a cause. In other words, trapped DHT is just a by-product of fibrotic tissue – but it doesn’t cause the tissue to become fibrotic.

      2) With regards to synthetic (Propecia) v. natural (pumpkin seed / saw palmetto) substances, as a general rule I avoid taking any synthetic drugs (and yes, I have taken Propecia back in the 90’s without much success).

      I don’t know of any synthetic drug that lacks substantial side effects, likely because our bodies have difficulty metabolizing substances that are not themselves constructed as we are- from DNA. There’s an old axiom that whatever is natural cannot be wrong. Use of plant / herbal substances in the proper dosage to treat an ailment, in my view, are far preferable to a synthetic alternative, and do not carry any side effects (except for maybe digestive issues or allergic reactions).

      That being said, if you’re going to approach hair loss on the basis of the DHT theory, then use of saw palmetto or pumpkin seed in moderate dosage is probably not going to have detrimental impact on sexual health. I have experimented with these herbs myself and have not had any side effects; but I can’t say for sure that they have helped. But for those willing to try, I would avoid digesting these substances. Instead, I would apply the oil to the scalp and massage it in topically.

      • James – incredibly well-made points. Thanks for taking the time to comment.

        RE: The DHT-hair loss argument–

        I 100% agree with you. There’s plenty of evidence that DHT expression increases in chronically inflamed tissues – and that when we target DHT, we might just be targeting a symptom of inflammation, and not the cause of hair loss.

        I was worried that the DHT counterargument might derail readers from the main objective of the article: to highlight that steroidal 5-alpha reductase inhibitors work differently than non-steroidal 5-alpha reductase inhibitors – and that this may explain the discrepancy in side effects between herbal DHT reducers and Finasteride. Looking back, I should’ve included it. Your points are well-taken and deserve mentioning.

        I’m 99% sure you’ve read and commented on these other articles – but for anyone else reading this – here’s a more detailed breakdown of where the DHT-hair loss argument falls apart:


        Another reader (Dante) has asked me to look more into DHT metabolites and whether certain metabolites might be implicated more so than others in MPB. So that’s my next research project. And if you have anything you’d like me to research, by all means please ask away.

        RE: topical use of saw palmetto and pumpkin seed oil–

        I’m very interested to see how this works out for people. Topical vs. oral use of these supplements is still up for debate, with no clear consensus in the literature. I’ve heard success stories from both topical and oral use. I’ve also heard of lacking success from both. In any case, I think adding in a massage would absolutely help!


        • Some useful research projects:

          1) Whether foods that boost Nitric Oxide production, thereby increasing vasodilation of blood capillaries, could help combat hair loss. https://www.amrapnutrition.com/interesting_other/fuel-performance-18-foods-nitric-oxide-production/

          2) Angiogenesis vs. Neurogenesis: the idea behind detumescence therapy is to restore blood flow to galea, but it remains to be seen whether mechanic stimulation of scalp can actually create new micro-capillaries. I suspect that it can. But there’s a related issue: I’ve noticed over the course of time that as the scalp becomes more pliable, there’s definitely new feeling or sensation in the scalp and decidedly less pain in affected areas. I’m thinking that massage not only adds new blood capillaries, but also may stimulate new nerve endings in scalp. This got me thinking – maybe there’s a neurological explanation of some kind for MPB.

      • James, I don’t know if you are aware of eunuchs that serve in the Chinese Imperial Palace. In order to serve, castration is a prerequisite and they never go bald in later life.

    3. Hi Rob,
      Nice article. I didn’t know that fin alters the expression of 5-AR by messing with NADPH. I read somewhere that young people in general have high NAD+/NADPH ratio, the ratio decreases with age that is less NAD+ and more NADPH. Some people were hypothesizing that it might be low NAD+/NADPH ratio in the scalp environment that alters the “sensitivity to 5-AR”, hence the use of topical vitamin b3/niacinamide which is a great precursor to NAD+(but this is just a random hypothesis 🙂 )
      Some doubts –
      1. You wrote about zinc inhibiting 5-AR, i have read that it’s more of a biphasic response. At 5mg-15mg orally, it actually increases 5-AR but at very higher doses it inhibits it. The study you cited is this – https://www.ncbi.nlm.nih.gov/pubmed/?term=8279712
      The study used rats who were supplied 10-20 mg intraprostatic zinc ,the rats weight was around 325 g. Now would this translate to 10 mg zinc to a human weighing 70 kg ? I am not sure how the conversion factor takes place but would be pretty sure that the amount required for humans would be much more. So, in reality the amount of Zinc needed to inhibit zinc would be much more than the RDA set at 11 mg imo.

      2.”The more androgen receptors you have, the more likely free testosterone will bind to them and become DHT” – Are you sure that this is the case i.e the more likely androgen receptors one has, the more likely free testosterone will bind to them and become DHT ( i am doubtful of this) ? I am not sure if anyone really knows how the actual mechanism happens in a real living organism though i might be wrong here (not talking about isolated cultured cells). As far currently known steroid chart is considered, this is a good one http://www.regeneruslabs.com/website/image/ir.attachment/25906_232a29a/datas though in reality there are going to many more hormones and links between them

      • Hey Dante,

        Thanks for reading. And you’re totally right – I should’ve called out that the study cited in rats was at zinc quantities that are unrealistic for humans. As far as zinc being a biphasic 5-AR inhibitor, could you link me to your sources? I looked into it a bit more, and found this study…


        …which suggests that zinc sulphate at low thresholds inhibits 5-alpha reductase, with increasing inhibition at even higher thresholds.

        While that study is from 1988, the only one that I could find that suggested zinc increased 5-AR activity at low thresholds (and was biphasic) was this one…


        …which predates the above study by four years. So maybe the type of zinc matters, or that the studies done so far are more or less inconclusive.

        RE: androgen receptors–

        Thanks. I reworded this to be more specific, and added a study into the text. The idea is that DHT has a higher affinity for androgen receptors than many other testosterone derivatives / metabolites. So all else equal – the more androgen receptors present in a tissue, the higher the chances that DHT will arrive to those tissues. The way I originally worded that sentence was too liberal. So I’ve changed it to fit more of what we know.


    4. Wow another great informative and well researched article. Rob never fails to impress. Pumpkin seed oil supplementation seems very safe to me from a perspective of a trained herbalist. As a food, pumpkin seed is very important to the male sexual function including the prostate. It has levels of zinc and essential fatty acids that are great nutrition for the body, as Rob mentioned. Traditionally Saw Palmetto as well as Pygeum Africans are strong medicine for BPH but they do carry the stigma of having effects on the libido and erection quality of some patients. I prefer to steer clear of prescribing them except in cases of a bonafide prostate issue, like cancer or a high PSA. Consuming the oil of pumpkin seed has a culinary history too, in the middle east going far back. I tend to view this as empirical evidence of safety. Also by consuming seed oils, which is a traditional practice versus eating the nuts(such as macadamia nuts, aborigines used the seed oil but did not eat the nuts) we can bypass some of the problems of eating too many nuts, namely high levels of anti nutrients such as physic acid which blocks mineral absorption. So to sum up my rambling comment. Pumpkin seed oil seems like a good choice, for me at least, in that it has a good nutritional value, it has specific prostate protective function, and it just might help with hair loss as evidenced of that one study that you mentioned, it was in Korea I believe. Plus it is mighty tasty on a salad or drizzled on top of a bowl of pumpkin, or sweet potato, or squash soup.

    5. Rob , amazing article.

      James – some great points .

      There is something coming together here.

      Ive read that Finisterdie doesant have an effect on temples ?

      And the results in general are mixed for people who use FIN.
      This needs more investigation , but this could be a vital lead.
      How can DHT or alpha reductuse in the temples behave differently ?

      The same could be said for minoxidil( whenn comparing with temples)


      • Hey Kuba – I’ve read some of his articles but have never gotten his stuff – so I can’t say. There’s absolutely a relationship with IGF-1 and hair loss (as it seems so far, the less IGF-1, the more baldness). But increasing IGF-1 is tricky and people often confuse studies that test serum IGF-1 and not tissue IGF-1 – and then take those findings and apply the recommendations to the scalp which isn’t necessarily comparable.

        With that said, I’m sure some people find success with Chris’ methods. I can’t comment on his research or his methodologies since I haven’t bought his book.


        • Rob , one more thing yet. A few weeks ago I found on youtube a certain lecture with monk or guy similar to monk. I don’t know who was he. Doesn’t matter. He claims that when you are bald you should concentrate on sebum on your bald spot and using honey. He talked that when you want to release excess of sebum you need to take some honey on hand , stick to bald spot and then tear them. Do this move by ten minutes a day. This method should help to get rid of sebum and feed the scalp. I have to say that this is the most weird regimen I’ve ever heard but It seems to have sense. Have you maybe ever heard about this? Now I am trying to look some information about this but it’s hard to find something.

        • Completely can’ t find this video. I remember that he rather was not the monk , but homeopathist. I think russian homeopathist. I ve never seen this before but he was giving a lecture to people and I am thinking that he was respected by this people. He proposed two thing honey and onion. Of course everybody knows that these ingredients are popular in cure baldness but his regimen with honey was something completely new. I tried to do this and when you stick your palm on your bald spots ( palm covered appropriate amount of money) and then pull out , you have very mechanical feeling. As you see this is not only apply honey but rather a mechanical excercise. The worse thing is that you can pull out also your hairs so you need to be careful and use this technique just in bald spots.

          If I will find this video , I ll give you a link, but it can be hard I think… I am not sure that this video was talking in english. Probably there were englisch subtitles. I was found this video a few months ago and now I remembered this.

        • I finally found this guy but he is talking in Russian and subtitles are in Polish.

          His name is Trehlebov.

          https://www.youtube.com/watch?v=EmGTsE80t2E&t=103s, since 1:30 is showed how to do this.

          In short , he show how to do this and are giving a little bit information. What is very interesting, he recommend doing this for 20 min twice a day, like you and call this regimen massage, so this isn’t only rubbing but massage.
          He tell that we need to release fatty toxic substance from our follicles which kill them and honey have ability to heal them. When you heal your follicles, hairs will growing up , What else…When you have some hairs on your head he propose to cut off them all and starting doing this exercise because they can disturb.

          What do you think about it?

        • It’s an interesting idea. It almost seems like some form of hair tugging or even galea-loosening. There are some pro-hair benefits of bee byproducts. As far as the idea of releasing fatty toxic substances – this is where I get a little lost. For one, hair loss is associated with a decrease in subcutaneous fat. And while many toxins have a propensity to be stored in fatty tissues, I’d assume that with an erosion of subcutaneous fat in our scalps, we’d see fewer toxins. So the net: while the end-result might be hair growth from this guy’s techniques, it might be a different mechanism at play than what he’s saying.

    6. I actually doing regimen from your book but I am courius what he knows. If you something know, please tell me. Are they maybe also similar excercises like yours? or something else? Thx for response

      His site and name

      Chris Carter

    7. Kuba that’s interesting stuff. So DHT increase is linked with 1gf decrease.

      Rob ?

      So increasing 1gf in the scalp via ?
      Soy isoflavones? Capsaicin excerize ?

      • Hi

        The nicehair protocol is multi-faceted, much like Rob’s approach, however, there is more of a focus on topical agents to increase IGF-1 locally, specifically through deer antler extract, rather than through stimulating new growth through manual manipulation.

        • Thanks for the info Greg!

          Kuba – I don’t want Greg to have to rehash a researcher’s book here on another site – especially if some of the book’s contents are behind a paywall. So I’d like to refrain from getting too specific about the exact regimen, the exact exercises, etc. Those are great questions to ask Chris Carter, but not necessarily to ask on this site.


        • Could you tell us more about using deer antler extract? For example what doses? What form? Spraying on tounge or scalp? I hear about this the first time… but I am very interested.

    8. The regimen in it simplest form, addresses nutrition (to correct hormones, and support health)with a special green smoothie based around the TRX2 formula (though I believe this has been modified with user feedback), stress relief (positive affirmations, EFT), DHT (typical natural inhibitors), galea exercises (Tom Hagerty’s and general scalp laxity exercises) and a topical applied to the scalp daily concurrent with DR (not daily) to aid in delivery of topical rather than wounding itself. The deer antler extract is part of the topical purported to aid in increase in local IGF-1 levels (based around a Japanese groups research I believe). I’m afraid I can’t really comment as to its efficacy as I have not tried it in its entirety, but as has been discussed here before approaching hair loss from multiple angles is likely to yield more definitive results. I just happen to think that the manuals offer a more effective approach, than relying on topicals to do the job…….though i do cycle some topicals

    9. Some places are selling IGF-1 deer antler topicals​.
      But they seem to fight the same causes as something like emu or Rosemary, anti inflammatory ect

      • In answer Rob for my post about honey he attached study about honey. Honey also can increase IGF-1. See my previuos post and Rob’s study.

    10. Hello,

      sorry for being OT, but I’ve been experimenting with the massage thing for the past two weeks: in such a short time lapse, I’ve been able to turn my almost completely unpinchable scalp into a very soft skin layer.

      I was wondering if for you and your readers, the progression from hard to soft has been as quick as mine.

      Thank you, and keep up the good work!

      • Hey Alberto – what you describe isn’t abnormal. Some people experience dramatic shifts in the scalp environment, and in a very few short weeks. For others – this takes many months. I was of the latter – but I’ve spoken with several readers who experience the shift much sooner.

    11. I will include more Soy Isofalvanes in my diet, and may even supplement. There seems to be some hype around their ability to increase IGF-1

    12. Hi rob.. just read through your amazing content. It looks very promising and i want to be a part of it. I just had one query.. how to reach you if i get a doubt in between?? do you reply on your mail?? we get a seperate email id to contact you? how does it go?

      • Thanks for the kind words Jd. My email is inside the book, and I respond to everyone (though sometimes it takes me a few days).

    13. Hi Rob,

      Thanks for the great info. I was particularly interested about how you mention that finasteride remodels the androgen receptors..

      “And for those who’ve already committed to taking Propecia, if you stop taking it today, you’re probably at a higher risk for hair loss now than if you’d never started taking it at all.”

      I recently turned 40 and decided to stop finasteride after taking it for 8 years for several reasons including all the side effects mentioned above. If what you’re saying is true about increased levels of DHT due to the remodeling of androgen receptors, would taking the natural DHT inhibitors (even though they’re not as effective as finasteride) allow me to pick up where I left off (so to speak) or am I screwed because of the DHT flooding since I stopped finasteride?

      Appreciate your help..

      • Thanks Jules. Unfortunately I don’t have a great answer to your question (I’m also not a doctor, so I can’t legally advise you). But if I were in your position, I’d absolutely consider looking into non-steroidal 5-AR inhibitors – zinc, saw palmetto, or linoleic acid (pumpkin seed oil – topical or oral). This should help quell the potential DHT-flooding effects of androgen receptor remodeling, while at the same time, minimizing your risk for side effects. If there’s anything we’ve learned from 5-AR inhibitors or DHT-reducers in general, it’s that anything derived from steroids tends to reap far worse (and sometimes irreversible) side effects versus non-steroidal DHT reducers. See this four-part series for more information:


        Otherwise, please keep us posted with your transition. I know of two people who’ve transitioned off long-term Finasteride use and instead started using non-steroidal 5-AR inhibitors. Both reported that they 1) didn’t lose hair during the transition, and 2) feel much better and are no longer experiencing any side effects. I hope your experience is the same!

        • Hi, I know this was posted a while ago but wondering what happened Jules after you stopped? I am in an almost identical situation, and have read enough to know that my hair is likely to fall out quickly now I have stopped Fin – did the natural supplements help at all during the transition? Thanks

    14. I think herbs like Saw Palmetto and Beta Sitosterol can initially increase sexual function for men who are suffering from some degree of BPH (enlarged prostate). However, once the prostate size is reduced, continued use of these substances seems to have a libido-lowering effect. Therefore, I agree with the thesis of this article, that—natural or pharmaceutical—DHT/5AR inhibitors lower libido.

    15. Hey i am just started using your methods,i said i will gonna try this and e mailed you 2-3 months ago,need to ask a few questions.

      Do you wash your hair after massage session with just plain water? i usually take shower at mornings but i started to wash my head after night sessions cuz it feels discomfortable to sleep with that sebum.(on no-poo for 3 weeks)

      Secondly,when i eat chili food,i am sweating mildly from the balding spot(which is in crown,aprox a baseball size,no any loss in any other parts of scalp-very funny hair loss-)and my scalp is becoming itchy,is this can be related to calcification ?

      And by looking your older pictures,you had that kind of balding too, i want to learn that due to your experiences is it easier or harder to grow hair on crown with your methods?I have really thick hair at other parts and my hair grows very fast normally.

      I started to lose hair agressively 3-4 years ago,only at crown,i was finding 100s of hairs on my pillow everyday.I had succes with minox in 4-5 months,then got sloppy and missed some sessions,eventually hair worsened and i stopped it,then i started again and stopped 4 weeks ago again 🙂 And i believe i went through the shedding phase after minox earlier.(didnt have much gains in 2nd usage)

      I am moderate alcohol drinker(weekly) and daily smoker,doing exercises regularly.

      BTW i bought the book,just some questions in mind.

      • Hey Maaya,

        Thanks for your support! To answer your questions–

        I wash my hair with just water.

        As far as the chili sauce-induced sweating is concerned — it depends. We’d need to know if you sweat from your bald spot just as much in other scenarios – like with other foods, or when beginning to workout, etc. And even then, I’d categorize this more as a reaction to the food substance, and not necessarily a sign of calcification (sweat and calcification are two different things).

        People typically report that regrowth at the vertex happens more quickly than the temples, though if the case studies on the site have shown anything, it’s that both temple and vertex hair regrowth are possible.


    16. A few years back when my hair loss started in earnest and wanting to avoid pharmaceuticals, I tried saw palmetto. Sure enough my libido went almost completely and it took a while for it to return, even having stopped taking it.
      Personally, I think green smoothies or juicing do the best work for my hair in terms of nutrition (I have diffuse hair loss).


    17. What are your feeling about natto? Other than the special taste, would it be beneficial for us? Natto is fermented soy beans, containing lots of K2.

      • Hey Nick — I’m a fan of natto! I think the benefits of the K2 outweigh the concerns of natto’s goitrogen / lectin content. I eat natto weekly and stir it into a white rice dish.

        • Made 2 pounds of natto yesterday! Anyone looking for a great source of K2 natto is among the highest. You can even make it yourself cheap. Just get organic non GMO soybeans and some natto starter culture. It will take some trial before I get it top notch but it looks alright at first try. I will eat about 50g of this a few times every week.

    18. Rob,

      An excellent article as always. I distinctly remember the day I decided against Propecia; my anxiety had swelled as a result of taking it, and I learned that it can break the blood brain barrier. This article is further confirmation I made the right choice. The first thing suggested to me in my hair recovery journey- this is prior to discovering your work- was nettle root, a “natural” DHT inhibitor. I was recently muscle-tested on it, and my body can benefit from a small daily dosage (I would encourage anyone looking to supplement to first get muscle-tested by a Chirorpractor to determine the necessity of and dosage). I’m considering checking out ecklonia cava as my next step.


    19. Hey Rob,

      I know you’re not a fan of shampoo, but I found one that contains pumpkin seed oil, pumpkin seed extract, and saw palmetto. I was wondering if you think these are safe topicals for women? I’m not sure how much would get absorbed in the course of hair washing but I was concerned about any potential issues. I haven’t seen anything about it apart from the fact that women shouldn’t use any saw palmetto if pregnant or nursing. Thanks!

      • Hey Tara,

        As long as you’re not pregnant or nursing, I don’t see any issues in testing the shampoo! In general, shampoos rarely make the difference between regrowth and no regrowth — the exception being ketoconazole shampoos which help reduce certain fungi and bacteria that can contribute to the inflammation that precedes hair loss. I have my doubts that a shampoo containing pumpkin seed oil/extract and saw palmetto will significantly benefit the hair since the ingredients will be washed out so quickly. But in any case, I don’t think it’ll hurt much. Keep us posted with how your experiment goes!


        • Thanks for always responding to comments – and quickly! If I do this experiment I will definitely let you know how it goes. I’m just taking this stuff one day at a time!

    20. Hi Rob,
      I’ve been suffering from hair loss since i was in my 20s. I am 58 now and have lost almost all of my hair on the top, only some left in the sides and the back. You can tell that i have been around and when it comes to hair loss products. I started using a DHT Shampoo (Groganics), and a DHT Hair tonic (Elite Super H. Tonic 5000) for over a month. And I’ve already noticed some sexual side effects since (despite the fact that they are all Natural)!

      Do you happen to know anything about shampoos or tonics and their functionalities? If so, my question is: do DHT blockers (shampoos or tonics) in these products have long term effect my sexual functioning even if i stop using them now or not? Or these side effects are temporary? I had similar x-dysfunctions with oral Saw Palmito 500m. When i stopped using it, my sex-drive eventually came back.

      • Hey Mike,

        From all the research I’ve read, it appears that the sexual side effects from food-based concentrates of 5-AR inhibitors (like saw palmetto) are all temporary. I’ve yet to see a report of long-term sexual dysfunction after someone stops using what we consider “natural” 5-AR inhibitors. So my best bet is that within a few weeks of you stopping their use, your sexual function should absolutely return back to normal.

        Please keep us posted!


        • Actually Rob I am more curious about the DHT shampoo and tonic that I’ve been using for a while. It seems to me that they have the same effect on me as SP did in the past. And overall i am a healthy and sexually active individual.


        • Hey Mike — the best evidence we have of any topical 5-AR inhibitor getting systemically absorbed is with topical finasteride studies:


          In stronger formulations of a topical finasteride, even once-daily application resulted in a 70% decrease in scalp tissue DHT and a 60-70% decrease in serum DHT. That suggests significant systemic absorption, depending on the dose. And I’m sure there’s individual variance here too. While saw palmetto shampoos are much more mild DHT reducers, it’s possible there could be some systemic absorption, and if your body is very sensitive to DHT reduction, this might explain your experience.


    21. Hi rob i am 23 yr old i went to many endo nd derma doctor but it didn’t work, i am suffering in hair losing and acne what should i do could i use saw palmetto or finasteriod. ?

      • Hey Zaid,

        Treating hair loss depends on 1) whether you want to use prescription drugs, 2) how much money you’re willing to invest in treatment, and 3) how much time per day you’re willing to invest in treatment. It’s hard for me to answer these questions without knowing more about you. I’d suggest taking the free email course I offer, reading the articles on this site, and speaking with your doctor about your treatment options.


      • Hey S.E.,

        In general, topical 5-AR inhibitors like saw palmetto — and even finasteride — don’t have the same pro-hair effects as oral inhibitors in terms of hair regrowth. So it’s tough to say if this product will have any impact at all. With that said, there’s no harm in testing and experimenting so long as that’s financially feasible.

        Keep us posted!


    22. Hello, Rob- This is absolutely the best analysis I’ve encountered on the use of saw Palmetto. I’ve read it many times, mostly just to cheer me up because of what I’m currently going through…

      I took SP for years- no sexual sides ever- stopped last summer due to hair shed (was taking Curcumin, too, which I stopped), but started up again with SP this past September. Suddenly, after about 3 weeks of taking 1 pill daily- Nature’s Way Saw 585 mg SP berries in capsule- I developed ED and plummeting libido. I immediately stopped taking the SP (Oct 2nd) as I attributed it to that, since it was the only change I had made to my vitamin supplement regime.

      Went to an Endocrinologist, all blood work came out fine (Testost. at 639, did not test DHT tho), but here it is early November (1 month later) and still have ED and low libido. I started taking Creatine and Sorghum powder, as I read they can boost DHT levels, but doesn’t seem to be doing much.

      1) SP has beta-sitosterol as a component… I thought this was considered steroidal?
      2) I’ve read some online horror stories of people taking SP and years later suffering ED, no libido… I realize this is anecdotal evidence, and not controlled studies, but still… wondering if there is any validity to these stories or should i just ignore as fake?
      3) Any suggestions? I’ve read about a supplement called L-Arginine for ED, but haven’t researched it much yet. I’m pretty afraid to try anything at this point, since I don’t want to compound the damage I’ve already inflicted on myself.

      Your writing style is very refreshing, and easy to follow. It actually gives me some hope. Any feedback you can impart, I would appreciate that.

      Thank you very much. Paul

      • Hey Paul,

        Thanks a lot for the kind words, and for sharing your experience. To answer your questions–

        1) Beta-sitosterol is typically found in very low quantities in saw palmetto extracts. However, beta-sitosterol is similarly structured to cholesterol — and cholesterol is a building block for endogenous androgen production — so it’s possible that increasing beta-sitosterol might increase testosterone… but it’s likely not going to move the needle in huge ways. Saw palmetto’s testosterone-boosting effects are more likely due to its 5-alpha reductase inhibition, so more free testosterone ends up converting to testosterone instead of DHT (the same thing happens with finasteride — where we see a 10-20% increase in testosterone and estrogen in the men who take it).

        2) It all depends on each individual. However, I’d have to know more about each anecdotal case (the person’s age, what else they were taking, pre-existing conditions, etc.) before making a call. In general, I try to never ignore anecdotes (they’ve become incredibly valuable for me), but at the same time, evaluate them within the context of the overarching trends in the data. And what we know so far is that in all reported studies, we’ve yet to see permanent side effects from saw palmetto.

        3) Send me an email and let’s set up a consultation. I see no reason why we can’t get you back on track, but at the same time, I need to understand more about your case before recommending any supplements / regimens.


      • Could you tell me if your problems resolved from the saw palmetto and if so how long it took and what if any supplements, etc. you took? I am having a similar problem. Thanks, John.

    23. Hey, Rob

      I’m interested in purchasing one of the packages, I was just hoping to ask you a couple questions via email beforehand if possible.



    24. Hello,

      i also had ED problems from a previous finasteride intake and i just wanted to tell you that i had a drastic improvement after taking the supplement “nicotinamide riboside”, which supposedly increases NAD+-Levels. I am 39 years old.

      I am not a medial doctor and i cant really explain it, but maybe there is a connection which could help other people as well.

    25. My only concern left is how do these natural dht reducers work for female hair loss. Since most of these compounds are also out to estrogens. How strong is their estrogen blocking capability? Is it strong enough to masculinize a women? Is it strong enough to mimic menopause ?

      I’d like to help my hair but every thing that helps also blocks estrogen. So I’m afraid it stops female hair loss but masculinizes women making it clearly a very bad choice.

      But I also do not want to take unnatural dht blockers. Some things you might want to add to this article which are very I important! Is…

      Unnatural dht blockers permenatly mutate the 5a reductase enzyme! 5a reductase is also what the body uses in the liver to metabolize cortisol! Without out 5a reductase you can no longer metabolize cortisol so you can not get rid of excess so easily. Leading to raised cortisol. Of course it doesn’t fully block 5a reductase so you get some metabolized.

      However! Unnatural dht blockers after prolonged use leaves 5a reductase mutated permenatly! So what ever 5a reductase you have left in the liver no longer works to metabolize cortisol anyways.

      So it raises cortisol which increases sexual side effects. Not only that cortisol directly causes breast cancer, colon cancer, prostate cancer, endometriosis, and they are earning cortisol pretty much aids in causing all cancers period. Not only that it caused mental illness and is the root of a lot of mental illness. Also it is the root of a lot of obesity. Also it causes diabetis. Also it causes hypothyroidism.

      Also hypothyroidism, diabetis. Cause hair loss. Also weight gain increases toxins which increases inflammation which increases hair loss, also cortisol directly causes hair loss itself . Also cortisol causes a hormone imbalance which leads to hair loss.

      And yes it causes very severe sexual side effects.

      The worst part about this is this is permenant!

      I think maybe the only way around this would be to directly inject the liver with a very long needle with 5a reductase naturally created in a lab somehow maybe by livers grown and kept alive in tanks.

      Then inject this,daily in to your liver and take natural dht bkockers. Combined with hair transplants seeing how you now also have deformed androgen receptors.

      • Hey Adrianna,

        Have you looked into testing for any of the following:

        -Nutrient deficiencies (iron, zinc, vitamin D, vitamin B-12)

        Typically these conditions precede hair loss in women, and in many cases, compound the issue. Of the women with whom I’ve worked, I’ve found that resolving these conditions almost always improves their hair loss. So rather than target to reduce DHT through a 5-AR inhibitor or an androgen receptor antagonist like Spironolactone, I’d recommend starting with testing (and treating) those conditions — then retesting hormone levels and seeing where you net.


    26. I did not get sexual side effects but devastating physical sides of massive weight and body fat changes..Have gained 80lbs of strange watery like flab and was an avid runner for years keeping a food journal daily and weighing 165lbs..After stopping this med I cannot run 1 mile now with no energy and I gain so much water weight through the day its unreal..Much smaller in the mornings..Also severe drying scalp and facial hair..Almost like straw and dry skin also..Tried trt for a few months and also clomid helped some but this drug can alter your life…Don’t listen to those who down play this and the mental anguish that goes along with these physical changes is almost unbearable and the anxiety is huge..I got no sexual side effects but seems to depend on ar gene expression that is silenced through and unknown mechanisim after stopping and the flood of hormones comes back..Wether you get physical, sexual, nuerological side effects or a combination of all three..

    27. Hi Rob,

      Amazing article, thank you.

      I just wanted to share my story about using saw palmetto and pumpkin seed oil and ask you some questions. I was 19 when started taking low doses of these for about two years and stopped because of some insomnia and brain fug sides. These sides were not terrible but I am in school and cant really function with these problems. I had done a lot of research before taking these and knew the sides wouldn’t be as bad Propecia. But to my surprise I had a hormonal crash about a year after I stopped taking SP. While it was tough, it went away soon after. I was wondering what you tough about this crash , why it took some time for my body crash, and why it happens with natural inhibitors. I have read other stories of people crashing and having serious sides from SP but seems like they have taken high doses. What do you think about this?



      • Hey Juan! It’s tough to say, since everyone seems to react differently to 5-AR inhibitors. One potential mechanism is that DHT plays a role in neurological function and brain health — and reducing DHT levels via 5-AR inhibitors (even if they’re natural) could negatively affect a certain percent of the population. Some may have a higher sensitivity than others. That certainly seems to be the case for Propecia and sexual side effects.


        • Hey Rob,

          Makes sense. I feel so dumb for taking this as such a you age. I want to mention that the sides came back and some day I feel good some days I don’t. The sexual sides seem to be there and its been tough since the crash. Could you email me to talk about this further please. Could use the help.

          Thank you,


    28. Hi!

      I’ve recently found SAW PALMETTO extracts from a company called Nutrigen Laboratories.
      They offer doses of 320/1000/2500 mg per capsule. The amount I haven’t seen anywhere else.
      Do you think it is safe to go for 2500? Is it the more the better or could it cause side effects?
      What dosage would you recommend? And is it safe at all to take it alongside anti-depressants?


    29. You mention peppermint oil in this article — have you noticed that in the female African American community there are many who swear by the use of Vicks VapoRub on the scalp to induce hair growth.

      This mouse study compared peppermint oil against Minoxidil and Jojoba oil and the peppermint (menthol) group showed drastically more growth:

      A benefit — peppermint could have benefits for depression and memory.

      Do you have any thoughts about this?

      • Hey Damion,

        Thanks for sharing the study. In general, peppermint and rosemary have similar volatile acid profiles — which likely means the mechanisms of action for hair-promoting properties are likely the same. It’s certainly possible peppermint oil might be more effective than rosemary, but I’d just need to see a study in humans with AGA demonstrating this. Right now, rosemary is the only one studied in AGA participants (that I know of), and as a result, it gets more attention in hair loss circles.


        Hopefully we’ll have more clinical studies on essential oils in the future. They’re hard to find funding!


    30. Hi Rob,

      I have been reading numerous articles on hair loss for past many years. This is definitely one of the best articles I have read till date.

      Would you be kind enough to answer my two questions:

      1. Does smoking has an impact on NAPDH?

      2. If we focus on reducing the inflammation on scalp through diet and naturopathy, will it directly impact scalp DHT and thereby impacting hair loss ?

    31. Hi Rob

      I would like to translate this article into my country’s language, Korean, in order to convey reliable information to people who misunderstand about hair loss. Could you allow for this?

      • Hi Jj,

        Thanks for reaching out. Could you please provide a link to the website where you plan on doing the translation? I’ve allowed translations in the past before, provided that the translator 1) mention that the work is translated from an article on Perfect Hair Health, and 2) provide a link to the original article.


    32. Hi Rob,

      As my hair loss needs to be stabilized immediately ive come to decide on finasteride as my solution at least for now, however i have a question:

      1) What actually is the required serum DHT levels to cause hair loss in the first place?

      I see finasteride being prescribed all the time as well as people just blindly taking it on hair loss forums, however the purpose of finasteride is to lower DHT levels so the less DHT we have the higher the chance it wont attack our follicles, which is great but how much DHT is actually required to cause this hair loss in the first place, if the normal range is between 40-575 ng l(-1), then would 60ngl(-1) be enough for baldness to occur, then maybe if we just make our DHT levels down to 35 (a little under the normal range), perhaps thats enough to halt the balding? Rather than say 1mg finasteride inhibits 70% of DHT, what exact levels are we talking about here.

      I was thinking that if i found out the typical range of DHT for balding to start occurring then i could take a range of natural supplements until my DHT falls to a required low level without having to take finasteride. I feel when people say natural DHT supplements dont work, i think it could if we take the amounts needed to reduce DHT to a level similar to that of finasteride, but until we find out exactly what that serum level is, we’re just shooting in the dark until we think its working for us.

      I dont want to blindly take finasteride like most of those who enter the hair loss forums, i want to know what my DHT levels are (and if they’re high/normal) and then finasteride would be considered. I feel if i do have high DHT levels then perhaps it is just that my DHT is too high and finasteride would work for me, if i have normal DHT levels, perhaps then my follicles have just turned too sensitive, in which case id like to know why, if i already have low DHT levels then i’ll be completely confused and taking a DHT blocker would no doubt cause side effects.

      Thank you Rob for taking the time to read!

    33. you are totally wrong about saw palmetto. It is like finasteride or maybe worse for some people.I took it for 3-4 months about eight years ago.I thought SP was natural and since being sold OTC is safer too. I felt side effects within 2-3 weeks. These side effects were mainly fatigue and indigestion. Since they were mild initially so I kept taking it. But after 3 months suddenly these effects became so intense that I had to stop it. After stopping SP, these side effects did not go away, instead kept getting worse and worse. Soon I was so sick that I had to quit my job. Now eight years after I am still suffering. My muscles are always sore. I cannot do physical work. My joints and bones hurt 24 hours. I looked way more aged for my age. SP has turned off something in my body. Believe me I am no more what I used to be.
      If there is no study about SP showing it is bad, it does not mean it is safe.

    34. Hi Rob,
      It’s a great site on MPB, or alopecia and well worth the trouble to read. I have tried regain regularly and later in combination with Saw Palmetto but haven’t had great success with them, though they did stave off complete and total baldness for me over the past 10 years, and am now aged 51. I have had no sexual side effects due to Saw Palmettto or Regain. The issue for me with Regain was having to wash it off and too much of that doesn’t help the hair. I still use it but once or twice a week, more as a hair oil than a treatment to increase hair density. I do also have the herbal Saw Palmetto capsules and use them occasionally too. Two months ago I started on Finasteride and the results are amazing. It has worked very fast and effectively in the spate of just two months. It is not just staving off issues but acting remedially too. I may have some side effects or not , I can’t state for sure but this drug for me works better and outshines all other treatments currently available. I have the 5mg marketed as Proscar, which I split into six or seven pieces and take daily. If there are serious side effects then I would happily discontinue use but at present I’m free from any. I am prepared for some side effects but wouldn’t desire total impotence. Finasteride is helping me with hair like I had at school and later, often teased as hair bear bunch and mop head. My hair started thinning at around age 40 and Regain and the SP have helped but Finasteride is far more powerful. I’ve heard sportsmen, politicians and even judges taking it but would feign admit it. The science on this topic will in future, hopefully advance and no drugs may perhaps be needed, but for now, for people like us it is necessary to keep weighing unexpected risks and benefits. I knew about this drug long ago and am now on it myself and it is working. I am not suggesting every one take it because that is individual choice, but I am willing to take it, in small doses if it is more helpful in reducing some DHT.


    35. Well, I took Saw Palmetto on 17.03.2017, today is 28.01.2019. Still struggling with the sides of this poisonous herb. Never had ED, but I lost my nocturnals, got really bad brain fog and issues with my joints. Dunno how to get away recovered after what happened with me… The doctors do not believe what I am saying and think I am a mad person. I am certainly not!

    36. This was an excellent article. Best I’ve read concerning hair loss and also explains why I was able to stop shedding and regrow hair for a time while on Pumpkin seed oil. I recently did PRP and my doc gave me some interesting instructions which included Fin. I decided not to take Fin, but the other directions are very interesting because they seem to be directed at reducing inflammation. I should tell you my new regimen in an email or something, I have seen some pretty good progress in this very short time.

    37. What about women taking finastride. I’m a 40 year old woman who has been prescribed Finast 5mg for hair thinning and have just started taking the drug. Not sure what to expect as its generally prescribed for men and researched on men. The only instruction given was I cant get pregnant while on the drug I have diffuse hair thinning for the longest time that I can remember. I’m ‘very skinny with mild hirsutisim, and oily skin/acne issues. Any thoughts ?

      • I’m clear on most blood tests that is pcod, thyroid, vitam D, B 12 , sugar, iron, dheas.. except for Sibo haven’t taken that test yet , no other symptoms and generally healthy

    38. This whole discussion is really introductory at best.. We have all these scientific theories on MPB and trying to treat it with herbs.
      First off no one knows exactly what causes MPB. Suffice to say, the leading culprit is excess DHT in scalp. So let’s assume it is, how to safely treat.
      Medical science says Finasteride & Duasteride.
      So if one doesn’t want to take it orally, take it topically.
      Possible reason for declining hair growth is scalp is, it’s saturated with DHT.
      So I would recommend taking herbs & amino acid formulations orally. By the way there are more than what’s mentioned above, plus topicals of Duasteride, Minoxidil’, and few others.
      You are not going to get regrowth until you dramatically lower scalp DHT.

    39. I Really Appreciate your hard work, great effort bro.
      i dont know from where you got all these detailed info, but i rarely find these details even on popular websites or even by Doctors. it is like i find a New World
      & i will like to tell you that i am currently using saw palmetto 450mg (puritans pride) twice a day for Male Patern Baldness, i did not find lower dose like 200mg. i was very confused about drugs like finasteride, so i decided to use something less scary until i get more info about finasteride.
      using for 1 month now, strangely, i have already seen some new small hairs, even on spot that are bald for years now, but yes i can understand that i have to wait to see if these new hair will really grow full size.
      & about side effects, no side effects yet, thanks God, in starting few days felt a bit ED but i think it was only bcz i was afraid of side effects, psycho. And after this, i am clearly feeling even better ED & libido, am not sure if it is bcz saw palmetto or something else.
      & after reading here, i think i will not opt for Finasteride soon, & keep using SP & possibly some oil like Pumpkin if found here.
      Found some comments here regarding side effetct of SP, did you talked with them in email? Did u find any connection of these side effect to SP?
      i will try to give you updates, if this can be helpful for someone.

      • Thanks Azher! I’m glad to hear you’re seeing some success with saw palmetto alongside pumpkin seed oil.

        Please keep us posted with your progress over the coming months. If things tend to stop improving, there are newer topical formulations of finasteride which help to reduce scalp DHT, haven’t yet caused sexual side effects, and only lead a 1/18 reduction in circulating (blood) DHT. This is exciting news for us guys who don’t want to take finasteride due to the sexual side effects.

        To answer your other question – yes, saw palmetto use (for a few people here) has led to some pretty negative side effects. Having said that, it’s hard to tell just how many people this effects. Contrarily, some people report that saw palmetto improves their sex drive. So it really seems to be a case-by-case issue.


    40. Dear Rob

      Firstly I want to take this opportunity to thank you for this website, – it’s a priceless resource.

      Just one question: do you have any idea how long you have to take Finasteride before the increase in androgen receptor activity becomes irreversible?

      I would really appreciate anything you can say about this, however speculative, as I’ve only recently started taking Finasteride, and I want to try and work the best way to proceed.

      Many thanks,


      • Hey Stuart,

        Thanks for reaching out. It’s a great question, and I should probably clarify a few things before proceeding with an answer:

        1. The androgen receptor remodeling seen from finasteride was studied in prostate tissues in gerbils, not scalp tissues in men with AGA. However, both the prostate and scalp tissue types are comparable, as they both contain high amounts of type II 5-alpha reductase (the enzyme finasteride inhibits).

        2. The gerbils weren’t just taking finasteride; they were taking finasteride + an aromatase inhibitor. This means we can’t attribute all of the findings of that study to finasteride exclusively.

        3. The gerbils were taking 10mg/kg daily of finasteride as delivered via food sources. This dosage is way higher than human doses for AGA – which are 1mg daily. However, finasteride’s effect on type II 5-alpha reductase is logarithmic, meaning that daily dosages of 0.2mg to 5.0mg and beyond have almost the same effect on DHT levels. So, it’s unclear if this fact actually matters that much.

        4. The study showed androgen receptor remodeling after 30 days of treatment. These androgen receptors stayed upregulated (i.e., overexpressed) after stopping finasteride – and they remained unchanged at each stage of study post-treatment (1, 7, 14, and 21 days after quitting finasteride + the aromatase inhibitor).

        Long-story short: we have to be super careful about drawing any conclusions from this study and applying them to men with AGA! Technically-speaking, even making the claim that androgen receptors remodel – and stay remodeled – in balding scalps is speculative (even though I believe it).

        Have you looked into topical finasteride? Studies have shown that 0.025% topical finasteride can reduce scalp DHT levels by 60%+ (on par with oral 1mg finasteride), but only reduces serum DHT by 18%. While you may still have the same risk of androgen receptor remodeling, you’ll also likely limit the systemic risk of use.


    41. Rob

      Thank you very much indeed for getting back so quickly, and with such a detailed response (not that readers would expect anything less, of course!)

      The one thing that makes me wonder how much we can read into this study is its duration.

      Firstly, the gerbils were given Finasteride for 30 days. Now, the average life expectancy of a human being is about 16 times that of a gerbil; so, if we extrapolate, that would be the equivalent of a man taking Finasteride for 480 days (about 16 months)

      Secondly, after 21 days, ( 336 days / 11 months human equivalent), the androgen receptors remained overexpressed.

      Is that really long enough to conclude that the remodelling is permanent?

      Anyway, I did some further research, and I came across the following study:


      I’m not sure if it’s directly relevant to the matter in hand, or what conclusions to draw from it, but it’s interesting all the same, and I would very much welcome your thoughts.

      As for topical Finasteride, I’m aware of it, but it’s not something that I’ve looked into, so I’ll do some investigation.

      Thanks again,


      • Hey Stuart,

        I agree! The study duration was probably not long enough to conclude if androgen receptor remodeling was permanent. While it does raise cause for concern, we can’t apply this research to all men taking finasteride for AGA. There are just too many differences.

        Thanks for sharing the quercitin + finasteride paper! To summarize the results (for anyone else reading) – the authors found that, compared to finasteride alone, quercitin + finasteride counteracted the serum DHT-reducing effects of finasteride but still led to a reduction in prostate weight. To me, that implies that quercitin + finasteride might help to isolate finasteride’s effects on the prostate to just those tissues.

        Before making any recommendations, I’d need to see (1) DHT levels in the prostate from the quercitin + finasteride group, (2) human studies showing the same results, and (3) human studies demonstrating the same effects on scalp skin in balding regions. But, it seems like this preliminary study opens up the possibility that quercitin + finasteride (for humans) might help to isolate finasteride’s effects and maybe even stave off some risk of adverse effects.

        Thanks again for finding this!


    42. Hi Rob,

      Could you tell us your opinion about zix (zinc + b6) it’s a topical and there’s a huge thread on hlt.com.



    43. Rob,

      You highlighted some great alternatives therapies to oral finasteride that may/may not reduce serum DHT (and therein decrease hair loss). However, how likely would sexual side effects persists if a topical vehicle would be utilized in low-dose finesterade. I have found various articles talking about a moderate reduction (~30) in serum DHT while significantly reducing local DHT in hair follicles. What are your thoughts on this and is it worth the risk?

      • Hey Jake,

        It’s a great question. I’ve been in communication with a few dermatologists about this. The clinical evidence for topical finasteride, at least in terms of reductions to scalp versus serum DHT, look promising. See this study, and this review:



        The “sweet spot” for topical finasteride – at least in terms of maximizing scalp DHT reduction while minimizing serum DHT reduction – seems to be 0.4 mL per application at a 0.2275% dilution.

        However, there are A LOT of clinics offering this, and with mixed results (per the anecdotes from those dermatologists). The problem is that delivery and compounding methods, as well as adjunct ingredients, vary wildly across manufacturers and clinics. It seems like the majority of topical formulations, at least so far, are missing the mark (anecdotally) in terms of hair regrowth.

        The clinic with the most anecdotal success seems to be coming out of Italy. Where are you based?


    44. Rob,

      Those were actually two of the articles I drew my interest in topical finasteride from! I’m based in the U.S and have also seen various clinics offering this. I’m still reluctant to try any form (oral or topical) but out of curiosity, is there any particular clinic that you recommend that is offering this dilution? If there’s a conflict of interest in mentioning a clinic by name feel free to e-mail me instead.

    45. Ive tried many things to combat thinning hair, and the only thing that started to make it grow back was as follows. By the way, I noticed the regrowth when I saw a birds eye view on my home security, and family members also mentioned it.


      ‘ANTI-HAIR LOSS Magnesium Spray. Organic, Natural Product – Thinning Hair And Hair Loss Treatment For Men And Women …’


      ‘Magnesium oil, Organic Aloe Vera, Organic Thyme Oil, Organic Rosemary Oil, Organic Lavender
      Oil, and Organic Cedarwood Oil’

      It’s 95% magnesium oil, and 5% essential oils. I spray it on the scalp every other day, leave for 20-30 minutes, then wash off.

      When I first used it, my scalp was tingling, then I could feel my scalp loosening up as if it had been massaged. This sensation happened for the next 4-5 uses, then it went away but my scalp feels more ‘relaxed’. I also noticed an itching sensation but only in the thinnest areas of the scalp hair. That could have been due to the magnesium oil making more contact in those areas, or something else.

      It’s possible that my scalp had calcification, but each essential oil in that formula does have some evidence about its effectiveness. You can read about them (and others) here https://www.healthline.com/health/essential-oils-for-hair-growth

      I also use magnesium oil spray on my skin too. The essential oils may also be helping to reduce inflammation and block DHT. You can make your own mixture if you wish.

    46. Hi Rob, few months ago I got a urethritis and e coli, I got treated for both, but the doc told me to take permixon aka saw palmetto 320mg because he was thinking this was a prostatitis and this was not so I stopped taking it after 8 days, since that period and I’m not sure if I what could be the cause, my sperm is way more watery, this is getting better after a few months, but this is almost 5 months since the whole problem and I still don’t have my sperm like I used before, do you think in your experience that could be the saw palmetto ? I’m skeptical about having side effect from 8 days, but when I read internet and people having side effects for years with a just a few day of SP I’m getting paranoid and depressed, thanks for your input and awesome job on this article, very well written.

    47. Hi Rob,

      Great article, thank you for the detailed info. What are your thoughts on topical saw palmetto with regards to potential side-effects? How likely is one to experience side-effects from the supplement when taking it topically compared to orally? Is there any way to breakdown the percentage of DHT in the body that is effected when taking it topically? By the way I mean with regards to a spray that would be left on the hair as opposed to a shampoo that would be washed out. Thanks for the help!


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