While stopping hair loss is a major concern for people experiencing shedding and balding, stimulating new hair growth is perhaps even more important. But it’s also a more difficult step, and one that requires a bit more patience and persistence.
This article will introduce the variety of techniques that may stop hair fall and perhaps even stimulate growth.
Hair Loss: A Quick Overview
What is the main cause of hair loss, and can it be reversed?
These are the questions that thousands of hair loss sufferers ask everyday, and it’s also one that scientists and drug manufacturers have been researching for years.
Unfortunately, the answers aren’t so clear cut. That’s because hair thinning and balding can occur for many reasons and regrowth of lost hair is dependent on many factors.
However, the most common cause of hairline recession and balding is Androgenetic Alopecia (AGA), also known as Male-Pattern Baldness (MPB) (1). It affects 30-50 percent of men by age 50, but it can also occur in women known as female-pattern hair loss. Interestingly, the exact cause is still unknown.
- Genetic predisposition
- Lack of blood flow to the scalp
- Sensitivity to DHT
In particular, the theory of sensitivity to DHT has a lot of credence and is believed by many doctors to be the main trigger. After all, DHT sensitivity has been shown to miniaturize the follicles and this can reduce blood flow (4).
Eventually, the follicle will have no access to nutrients and oxygen, which will further miniaturize the hairs until they can no longer be produced.
But even further, the hair loss framework helps to explain how DHT and the other factors fit into the bigger scheme of things.
In short, the framework indicates two main contributors to hair loss: chronic inflammation, and hormonal imbalance.
These are triggered by various things, including diet, lifestyle, microbiome, and scalp environment.
For example, a poor diet or unhealthy microbiome may contribute to inflammation which, in turn, contributes to calcification. Calcified tissues can then lead to even more inflammation, and the vicious cycle continues.
A hormonal imbalance has also been linked to Androgen Receptors (ARs), and this can have an effect on DHT production.
Both the chronic inflammation and increased amount of DHT can promote an unhealthy scalp environment with reduced blood flow and poor oxygen and nutrient delivery.
Fortunately, there are plenty of methods that can help you to stimulate hair growth.
Use a Dermastamp
Microneedling is a technique often used by dermatologists and even general practitioners to reduce signs of scarring and even wrinkles (5, 6). However, did you know it can also be used to stimulate hair growth (7)?
The method involves the use of tiny needles which puncture the scalp. As the small wounds heal, a three-step process occurs all without scarring (8):
And while the technique may seem counterintuitive, it does have proven benefits.
Foremost, microneedling works because it induces collagen production which is crucial for the hair growth process (9). It also stimulates new cell production, which is required within the hair follicles (10).
These concepts were both proven in a 2013 study that compared microneedling + minoxidil to a minoxidil-only group (7). At the end of the 12-week study, the group that received both microneedling and minoxidil saw benefits greater than the group to receive just minoxidil.
How to Use the Dermastamp
The dermastamp is a microneedling tool that consists of a rectangular block with micro needles on the end of a handle. It’s pressed against the scalp to induce the process mentioned above.
To use the tool, clean the scalp with a gentle shampoo. Then press gently into the targeted area of hair loss, and hold in place for a few seconds. Repeat the pressing vertically, horizontally, and then diagonally.
You can place the stamp in areas of balding or even in areas with thinning.
To clean the stamp, you can wipe off the needles and block with an alcohol wipe or soak in an antibacterial soap and then rinse after a few minutes. You may repeat the procedure once per week.
Practice Scalp Massage and Exercises
The dermastamp is a great way to increase blood flow to the scalp while also stimulating new cell production. However, there are two other practices which you should be sure to incorporate into your hair care routine – scalp massage, and exercises.
These techniques can be performed daily and they work by increasing blood flow as well as stretching the Dermal Papilla Cells (DPCs) (11). These help to naturally stimulate the follicles.
How to Perform Scalp Massage
There are two ways to massage your scalp. The option you choose is up to you, as it’s largely a matter of preference.
With a Scalp Massager
A scalp massage is a metal tool with rubber caps that can be used to massage the scalp in multiple places at once. To use, place the massager on the outer edges of your hairline and around the scalp, and slowly move the tool up and down.
With Your Fingers
While the scalp massager can be useful, it isn’t the most effective at targeting specific areas of the scalp. To do that, you can use your fingertips.
Begin by placing your thumb, index, and middle fingers on the sides of your scalp. Use gentle, circular motions to move your fingers around the area, and then slowly move them towards the crown.
Continue these movements for one to two minutes in each location, and then move onto the hairline, back to the sides of the head, and finally to the base of the skull.
In total, the massage should take 10 minutes per session.
How to Perform Scalp Exercises
To further increase blood circulation and to reduce tension, scalp exercises can also be included in your hair care routine. These will help to improve skin elasticity as well.
To perform scalp exercises, place your thumb and index finger on your scalp a few inches apart. Gently pull your thumb and index fingers together without lifting them from the skin. You can then slowly increase the distance between the fingers until they’re back in their original positions.
These movements will slowly stretch the skin. You can also use your muscles – namely, your eyebrow muscles – to further induce stretching. Here’s how.
- Using your eyebrows, slowly lift them up towards the hairline as high as they can go. Hold in place for one minute, and then return them to neutral position. You can repeat this movement 5 – 10 times per session.
- Next, furrow your eyebrows deeply and hold in place for one minute. Return them to neutral position, and repeat as needed.
You can also alternate exercises, first by lifting your brows and then furrowing them without stopping in the neutral position first.
Use Natural DHT Blockers
If DHT is one of the major contributors to hair loss, what about ingredients that work directly to reduce DHT levels in the scalp?
Perhaps the most well-known DHT blocker among hair loss sufferers is saw palmetto. It’s a berry-producing plant that has been shown to inhibit 5-alpha-reductase (12).
A 2016 study, performed on Syrian hamsters, looked to answer this exact question (13).
Study: Effect of saw palmetto supplements on androgen-sensitive LNCaP human prostate cancer cell number and Syrian hamster flank organ growth
Syrian hamsters were randomly divided into groups and the lower back of each was shaved to expose flank organs. The groups were then set to receive either a control (ethanol only), GNC Herbal Plus SPS (HLLP), Jarrow Formulas SPS (HLHP), or Doctor’s Best SPS (HMLP) daily.
Even further, the hamsters were to receive either testosterone or DHT.
The results of the study showed that saw palmetto when combined with testosterone was better at reducing pigmentation of the flank organ than when combined with DHT. This is a sign of androgen activity, and it indicates that saw palmetto is better able to inhibit 5AR than it is to reduce DHT.
This means that saw palmetto can be used to reduce the activities of 5AR and, as a result, indirectly block DHT production.
Limitations and Considerations
The results of the study clearly show that saw palmetto can be used to reduce DHT levels indirectly by inhibiting 5AR. This is similar to how finasteride and dutasteride work, which means that side effects are possible.
One major limitation to the study is that it was carried out on hamsters of which none experienced alopecia.
This doesn’t automatically translate to positive results in men with AGA.
It would be interesting to see further studies performed, preferably on humans. It would also be interesting to note the risk of side effects when taking oral saw palmetto as compared to other 5-alpha-reductase inhibitors.
Reishi mushroom is another inhibitor of 5AR and, as such, can be helpful in reducing DHT levels within the body and at the scalp. This was shown in a 2005 study (14).
Study: Anti-androgenic activities of Ganoderma lucidum
Researchers collected 19 different mushrooms (including Ganoderma lucidum, also known as reishi). Extracts of the samples were prepared, and they were then added to a rat liver microsome suspension.
The goal of the study? To determine how effective each of the species was at inhibiting 5AR’s activities.
As the results showed, reishi mushroom was the most effective at inhibiting 5AR when compared to the other 18 species. In fact, it inhibited between to 75 and 80 percent of 5AR activities while the next closest species Pleurotus ostreatus inhibited just 60 percent.
And while no studies have been done to compare the two, both reishi and finasteride inhibit 5AR. This means that reishi may be used similarly to finasteride to stimulate hair growth in AGA sufferers.
Limitations and Considerations
The greatest limitations presented by this study are that they were performed in vitro.
While they may be effective at inhibiting 5-alpha-reductase in a laboratory setting, there are likely other factors at play should the ingredient be introduced to a living organism.
Study: Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study
The study to show its internal effects was performed in 2005 (15). Researchers recruited 620 men with Benign Prostatic Hyperplasia (BPH) and split them into two groups.
The first group received two stinging nettle capsules of 300mg each, twice daily, while the second group received a placebo. At the end of the study, 81 percent of the patients in the treatment group saw a reduction in serum Prostate-Specific Antigen (PSA) and prostate size.
What does this mean for the treatment of AGA?
BPH is a condition which, much like AGA, is largely affected by DHT levels (17). The reduction in serum PSA and prostate size indicates that stinging nettle reduces DHT levels within the prostate.
Study: Ameliorative effects of stinging nettle (Urtica dioica) on testosterone‐induced prostatic hyperplasia in rats
The second study, performed in 2011, considered the effects of stinging nettle on rat prostate size (16).
As the results showed, the various levels of stinging nettle used were beneficial in treating testosterone-induced BPH. And while the results weren’t exactly up to par with finasteride (the positive control), they still show that stinging nettle may be an effective alternative option.
Limitations and Considerations
An interesting aspect that was not considered in this study was that nettle and its extract contain lignans (18). These have been shown to bind with sex hormone binding globulin (SHBG) which can actually increase DHT levels (by limiting how many androgen receptors are available to free testosterone and DHT) and, therefore, contribute to hair loss (19).
Other studies have even called into question whether nettle root actually decreases DHT levels as the above study indicates (20).
Does this mean that stinging nettle cannot be used to promote hair growth?
The truth is, the science isn’t there to fully support its use.
That’s not to say that nettle should be avoided, but you should closely monitor the number of hairs you shed during treatment to ensure it’s not working against your goal of hair growth.
Consider Using Traditional Pharmaceutical Therapies
While a trend towards ‘natural’ ingredients and treatment methods is common in the hair loss community, it’s important to consider that many such techniques have yet to be proven effective at promoting hair growth in humans.
This is why it’s important to consider the more traditional options mentioned below.
Minoxidil, better known by the brand name Rogaine, is a topical formulation that was first developed as an oral tablet to treat hypertension (21).
One of the most prominent side effects, though, was its ability to regrow hair on the scalps of balding men. This discovery eventually led to the development of the topical formulation used by millions of people today, and it was approved by the FDA in 1984 (22).
- It stimulates blood flow to the scalp
- It upregulates vascular endothelial growth factor (VEGF) which contributes to healthy vascularization and hair growth
- It opens potassium channels which may initiate the onset (and prolong the duration) of anagen phase
The above three theories are likely all contributors to the success of the drug.
But how effective is it?
Study: Topical minoxidil in early male pattern baldness
This 1985 study consisted of 126 healthy men with early MPB (26). The men were randomized into one of three groups, where they would receive either a placebo, 2 percent minoxidil, or 3 percent minoxidil. After four months, the placebo group was then switched to 3 percent minoxidil.
To test the efficacy of the treatment, the count of vellus, terminal, and total hairs in a vertex target balding area were tracked and subjective assessments by subjects and investigators were done.
As expected, the groups to receive either 2 percent minoxidil or 3 percent minoxidil saw a significant increase in hair count over the placebo group at the four-month mark.
The placebo group, who was then switched over to minoxidil, also showed a significant increase in the number of terminal hairs at the end of the 12-month study.
Overall, none of the subjects had a net hair loss in the target area and 24 percent to 56 percent of participants experienced moderate to dense regrowth.
Study: Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil
To test the long-term effects and impact of minoxidil on hair growth in men with AGA, thirty-one men from the previous study were recruited for a five-year follow up study (27).
Hair counts were continued in the same manner as before, and they were completed at two years and nine months, three years, and at four-and-a-half to five years.
The researchers found that hair regrowth peaked at one year, and there was a very slight decrease in hair counts at the three-year mark when compared to the one year results.
However, there was still a significant increase over baseline at the five-year mark which shows that minoxidil can maintain nonvellus hair counts with prolonged use.
The next drug to be approved by the FDA in the treatment of AGA is finasteride, also known by the brand name Propecia.
The drug was originally used to treat prostate enlargement, but hair growth was noted in trials and was then soon tested as a possible pharmaceutical for hair loss (28).
Study: Finasteride in the treatment of men with androgenetic alopecia
In a review study that looked at the results of two one-year long studies, the effects of finasteride in men with AGA was shown (31).
The studies consisted of 1,553 men total who received oral finasteride 1 mg/d or placebo. The results were tracked by scalp hair counts, patient and investigator assessments, and review of photographs by an expert panel.
The baseline hair count was an average of 876 hairs with an increase of 107 hairs at one year in the finasteride treatment group.
Twelve hundred and fifteen men from the previous study then continued on for a second year.
At the end of two years, the men in the finasteride treatment group saw an average hair count increase of 138 when compared to the baseline count.
As summarized by researchers:
[F]inasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years
Study: Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia
But that wasn’t the end of the study mentioned above.
In fact, some of the men from the original study continued to participate in 1-year, placebo-controlled extension studies for up to five years total (32).
The same methods for tracking results were utilized.
As was to be expected, the men to receive the placebo treatment saw progressive hair loss over the five-year period. However, “treatment with finasteride led to durable improvements in scalp hair over five years.”
Even better, the treatment was generally well tolerated and no new safety concerns were identified.
While finasteride has been proven effective in treating AGA hair loss, another possible treatment option may be even more so.
Dutasteride is a drug currently prescribed in the treatment of enlarged prostate under the brand name Adovart (33).
Similar to finasteride, dutasteride works by inhibiting 5-alpha-reductase which is the precursor to DHT. Unlike finasteride, though, dutasteride does so by inhibiting both types of 5-alpha-reductase as opposed to just one (34).
And while dutasteride is not approved by the FDA for AGA, there are trials currently underway.
Study: Dutasteride improves male pattern hair loss in a randomized study in identical twins
One study compared the efficacy of dutasteride compared to placebo in 17 pairs of identical twins with AGA (35). The trial took place over one year.
One twin from each pair was given a 0.5/mg daily dose of dutasteride, while the other received a placebo.
Standardized clinical photographs, hair counts, and patient self-assessment questionnaire were used to evaluate results.
As the results showed, “dutasteride significantly improved hair growth at 1-year compared to placebo based on the analysis of the investigator assessment and the patient self-assessment questionnaires.”
And out of 17 of the twin pairs, 15 of them were able to distinguish which twin was undergoing the active treatment from the placebo treatment based on visible results.
But how effective is dutasteride when compared to finasteride?
Study: The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride
In 2006, researchers recruited 416 men between the ages of 18 and 41 to receive either dutasteride 0.05, 0.1, 0.5 or 2.5 mg, finasteride 5 mg, or placebo daily for 24 weeks (36).
To measure results, expert panel photographic review and investigator assessment were performed. Scalp and serum DHT levels and testosterone levels were also measured.
As the results of the study show, “dutasteride increased target area hair count versus placebo”.
Even further, the 2.5mg dose of dutasteride was shown superior to finasteride at 12 and 24 weeks.
At this time, dutasteride has not been approved by the FDA for the treatment of hair loss. However, your doctor may see fit to prescribe the drug for off-label use if minoxidil and/or finasteride have led to little to no results.
When it comes to tackling hair loss, there are various options available.
These include mechanical techniques such as microneedling and scalp massage, and even herbal supplements such as saw palmetto, reishi mushroom, and stinging nettle.
But the most common include prescription drugs such as finasteride and dutasteride and topicals such as minoxidil (3). This is because these treatments tend to provide the greatest results, and they can often be combined with other methods.
So, is it possible to stimulate new hair growth?
Yes. This is especially true when you utilize the traditional treatment options as opposed to natural alternatives.