Minoxidil, commonly sold under the trade name Rogaine, has long been held as the “gold standard” for topical hair regrowth treatments.
Yet there are alternatives touted as “safe,” “natural,” and “effective,” by many online sources — but are they, really?
This article will delve deep into the research to determine which, if any, products can give you results equal to — or better than — minoxidil.
Before examining purported alternatives, it’s important to understand the mechanism by which minoxidil encourages hair growth.
Minoxidil is a topical formulation that was first developed as an oral tablet for the treatment of hypertension (1). It works as a direct vasodilator, and it’s still used in patients with resistant hypertension.
One side effect that was discovered during initial trials, though, was hypertrichosis. This is excessive growth of hair that usually occurs on the face and other unwanted locations, though in this case it also extended to the scalp.
A topical formulation was soon developed as a way to target the effects of the drug in men (and in later years, women) with Androgenetic Alopecia (AGA).
The ability to increase blood flow to the scalp is clear, and this very likely contributes to its positive effects. However, there are two other theories as to why minoxidil is so successful as regrowing hair (2, 3):
- It upregulates the expression of vascular endothelial growth factor (VEGF) in dermal papilla cells
- It opens potassium channels which has been indicated as influential on hair growth
In cases of androgenetic alopecia, the most common cause of hair loss among men and women, a build-up of di-hydrotestosterone (DHT) builds up at the base of the hair follicles, causes inflammation. As inflammation builds, circulation is affected and the hair stops receiving needed nutrients and oxygen (4).
Over time, this lack of nourishment leads to a phenomenon known as “hair miniaturization,” in which the hair gradually becomes thinner, weaker, and eventually stops being produced.
Minoxidil doesn’t target DHT. Instead, it increases blood flow (and oxygen and nutrients as a result) to the scalp which makes it possible for the follicles to thrive in an otherwise hostile environment. As the hair follicles begin to receive nourishment again, they revive, and hair regrowth is seen (5).
Two things that are important to note about minoxidil: Results are temporary, that is, they disappear when you discontinue therapy, and there are adverse side effects.
Side effects of minoxidil include (6):
- Rapid heart beat
- Unwanted facial/body hair
- Weight gain
- Chest pain
- Swelling of hands/feet
- Weight gain
- Trouble breathing
Do keep in mind, though, that side effects are rare and they are often minor enough that people continue with therapy anyway.
What Are the Odds of Experiencing Side Effects?
So, what are the odds of side effects while using minoxidil?
This question was answered in 1988 when the manufacturers of Rogaine, Upjohn, performed their own study (7).
The study consisted of a total of 2,326 patients from 27 different medical centers.
The most common side effects included headache, edema, dizziness, syncope, visual disturbances, altered taste, impotence, and cardiovascular changes. The researchers classified these as medical, as opposed to dermatological.
These side effects occurred in 418 participants (or 18 percent) and were experienced at varying degrees.
Dermatologic effects, including itching, burning sensation, erythema and flushing, scaling, and follicultis occurred in 136 patients (or 13.6 percent). These also ranged in severity.
But what about women?
While minoxidil wasn’t approved by the FDA for use on women until the 2000s, a study performed in the same year as the above considered the side effects associated with 3 percent minoxidil on women (8).
The study consisted of 25 women affected by AGA and, overall, the side effects were similarly minimal in women as in men.
Natural Alternatives to Minoxidil
If you consider that one of minoxidil’s main mechanisms is its ability to increase circulation, it would make sense that similar techniques and ingredients might have the same effects on hair regrowth.
Let’s look at each category of alternatives, beginning with those that work in the same way as minoxidil — by increasing blood, nutrient, and oxygen circulation to the hair follicles.
Circulation Boosting Alternatives
Since minoxidil works directly to increase circulation to the scalp, one of the best ways to find a suitable alternative is to find a substance that replicates — or surpasses — this effect.
But are there any ‘natural’ alternatives that have been proven without a doubt to do so?
A native plant in Europe, peppermint (Mentha piperita) has been used around the world for food and health purposes. Some of the ways peppermint has been used are:
- Food flavoring
- Essential oil for fragrance and cosmetics
- Gastric stimulant
- Gas relief
And now a study has looked at the effect of peppermint oil on hair growth in mice (9).
Researchers divided the animals into four groups upon which were tested saline solution, jojoba oil, 3 percent minoxidil and 3 percent peppermint oil.
Out of these groups, the group receiving peppermint oil showed the greatest results including:
- Increased follicle number
- Increased dermal thickness
- Increased follicle depth
- Increased expression of insulin-like growth factor (IGF-1)
No weight changes, food efficiency, or other toxic effects were noted in the peppermint oil group (10).
Another study showed that topical menthol had significant blood-vessel widening properties, which contributed to greater blood flow for increased circulation (11).
Limitations and Considerations
As the hair growth study comparing peppermint oil and minoxidil was performed on mice, the results should be taken with a grain of salt.
It’s also interesting to note that over the course of the four-week study, the saline (control) group saw very little in the way of hair regrowth.
The length of anagen (active growth) phase in mice is significantly shorter than in humans. While humans will experience anagen phase for up to five years, it occurs in mice in just a matter of two weeks or so (12).
The lack of regrowth in the saline group, then, may indicate an issue with the controls which further calls the result into question.
That’s not to say that peppermint oil is useless when it comes to promoting hair growth. After all, it does contribute to greater blood flow which is crucial for hair growth. But it may be more effective when combined with more traditional techniques.
Another aromatic herb, research indicates that rosemary (Rosmarinus officinalis) may have hair growth qualities on the same magnitude as 2 percent minoxidil.
Researchers comparing the two substances found a similar increase in hair count at the end of the study period, with the subject assigned to rosemary oil experiencing significantly less scalp itching than the minoxidil group (13).
According to researchers, the rosemary group’s hair count increased nearly twice as much as the minoxidil group.
The oil from rosemary plants contains bioactive antioxidants including rosmarinic acid, ethanolic acid, 1,8-cineole, carnosic acid, and camphor. These compounds may have a number of effects on the growth of hair.
- Reduce inflammation
- Reduce bacteria on the scalp
- Decrease DHT levels by inhibiting its attachment to androgen receptors
- Increase circulation
Besides helping to moderate oxidative stress, rosemary oil also exhibits hepatoprotective characteristics. That means that rather than being toxic, it protects your liver from other toxicity (18).
Limitations and Considerations
When the researchers state that the rosemary oil group saw almost twice as much hair growth than the minoxidil group, it seems almost impossible to believe.
But let’s take a closer look at the actual numbers.
According to the research paper’s charts, the actual difference between baseline and the six-month results are insignificant.
The rosemary oil group saw an increase from an average of 122.8 hairs to 129.6 hairs, while the minoxidil group saw an increase from 138.4 hairs to 140.7 hairs. That’s an increase of 5.5 percent for the rosemary group, and 1.7 percent for the minoxidil group.
And while, yes, the percentage increase is greater in the rosemary group, the difference of 3.8 percent is not as significant as researchers suggest.
These results, then, can be explained away by the placebo effect, or uncontrollable outside forces (such as seasonal changes).
Another way to increase the circulation to your scalp is through massage.
One Japanese study showed a significant increase in hair thickness after just 24 weeks of scalp massage for just four minutes each day (17).
This was attributed to the stretching of the dermal papilla, which contributed to gene expression that open potassium channels, and accelerate the anagen phase of the hair growth cycle (19).
Although this experiment used a device to conduct the massage, the Panasonic EH-HM75-S, you can get similar results using your own hands.
- Spread your fingers as wide as is comfortable and place each hand on the side of your head, reaching through the hair to your scalp.
- Now, move your fingers in a circular motion using gentle pressure with the pads of your fingers.
- Continue massaging the sides of your scalp for one to two minutes, and then slowly move your hands towards the crown (top) of your head.
- Massage the crown for one to two minutes, and then place your fingers on your hairline. Begin massaging at the top center, above your forehead, and slowly work out to temples, keeping your fingers in the hairline area.
- Move from the sides to the center of your hairline and back again for one to two minutes, then move your hands to the back of your scalp.
- After you finish with one to two minutes of massage on the back of your scalp you can revisit previous areas if you feel you missed a spot or you need extra benefit in an area.
Not only will massage stimulate your scalp’s circulation, but it will provide stress relief, which is also important for people suffering from hair loss.
If mechanical stimulation of blood flow is something you’re interested in, then microneedling should be another treatment option to consider.
Microneedling, also known as Collagen Induction Therapy (CIT), is a technique that involves the use of miniature needles to puncture the skin. This therapy is believed to induce collagen production, and even promote the production of new skin cells (20). It does so by inducing the three-step healing process, which includes:
But does it work to induce hair growth in men with androgenetic alopecia?
A study published in 2013 asked this very question (21).
The study consisted of 100 men with mild to moderate AGA who were split into two groups, one which received both weekly microneedling and daily minoxidil 5 percent application and the other which received just the daily minoxidil application.
There were three parameters used to determined the efficacy of the treatment. They were:
- Change from baseline hair count at 12 weeks
- Patient assessment of hair growth at 12 weeks
- Investigator assessment of hair growth at 12 weeks
At the end of the 12-week study, the results showed that the minoxidil treatment group saw greater results over the minoxidil-only group. The mean change in hair count from baseline was 91.4 for the microneedling and minoxidil group versus 22.2 for the minoxidil group.
Another study, performed in 2015, tested the efficacy of microneedling in men with AGA who failed to respond to conventional therapy (22).
The study included four men who had been on minxodil 5 percent and finasteride for between two and five years, and who showed no hair growth (though there was no worsening of symptoms during this time).
The four men were given microneedling treatment over a six-month period, and they were then followed up over 18 months to assess the sustainability of the treatment.
Patients were assessed with the use of the standardized 7-point evaluation scale.
Amazingly, new hair growth started after eight to ten sessions, and all patients showed a response of +2 to +3 on the standardized 7-point evaluation scale.
This study (and the previous one) suggest that microneedling may be successful at stimulating new hair growth alongside the use of traditional treatment options.
DHT Build-up Reducers
Minoxidil does nothing to tackle the root cause of androgenetic alopecia — the build-up of di-hydrotestosterone (DHT) on the scalp (23).
When DHT accumulates on your scalp, it connects to the androgen receptors at the base of the hair follicles. For those sensitive to DHT, this leads to miniaturization of the hair follicles and, eventually, hair thinning and loss.
You can use natural products to block DHT or to inhibit 5-alpha-reductase to prevent the production of DHT (24).
Rosemary oil gives you a double-boost by increasing circulation, as shown previously, and by inhibiting 5-alpha-reductase.
One study to highlight this ability was published in 2013 (25).
The researchers utilized mice, of which one group had their dorsal areas shaved and the other group experienced hair regrowth interruption induced by testosterone treatment.
The mice were treated with 2mg of rosemary oil once per day, and the study continued for 30 days.
As the results showed, rosemary oil showed inhibition of 5-alpha-reductase at 82.4 percent and 94.6 percent at 200 and 500 µg/mL, respectively.
Limitations and Considerations
The first thing to point out is that this study was carried out on mice and, as mentioned, the human and mouse hair cycles do have differences.
But perhaps more important is the fact that rosemary oil was tested on testosterone-induced hair growth interruption and NOT on a proper AGA model.
What’s the difference?
While there’s no doubt that testosterone plays a role in hair loss in AGA patients, it is not the only cause. This means that, while rosemary oil was enable to induce regrowth in the testosterone model, there may be other factors at play when introduced to participants suffering from AGA.
To get rid of the DHT present in your scalp, try saw palmetto (Serenoa repens). This native American plant produces a substance that, according to research, can inhibit 5-alpha-reductase and prevent DHT from forming.
Moreover, in animal studies, flax seed was shown to have a positive effect on hair density and no adverse effects were noted, making it safe for consumption and topical use (30).
Both of the most recent studies showed that flaxseed supplementation had significant benefits for hair growth.
The first study measured the effects of various plant-based lignans on DHT. These plants included flaxseed, sesame, safflower, and soy (31).
The study was performed on castrated male rats, with a focus on prostate weight, as lowered weight indicates less androgenic activity.
Flax was connected with decreased prostate weight as well as lower testosterone levels — both strong indicators of 5-alpha-reductase inhibition.
Building on this, the second study specifically measured flaxseed’s hair growth benefits (32).
The group of animals that received flaxseed supplementation rather than just plain feed had improved length, width, and weight of hair.
Finally, flaxseeds hormone-balancing ability, while useful for men with androgenic alopecia, can also be of great benefit to women with this condition (33).
Limitations and Considerations
One interesting thing to note is that not all studies believe that lignans are a benefit to hair growth. In fact, one study even shows that lignans bind to sex hormone binding globulin (SHBG) which may indirectly increase the levels of free testosterone and DHT in the scalp (34).
SHBG is a glycoprotein that binds to two sex hormones: androgens (including testosterone and DHT) and estrogen (35).
This glycoprotein acts as a regulator of the bound hormones, as it reduces the ‘free’ levels of androgens and estrogen in the blood serum and throughout the body.
However, as lignans bind to SHBG they make them less available for the circulating androgens and estrogen.
This may contribute to higher serum and scalp DHT levels, which is a major contributor of hair loss in men and women with AGA.
Until further studies are done on lignans and their effects on hair growth, it’s best to avoid flax seeds and other lignan-containing herbs and ingredients.
Pumpkin Seed Oil
Pumpkin seed oil is produced from the hulled pumpkin seed and it provides an incredibly rich source of hair-nourishing fatty acids, minerals, and antioxidants.
Pumpkin seed oil can be applied topically to provide gentle cleansing and maintain a healthy scalp.
However, for those looking to treat male-pattern baldness, ingested pumpkin seed oil may be able to reduce the activity of 5-alpha-reductase (38).
In a study involving pumpkin seed oil, 76 male subjects with mild to moderate received either a supplement containing 400 mg of pumpkin seed oil per day while the other half received a placebo capsule.
At the end of the 24-week study, 44.1% of the men in the supplement group saw a mild-moderate improvement in hair growth. This same improvement was seen in only 7.7% of the placebo group.
Limitations and Considerations
The greatest limitation of this study is the use of a “supplement containing pumpkin seed powder.”
The supplement Octa Sabal Plus was used in the “PSO treatment group,” but it contains many more ingredients than just pumpkin. These include octacosanols (derived from vegetable powder), gamma linolenic acid (derived from evening prim rose powder), polyphenols (derived from red clover powder), and lycopene (derived from tomato powder).
The source of pumpkin within the supplement is also powder, as opposed to oil as the title of the study suggests.
Due to this, there is no way to tell whether the results of the study were due to the presence of pumpkin, or whether the other components contributed (which is quite likely).
Interestingly, the study also shows that the placebo group saw almost as much of an increase in hair thickness as the treatment group.
Participants to receive Octa Sabal Plus saw an increase in thickness of up to 360 percent, but the placebo group saw an increase of 350 percent.
This suggests that the placebo effect may have been present in both treatment groups (as neither group knew whether they were receiving the active treatment or not), or another factor (such as seasonal hair growth) was also taking place.
One study of mice given green tea extract in their drinking water showed a statistically significant hair growth after 6 months (43).
What is interesting about the catechins in green tea is that they are type 1 isoenzyme selective — that is, they work mainly upon the conversion of testosterone to 5 alpha DHT in skin.
The type 2 isoenzyme is the one finasteride works on, and it is found in the prostate, epididymis, and seminal vesicles (46).
To reap the benefits of green tea supplementation, you could increase your tea intake or add in a green tea supplement.
The bark from the Pygeum africanum, a tree native to Africa, is a powerful DHT blocker. It’s been shown in numerous studies to reduce the symptoms of Benign Prostate Hyperplasia (BPH)
BPH is an enlargement of the prostate, and DHT is a prime aggravator of the condition. When DHT is reduced, the enlarge prostate shrinks and symptoms are minimized (49).
In a study completed in 1998, pygeum bark was shown to play a part in the reduction of BPH symptoms (50).
Interestingly, one of pygeum’s constituents is beta-sitosterol, a plant sterol that’s also found in cashews, canola oil, almonds, and avocados.
Beta-sitosterol can assist in blocking DHT, leading to improved hair thickness and growth (51). It also helps boost scalp circulation, ensuring that vital nutrients and oxygen are available to nourish your hair follicles. (52)
An edible brown alga that’s found off the coasts of Japan and Korea, E. Cava is a promising new lead when it comes to the cessation of hair loss and growth of new hair.
While E. Cava may make a delicious addition to your soups, its topical use has been proven to inhibit 5-alpha-reductase and, therefore, DHT. When applied as a whole, E. Cava was shown to inhibit 5-alpha-reductase up to 61.5% (55).
Even better, though, was the inhibition results of the polyphenol extract dieckol. Dieckol is found in abundance within the alga. The highest concentration tested (100 mg/mL) actually proved to be just as effective as finasteride.
This means that E. Cava and its extracts are a good option to consider if you’re looking to block DHT and encourage the proliferation of new dermal papilla cells (56).
Why Natural Alternatives May Not Be the Answer
There’s no shortage of natural remedies that claim to be the miracle cure for an array of conditions. And at this point, there isn’t even an objective definition of ‘natural’ that everybody can agree on.
However, there are nature-based hair loss treatment alternatives that have been studied in regards to their hair regrowth abilities.
There are many of them which have very little evidence to support their claims, but there are others (such as saw palmetto and pumpkin seed oil) that do show some promise.
However, you should remember that even ‘natural’ ingredients have their downsides and will have the very same side effects as the more traditional AGA treatment options. This is especially true for DHT blockers, which may cause loss of libido among other things (55).
You’ll also want to consider that many of these ingredients target just one cause of hair loss and, therefore, may not be as effective in people with more advanced AGA.
Androgenetic alopecia is a disease with many factors that contribute to its development and progression. By targeting just one or two of these factors, you won’t necessarily see long-lasting results, or results that are worth the side effects you may experience.
So, when should you consider using ‘natural’ alternatives?
In many cases, you can use the natural ingredients above in conjunction with minoxidil or finasteride. This may boost hair regrowth.
And while you can use them by themselves, you should remember that results will not occur overnight (but neither will that happen with minoxidil or finasteride). It can take weeks to months to begin to see a reduction in shedding and even longer to see regrowth, and this will vary depending on the option you choose.
While minoxidil remains the most common topical product for hair loss, there are natural alternatives that may provide the same — or ever better — results.
Minoxidil works by increasing circulation in your scalp, but effective alternatives focus on three ways of halting hair loss: boosting circulation, lowering inflammation, and blocking the production of DHT (57).
Among these alternatives to minoxidil therapy, you can choose topical treatments such as rosemary or lavender oils, or ones you ingest, such as pumpkin seed oil or flaxseed oil.
That’s not to say that minoxidil and other traditional treatment options such as finasteride don’t have their place. And in many cases, they can be the best option when you want to aggressively target your hair loss.
Ultimately, you’ll have to decide whether you’re willing to test out the natural alternatives with the risk of them not working or choose the more solidly proven path. There’s no right or wrong – just whatever works for you.