What is male pattern baldness?

Male pattern baldness (MPB) is also known as androgenetic alopecia. If you break this down, “andro-” refers to hormones, “genetic” refers to our DNA and “alopecia” refers to baldness. MPB is responsible for a whopping 95% of male hair loss so, naturally, the search for a cure has gathered enormous interest. But treating male pattern baldness means understanding what actually happens at the level of the hair follicle.

In MPB, hair follicles in susceptible individuals are genetically programmed to be sensitive to the effects of hormones. This triggers gradual hair loss as the hair follicles become smaller over time until they eventually stop producing hair altogether. This process usually begins at the temples or crown of the scalp and gradually spreads, resulting in a characteristic pattern of baldness in men.

What is DHT?

DHT is a male sex hormone (or “androgen”) made from the natural conversion of testosterone. While we think of testosterone as the quintessential male hormone, DHT is actually far more potent and plays a crucial role in developing male characteristics; sexual development, facial hair and body hair growth, a deep voice and increased muscle mass are all driven by this DHT hormone.

But while DHT has essential roles in male development, it does produce some unwanted side effects, such as:

• Acne
• Increased heart disease risk
• Prostate growth, leading to an enlarged prostate or prostate cancer
• Male pattern baldness

So while DHT can give you the bushy beard of your dreams, you may well be sacrificing your luscious locks.

The role of DHT in hair loss

In all men, the conversion of testosterone to DHT happens in the hair follicles. But in those who are genetically susceptible, these hair follicles are especially sensitive to DHT. This triggers hair loss in two ways.

Miniaturisation.

When DHT binds to hair follicles they can slowly shrink, weaken, and ultimately stop producing hair. This process is known as follicle miniaturisation. Even if you haven’t fully lost your hair, you may notice your hair thinning or becoming coarser — and this miniaturisation process is responsible.

Disrupted hair growth cycle

Your hair follicles usually follow a characteristic growth cycle. However, DHT interferes with this cycle, shortening the growth phase and lengthening the period in which your hair doesn’t grow at all.

The overall effect is the characteristic pattern of hair loss that we associate with male pattern balding.

How do DHT blockers work?

DHT blockers work by targeting the production of DHT. Remember that DHT is made from the conversion of testosterone, which is done using an enzyme called 5-alpha-Reductase. DHT blockers bind to this enzyme, preventing it from producing DHT.

This reduces the circulating level of DHT, explaining the role of DHT blockers in hair loss prevention. However, we’ve discussed the other useful roles of DHT which would also be affected by blocking its production, meaning these treatments can have side effects.

Many treatments for male pattern baldness only seek to manage the symptoms of the condition. But by using an effective DHT blocker you can tackle the cause of MPB directly and fight hair loss head-on.

What are the best DHT blockers?

Given the hype around DHT blockers, there are plenty of treatments that claim to reduce DHT levels and therefore combat hair loss. Let’s take a look at the main candidates:

Finasteride

Finasteride (often sold as Proscar or Propecia) is currently the only evidence-backed DHT blocker on the market. It works by blocking the enzyme 5-alpha reductase which prevents DHT production from testosterone- and it’s very effective. In fact, studies have shown that with finasteride, DHT levels in the scalp are reduced by 60%, giving your hair follicles time to recover.

This has made finasteride one of the most effective hair loss treatments currently available and it has been consistently shown to be effective in about 9/10 of men who use it. For androgenic alopecia, finasteride can not only slow further hair loss but actually encourage hair growth and undo the DHT hair loss damage. It won’t be exactly the same for everyone but, if there’s one medication to try for male pattern hair loss, it’s this one.

Dutasteride

While it’s the only one licensed for the treatment of male pattern baldness, Finasteride is not the only 5-alpha reductase inhibitor out there. Dutasteride, a common treatment for an enlarged prostate, has a similar function. It just hasn’t been comprehensively studied on male hair loss.

The research that has been done on Dutasteride suggests that it could be just as effective as Finasteride. However, more information is needed before it can be prescribed to tackle DHT-induced hair loss.

Natural DHT blocking treatments

Finasteride is not the only medicine that may have DHT-blocking properties. There are also plenty of “natural” herbal treatments which may help to reduce DHT. However, be aware: the jury is still out on how effective they might be. These herbal treatments are cropping up in everything from tablets to “DHT blocking” shampoos so it’s worth being aware of the shaky evidence basis.

Saw palmetto

Saw palmetto is the commercial name for the medicinal extract from Serenoa repens, a type of palm that grows in the United States. It’s thought to be a bit of a wonder drug these days — with claims around that it can increase testosterone levels, improve the health of your urinary tract, and treat an enlarged prostate.

There aren’t too many studies on its use in hair loss, but one study found that it decreased DHT levels by 32%. So while the evidence is fairly sparse on this, it’s worth considering as an option.

Pumpkin seed oil

Pumpkin seeds are another substance believed to be a natural DHT blocker. Originally found to be a 5-alpha reductase inhibitor in rats, studies have now explored the potential of pumpkin seed oil to reduce DHT in humans too.

The good news? Participants in the study who were treated with pumpkin seed oil had 40% more hair and no side effects. The less good news? It was a very small study, which isn’t hugely reliable.

Green tea

Another natural substance with a reputation as a miracle cure, green tea has been found to have possible 5-alpha reductase-inhibiting powers. That’s down to a chemical known as epigallocatechin gallate (ECGC), which has been found to reduce the impact of DHT on your hair follicles.

However, scientific studies have not yet been conclusive. One study even found that green tea increased the amount of DHT. 

Pygeum

This extract from the bark of the African plum tree has been used to treat a variety of health conditions for decades, including the symptoms of an enlarged prostate. However, the evidence is inconclusive and it’s not confirmed whether the bark extract acts to block DHT, or if it works in another way.

Caffeine

Caffeine has also been credited with certain powers in the battle against balding- but don’t go dunking your head into your morning cappuccino! For caffeine to have any effect on your hair, it should be applied topically — such as with a hair growth shampoo.

What do the studies say? There seems to be pretty good evidence for caffeine and hair growth when it is applied to hair follicles, even producing comparable results to medications. However, the study results do vary so for now we probably need more evidence to make any definitive conclusions.

Ketoconazole

Okay so this one isn’t a “natural” DHT blocker but it’s worth mentioning as an increasingly popular off-label treatment for hair loss. Ketoconazole is actually an antifungal medication, commonly used to treat dandruff and other scalp conditions. However, some studies have suggested that it may also be effective in treating hair loss, potentially through a DHT-blocking effect.

While ketoconazole shampoo may sound like an easy solution, it’s important to note that the evidence supporting its effectiveness is limited. Most of the studies conducted on ketoconazole and hair loss have been small and have not been conducted over a long period of time, so for now it’s worth keeping as a backup option. Make sure to speak to your doctor before you try it because it can interfere with other medications.

What other hair loss treatments are there?

Minoxidil

Whilst not a DHT blocker strictly (as it doesn’t intervene in the process of hormone conversion association with 5α-Reductase) there is another option to help keep the hair on your head: Minoxidil. Minoxidil is also known by the name Regaine and is approved by the FDA as a treatment for MPB.

Minoxidil works in a slightly different way to DHT blockers. Instead of blocking DHT production, Minoxidil improves the health of your scalp (and, therefore, your hair follicles) by increasing blood flow. It is a vasodilator, meaning it widens the blood vessels in your scalp to encourage blood circulation to the area. This increases the delivery of nutrients and oxygen to the scalp, promoting healthy hair and encouraging hair growth.

Minoxidil is applied topically to your scalp as a spray, meaning it can get to work directly on your hair follicles. Minoxidil has been shown to stop further hair loss in two-thirds of men, and it comes with a low risk of side effects. The great thing about it is that there are no interactions with Finasteride – meaning you can use them together to give your fight against hair loss an extra boost.

Hair vitamins

Just like iron tablets for anaemia, sometimes your body needs a helping hand. Our hair vitamins are packed with biotin, zinc, and selenium. These essential minerals are not produced by your body, but they are crucial for healthy hair- and this is a simple way to get all of them! 

DHT blocker FAQs

What is the best DHT blocker?

Finasteride is currently the only medical-grade DHT blocker licensed for male pattern hair loss and has demonstrated great results in trials (and with our customers!) While others may work for you, finasteride is by far the best choice.

Can I use DHT blockers with other hair loss treatments?

Finasteride works well alone, but it works even better when combined with another drug like minoxidil. Combined Finasteride and Minoxidil produce results in 94% of cases, according to studies.

What are the side effects of DHT blockers?

Finasteride is a safe drug, with nearly 99% of men experiencing zero serious side effects in clinical trials. However, as with most medications, some side effects can occur.

They include dizziness, weakness, and swelling in the hands or chest. In very rare circumstances, sexual side effects are possible – including erectile dysfunction, decreased libido, and ejaculation disorders. Studies have found these to be rare, usually reversible, and most often associated with the higher 5mg dose of Finasteride taken by men treating an enlarged prostate gland. If you are concerned about the potential side effects, please get in touch with a Manual clinician.

With herbal remedies, it can be harder to quantify side effects as the full ingredient lists are not always available. However, as herbal DHT blockers tend to not work as well (if at all), side effects are usually milder. Please speak to your doctor before starting any new herbal treatments, particularly if you suffer from any conditions or take existing medication.

Key Takeaways

DHT blockers are medicines that prevent your body from producing the hormone dihydrotestosterone (DHT), which is responsible for male pattern baldness. By reducing the amount of DHT in your system, DHT blockers prevent hair loss – and, in some cases, encourage hair regrowth. While many medicines claim to be DHT blockers, there is only one that has proven effectiveness- Finasteride.

While we’ve ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.