Androgenic Alopecia (Hair Loss) Treatment - Diet & Supplements

Key Takeaways

• Different types of hair loss can be irreversible or reversible depending on if the condition is scarring or non-scarring.
• Adequate dietary intake of protein is important for hair growth. Adding fermented foods and soy into the diet may be beneficial for hair growth as well.
• Some vitamins, minerals, and herbs can be used to support hair growth in individuals with non-scarring hair loss.

What is Androgenic Alopecia & Other Types of Hair Loss?

Androgenic alopecia is a type of non-scarring hair loss commonly referred to as male or female pattern baldness.¹ Non-scarring hair loss signifies that the hair follicle is not destroyed, in contrast to scarring hair loss. Non-scarring types of hair loss are more common and have a better chance of being reversed than scarring types of hair loss.¹

Androgenic alopecia can be inherited from either or both parents. A metabolite of testosterone called dihydrotestosterone (DHT) is thought to play the main role in the development of androgenic alopecia. DHT is stronger than testosterone and can bind to an androgen receptor longer than testosterone.² Testosterone is converted to DHT by the type II 5-alpha-reductase enzyme.² DHT then attaches to androgen receptors in the dermal papilla and tissues around the hair follicles.² Hair follicles of individuals prone to androgenic alopecia become sensitive to DHT and start to shrink, resulting in hair thinning.²

Figure 1. Testosterone to Dihydrotestosterone³

Other conditions can also affect hormones and result in non-scarring hair loss such as polycystic ovarian syndrome and hypothyroidism.¹

Scarring hair loss results in the destruction of the hair follicle due to inflammation and is typically irreversible.¹ There are mixed types of hair loss where individuals may experience scarring and non-scarring hair loss that can occur due to environmental or behavioral causes.¹ It is important to identify the type of hair loss a patient is experiencing to treat it properly.

The different types of non-scarring, scarring, and mixed hair loss can be seen in the table below.

*male and female pattern hair loss

 

Dietary Interventions for Hair Growth

• Protein
• Fermented foods
• Soy

Protein

Adequate protein consumption is important for hair growth. A recent study performed over a period of one month found scalp biopsies from the low protein intake group (less than 20 g/day) to have chronic perifollicular inflammatory infiltrate and perifollicular fibrosis.⁴ Whereas the high protein intake group had normal follicular structure on scalp biopsy.⁴  

The amino acid L-lysine may play an important role in hair growth. L-lysine combined with iron supplementation significantly increased mean serum ferritin concentrations and decreased hair shedding in some women experiencing hair loss who did not respond to iron supplementation alone.⁵ However, more studies are needed to evaluate L-lysine as an intervention for hair loss.

Fermented foods

Kimchi and other fermented products contain several beneficial probiotics. A recent pilot study in Korea evaluated the use of a product containing probiotic-rich kimchi and a traditional Korean fermented soybean product, cheonggukjang, for individuals with androgenic alopecia.⁶ Greater improvement of hair thickness and count was seen in male participants compared to female participants.⁶

The increase in hair growth may be due to the beneficial effects of the probiotics in kimchi and cheonggugukjang. The bacteria Bacillus subtilis used to ferment cheonggukjang contains ultra-high molecular weight poly-γ-glutamic acid. This acid has been shown to inhibit 5-alpha-reductase activity.⁶ Probiotics have also been shown to improve serum lipid profiles. This may indicate improved peripheral blood flow and circulation, both of which are important for hair growth.⁶

Soy

A 2013 study investigated environmental and lifestyle factors that may contribute to or prevent androgenic alopecia. Researchers found that blood vanadium concentrations and frequent soybean drink consumption may provide preventative androgenic alopecia.⁷

Soybeans are high in isoflavones which display antioxidant and estrogen-like activities.⁷ Soy can modulate estrogen-dependent mechanisms and inflammatory activity to potentially reduce hair loss.⁷ While more studies are needed to test efficacy, one study evaluated the effects of a soy derived immunostimulating peptide (soymetide-4) on neonatal rats with alopecia. Oral administration of this peptide was found to suppress alopecia caused by the anti-cancer drug etoposide in these rats.⁸

Supplements to Support Hair Growth

Certain vitamins, minerals, and herbal supplements may be beneficial in supporting hair growth. While vitamin and mineral deficiencies aren’t the direct cause of androgenic alopecia, some individuals with androgenic alopecia may be deficient or have low levels of the following nutrients which may also contribute to their hair loss.

Vitamins

• Biotin
• Vitamin C
• Vitamin D
• Vitamin E

Biotin

Biotin deficiency is rare but may result in hair loss if present.⁹ A study involving 18 individuals with either genetically caused or environmentally acquired biotin deficiency showed clinical improvement in hair growth after biotin supplementation.⁹

No clinical trials show its efficacy in individuals experiencing hair loss without a biotin deficiency.⁹ However, biotin may strengthen the hair that exists to prevent breakage and provide a thicker appearance. It’s important to note that biotin may alter the results of biomarker testing for thyroid stimulating hormone, troponin, and qualitative urine human chorionic gonadotropin (hCG).⁹ These markers assess thyroid function, heart attacks, and pregnancy respectively.¹⁰ The FDA states that biotin levels higher than the recommended daily allowance of 0.03 g may cause interference with lab results.¹ Some supplements may contain 1.25 - 20 mg of biotin, so a discussion regarding what supplements a patient takes is warranted before testing for these markers.¹⁰

Vitamin C

Vitamin C is a potent antioxidant and is important for collagen fiber synthesis.^9,11 Oxidative stress has been linked to hair loss and may play a role in the balding phenotype and development of androgenic alopecia.¹¹

Vitamin C is also important for iron absorption.^9,11 Decreased iron levels can contribute to hair loss so it may be beneficial to look at the patient’s iron levels and consider supporting iron absorption with vitamin C if their levels are low.⁹

Vitamin D

Vitamin D is thought to stimulate dormant hair follicles to enter the growth cycle.¹¹ Some animal studies imply that vitamin D plays a role in hair follicle cycling and some in vitro studies have found increased vitamin D receptor expression on the outer root sheath of keratinocytes during the growth phases of the hair cycle.^11-14

A study involving a small sample size of women with female pattern hair loss and telogen effluvium found serum vitamin D2 levels to be decreased in affected individuals.¹¹ Other studies have shown mean serum vitamin D levels to be significantly decreased in individuals with alopecia areata as well.⁹ However, more clinical research is needed to evaluate the use of vitamin D for androgenic alopecia or alopecia areata.^9,11

Vitamin E

Vitamin E is another potent antioxidant that can protect cells against oxidative damage.¹¹ There haven’t been many studies investigating the benefits of supplementation with vitamin E specifically for hair loss. However, one study with a small sample size found supplementation with mixed tocotrienols (a group of chemicals that are a part of the Vitamin E family) to have a significant increase in hair count compared to the placebo group.¹¹

Vitamin E should not be taken in excess as it may have adverse effects on hair growth as seen in volunteers who took a dose about 30 times the daily recommended intake.⁹ More studies are needed to support the use of vitamin E for hair loss.⁹

Minerals

• Iron
• Zinc
• Silicon

Iron

Iron is one of the most common nutrient deficiencies that can contribute to hair loss.⁹ Iron deficiency is common in women, but not necessarily more common in women with androgenic alopecia.⁹ One study found women with androgenic alopecia to respond best to treatment of anti-androgen cyproterone acetate and ethinyl oestradiol when serum ferritin levels were above 40 micrograms/l.¹⁵ It may be worthwhile to check the iron levels of female patients if they are experiencing hair loss as iron deficiency could be a contributing factor.

Zinc

Zinc deficiency can contribute to hair loss but can be reversed following oral supplementation.¹¹ A study involving patients with alopecia areata, androgenic alopecia, and telogen effluvium found all groups to have statistically lower serum zinc levels than the healthy control group.¹¹ A case series of five individuals with telogen effluvium and zinc deficiency found reversal of hair loss after zinc supplementation.^11,16 Another study found oral supplementation of zinc sulfate to create thicker hair shafts in individuals with androgenic alopecia.¹⁷

More research is needed to evaluate the use of zinc supplementation for hair growth in individuals without zinc deficiency. If a deficiency does not exist, caution should be taken when taking zinc supplements to avoid toxicity.¹¹

Silicon

Silicon is one of the most abundant trace elements in the body and is important for optimal collagen synthesis and activation of hydroxylating enzymes.¹⁸ A form of silicon called orthosilic acid (ch-OSA) has been found to stimulate fibroblasts to secrete collagen type I which is used to build strong hair.¹⁸ A study involving women with fine hair found supplementation with 10 g/day of ch-OSA to result in thicker hair by having a positive effect on the tensile strength, elasticity, and break load of hair strands.¹⁹

Herbal supplements

• Saw palmetto
• DIM-diindolylmethane
• Horsetail

Saw palmetto

Saw palmetto (Serenoa repens) is an herb that has 5-alpha-reductase inhibiting properties and has been used in the past for the treatment of benign prostatic hyperplasia.^3,20 Although more studies are needed, there is some evidence showing its efficacy for hair loss.

A study involving men with mild to moderate androgenic alopecia found 60% of individuals taking a 200 mg liposterolic extract of saw palmetto to have improved hair growth after treatment.²⁰ Another study compared the use of a 320 mg saw palmetto extract to 1 mg of finasteride over two years in men with androgenic alopecia.²¹ While the finasteride group showed higher hair growth scores, 38% of individuals in the saw palmetto group saw an increase of hair growth, primarily at the vertex of the scalp.²¹ Liposterolic extracts of saw palmetto have also been found to promote hair regeneration by activating TGF-β and mitochondrial signaling pathways in mouse models with hair loss induced by DHT.²²

DIM-diindolylmethane

DIM-diindolylmethane is another anti-androgenic compound found in cruciferous vegetables.^23,24 There is a lack of clinical data that exists for its use for hair loss. However, it has been shown to have an anti-inflammatory effect via the inhibition of NK-kB in mouse models and has also been shown to have a balancing effect on estrogens.^23,24 An in-vitro study of androgen-dependent human prostate cancer cells found that DIM has potent antiproliferative and antiandrogenic properties as a pure androgen receptor antagonist.²³

Horsetail

The herb horsetail (Equisetum arvense) has been found to have high silica content in multiple parts including the rhizome, stem, leaf, and spores.²⁵ As previously mentioned, silicon is important for collagen synthesis and building strong hair. Historically, this herb has been used in folk remedies as a diuretic, muscle relaxant, and hair growth stimulant.²⁶

Equisetum arvense has not been tested for 5-alpha reductase inhibition activity but Equisetum debile extracts have been.²⁶ Palmitic acid and phytosterols are a major component of plants in the Equisetaceae family that may be responsible for their 5-alpha-reductase inhibition activity.²⁶ Fraction ethyl acetate extracts thought to contain these compounds were found to have the highest 5-alpha-reductase inhibition among the five other types of extracts tested.²⁶ More studies are needed to evaluate the clinical application of horsetail for hair loss.

Practical Tips

• Make sure to make a correct diagnosis before treating a patient for hair loss, as some types are irreversible.
• Ask the patient about their diet to see if they are getting enough protein and other nutrients to support hair growth. Consider suggesting adding kimchi or other fermented foods into the patient’s diet.
• Consider testing vitamin and mineral levels for deficiencies when treating a patient with a non-scarring type of hair loss as zinc, iron, biotin, and vitamin D deficiencies may be contributing to the hair loss.