Thanks a lot Mala. The attached documents are helpful.

Natural Interventions for Alopecia Treatment

Some good potential sources have already been cited above. What I add here is a summary of my findings from a recent internal review I completed on the issue of natural interventions for alopecia. Note that I deliberately confine my attention solely to human clinical studies. What's important to note is that we have several natural agents that have a plausible degree of evidentiary support through based on human clinical data, and my own observation is that these may on their own provide clinically significant relief from alopecia, and they may also provide a synergistic or at least additive benefit to current conventional treatments (note; several other interventions - like millet seeds, among others - have shown some preliminary promise, but I focus on the more robust of the studies, to be updated as new evidence appears].

Essential Oils

A double-blind, placebo-controlled trial1 found efficacy for a treatment oil containing essential oils of thyme, rosemary, lavender, and cedarwood in a grape seed and jojoba oil base. The clinical significant benefit of essential oils in the treatment of alopecia was further confirmed in a randomized placebo-controlled double-blind study of a pulsed electromagnetic field in combination with essential oils2.

Vitamins/Minerals/ Amino Acids

Biotin/Zinc/Silicon: High - and potentially dangerous - dose zinc aspartate and biotin in combination showed preliminary benefit3 for alopecia areata in children, but I note that this was in conjunction with the ultrapotent corticosteroid clobetasol, a problematic deployment in children. In addition, biotin and niacin appear to have some preliminary positive activity4,5. And a proprietary form of silicon (choline-stabilized orthosilicic acid) has shown some promise6,7.

Cysteine: A combination oral supplement of cysteine, histidine, copper and zinc induced a significant mean change in total hair count in male and female patients8.

Melatonin

One double-blind study found that the pineal hormone melatonin, applied topically to the scalp as a 0.1% solution, may be helpful for women with diffuse hair loss9.

Vegetable/Fruit Based Interventions

Topical Onion/Garlic Extracts: Topical crude onion juice in the treatment of patchy alopecia areata was tested single-blind, placebo-controlled clinical study, hair regrowth being observed in 87% of patients treated with onion juice compared to only 13% of the control group10. And topical garlic gel was tested in conjunction with a corticosteroid, a beneficial effect being observed for the garlic gel on the therapeutic efficacy of topical corticosteroid therapy in patients with alopecia areata11.

Preliminary data12 also has found that topical khellin, an extract derived from the fruit of the Mediterranean plant khella ( Ammi visnaga) may promote new hair growth in combination therapy with ultraviolet light for alopecia areata.

Herbals and Phytochemicals

A combination of two herbals, peony-derived glucosides and licorice-dreived glycyrrhizin was tested in pediatric alopecia in a randomized controlled trial13 and found both safe and effective and an earlier RCT also confirmed efficacy in adults14. And the proanthocyanidine flavonoid procyanidine B induced significant mean changes from total hair count in male patients15.

Natural 5-α reductase (5AR) Inhibitors

One of the most extensively researched - and clinical successful - arenas of potential benefit dervies from natural 5-α reductase (5AR) inhibitors, given the fact that he conversion of testosterone to dihydrotestosterone (DHT) via the enzyme 5-α reductase (5AR) is a well-documented major contributing factor of alopecia disorders, and the same mechanisms is of course also implicated in the onset and progression of benign prostatic hyperplasia (BPH).

Curcumin: It is known that curcumin behaves as a natural 5-α reductase (5AR) inhibitor, and this activity was exploited in a multicenter, randomized, double-blind, placebo-controlled study16 which tested the efficacy of 5% hexane extract of Curcuma aeruginosa when added to 5% minoxidil, the combination inducing slowed hair loss and increased hair growth.

Saw Palmetto/Beta-sitosterol: A liposterolic extract of Saw Palmetto (Serenoa repens) and the plant sterol beta-sitosterol (found in Nigella sativa, Serenoa repens, Pygeum africanum, and sea-buckthorn, among other plant sources), both botanically derived 5AR inhibitors, were tested in a randomized, double-blind, placebo-controlled trial5 and found to induce a highly positive response.

Methodology for this Review

A search of the PUBMED, Cochrane Library / Cochrane Register of Controlled Trials, MEDLINE, EMBASE, AMED (Allied and Complimentary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, ISI Web of Science (WoS), BIOSIS, LILACS (Latin American and Caribbean Health Sciences Literature), ASSIA (Applied Social Sciences Index and Abstracts), and SCEH (NHS Evidence Specialist Collection for Ethnicity and Health) was conducted without language or date restrictions, and updated again current as of date of publication, with systematic reviews and meta-analyses extracted separately. Search was expanded in parallel to include just-in-time (JIT) medical feed sources as returned from Terkko (provided by the National Library of Health Sciences - Terkko at the University of Helsinki). Unpublished studies were located via contextual search, and relevant dissertations were located via NTLTD (Networked Digital Library of Theses and Dissertations) and OpenThesis. Sources in languages foreign to this reviewer were translated by language translation software.

References

Thanks a lot Constantine. Your review was so helpful. I noticed though that you added few materials that don not fit in the " natural" remedies like corticosteroids and melatonin

Najla:

As to the corticosteroids, they were incidental to the studies: the natural agents (biotin, cysteine, etc.) were the essential partners and have independent benefit in alopecia, since it is known and established that steroid treatment on its own has no clinically significant value in hair loss or hair growth.

But let me correct one confusion that appears in your response: melatonin is a wholly natural agent, and officially classified as such by the Natural Medicines Comprehensive Database (NMCD), by NCCAM, by the MSK Natural Database, by the Canadian Natural Remedies & Products Database, by the Allied and Complimentary Medicine Database (AMED), and dozens and dozens of other authoritative repositories. It is natural in the same way that Vitamin D (which is also hormonal) is natural (non-pharmaceutical), CoQ10 is natural, glucosamine is natural, etc., and again precisely so categorized in literally hundreds and hundreds of studies - it's status as a natural remedy is not in dispute (it is not herbal, but of course the category of natural  is wider than herbal) - and by all authorities in CAM and integrative medicine (like the eminent Michael Murray, etc.), and of which I am one. Granted, it is not  a botanical, and perhaps that is where the confusion lies, but it is nonetheless naturally derived and hence a true natural remedy like the VDR hormonal Vitamin D is (which occurs in no foodstuff or plant but is still naturally derived).

Glad the review may be helpful, and thanks for the excellent - and important - question!

Constantine

Saw Palmetto (5alpha reductase), stinging nettles, and something for the liver like burdock.

Thanks once more Constantine for your time and for the great answer. Yes there was a confusion between the words "natural" and "herbal", where of course I meant the former. But, things become serious, for me, when hormones are involved, since therapy with hormones is not without complications. Another questions that comes to my mind is "which treatment can be used topically, and which treatment can be used orally?" and who gets to control intake? is it the patient or the doctor? Are these details in your review?

I hope that my questions are not too exhaustive for you, but are the therapies you mentioned suitable for androgenic alopecia?

Thank you Lynn.I wonder if the plants you mentioned have certain geographic distribution or they are widely available.

Najla:

First, as to oral versus topical:

All the interventions cited in my review are topical except for:

All the above were - and must be - administered as oral supplements.

As to dose and scheduling control, that is prescribed by the study, but may be modulated by the patient given the absence of significant harm per the supporting studies.

In addition, all the intervention cited were of benefit to androgenetic alopecia, both male and female pattern baldness.

As to Lynn's suggestions:

(1) I did of course document in my review, above, the benefit of Saw Palmetto (see my discussion under "Natural 5-α reductase (5AR) Inhibitors"), and here Lynn and I are in agreement.

(2) the phytosterols of burdock root are sometimes claimed to be of potential benefit in alopecia conditions, but we lack not only human clinical data to support this claim, but nor is there any supportive in vitro or in vivo preclinical data.

(3) The same is true of stinging nettles, often claimed to be of potential benefit due to component antiandrogens, but again without supporting preclinical or clinical data (although I should note that there are several patents, current and pending, on use of a formulation comprising a combination of Saw Palmetto extract, African Pygeum extract, and stinging nettle extract, but as the patent holders themselves admit, this is speculative and hypothesis-generating but without evidentiary support).

Melatonin

Finally, I will correct another misunderstanding about hormonal agents - and perhaps I should have clarified this within the summary of my review - of which we have to distinguish different classes: therapy with hormones is not necessarily problematic as to safety or complications, but rather that is true ONLY of certain hormones, especially the steroidal sex hormones (estrogen, progesterone, testosterone, etc.), of which melatonin is not one. It is most certainly NOT true of melatonin, to date documented to be the safest - and one of the most effective - CAM intervention ever studied, and remains the single most studied CAM agent in medical history (over 12,000 studies in PUBMED alone, and above 30,000 across just EMBASE, AMED, and ISI Web of Science (WoS) after removal of duplicate entries). And its safety and absence from any clinically significant complications and adverse events has not only been demonstrated in adults, but also in the pediatric setting, and even in preterm infants and neonates where it has been found of significant benefit in dozens of neonatal diseases! It is the most pervasive active natural agent in all life forms down to the amoeba and paramecium as well as in virtually all primitive plant life. I myself have documented it's extraordinary benefits in the oncology context, and backed by Level I evidence from over a dozen randomized controlled trials (RCTs) and several meta-analyses, and with not only anticancer therapeutic benefits, but also significant oncological supportive activity as a chemoprotective, radioprotective, cardioprotecive, and antithrombocytopenic agent, and it's range of demonstrated benefits is a wide spectrum that also included movement and neurological disorders, among over two dozens additional arenas with human clinical data supporting safety and benefit. Hence it remains one of our best, safest, and most effective CAM interventions (and with level I supporting data), bar none.

Caution and Lessons Learned:

The only interventions reaching a level of "probable" efficacy are:

However, except for essential oils, the agents used were in proprietary formulations that are not commercially available, so it is unknown whether any other similar formulations would be of an comparable benefit, since they were not tested. For essential oils, one company (Silky Scents) does market precisely the formulation used successfully in the studies (https://silkyscents.com/blend_p67.htm).

Finally, it must be remembered that none of these interventions have been tested in head-to-head comparisons with the conventional medicine 5-α reductase (5AR) Inhibitor minoxidil, which remains the best evidenced intervention for clinically significant benefit in hair loss and thinning, in both male and female pattern baldness, as well as for chemotherapy-induced alopecia. To make any comparative judgments of the natural interventions versus minoxidil, we must await more mature human clinical data to appear, if any.

Shiatsu therapy is sometimes used to treat alopecia. There are specific sequences of points on the head that are used. However, there is no evidence-based research to support its use, to my knowledge.  

Dear Leisa,

Guess the following paper might be useful to you..

http://www.hindawi.com/journals/ecam/2014/549721/35183826/

Anthroposophic medicine uses the non oncologic version of VISCUM ALBUM( by WALA or WELEDA) to treat alopecia, but mostly Alopecia Areata. The recommendation is to inject in the affected area once a week every second week between 1mg-10mg. I suppose a good option would also be massaging the areas with it. The commercial name is Iscador M c. Hg or Iscador M.

A funny one that sounds worth trying is also the grandmothers´treatment: pressing onion juice and leaving it on the affected area some 20 min. before washing....;)

Thank you Leisa and Apar. Unfortunately I am not aware of Shiatsu, although it seems an interesting option to try with patients.

The term Anthroposophic medicine is also new to me, but thanks anyway Erica. If I understand the term right, the role of spirituality in health and disease should be emphasized by all doctors. 

What did you mean by "non oncologic version" ?

Well, VISCUM ALBUM is actually Mistletoe and some preparation of it are used as oncologic therapy. In this case, they are not necesary. 

please find attached paper herbs used to treat androgentic alopecia

https://www.researchgate.net/publication/278045537_Hair_Growth_Focus_on_Herbal_Therapeutic_Agent

Article Hair Growth: Focus on Herbal Therapeutic Agent

5 alpha reductase is an enzyme in the body that converts testosterone into DHT which then goes on to cause hair loss in men affected with androgenic alopecia. By inhibiting the enzyme we can essentially slow down the production of DHT and thereby prevent hair loss.

Alkalizing the bloodstream by consuming foods that have a net alkaline effect on the body can significantly reduce the amount of type 2 alpha 5 reductase in the scalp. You should find out what foods have alkalizing properties and increase the proportion of these foods in your meals, and conversely find which foods have acidifying properties and try to eat less of them. Amazingly this is a method that’s far more effective at inhibiting alpha 5 reductase from creating DHT in the scalp, than any synthetic drug like finasteride. It’s also completely in line with nature and the only side effects are increased health, energy, metabolism and sex drive. Type 2 alpha 5 reductase is an enzyme that converts testosterone to dihydroxytestosterone. 

Enzymes have a very narrow range of pH that they can operate within, and outside this range they can’t do their job. Type 2 alpha 5 reductase operates below neutral in our scalps. So by raising our bodily pH we can directly reduce the amount of DHT in the scalp. Alkalizing the bloodstream is the most effective and long term solution for inhibiting 5 alpha reductase and can have a dramatic effect on preventing further hair loss. 

Thank you Nagendra and Alok for the valuable answers