DHT, Hair Loss and Treatment Options: Finasteride vs. KESHAH’s Natural Approach

Why DHT Matters

Androgenetic alopecia (AGA) is driven by an excessive response to androgens, especially dihydrotestosterone (DHT). People with AGA show elevated DHT levels, increased 5‑alpha reductase activity and higher androgen receptor density in balding scalp regions. This androgenic milieu progressively miniaturizes hair follicles, leading to thinner, shorter hairs and eventual loss¹. Two isoforms of the 5‑alpha reductase enzyme convert testosterone to DHT. Type 2 is most significant in AGA and resides predominantly in hair follicles and dermal papillae, while type 1 is found mainly in sebaceous glands². Inhibiting type 2 5‑alpha reductase reduces scalp DHT by more than 60 %³, slowing the miniaturization process.

Drug‑Based Solution: Finasteride

Finasteride is a selective, competitive inhibitor of type 2 5‑alpha reductase. By lowering DHT in the scalp and serum, it can halt or reverse hair loss in many men. Finasteride is usually prescribed at 1 mg/day and is more effective at the vertex than at the frontal hairline³. Noticeable results require 4–6 months of continuous use, and treatment must continue indefinitely to sustain hair growth⁴. Finasteride is contraindicated in women of childbearing age because it can cause ambiguous genitalia in male fetuses⁵.

Efficacy

Large randomized trials and meta‑analyses show that finasteride increases hair count and density compared with placebo. Its DHT‑lowering effect explains why it’s one of the only FDA‑approved pharmacologic treatments for AGA⁴. However, results vary; some individuals see modest regrowth, while others experience stabilization without significant new growth. Combining finasteride with topical minoxidil often yields better outcomes⁴.

Side Effects

Finasteride’s DHT suppression isn’t limited to the scalp, so systemic side effects can occur. Sexual dysfunction is the most discussed adverse effect, but studies differ on its prevalence:

• Reviews report that erectile dysfunction (ED) affects 2.1–15.8% of users, ejaculatory problems 2.1–7.7%, and decreased libido 3.1–5.4 %⁶. These effects typically emerge early and often resolve either after discontinuation or with continued use⁶. A large seven‑year trial involving over 17,000 men found that finasteride increased sexual dysfunction only slightly, and the effect diminished over time⁷.

• A systematic review of 12 randomized trials (3,927 men) found moderate‑quality evidence for increased ED risk (relative risk 2.22) and a possible increase in any sexual disturbance, but discontinuation rates due to sexual adverse effects were similar to placebo⁸.

• A small, widely publicized study reported persistent sexual dysfunction lasting months after stopping finasteride, but it involved only 71 men and had several limitations, including selection and recall bias⁹.

Finasteride may also reduce ejaculatory volume, as DHT acts on the prostate⁶, and there are case reports of decreased sperm quality that improved after stopping the drug¹⁰. Due to its DHT suppression, finasteride can mask prostate‑specific antigen (PSA) levels, potentially delaying prostate cancer diagnosis; thus, men taking finasteride should inform their healthcare providers⁵.

How KESHAH Addresses DHT Naturally

KESHAH takes a non‑pharmacologic approach to hair loss by targeting both mechanical scalp stress and androgenic excess. Our program combines mechanotherapy with plant‑based oils rich in compounds that modulate DHT, reduce inflammation and support follicle health.

Mechanotherapy: Studies show that scalp regions prone to balding are tightly bound to the galea aponeurotica and experience elevated mechanical stress. A finite‑element analysis found a strong negative correlation between scalp tension and hair density (r = –0.885, P < 0.001)¹¹. Chronic tension can impair blood flow, create inflammation and set the stage for miniaturization. KESHAH’s guided massage techniques relieve this stress, improve circulation and restore a healthier scalp environment.

Natural DHT Control: Our Vriddhi and Ojus oils deliver botanical extracts with anti‑androgenic properties:

• Saw Palmetto: Contains fatty acids that inhibit both type 1 and type 2 5‑alpha reductase, reducing DHT binding to receptors by nearly 50 % and improving hair density in clinical trials¹².

• Rosemary: Improves scalp vascularity and inhibits 5‑alpha reductase activity by up to 94%, with a human trial showing hair growth comparable to 2% minoxidil but with less itching¹³.

• Ashwagandha: An adaptogenic herb that reduces cortisol levels and has antioxidant properties. A randomized trial of a topical ashwagandha serum significantly increased hair density and thickness while reducing shedding compared with placebo¹⁴.

• Other ingredients: Sesame, coconut, castor, neem, Bhringraj and peppermint oils offer anti‑inflammatory, antioxidant and vasodilatory benefits, and several have demonstrated hair‑growth promotion in animal studies¹³.

By using these botanicals in conjunction with mechanotherapy, KESHAH aims to lower scalp DHT levels naturally, reduce inflammation and promote a healthy hair cycle without systemic side effects. While the evidence for some herbs is limited to small trials and preclinical studies, they provide a promising, lower‑risk alternative or complement to pharmacologic treatments.

Takeaway

DHT plays a central role in AGA, driving follicular miniaturization via 5‑alpha reductase. Finasteride combats this by inhibiting type 2 5‑alpha reductase, but it requires continuous use and can cause sexual or systemic side effects in a minority of users. KESHAH offers a different path: alleviating scalp tension through mechanotherapy and using plant extracts that naturally modulate DHT and inflammation. As with any treatment, individual responses vary, and consulting a healthcare professional is essential. For those seeking a holistic, drug‑free option, KESHAH provides evidence‑informed tools to support scalp health and hair growth.