On February 2, 2017, the New York Times published an article “Trump Takes a Hair-Growth Drug”. I’d like to cover the rest of the story and make alternative suggestions for men with hair loss issues as well as prostate issues, which are remarkably related.

The NY Times revealed that Dr. Harold N. Bornstein, President Trump’s longtime physician, prescribed finasteride, a drug marketed as Propecia™ to promote hair growth.  Propecia is a low dose (1 mg/day) version of Merck’s Benign Prostate Hyperplasia (BHP) drug Proscar™, which for BPH which is dosed at 5 mg/day (5 x President Trump’s dosage).  For Proscar and BPH, it is often prescribed in combination with the alpha-blocker doxazosin for men with high blood pressure.

At the onset it should be emphasized that finasteride, Propecia and Proscar should NEVER be taken or even touched by women since it can have risks associated with birth defects and possible additional adverseimpacts in females. 

Obviously, President Trump’s signature “look”involves his fabulous hair and, yes, Propecia does work to prevent hair loss at a very low dose.  Generally, this 1 mg/day dose is safe in men.  Propecia works is by blocking the enzyme 5 alpha-reductase from converting the body’s testosterone into dihydrotestosterone (DHT).  DHT causes androgenic alopecia (hair loss) in many men. DHT is a highly androgenic hormone that is more potent than testosterone and is primarily associated with “masculine” features including the development of male external genitalia in children, increasing muscle development and, unfortunately, hair loss.  In other words, if you block 5 alpha-reductase, males will lose some muscle structure, have a slightly lower libido (sex drive), but will have more hair and possible grow new hair.

President Trump, like me, Dr. Rudi, is 70 years young and 70% of men of that age will have signs of BPH (I still have all my hair also!).  President Trump is actually doing a smart thing for his prostate. His reported PSA (Prostate Specific Hormone) levels are very low and therefore he has a very low risk of BPH and very low risk of prostate cancer, a common cancer in men over 60.  In fact prostate cancer is the second leading cause of death in men over 70 after heart disease.

I am one of those rare people that recommends both pharmaceutical drugs and natural products to prevent and mitigate disease.  Combinations of supplements and drugs can be better than drugs alone and in some cases natural products alone work very well.  On his deathbed, my hero, Steve Jobs regretted trying to fight his pancreatic cancer initially using only natural products.

So the question is are there alternatives to Propecia (finasteride)?  The answer is: yes!

1. Rogaine(Minoxidil) is a hair loss drug treatment that must be applied daily/topically and can be used by both men and women. It was first used as an anti-hypertensive. In clinical studies it presented a side effect of hair growth.  Rogaine can be used as a stand-alone product or combined with Propecia for a very effective 2-drug solution. The main issue with Rogaine is the daily topical treatment regimen requirements. Rogaine can also be used in combination with oral natural products such as saw palmetto extract (oil), or pumpkin seed oil, both of which block the same enzyme, 5 alpha-reductase from converting the body’s testosterone into dihydrotestosterone (DHT) that Propecia targets.  So if you start using Rogaine, my suggestion is to also use saw palmetto and or pumpkin seed oil.  You will get great results.
2. Saw Palmetto Extract. The American Indians, over 1,000 years ago, habituating near Eldora, Florida, were the first persons to treat baldness and hair loss using saw palmetto. Saw palmetto oil was also Eli Lilly’s first drug! It also appears that the Florida Indians used the product for BHP. Though at that time very few men reached the “BHP ripe age” of 60 plus. Saw palmetto oil at 320 mg a day is an effective 5 alpha-reductase inhibitor that prevents converting the body’s testosterone into dihydrotestosterone (DHT) to some degree.  The enzyme inhibitor arises from the natural phytosterols found in the ripe saw palmetto berries. The best saw palmetto oil on the market is called US Plus™ and it is made using super critical fluid extraction (CO2 extraction).  It is very important that you take at least 160 to 320 mg a day with food.  The product takes about 2 months to function because reversing the enzyme 5 alpha-reductase from conversion is incremental.  It is not instant relief.  Caution needs to be exercised when buying saw palmetto extract, it must be an oil or an oil absorbed onto a powdered carrier that delivers at least 320 mg of oil a day.  About 50% of the saw palmetto products on the market today are “fake”saw palmetto because they are essentially immature dried saw palmetto berries that have been ground and powdered.  This does not provide enough oil.  Saw palmetto extract is a registered drug for BPH in Europe and it is very effective.  By itself it will lower your libido slightly, but, important to note, a clinical study showed that men using saw palmetto extract had a much better sexual experience due to their less enlarged prostates, resulting in better flow of semen/seminal fluid and therefore better sexual experience.
3. Saw palmetto oil is very acidic and therefore should be only taken with food.  If you suffer from acid reflux you should consider taking an acid reducer 1 hour before taking saw palmetto oil.  Never take it on an empty stomach.
4. Saw palmetto oil will reduce hair loss in older men and in some cases actually promote new hair growth.
5. Saw palmetto can be used in combination with Rogaine topically, but not in combination with Propecia.
6. Saw palmetto grows mainly in Florida, USA and any other country of origin that does not use Florida berries probably means “fake SP”.  Saw palmetto does not grow in China and the crop cannot be farmed or cultivated.
7. Pumpkin Seed Oil or raw Pumpkin Seeds.  Pumpkin seeds contain essentially the same phytosterols that are found in saw palmetto.  Therefore pumpkin seed oil and raw uncooked pumpkin seeds inhibit the enzyme 5 alpha-reductase and blocks the conversion of the body’s testosterone into dihydrotestosterone (DHT).  I do not recommend that women of child bearing age eat pumpkin seeds or consume the oil since there is the possibility that this could lead to birth defects.  Also, I do not recommend pumpkin seeds for children that have not reached sexual maturity since phytosterols could possibly lead to androgenic abnormalities such as insufficient development of male external genitalia in children.  The foregoing statement does not apply to pumpkin fruit meat that is used to make such delicious things like pumpkin pie.  Pumpkin seed oil has undergone clinical trials and has been shown to be effective for BPH. The oil is not acidic and therefore can be consumed on an empty stomach.  Eating raw pumpkin seeds daily or in addition to pumpkin seed oil or saw palmetto oil is another option.  I find pumpkin seeds delicious and I eat them regularly as a snack.  A note of caution, since pumpkin seeds have a high oil content, they are very caloric. One serving of pumpkin seeds consists of 3 tablespoons or 30 grams and this contains 16 grams of oil and 150 calories from fat and a total of 190 calories. On the other hand the fat is mostly unsaturated.
8. Pumpkin seed oil can prevent hair loss and even restore hair growth in men only, it is not suitable for women.
9. Like saw palmetto, pumpkin seeds and the corresponding oil will slightly reduce libido in men.
10. You can take products that contain both saw palmetto oil and pumpkin seed oil
11. Pumpkin seed oil can be taken instead of Propecia for BPH.
12. Pumpkin seed oil can be used along with topical Rogaine for an effective 2 punch hair loss treatment.

Additional thoughts in combating BPH and reducing the likelihood of prostate cancer:

1. Eat a healthy diet and exercise regularly.
2. Keep within you weight guidelines
3. Men must take at least 10 mg Lycopene a day as a supplement.  Tomato sauce has a lot of Lycopene but it may cause kidney stones in many cases.
4. Do not smoke.
5. Avoid being constipated.  Constipation puts pressure on the prostate and toxins in the body’s waste can be reabsorbed into the prostate
6. Sexual activity increases testosterone in men and this contributes to less hair loss and better prostate health.
7. Avoid vasectomies.  If you have one get it reversed.
8. “Keep the pipes open” men need to have their seminal vesicle “purged” on a regular basis and this means ejaculation. How one does this is an individual matter, but it is important for good prostate health.