Can Red Ginseng Ethanol Tincture Regrow Hair?'

Name: Kiran

Question: My friend told me he's using red ginseng ethanol tincture to treat his hair loss. I just want to know if this really can regrow hair for Male Pattern Baldness, how much should you use and if it is safe?

Answer: Hi, Kiran. Red ginseng - also known as panax ginseng - is believed to inhibit DKK-1, a gene found to be highly upregulated - made more prevalent - in the dermal papilla of hair follicles affected by androgenic alopecia, which is perhaps better known as Male Pattern Baldness.

A 2007 study from Kyungpook National University in Daegu, Korea, found that DKK-1 mRNA is upregulated only 3-6 hours after dihydrotestosterone (DHT) treatment; DKK-1 is then secreted from dermal papilla cells in response to DHT.

This was seen to inhibit the growth of cells in the outer root sheath and trigger cell death. These findings would, therefore, explain the gradual follicluar miniaturisation process and eventual baldness that occurs in cases of androgenic alopecia.

Researchers from the study concluded that “…DHT-inducible DKK-1 is involved in DHT-driven balding” adding that, to reverse the effects of DHT in the dermal papilla, a DKK-1-neutralising antibody should be used.

A further hair loss study was carried out in 2017 at Dankook Medical College in the Republic of Korea, using panax ginseng extract to inhibit the effects of DKK-1 in the hair follicle. This was successfully achieved on ex vivo human hair organ culture.

Published results show the panax ginseng extract managed to regulate apoptosis-related gene expression in the hair follicle. This essentially means the genes responsible for cell death in the hair follicles were better regulated with the help of the panax ginseng extract, leading to a reduction in the rate of cell death in the follicles.

Although only ex vivo trials were conducted, I believe this has good potential for further research and we may well see it being used in genetic hair loss treatments in the future.

Panax ginseng has anti-inflammatory and antioxidant properties, both of which are important for healthy hair follicles. Several studies over the years have also found it to be helpful in promoting hair growth as it stimulates cell proliferation. Now we also know that it inhibits cell death in outer root sheath keratinocytes in the hair follicle.

Most studies I reviewed used panax ginseng extract in ethanol which is also known as a panax ginseng tincture, 'tincture' referring to the common pharmacology practice of dissolving a medication or drug in alcohol. Many minoxidil preparations are also dissolved in alcohol.

Usually when a medication is used, the administered dose is strictly regulated, for example the only clinically-proven oral male hair loss treatment - the DHT-blocking tablet finasteride - is taken in a 1mg dose each day. Also, when applying minoxidil, usually only 1ml of the formula is used in total during each application (usually once or twice per day depending on the instructions provided). This is a very small amount and is unlikely to cause skin irritations, unless there is a pre-existing skin condition or sensitivity to one of the ingredients.

Regarding absorption or efficacy of red ginseng extract or tincture, it is difficult to comment as we need more research. Red ginseng extract is already used orally, and occasionally topically, with various effects, however, as with most herbal preparations, there is no particular dose that is widely or strictly recommended - nor is this regulated - for use relating to hair regrowth.

There is no reliable evidence determining precisely what percentage of ginseng tincture is absorbed topically into the hair follicles if it is applied to the scalp.

Whilst one study I am aware of used 20ppm (parts per million) root of panax ginseng extract in 70% ethyl alcohol, this was in a lab setting and not tested on human patients. The few human trials I have seen involved red ginseng taken orally while the participants were also using other hair loss medications, such as corticosteroids for Alopecia Areata.

Overall, it seems clear more research is needed in this area to establish not just its proper safety, efficacy and tolerability, but also the optimal dosing and delivery methods.

There are warnings regarding possible side effects for oral red ginseng, which include sleep disturbance, blood pressure changes, breast pain, mood changes and rashes developing. Topical use is likely to be safer but this has not yet been properly established. I consulted my colleague, Superintendent Pharmacist Prescriber, Christina Chikaher, on this who advised it is unlikely the tincture element would cause any harm, but agreed that the likelihood of adverse events related to the red ginseng was yet to be properly established.

Again, I believe we need more research on the efficacy and safety of topical red ginseng when used specifically as a hair loss treatment, as well as its long-term profile, given pattern hairloss requires on-going use.

Given this, for now at least, there is not enough concrete scientific evidence to support our recommending it without further research but if you wish to give it a go, we advise you to do so under the supervision of your GP. However, if you wish to explore authorised treatment options, a consultation with a dedicated specialist can provide you with a diagnosis and, if appropriate, tailored recommendations for suitable hair loss solutions and hair growth supporting products.