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Is ginseng a DHT blocker?

Red Ginseng Extract (RGE) and ginsenosides protect hair matrix keratinocyte proliferation against dihydrotestosterone (DHT)-induced suppression and affects the expression of androgen receptor.

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Ginseng is an ancient herbal remedy that was recorded in The Herbal Classic of the Divine Plowman, the oldest comprehensive Materia Medica, which was scripted approximately 2000 years ago [9]. Among different species which are known as ginseng, Panax ginseng (Korean or Asian red ginseng) is the most frequently used one. The Ginseng is widely appreciated because it promotes health effect improving the immune response, the cardiovascular system, helping with sexual dysfunctions, preventing cancer, inhibiting tumor cell proliferation among others. In Dermatologic diseases, cancer is being investigate for its therapeutic effects in skin wound reparation, reducing immune response in dermatitis, reduces and prevent skin damage due to photo aging and cold hypersensitivity, improves hair growth reducing hair loss in alopecia [14]. Nowadays has gained fame as one of the most popular herbs originating from Eastern Countries, because contemporary science has revealed that ginseng contains a wide variety of bioactive constituents, especially a group of saponin compounds collectively known as ginsenosides, which have been proposed to account for most of the diverse biological activities, including the hair-growth potential of ginseng [9]. Ginsenosides can be classified, depending on the number of hydroxyl groups available for glycosylation via dehydration reactions, as protopanaxadiol (PPD) and protopanaxatriol (PPT). Common PPD-type ginsenosides include ginsenosides Rb1, Rb2, Rc, Rd., Rg3, F2, Rh2, compound K (cK), and PPD, whereas PPT-type ginsenosides include Re, Rf, Rg1, Rg2, F1, Rh1, and PPT [9] and malony ginsenosides mRb1, mRb2 and mRbc [15]. Ginseng extract or its specific ginsenosides have been tested for their potential to promote hair growth.

3.1 Ginseng biochemical effects on hair growth promotion

The major bioactive constituents of ginseng are ginsenosides and there has been evidences suggesting that promote hair growth by enhancing proliferation of dermal papilla and preventing hair loss via modulation of various cell-signaling pathways [9, 16, 17]. The role of 5α-reductase enzyme in the hair-loss process has been well-documented [18], affects androgen metabolism, and it is the pathway how drugs approved are used nowadays. Novel therapeutics ways for the management of hair loss and alopecia improving hair-follicle proliferation and reducing hair-loss need new targets (Figure 2). These targets include, matrix metalloproteinases (MMPs), extracellular signal-regulated protein kinase (ERK), and Janus-activated kinase (JAK), the activation of the proliferation by WNT/Dickkopf homolog 1 (DKK1), sonic hedgehog (Shh), vascular endothelial growth factor (VEGF), apoptosis inhibition by transforming growth factor-beta (TGF-β). 3.1.1 Photo aging prevention Photo aging is skin damage induced by radiation exposure (Sun exposure) characterized by different inflammatory responses to ultraviolet radiation (UVR). Excessive UV irradiation is known to cause skin photo damage by release of oxidative species which leads to skin inflammation, and keratinocyte cell death producing photo aging and carcinogenesis. There are evidences that suggest that misbalances in the hair-growth cycle, affecting keratinocyte and dermal papilla growth [19] is cause by UVR exposure not only producing the damage of the hair shaft as an extracellular tissue, as it is clearly evident but also alters the molecular growth [19]. The Reactive Oxidative Species (ROS) accumulation and activation of matrix metalloproteinase (MMPs), a tissue-degrading enzymes, produced by UV irradiation compromises dermal and epidermal structural integrity [9]. The inhibitory effect of ginsenosides on UVB-induced activation of MMP2 suggests the potential of these ginseng saponins in hair-growth regulation [9]. Ginsenosides Rb2 [20] and 20 (S) PPD, have been reported to reduce the formation of ROS and MMP-2 secretion in cultured human keratinocytes (HaCaT) cells after exposure to UVB radiation. Ginsenoside Rg3 20 (S), reduced ROS generation in HaCaT cells and human dermal fibroblasts without affecting cell viability. The 20 (S) Rg3 also attenuated UVB-induced MMP-2 levels in HaCaT cells [21]. Ginsenoside Rh2 reduced UVB radiation-induced expression and activity of MMP-2 in HaCaT cells, but UVB-induced ROS formation was only suppressed by 20 (S)-Rh2 [22]. Ginsenosides extracts from the Ginseng radix have shown attenuates radiation-induced cell death in the skin, improving hair growth. Ki67 positive number of cells and Bcl2 protein expression, an antiapoptotic protein, are induced by Total-root saponins and ginsenoside Rb1 diminishing apoptotic cells in UVB-exposed human keratinocytes [9, 23]. Ginsenoside F1, an enzymatically modified derivative of ginsenoside Rg1, by maintaining a constant level of the antiapoptotic protein Bcl-2 expression in UVB-irradiated HaCaT cells, protect keratinocytes from radiation-induced apoptosis [9, 24]. 3.1.2 Ginsenosides reduces skin aging Skin aging is a multifactorial process consisting of two distinct and independent mechanisms: intrinsic and extrinsic aging. Ginsenosides, extracted from Ginseng have been tested in several studies in antiaging [25, 26]. This antiaging effects, of ginseng extract and ginsenosides is produced by maintaining skin structural integrity and regulating hair-growth by stimulating wound healing cells, collagen and hyaluronic acid. Lee et all incubates fibroblasts, which are key wound-healing cells, with Panax ginseng , and found that P. ginseng stimulated human dermal fibroblast proliferation and collagen synthesis [27]. Human dermal fibroblast have different functions and are classified as key wound-healing cells because their function includes the production of collagen, growth factors, antioxidants and a balance of matrix-producing proteins and protease enzymes. In the Human fibroblast P. ginseng root extract activates human collagen A2 promotes and induces type-1 pro-collagen via phosphorylation of Smad2 [28]. Wrinkle formation, is associated as marker of dermal aging and present a reduced level of hyaluronan in the dermis [29]. On HaCaT cell treated with major ginseng metabolite (compound K, 20-O-beta-D-glucopyranosyl-20(S)-protopanaxadiol) were report that hyaluronan synthase2 (HAS2) gene is one of the most significantly induced genes [30] and also was tested that topical application of compound K on mouse skin and shows elevated the expression of hyaluronan synthase-2 [30]. The hyaluronan synthase-2 is an enzyme essential to hyaluronan synthesis, hyaluronan is a major component of most extracellular matrices that has a structural role in tissues architectures and regulates cell adhesion, migration and differentiation. These antiaging effects of ginseng extracts through Src kinase-dependent activation of ERK and AKT/PKB kinases in the dermis and papillary dermis result in improved skin health, thereby ensuring hair-follicle health and a regular hair cycle [9, 30].

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3.1.3 Ginseng on androgen alopecia The exposure to androgens is the major triggers for hair loss is which in most cases is genetically predetermined in androgenic alopecia patients [9, 31, 32]. The androgen that mainly plays a role in altering hair cycling is 5α-dihydrotestosterone (DHT), which is a metabolite of testosterone. The conversion of testosterone to DHT is mediated by the 5α-reductase (5αR) enzyme in each follicle [33, 34] (Figure 2). Treatment with 5α-reductase inhibitors, e.g., finasteride, prevents the development of alopecia and increases scalp-hair growth [9]. Topical application of ginseng extract or ginsenosides was reported to enhance hair growth. Rhizomes of P. ginseng (red ginseng) containing a considerable amount of ginsenoside Ro, Ro is the predominant ginsenoside in the rhizome showed greater dose-dependent inhibitory effects against testosterone 5α-reductase (5αR) [35]. Ginsenoside Rg3 (a unique ginsenoside in red ginseng) and Rd. also exhibited similar inhibitory effects against 5αR [36]. Another variety of ginseng, the Parribacus japonicas rhizome extract that contains a larger quantity of ginsenoside Ro also inhibited 5αR enzyme activity. Topical administration of red-ginseng rhizome extracts and ginsenoside Ro onto shaved skin of C57BL/6 mice abrogated testosterone-mediated suppression of hair regrowth [36]. Major components of hair regenerative capacity such as linoleic acid (LA) and β-sitosterol (SITOS) were significantly restored with Red Ginseng Oil (RGO) after testosterone (TES)-induced delay of anagen entry in C57BL/6 mice, also RGO and its major components reduced the protein level of TGF-β and enhanced the expression of anti-apoptotic protein Bcl-2, suggesting that RGO is a potent novel therapeutic natural product for treatment of androgenic alopecia [37]. Red Ginseng Extract (RGE) and ginsenosides protect hair matrix keratinocyte proliferation against dihydrotestosterone (DHT)-induced suppression and affects the expression of androgen receptor. Moreover, RGE, ginsenoside-Rb1, and ginsenoside-Rg3 at lower levels that have been shown to inhibit 5a-reductase [35] inhibit the DHT-induced suppression of hair matrix keratinocyte proliferation and the DHT-induced upregulation of the mRNA expression of androgen receptor in hDPCs [16]. DHT is the product of testosterone and does not require the activity of 5a-reductase to affect hair follicles, and the inhibitory effect of DHT on hair growth is mediated by the androgen receptor in DPCs [38]. These results suggest that red ginseng may promote hair growth in humans through the regulation of androgen receptor signaling [16]. 3.1.4 Effects of ginsenosides on chemotherapy Majeed et al. review the recent perspectives of ginseng phytochemicals as therapeutics in oncology and explain the chemotherapeutic effect of ginsenoside as result of its appetites, ant proliferative, anti-angiogenic, anti-inflammatory and anti-oxidant properties [39]. The anticancer effect of ginseng was proven in various types of cancer: breast, lung, liver, colon and skin cancer. It increases the mitochondrial accumulation of apoptosis protein and down regulate the expression of anti-apoptotic protein, reducing cancer development. It also aids in the reduction of alopecia, fatigue and nausea, the known side effects of chemotherapeutic drugs [39]. Alopecia induced by chemotherapy is one of the most distressing side effects for patients undergoing chemotherapy. One drug used as chemotherapy is Cyclophosphamide (CP), also known as cytophosphane. Cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC) inhibited human hair growth, induced premature catagen development, and inhibited proliferation and stimulated apoptosis of hair matrix keratinocytes inducing the side effect of alopecia. In human hair follicle organ culture model pre-treatment with Korean Red Ginseng (KRG) before cyclophosphamide metabolite Dong In Keum et all shows that KRG suppress 4-HC-induced inhibition of matrix keratinocyte proliferation and stimulation of matrix keratinocyte apoptosis, playing a protective effect on 4-HC-induced hair growth inhibition and premature catagen development. Moreover, KRG restored 4-HC-induced p53 and Bax/Bcl2 expression [17].

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3.1.5 Activation of dermal papillary cell proliferation Different intracellular signaling pathways are involving and plays a critical role in stimulating hair growth by promoting dermal papillary-cell proliferation. Hair growth is promote by Ginsenoside Rg3 upregulating Vascular Endothelial Growth Factor (VEGF) expression [36]. VEGF is a signaling protein which is released from the epithelium and increases the angiogenesis of the hair follicle [9, 40, 41, 42]. Was also demonstrate by Shin et al. that Rg3 increased the proliferation of human dermal papillary cells, associating this proliferation with an upregulation of mRNA expression of VEGF also stimulated stem cells by upregulating factor-activating CD34 and CD8 [36] and promoted hair growth even more than minoxidil in mouse [43] it was conclude that Rg3 might increase hair growth through stimulation of hair follicle stem cells [36]. RGE and ginsenoside-Rb1 enhanced the proliferation of hair matrix keratinocytes, human hair-follicle dermal papillary cells (hDPCs). Treated hair with RGE or ginsenoside-Rb1 exhibited substantial cell proliferation and the associated phosphorylation of ERK and AKT [16], it was recently demonstrated that ERK activation plays an important role in the proliferation of hDPCs [42] and AKT mediates critical signals for cell survival and also regulates the survival of DPCs as an antiapoptotic molecule [9, 16, 44] proliferation and the prolongation of the survival in the hDPCs by red ginseng may be mediated by the ERK and AKT signaling pathway [9, 16]. Human DPC treatment with Gintonin-enriched fraction (GEF) stimulated vascular endothelial growth factor release. Topical application of GEF and minoxidil promoted hair growth in a dose-dependent manner. Histological analysis showed that GEF and minoxidil increased the number of hair follicles and hair weight [45]. The Bcl-2 family proteins is notable for their regulation of apoptosis machinery, a form of programmed cell death, the member of this family either acts as antiapoptotic or pro apoptotic in nature. During the hair cycle, the dermal papillary cells (DPC) is the only region where Bcl-2 is expressed consistently and is considered to resist apoptosis [9, 46, 47, 48]. In mice Fructus Panax ginseng extract (FPG) increases the expression of Bcl-2 and decreases Bax expression, a pro apoptotic species, in cultured DPCs [49]. Parks et all concluded that FPG extract improves the cell proliferation of human DPCs through anti apoptotic activation. Topical administration of FPG extract might have hair regeneration activity for the treatment of hair loss [49].

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