Natural Remedies Help Reverse Hair Loss and Baldness
There is now enough scientific evidence to contend that baldness can be at least partly reversed naturally.
Natural strategies for premature baldness or hair loss are not magic bullets. Rather, they help the body help itself. In the case of hair loss, herbal and nutrition strategies can assist the health of our hair follicles.
In the case of alopecia, herbs and dietary changes can affect hormone and enzyme changes that change the dynamic of the hair follicles.
Baldness and hair loss
Male pattern baldness is also referred to as androgenetic alopecia. For those with male pattern baldness, about two-thirds will start showing symptoms by age 60, and about a quarter will start by age 30. About 95% of hair loss cases are due to male pattern baldness, according to a review by the American Medical Association. About 40 million American men have male pattern baldness.
Premature baldness is not an accident. It is also not necessarily genetic. Certainly there are genetic factors, but research is increasingly showing that epigenetic factors – things we do now that switch on those genes – often have a bigger influence.
More specifically, scientists have confirmed that baldness and premature hair loss are associated with a number of lifestyle choices, including diet, alcohol use, smoking, caffeine use and others. Other research has found that certain nutrients and herbs can slow and even reverse hair loss, hair thinning and even baldness.
What causes hair loss?
There are generally two issues related to hair loss. One is related to hormones. The other is related to the health of the hair follicles and the ability of the body to replace them.
When we lose a hair, we also lose the hair follicle. Typically the body’s stem cells will produce a new hair follicle to replace the lost one. When there is inflammation, the process is diverted.
2017 research from the University of California at San Francisco found that regulatory T cells (Tregs) surround the hair follicles. When the hair follicle dies, the Tregs kickstart the process of creating a new hair follicle. When Tregs are diverted during times of increased inflammation, they don’t stimulate new hair follicles.
This inflammation connection was stated clearly by scientists from the State University of New York:
“Chronic inflammation of the hair follicle is considered a contributing factor in the pathogenesis of androgenetic alopecia.”
Androgenic alopecia is often also connected to an decreased conversion of testosterone to dihydrotestosterone (DHT) – or 5-alpha- dihydrotestosterone (both of which are androgens). This conversion is stimulated by an enzyme called 5-alpha reductase. In women, DHT is mostly converted from DHEA.
Because the hair follicles are sensitive to and stimulated by DHT, having enough DHT conversion (but not too much) is essential to healthy hair follicles. For many men, the hair follicles have become sensitive to too much DHT. This sensitivity, along with too much DHT, causes the hair follicle to shut down.
There are many indications, as we’ll find below, that inflammation increases the risk of hair follicles becoming overly sensitive to DHT.
The 5-alpha reductase enzyme is involved in the conversion of a myriad of hormones, including aldosterone, testosterone, cortisol and others.
But when 5-alpha reductase is increased within the hair follicles and converts too much of a man’s testosterone to dihydrotestosterone (DHT), this can damage the hair follicles. The first sign is the hair begins to thin. As the damage becomes worse, the follicle goes into dormancy. At this point, there is complete hair loss at the follicle.
About 95% of hair loss is due to this increased level of 5-alpha reductase. While there are indications that this process is driven through heredity, there is significant evidence to believe that the heredity factor is related to the diets of our family lineage, which produced epidemic markers that increase the release of this enzyme.
While we cannot pose to reverse the genetic markers that increase 5-alpha reductase, there is ample evidence to indicate that lifestyle and nutrient strategies can affect hair follicle growth as well as prostate health in men.
This element of prostate enlargement is linked intimately with male pattern baldness because an increase in 5-alpha reductase – and its conversion of testosterone to dihydrotestosterone in the prostate – leads to prostate enlargement. Benign prostatic hyperplasia increases the risk of malignancy – and prostate cancer.
This mechanism was confirmed in a study of 60 men over the age of 50 years who had prostate enlargement. The research found that dihydrotestosterone – and the subsequent lack of testosterone – mediates prostate enlargement. This same issue can also mediate hair loss.
For this reason, some research has found that balding men have a 50 percent increased risk of prostate enlargement (hyperplasia).
Researchers from New York’s Roswell Park Cancer Institute found that increased 5α-reductase levels increases the risk of prostate hyperplasia. Another form, 5α-reductase-3, is also implicated. This, the researchers explained, is one reason why pharmaceutical 5-alpha reductase inhibitors such as finasteride, and dutasterid – used for hair loss – don’t work for everyone.
Lifestyle factors related to hair loss and baldness
In one study from the Case Western Reserve University School of Medicine, scientists studied 92 identical male twins. They tested each of the twins and quantified their level of baldness, along with their testosterone levels using saliva analysis.
Another study, presented at the 2011 annual conference of the American Society of Plastic Surgeons confirmed these findings. This research also examined twin sets – one study of 84 female identical twins and another study of 66 male identical twins.
The baldness analysis of both studies utilized digital imagery that measured and segregated hair loss of the front above the forehead (frontal), above the temples (temporal) and around the crown of the head (vertex).
The researchers then conducted an extensive survey of each of the subjects’ lifestyle factors, including drinking, smoking, exercise, use of hats and many other factors. They then compared these results with levels of hair loss between the pairs.
By utilizing identical twins, the researchers effectively eliminated the factors related to genetics, since it is accepted that identical twins will carry the same set of genes.
The researchers found that frontal hair loss (loss of hair on the front of the head) was significantly associated with having smoked for longer.
Smoking is linked with a number of disorders that relate to oxidative free radicals. Increased radicals can damage hair follicles and reduce antioxidants that provide nutrients for hair follicles.
Alcohol and caffeine consumption
The scientists also found that temporal hair loss – loss above the temples – was significantly associated with drinking more than four alcoholic drinks per week.
Greater loss of hair at the vertex – the crown of the head – was also associated with increased alcohol use – again more than four drinks a week.
Alcohol is associated with hair loss for a number of reasons. Alcohol can reduce the keratin available to hair follicles. It can also modify blood glucose levels, which can also affect hair follicles. It can also reduce hydration and reduce nutrients such as folic acid and others.
The research also found that increased caffeine consumption was also linked to more hair loss.
Hair products and dandruff
The research also found that those who used more hair products also had increased temporal balding. And those with more dandruff had increased front hair loss.
Dandruff is associated with an even faster skin cell turnover – from the typical 3-4 weeks to inside of a week. This hastened turnover of skin cells has been linked with chemical hair shampoos and hair products, as well as a type of skin fungus called Malassezia globosa. Malassezia globosa changes the fatty acid and amino acid composition among the skin cells to produce the dandruff.
As far as hair products, these can contain chemicals that damage hair follicles. Dandruff has also been linked to the use of more hair products.
Tying these together was the fact that the study found hair loss was also linked to a history of skin disorders
Lower levels of hair loss over the temples were linked to higher testosterone levels in the study. When there is less testosterone conversion, the hair follicles are not stimulated to grow hair. We discussed the metabolic link between testosterone and hair loss earlier.
Does wearing hats increase hair loss?
This is a common question, as there has been speculation that wearing a baseball hat all the time increased the risk of balding in men. Maybe this is because many people who are losing hair will wear a hat.
This notion has been disproved in the research. But the Case Western research, they found that wearing hats more was actually linked to less hair loss.
Stress and hair loss
The research also found – as have other studies – that hair loss is associated with increased levels of stress.
Hair thinning was associated with having more children. This supports the stress link as well.
Being divorced or widowed also was associated with increased hair loss, especially among women.
Hair loss types
There are several hair loss types, including andronogenic alopecia – male pattern baldness – and areata alopecia. Areata alopecia is often related to lifestyle and nutritional factors. Even genetically-oriented male pattern baldness can be related to nutritional deficiencies among ancestors. Research has traced ancestral baldness to zinc and copper deficiencies, for example.
Because the hair follicle cells are frequently replaced, ones diet can greatly effect the health of the replacement follicle cells. Nutrients that can affect the health of hair follicle cells include essential fatty acids, minerals, amino acids and vitamins.
Hair loss, inflammation and oxidative radicals
Some of the links to hair loss above are also linked to higher levels of oxidative radicals. Stress, alcohol and hair products all increase oxidative radicals, and produce inflammation in the hair follicles. We discussed the link between inflammation and hair follicle replacement earlier.
Confirming this, research from Turkey’s Firat University found that patients with alopecia have significantly higher levels of lipid peroxidation. They also found that antioxidant levels were decreased in balding men compared to others.
With these links to lifestyle, diet, and toxins, let’s review some of the natural strategies found to slow or reverse hair loss and balding:
Pumpkin seed oil
Research from the Republic of Korea’s Pusan National University proved that pumpkin seed oil will increase hair growth among balding men.
The medical researchers tested the pumpkin seed oil on 76 male patients with moderate androgenic alopecia – male pattern hair loss. None of the patients had tried any previous medication, supplement or topical therapy for at least three months prior to the beginning of the study. The researchers recruited 90 patients, but excluded those with high liver enzyme levels.
The patients were divided into two groups and half were given a placebo. The treatment consisted of giving the patients 400 milligrams of the pumpkin seed oil per day in capsules. They were given two capsules before breakfast and two capsules before dinner.
After three months and at the end of the study at six months the patients were assessed using blinded practitioner analysis, and given a point score, which ranged from -3 (greatly decreased) to +3 (greatly increased).
Each scalp was also photographed using phototrichography – a polarizing technology, allowing the hair loss region to be targeted and measured from the center.
The researchers also conducted hair counts using two different lenses. In addition, the patients rated their own hair gain using the Visual Analogue Scale (VAS).
In the photographic analysis, the researchers found that 44% of the group taking the pumpkin seed oil slightly or moderately improved hair growth, while 51% were unchanged and 2.7% – actually just one patient – had slightly more baldness at the end of the six months.
In comparison, among the placebo group, 28% had increased baldness and 64% were unchanged, while only 7.7% were slightly or moderately improved in hair growth.
In the phototrichographic analysis, the pumpkin seed oil group had significantly higher hair counts – over three times more. The pumpkin seed oil group saw 30-40% increased hair counts while the placebo group showed 5-10% more hair count on average.
The researchers found the treatment to be safe, with only one report of mild stomach upset during the trial.
Other research has found pumpkin seed oil can inhibit the 5-alpha reductase enzyme – in studies testing pumpkin seed oil and prostate hyperplasia.
Coffea arabica and Larrea divaricata
A 2017 study from the University of Buenos Aires tested a topical spray (Ecohair) containing the herbs Coffea arabica (Arabian coffee plant) and Larrea divaricata (chaparral). The researchers applied the topical treatment to the head of patients with non-scarring alopecia for three months. They performed hair counts and measured hair volume.
The researchers found the topical treatment of these two herbs significantly increased hair volume and produced new hair growth. They concluded that the application of these herbs was a valid treatment, with no apparent side effects.
Saw palmetto has also been shown to help reduce prostate hyperplasia. Research has found the effect is related to inhibiting 5-alpha-reductase. A University of Milan study confirmed this, as did a study from the State University of New York.
Research from France tested 21 people with alopecia for a week. They gave 11 of the subjects a Saw palmetto extract and 10 the drug finasteride. After the seven days, the research found both groups saw decreased dihydrotestosterone and thus 5 alpha-reductase by between 52 and 60 percent. They also found little difference between the drug and the Saw palmetto for the reduction in 5 alpha-reductase.
A 2012 study from the University of Rome treated 100 men with alopecia for two years. They gave half Saw palmetto and the other half finasteride. The research found that 38 percent of the patients treated with Saw palmetto showed increased hair growth. This compared to 66 percent improvement among the finasteride group.
(It should also be mentioned that finasteride comes with a number of possible side effects, including impotence, sexual dysfunction, swelling in hands and feet, rashes, dizziness, weakness, headaches and nasal drip.)
As to whether these will also reverse baldness is not known for sure. But because the mechanisms are similar, there is reason to believe these internally-taken herbs can reduce 5α-reductase in balding just as it does in prostate hyperplasia. Just as pumpkin seed oil has been found to reverse balding and prostate hyperplasia.
Diet and 5-alpha reductase
A number of studies have illustrated that the Western diet increases the risk of prostate hyperplasia and thus increases 5-alpha reductase activity.
This has been shown in human epidemiological studies and animal studies. Americans and particularly African Americans have some of the highest rates of prostate hyperplasia and cancer, and Japanese and Chinese men have significantly less. Increased levels of saturated fats and red meats in the diet have been particularly related to prostate hyperplasia and malignancy.
For example, a study from Harvard followed 27,607 men between 1994 and 2008. They found that the risk of prostate hyperplasia and mortality from prostate cancer was increased significantly by those eating more eggs, poultry and more red meat. Another study from Harvard that followed 51,529 men also found these relationships.
Other research has confirmed these relationships. And because of these, researchers have proposed that increased animal fats and decreased fiber increases the expression of 5-alpha reductase.
While few studies have investigated this directly, we can conclude that diet also relates directly to alopecia because of the relationship between 5-alpha reductase and baldness.
This relationship was slightly proven out in a French study in 2010 that studied 42 allopecia patients together with 230 control subjects. The researchers found that increased protein intake was “directly associated with alopecia.”
To this we can add that diets high in soy and other phytoestrogen foods such as red clover – have been found to reduce 5-alpha reductase levels and prostate hyperplasia. This has been found in both animal research and human research. The phytoestrogens genistein, daidzein, equol, and glycetin have all been found to inhibit prostate hyperplasia. These appear to result from blocking androgen receptors.
Foods and supplements
As far as specific foods and supplements go, a number of these have been shown to reverse prostate hyperplasia. Prostate hyperplasia is linked to hair loss in men because of the links with 5-alpha reductase and androgens such as testosterone.
Selenium has also been shown to help reverse prostate hyperplasia. Lycopene from tomatoes has also shown this effect. And the herbs Saw Palmetto, Turmeric and others have been shown to reverse hyperplasia.
Vitamin D has also been shown to reverse prostate hyperplasia. Studies on vitamin D3 analog elocalcitol found it reduced hyperplasia more than the drug finasteride.
A 2009 study showed that a tocotrienol complex – a form of vitamin E different than most E supplements – may increase hair growth in men with alopecia.
The eight-month study, done at the School of Pharmaceutical Sciences at University of Science Malaysia, followed 28 subjects with male pattern baldness.
According to data provided by Dr. Sharon Ling presented at the 2009 Vitafoods International Conference, the subjects, who were between 18 and 59 years old, supplemented 100 milligrams of a tocotrienal complex called Tocomin SupraBio produced by Carotech. The supplement is reported by the company to increase tocotrienol availability by 300 percent.
The randomized, placebo-controlled study also gave a placebo group a capsule, this one containing soybean oil. Both groups did not alter their lifestyles or diets outside of the supplementation intervention.
The researchers found that hair growth significantly increased by 41.8% among the tocotrienol group, but no significant growth occurred among the placebo group. Hair growth was calculated by counting the number of hairs within a selected area of the balding men’s scalp.
Other research supports this
Supporting this clinical study is a more recent study from researchers at Cairo University’s Department of Dermatology. This randomized study examined 60 adults – 45 patients with either psoriasis, vitiligo or alopecia areata (baldness). In other words, the study included 15 patients with baldness. The study examined blood and tissue levels of both vitamin E and paraoxonase 1 (PON1). All of the skin issue patients – including the baldness group – suffered from low levels of both vitamin and and PON1. The researchers stated:
“An association between oxidative stress and pathogenesis of these autoimmune diseases is identified. Attenuation of oxidative stress might be a relevant therapeutic approach and it would be useful to recommend additional drugs with antioxidant effects in the treatment of these conditions.”
What are Tocotrienols?
While most consider vitamin E a single nutrient, there are at least eight forms of vitamin E. Four of them are tocopherols, which include alpha-tocopherol, beta-tocopherol, gamma-tocopherol, and delta-tocopherol. There are also four tocotrienol forms of vitamin E. This includes alpha-tocotrienol, beta-tocotrienol, gamma-tocotrienol, and delta-tocotrienol. The primary vitamin E form in most supplements is alpha-tocopherol.
Most of the research on vitamin E has utilized only alpha-tocopherols. Multiple studies that included a mix of tocotrinols have found that they support cardiovascular health.
Diets can vary in terms of their vitamin E forms. Western diets are typically restricted to alpha-tocopherols and gamma-tocopherols. However, a mixed plant-based diet that includes coconut and palm foods, whole grain rice and other whole grains will render a mix of the tocotrienol forms.
Because herbs and dietary strategies contain multiple compounds rather than just one active constituent as pharmaceuticals do, herbs and dietary strategies also tend to help resolve multiple conditions. As such, it is not foreign to natural practitioners that a particular herb or diet strategy will help resolve multiple conditions at the same time.
But of course, natural metabolic changes also take time. Months – even years – are typically required for natural strategies to have their effects. Thus, determination and patience are virtues in natural strategies.
Cooling the scalp
Most of us know that hair loss is associated with chemotherapy. In 2016, an international team of researchers tested 182 women with breast cancer who were undertaking chemotherapy.
The researchers found that the application of scalp cooling resulted in a significant reduction of hair loss. This was evident especially after the fourth chemotherapy cycle. If you are undergoing chemotherapy, talk with your doctor about scalp cooling.
This may also be related to the finding that wearing a hat is linked with less hair loss. Perhaps the hat is keep the head cooler. Hats can also help reduce ultraviolet radiation – a healthier strategy for sun protection than putting on chemical-based sunscreens.
Alonso MR, Anesini C. Clinical Evidence of Increase in Hair Growth and Decrease in Hair Loss without Adverse Reactions Promoted by the Commercial Lotion ECOHAIR®. Skin Pharmacol Physiol. 2017;30(1):46-54. doi: 10.1159/000455958.
Nangia J, Wang T, Osborne C, Niravath P, Otte K, Papish S, Holmes F, Abraham J, Lacouture M, Courtright J, Paxman R, Rude M, Hilsenbeck S, Osborne CK, Rimawi M. Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial. JAMA. 2017 Feb 14;317(6):596-605. doi: 10.1001/jama.2016.20939.
Gatherwright J, Liu MT, Amirlak B, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to male alopecia: a study of identical twins. Plast Reconstr Surg. 2013 May;131(5):794e-801e.
James Gatherwright, Bardia Amirlak, David Rowe, Mengyuan Liu, Christy Gliniak, Ali Totonchi, Bahman Guyuron. “The Relative Contribution of Endogenous and Exogenous Factors to Male Alopecia: A Study of 66 Genetically Identical Males” and “The Relative Contribution of Endogenous and Exogenous Factors to Female Alopecia: A Study of 84 Genetically Identical Females.” Presented at the 2011 Annual Conf of the Assn of Plastic Surgeons. Sept 23-27, 2011.
Finner AM. Nutrition and hair: deficiencies and supplements. Dermatol Clin. 2013 Jan;31(1):167-72.
James AG, Abraham KH, Cox DS, Moore AE, Pople JE. Metabolic analysis of the cutaneous fungi Malassezia globosa and M. restricta for insights on scalp condition and dandruff. Int J Cosmet Sci. 2013 Apr;35(2):169-75.
Naziroglu M, Kokcam I. Antioxidants and lipid peroxidation status in the blood of patients with alopecia. Cell Biochem Funct. 2000 Sep;18(3):169-73.
Cho YH, Lee SY, Jeong DW, Choi EJ, Kim YJ, Lee JG, Yi YH, Cha HS. Effect of pumpkin seed oil on hair growth in men with androgenetic alopecia: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med. 2014;2014:549721. doi: 10.1155/2014/549721.
Ejike CE, Ezeanyika LU. Inhibition of the experimental induction of benign prostatic hyperplasia: a possible role for fluted pumpkin (Telfairia occidentalis Hook f.) seeds. Urol Int. 2011;87(2):218-24. doi: 10.1159/000327018.
Gossell-Williams M, Davis A, O’Connor N. Inhibition of testosterone-induced hyperplasia of the prostate of sprague-dawley rats by pumpkin seed oil. J Med Food. 2006 Summer;9(2):284-6.
Borst SE, Yarrow JF, Conover CF, Nseyo U, Meuleman JR, Lipinska JA, Braith RW, Beck DT, Martin JS, Morrow M, Roessner S, Beggs LA, McCoy SC, Cannady DF 2nd, Shuster JJ. Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial. Am J Physiol Endocrinol Metab. 2014 Feb 15;306(4):E433-42. doi: 10.1152/ajpendo.00592.2013.
Titus MA, Li Y, Kozyreva OG, Maher V, Godoy A, Smith GJ, Mohler JL. 5α-reductase type 3 enzyme in benign and malignant prostate. Prostate. 2014 Feb;74(3):235-49. doi: 10.1002/pros.22745.
Michaud DS, Augustsson K, Rimm EB, Stampfer MJ, Willet WC, Giovannucci E. A prospective study on intake of animal products and risk of prostate cancer. Cancer Causes Control. 2001 Aug;12(6):557-67.
Richman EL, Kenfield SA, Stampfer MJ, Giovannucci EL, Chan JM. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: incidence and survival. Cancer Prev Res (Phila). 2011 Dec;4(12):2110-21. doi: 10.1158/1940-6207.CAPR-11-0354.
Pienta KJ, Esper PS. Risk factors for prostate cancer. Ann Intern Med. 1993 May 15;118(10):793-803.
Heber D. Prostate enlargement: the canary in the coal mine? Am J Clin Nutr. 2002 Apr;75(4):605-6.
El Fékih N, Kamoun H, Fazaa B, El Ati J, Zouari B, Kamoun MR, Gaigi S. [Evaluation of the role of dietary intake in the occurrence of alopecia]. Rev Med Liege. 2010 Feb;65(2):98-102.
Jarred RA, McPherson SJ, Jones ME, Simpson ER, Risbridger GP. Anti-androgenic action by red clover-derived dietary isoflavones reduces non-malignant prostate enlargement in aromatase knockout (ArKo) mice. Prostate. 2003 Jun 15;56(1):54-64.
Strauch G, Perles P, Vergult G, Gabriel M, Gibelin B, Cummings S, Malbecq W, Malice MP. Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. Eur Urol. 1994;26(3):247-52.
Mahmoud AM, Zhu T, Parray A, Siddique HR, Yang W, Saleem M, Bosland MC. Differential effects of genistein on prostate cancer cells depend on mutational status of the androgen receptor. PLoS One. 2013 Oct 22;8(10):e78479. doi: 10.1371/journal.pone.0078479.
Deschasaux M, Pouchieu C, His M, Hercberg S, Latino-Martel P, Touvier M. Dietary total and insoluble fiber intakes are inversely associated with prostate cancer risk. J Nutr. 2014 Apr;144(4):504-10. doi: 10.3945/jn.113.189670.
Tiwari A. Elocalcitol, a vitamin D3 analog for the potential treatment of benign prostatic hyperplasia, overactive bladder and male infertility. IDrugs. 2009 Jun;12(6):381-93.
Ramadan R, Tawdy A, Abdel Hay R, Rashed L, Tawfik D. The antioxidant role of paraoxonase 1 and vitamin E in three autoimmune diseases. Skin Pharmacol Physiol. 2013;26(1):2-7. doi: 10.1159/000342124.
Chittur S, Parr B, Marcovici G. Inhibition of inflammatory gene expression in keratinocytes using a composition containing carnitine, thioctic Acid and saw palmetto extract. Evid Based Complement Alternat Med. 2011;2011:985345. doi: 10.1093/ecam/nep102.
Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C. Comparison of the potency of different brands of Serenoa repens extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells. Pharmacology. 2008;82(4):270-5. doi: 10.1159/000161128.
Case Adams is a California Naturopath with a PhD in Natural Health Sciences, and a Board Certified Alternative Medicine Practitioner. He has authored 26 books on natural healing strategies. “My journey into writing about alternative medicine began about 9:30 one evening after I finished with a patient at the clinic I practiced at over a decade ago. I had just spent the last two hours explaining how diet, sleep and other lifestyle choices create health problems and how changes in these, along with certain herbal medicines and other natural strategies can radically yet safely turn our health around. As I drove home that night, I realized this knowledge should be available to more people. So I began writing about health with a mission to reach those who desperately need this information. The strategies in my books and articles are backed by scientific evidence along with wisdom handed down through traditional medicines for thousands of years.”