Testosterone and Hair Loss

It is believed that testosterone and hair loss are highly related. But do high levels of testosterone cause hair loss or baldness in men? What about hair loss in women caused by DHT, a derivative of testosterone?

Testosterone is both a medication and a naturally occurring steroid hormone. It plays major roles in male reproductive system and most importantly promotes secondary male characteristics. These include muscle growth as well as hair growth on the body. Due to these, it is believed that it can also cause hair loss or thinning in both men and women.

In men, it is produced mainly in the testes, with a small amount made in the adrenal glands. The brain’s hypothalamus and pituitary gland control its production. The hypothalamus gives instructions to the pituitary gland on how much testosterone to produce, and the pituitary gland passes the message on to the testes.

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These communications take place by the help of chemicals and hormones found in the bloodstream. Apart from that, this hormone is involved in the development of male sex organs before birth, and the development of secondary sex characteristics at puberty, such as voice deepening, increased penis and testes size, and growth of facial and body hair. The National Institutes of Health regards testosterone as the most important male hormone.

Testosterone and Hair Loss

According to the National Institutes of Health (NIH), male pattern baldness, or androgenic alopecia, affects an estimated 50 million men and 30 million women in the United States. Hair loss is due to the shrinkage of hair follicles and the resulting impact on the growth cycle. New hairs become finer and finer until there’s no hair left at all and the follicles become dormant.

There are three things that are prominent in their contribution to hair loss. They are: genes, hormones and age. The hormone of great concern for this case here is testosterone. Just from birth, it is evident that this hormone is involved in hair growth and loss.

• What is the link between testosterone and hair loss? The link comes through a by-product of testosterone called dihydro-testosterone.

Does low testosterone cause hair loss?

The most common type of hair loss occurs in a predictable pattern, and the pattern of hair loss occurs when the normal cycle of hair growth changes. Usually pattern hair loss starts slowly, and continues to get progressively worse.

Progressive pattern hair loss is a common occurrence among men, and less apparent but still quite common among women. While men typically suffer pattern baldness with receding hairlines and bald spots on the crown of the head, women typically experience generalized thinning hair over the entire top of the head. And as we age, the occurrence and degree of hair loss increases.

• Hair on your body is made from hair follicles which are tiny pouches under the skin surface.
• A hair normally grows from each follicle for about three years. It is thereafter shed and a new hair grows from the follicle.
• The cycle of hair growth and shedding continues throughout the entire life of an individual.
• Hormonal changes and most importantly testosterone variance in your body can bring about hair growth, thinning hair or hair loss changes.

There is no study that narrows down to point out low testosterone levels to be the precipitating factor to hair loss. The available information puts it clear that there is a link between sensitivity of hair follicles and hair loss.

Men with male pattern baldness (androgenic alopecia) often have unusual hormone levels compared to people who do not suffer from this type of hair loss. Overall testosterone levels are usually lower in these men, although they typically have about the same amount of a type of unbound testosterone known as dihydrotestosterone (DHT).

According to Roodlane Medical, “Some men have areas on the scalp that are very sensitive to the male sex hormones that circulate in men’s blood. The hormones make the hair follicles – from which hair grows – shrink. Eventually, they become so small that they cannot replace lost hairs. The follicles are still alive, but are no longer able to perform their task.

• The cause of male pattern hair loss in both men and women is DHT in the blood signalling hair follicles genetically programmed to be sensitive to DHT to stop growing new hairs.
• It has been found out that in individuals with pattern hair loss, certain hair follicles are genetically programmed to be more sensitive to circulating in the blood dihydrotestosterone (DHT).

According to Hair Doc, DHT affects sensitive hair follicles in another way as well: it results in thinner and less pigmented strands of hair. Normally, a hair follicle shrinks in size after the anagen (growth) phase, and the hair shaft falls out during the catagen or telogen phase. There is evidence that hair follicles that are sensitive to DHT do not return to their full size after the telogen phase.

Does high testosterone cause hair loss?

Testosterone is not directly involved in hair loss but high levels of its by-product of metabolism; (Cells in the skin of the scalp convert testosterone into another hormone called dihydrotestosterone). It is evident that dihydrosterone has a significant effect on the hair follicles development.

• To shed light on this, affected hair follicles become more sensitive to DHT, which causes the hair follicles to shrink.
• As a consequence, this directly affects  the  growth  of  hair  leading to  hair  loss,  especially  among  men,  simply because this hormone  circulates  throughout  the
• The hair  follicles are reduced   until  they  can  no  longer  produce hairs  in  the  scalp

The major link between testosterone hair loss is DHT. DHT, a derivative of the male hormone testosterone, is the enemy of hair follicles on your head. Simply put, under certain conditions DHT wants those follicles dead. This simple action is at the root of many kinds of hair loss. Testosterone converts to DHT with the aid of the enzyme 5-alpha reductase. Scientists have come to believe that it’s not the amount of circulating testosterone that’s the problem but the level of DHT binding to receptors in scalp follicles.

DHT hair loss process

DHT shrinks hair follicles, making it impossible for healthy hair to survive. The process of becoming bald or losing hair is very sequential, i.e. does not occur abruptly. The sequence is as follows:

1. Affected hair follicles on the scalp gradually become smaller than normal.
2. As the follicle shrinks, each new hair is thinner than the previous one.
3. Before falling out, each new hair grows for much less time than the normal three years or so.
4. Eventually, all that remains is a much smaller hair follicle and a thin stump of hair that does not grow out to the skin surface.

There is a distinction between tissue and serum DHT with regards to the effect on hair loss. According to Perfecthairhealth, it is evident that tissue DHT is elevated in the scalps of balding men. Tissue DHT in the scalp is linked to pattern hair loss. Where DHT collects in the scalp, hair loss tends to follow. Some studies indicate that serum DHT has no correlation with pattern hair loss.

Testosterone and hair loss in women

Do women also suffer from testosterone hair loss? Women are not left out by hair loss as they may also experience this due to androgenetic alopecia. Although women have much lower levels of testosterone than men do, the available amount is enough to potentially cause androgenetic hair loss.

Notably, they experience a different pattern of hair loss. Thinning occurs over the top of the scalp in a “Christmas tree” pattern, but the front hairline doesn’t recede. Female pattern hair loss (FPHL) is also due to the actions of DHT on hair follicles.

“The actions of DHT and the sensitivity of hair follicles to DHT is what causes hair loss.”

Some studies even indicate that in every five women, one suffers from hair loss. Telogen effluvium and alopecia areata are the most common types of hair loss that women struggle with. Telogen effluvium is less common compared to alopecia areata.

Is testosterone a cause of hair loss in women?

Indeed, testosterone is produced to some extent in women, though not as much of it as it is in men. This as a result means that as a man, you are more likely to be affected grossly by loss of hair compared to women. In women, this is the hormone that gets you into mood, gives you self-confidence and keeps you vital and sassy.

In case testosterone levels get too high in women be it because of menopause, excess weight or other causes, you are likely to experience symptoms that are similar to those of male pattern baldness and rogue hair growth on the face.

Dr Sara Gottfried notes that too much testosterone in women creates all sorts of unpleasant results. Namely, it can cause hair growth on the face, neck or chest, and hair loss on your head. This clearly indicates that this hormone causes discriminated effects on different parts of the body with regards to hair. 

When are women most likely to suffer from hair loss?

Women’s hormone levels decline as menopause approaches and drop sharply during menopause and beyond. The cyclic nature of both our hair and hormones is one reason hair loss can increase in the short term even when you are having a long-term slowdown of hair loss (and a long-term increase in hair growth) while on a treatment that controls hair loss.

How would you point out hair loss associated with testosterone?

The type of hair loss associated with female pattern hair loss (FPHL) and testosterone levels is recognizable in appearance. Here are the symptoms of hair loss caused by testosterone in women.

• Patchy baldness or thin.
• The brittle hair widens out from the centre part.
• It is evident mainly on the crown of the scalp, while the front hairline remains intact.

Near or total baldness in FPHL is very rare, and the condition is neither itchy nor painful. In women, hair grows at a rate of around half an inch per month for two to six years before stopping and falling out. After this, new hair grows in its place.

Though the exact links between androgen and hair growth are not quite clear, testosterone has a significant role in stimulating the regrowth of hair. During perimenopause, women are prone to testosterone fluctuations.

Menopause causes declining estrogenic levels and increased androgen circulation, which can cause hair follicles in the scalp to shrink. This means after natural shedding occurs, there is no regrowth of lost hair. This condition is what is known as female pattern hair loss (FPHL).

Testosterone booster or therapy side effects

What is testosterone booster/therapy?

This is a medical treatment that entails careful monitoring and intense focus on maintaining proper dosage. It is done by medical professionals specialized in the field. Finding that proper dosage is important while low testosterone can have a number of unpleasant symptoms. Too much testosterone can also have side effects to your hair.

What should you consider before therapy?

Any time you consider taking testosterone, you should learn about some of the risks, expectations, long term considerations, and medications associated with medical transition. If it is very important to remember that everyone is different, and that the extent of, and rate at which your changes take place depend on many factors.

These factors include your genetics, the age at which you start taking hormones, and your overall state of health. It is also important to remember that because everyone is different, your medicines or dosages may vary widely from those of your friends, or any other person.

Many people are eager for changes to take place rapidly; remember that you are going through a second puberty, and puberty normally takes several years for the full effects to be seen. Taking higher doses of hormones will not necessarily make things move more quickly. It may instead be a risk to your health in the long run.

What are the side effects of testosterone therapy?

Testosterone boosting can have various effects to your body if the therapy is done over a long period of time, which leads to high amounts in the body. To be specific, increase in the amount of testosterone can:

1. Increase the risk of heart disease, stroke and diabetes.

The way this happens is that from time to time it:

• decreases good cholesterol (HDL) and increase bad cholesterol (LDL)
• increases fat deposits around internal organs and in the upper abdomen
• increases blood pressure
• decreases the body’s sensitivity to insulin
• causes weight gain

The above changes may increase the risk of heart disease (including heart attack), stroke and diabetes. The risks are greater if you smoke, are overweight, or have a family history of heart disease. Majority of the known contributing factors to these conditions can be reduced by creating care plan that is tailored to your specific situation.

You can reduce the fatality of the side effects by periodic blood tests to keep an eye on potentially risky conditions, and minimizing contributing factors. Stopping smoking, getting healthy levels of exercise, and eating well are key steps you can take to reduce your risks.

2. It increases red blood cells and haemoglobin

In as much as the increase is usually only to an average “male” range (which does not pose health risks), a high increase can cause potentially life-threatening problems such as stroke and heart attack. Blood tests ought to be carried out periodically to check red blood cell and haemoglobin levels.

3. Headaches and migraines

If you are getting frequent headaches/migraines or the pain is unusually bad, talk to a health professional as this might an effect of too much testosterone

4. Testosterone can negatively affect mental health.

There is evidence that there are often positive emotional changes from reduced gender dysphoria. However, in some Female to Males (FTMs) testosterone can cause increased irritability, frustration, and anger.

Some more reports of testosterone also indicate destabilizing FTMs with bipolar disorder, schizoaffective disorder, and schizophrenia. Changing to a daily dose of transdermal testosterone can be helpful if mood swings are linked to the highs and lows of an injection cycle.

5. There can be social consequences to taking testosterone

The noticeable changes caused by testosterone can increase the risks of harassment, violence, discrimination, and loss of support from loved ones.

6. Too much estrogen

Other than likely hair loss, overproduction of estrogen is one of the side effects of too much testosterone. Too much free testosterone in the body can lead to the over abundant hormone being converted into estrogen.

While some estrogen is important and natural part of a man’s hormone balance, more than the normal amount can lead to so many unwanted side effects, like mood swings, water retention, high blood pressure, breast sensitivity in women or even growth.

7. Testicular Shrinking

To explain this, when your brain senses high levels of testosterone in the body, it will assume the testosterone is coming from the testicles.

The brain then shuts off production of the LH (luteinizing hormone), the hormone that tells the testicles to produce testosterone, and the testicles may then experience a change in testicular firmness or volume as a result.

8. Oily Skin and Acne

Oily skin and acne are very common side effects of Testosterone Replacement Therapy (TRP), to varying degrees. In as much as not everyone experiences these effects and they are often mild, they can be brought on or aggravated by the elevated levels of DHT associated with increased testosterone.

9. Sexual effects

Soon after beginning hormone treatment, you will likely notice a change in your libido. Quite rapidly, your clitoris will begin to grow, and will become larger when you are aroused. You may find that there are different sex acts or different parts of your body that bring you erotic pleasure.

10. Weight loss or gain

Weight will begin to redistribute around your body. Fat will diminish somewhat around your hips and thighs, and the fat under your skin throughout your body will become a bit thinner, giving your arms and legs more muscle definition and a slightly rough appearance. Testosterone may cause you to gain fat around your abdomen.

What are the reproductive effects of testosterone?

1. Menstrual cycle

You may notice at first that your periods become lighter, arrive later, or are shorter in duration than previously. Some people will actually notice heavier or longer lasting periods for a few cycles before they stop altogether

2. Pregnancy

Testosterone greatly reduces your ability to become pregnant. However, it does not eliminate the risk of pregnancy completely. If you are on testosterone and you remain sexually active you should always continue to use a birth control method to avoid unwanted pregnancy. It is possible for transgender men to become pregnant while on testosterone.

3. Ovarian cancer

The risk of cancer of the ovaries may be slightly increased while on testosterone treatment. Ovarian cancer is one of the most difficult cancers to screen for, and most cases of ovarian cancer are discovered after it is too late to be treated.

In case of its confirmation, a full hysterectomy and bilateral salpingooopherectomy (removal of the uterus, ovaries, and fallopian tubes) are recommended within 5-10 years of beginning testosterone treatment in order to minimize your cancer risk.

4. Spotting or bleeding

After being on testosterone for some time, you may experience a small amount of spotting or bleeding. This may occur if you miss a dose, or change your dosage.

You should report any bleeding or spotting to the doctor; in some scenarios, it must be followed up with an ultrasound to be sure that you do not have a precancerous condition called “hyperplasia.”

5. Other effects

Taking more testosterone will not make your changes progress more quickly and can be unsafe. Excess testosterone can be converted to estrogen, which can then increase your risks of hyperplasia or cancer, as well as make you feel anxious or agitated, can harm your liver, and can cause your cholesterol or blood count to get too high. It is important to be patient and remember that puberty can take years to develop all of its changes.

Sources and references

1. patient.info/health/male-pattern-baldness
2. http://tctmed.com/low-t-faq-testosterone-reason-balding/
3. http://www.saragottfriedmd.com/hair-loss-hormones-and-how-to-regain-your-luscious-locks/