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How Does Low Testosterone Cause Hair Loss?

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Maria Jacob

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Wednesday, December 20, 2023

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Hair loss can be caused by multiple factors like environmental, genetic, disease, or drug-induced etc. One of the reasons that is often brought up in discussions about hair loss is a low testosterone level. Testosterone, a primary hormone responsible for male characteristics, is linked to various bodily functions. But the question is, does it genuinely have a noteworthy impact on hair loss? Many individuals wonder about the potential link between testosterone and hairloss, often searching for information on 'testosterone hairloss' online. Let's explore this topic more comprehensively.

Overview of Hair Loss

Hair loss or alopecia is a common dermatological condition affecting both the sexes and all age groups. Hair loss not only affects an individual’s physical appearance, but it is also often distressing and can lead to psychological conditions like anxiety and depression (Hunt and McHale 2005). 

Hair loss is broadly classified as scarring or nonscarring. Scarring hair loss is a type of irreversible hair loss caused by the destruction of hair follicles, while nonscarring hair loss is reversible as hair follicles are preserved (Alopecia 2023).

Androgenic alopecia is one of the most common types of nonscarring hair loss that affects up to 50% of males and females. The characteristics of androgenic alopecia are loss of the frontal hairline in males and diffused thinning of hair over the crown of the scalp in females (Androgenetic alopecia 2022). The pathophysiology for underlying androgenic alopecia is found to be genetic disposition along with androgen influence (excessive response to androgen) (Hanneken et al 2003) and its features are variations in hair cycle development coupled with progressive miniaturization of the follicle and inflammation (Ellis 2002). Several research studies have found certain differences in our genes that are connected to different types of hair loss. Among these genes, the AR gene seems to be the most closely linked to androgenic alopecia (Hillmer et al 2005).

Understanding Androgens

Androgen, or androgenic hormone, stimulates or controls the development and maintenance of male characteristics by binding to androgen receptors. The most common androgens known are testosterone (precursor of dihydrotestosterone), dihydrotestosterone (DHT), and androstenedione. Also, androgen (androstenedione) is the precursor of estrogen, the female sex hormone (Rao 2014). These androgens and their receptors have been implicated in skin physiology and pathogenesis based on the fact that androgens are metabolized in many skin tissues. Androgens stimulate the production of terminal hair in pubic and axillary hair in both sexes and beard growth in men, but have shown an opposite effect of suppressing hair growth in the frontal and vertex scalps (Lai et al 2012). Sometimes, it is essential to examine the role of androgens in women, as these hormones can also play a significant part in female pattern hair thinning and loss, sometimes referred to as androgenetic alopecia (Fabbrocini et al 2018).

Relationship Between Testosterone and Hairloss

The relationship between hair loss and testosterone is a concern for many men seeking ways to maintain their hair health. The relationship between testosterone and hairloss is complex. Understanding the dynamics of hair loss from testosterone is crucial for individuals looking to mitigate its effects and maintain healthy, vibrant hair. In the hair follicle, testosterone is converted into DHT by an enzyme 5 alpha-reductase. DHT is more potent and has a higher affinity for the androgen receptor than testosterone. In individuals genetically predisposed to male pattern baldness, hair follicles in certain areas of the scalp become sensitive to the effects of DHT. This sensitivity causes the hair follicles to shrink over time, leading to thinner and shorter hair, until eventually, hair may stop growing altogether in those areas. 

Studies have shown that the DHT level is increased in the balding scalp (Schweikert et al 1974 and Dallob et al 1994) and thus is the more relevant androgen for AGA pathogenesis. People with androgenetic alopecia have shown increased levels of DHT, 5 alpha-reductase, and androgen receptors in their balding scalps. Studies have also shown that the androgen receptor on the hair follicles increases in the balding scalps when compared with the non-balding scalps (Hibberts et al 1998)

It's essential to recognize that individuals with reduced testosterone levels may possess comparable levels of DHT. Studies have indicated that men experiencing hair loss often exhibit low testosterone levels but maintain average DHT levels. Interestingly, some individuals harbor equivalent DHT levels as their counterparts, yet their hair follicles possess a genetic predisposition to heightened sensitivity to DHT (Kische et al 2017). 

Individuals with higher levels of DHT or greater sensitivity to DHT may be more susceptible to male pattern baldness, but high or low testosterone levels alone are not the cause of hair loss. Some individuals experience hair loss from testosterone fluctuations, especially as they age. As people age, there's a natural decline in testosterone levels, leading some to investigate the connection between hormonal changes and conditions like testosterone hairloss. 

Treatment of Androgenic Hair Loss

Testosterone hairloss is a common topic in discussions about male health, with many seeking insights into preventive measures or treatments. Recent research studying the connection between testosterone and hairloss offers hope for innovative treatments and prevention strategies. Hair loss due to a testosterone/DHT imbalance can typically be temporary and can potentially be reversed through appropriate treatment. The process of hair regrowth is not immediate; it typically requires several months of adhering to a healthy lifestyle. Consultation with a healthcare professional is essential to determine the most effective androgenic hair loss treatment plan based on individual factors and needs. Expert evaluation of the condition, exploration of potential treatments, and tracking the progress as time passes are essential in the management of hair loss.

Dermatologists may recommend specific anti androgens for hair loss to regulate hormone levels and potentially slow down or prevent further hair thinning. Androgenic hair loss treatment can be done by topical minoxidil and oral finasteride. Both minoxidil and finasteride are approved by the Food and Drug Administration for androgenetic alopecia in men. 

Minoxidil works by reducing the binding of DHT to hair follicles, thereby preventing further hair loss and also stimulating and proliferating the hair follicle for increased growth. On the other hand, finasteride is potent and highly selective for the enzyme 5 alpha-reductase. It binds to the enzyme and prevents the conversion of testosterone to DHT. The efficacy of minoxidil and finasteride in averting hair loss may differ among individuals, and the decision between the two typically hinges on personal factors and preferences.

Dutasteride, another inhibitor of enzyme 5 alpha-reductase is used orally in Japan and South Korea as a treatment for androgenic alopecia. Dutasteride has been approved by the Korea Ministry of Food and Drug Safety for androgenic alopecia and awaits approval from the FDA for its use in the US and other regions (Cheon 2015). Other anti-androgens for hair loss treatment include spironolactone, cyproterone acetate, and flutamide (Nestor et al 2021).


Let us now answer our question: Can low testosterone lead to hair loss? In brief, the answer is no. Low testosterone levels may lead to various health concerns, but when it comes to hair loss, particularly androgenic alopecia, the primary driving forces are genetics and the sensitivity of hair follicles and androgen receptors to DHT. In essence, low testosterone levels alone do not serve as the root cause of hair loss, and elevating testosterone levels may not necessarily prevent or reverse it. Instead, it's the intricate interplay of hormones, genetic susceptibility to DHT sensitivity, and other individual factors that carry more weight. Understanding the factors contributing to hair loss from testosterone can help individuals make informed choices about potential prevention or treatment options.



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