Does Low Testosterone Cause Hair Loss?

A sink drain with hair in it, as a result of hair loss

The relationship between low testosterone and hair loss remains complex and not fully understood. Many studies have limitations such as small sample sizes, lack of long-term follow-up, and potential confounding factors like age, genetics, and other health conditions. Further research is needed to clarify the role of testosterone in hair loss.

Hair loss is a common concern affecting millions of men and women worldwide. By the age of 50, approximately 50% of men and 25% of women experience some degree of hair loss. While there are many potential causes, including genetics, age, stress, nutritional deficiencies, and certain medical conditions, the role of hormones, particularly testosterone, has been a topic of interest.

Testosterone, the primary male sex hormone, is often associated with male traits such as muscle mass, deep voice, and body hair. A popular belief is that low levels of testosterone lead to male pattern baldness. However, the relationship between testosterone and hair loss is more complex than this simple association suggests.

The Role of Testosterone and DHT in Hair Growth

Testosterone is a hormone present in both men and women. About 10% of testosterone is converted into dihydrotestosterone (DHT) by the enzyme 5-alpha reductase (5-AR). There are two types of 5-AR enzymes: type 1 and type 2. Research shows that type 2 mainly occurs in the hair follicles and plays a bigger role in androgenetic alopecia than type 1.

DHT attaches to androgen receptors on the cells of hair follicles. This binding activity typically results in normal processes like body hair growth. However, in people with a genetic predisposition to hair loss, the hair follicles are more sensitive to the effects of DHT.

The attachment of DHT to the androgen receptors disrupts the functioning of the hair follicles, causing them to shrink. High levels of DHT can overstimulate the follicles, resulting in the miniaturization of the hair follicle. Over time, the hair follicle shaft becomes so shriveled that it produces only a tiny, nearly invisible hair.

As the growth cycle shortens and follicles shrink under the influence of DHT, the hairs produced become progressively thinner, finer, and more brittle. Eventually the follicles become dormant and hair growth stops completely in the affected follicles, leading to baldness. However, the follicles are not completely gone, just greatly diminished.

The degree to which DHT shrinks hair follicles is determined by genetics. The androgen receptor (AR) gene makes the receptor on hair follicles that interacts with testosterone and DHT.

In people with hair follicles that are particularly sensitive, even small amounts of DHT can more easily trigger the miniaturization process and subsequent hair loss. This genetic predisposition can be inherited from either side of the family.

Screenshot of the Profollica website

Studies on Low Testosterone and Hair Loss

A population-based study conducted in Germany found no clear link between testosterone levels and hair loss in aging men. The study included 373 men aged 20-69 and measured testosterone levels, hair loss, and other factors. Results showed no significant difference in total or free testosterone levels between men with varying degrees of hair loss.[1]

Several other studies have reported similar findings, suggesting that testosterone levels alone do not directly correlate with the extent of hair loss in men. A review of the literature concluded that the majority of studies found no significant difference in testosterone levels between balding and non-balding men.[1]

Interestingly, some research suggests that low testosterone levels may actually slow down hair loss. A study examining the effects of testosterone supplementation on older men with low testosterone found that the treatment increased hair loss in the vertex area of the scalp.[7] This implies that raising testosterone levels in hypogonadal men might accelerate age-related hair loss.

Another study investigated the relationship between DHT levels and hair loss in men with androgenetic alopecia. Results showed that men with lower DHT levels had significantly less hair loss than those with higher levels.[8] This suggests that lower DHT production, which can result from low testosterone, may have a protective effect against hair loss in some men.

Despite these findings, the relationship between low testosterone and hair loss remains complex and not fully understood. Many studies have limitations such as small sample sizes, lack of long-term follow-up, and potential confounding factors like age, genetics, and other health conditions.[1][9]

Additionally, the inconsistencies in results across different studies highlight the need for further research to clarify the role of testosterone in hair loss.[10]

Other Factors Contributing to Hair Loss

Age-Related Hair Follicle Changes

As we age, our hair follicles naturally begin to shrink, leading to thinner, finer hair. The hair growth cycle also slows down, meaning that hair takes longer to regrow after falling out.

Additionally, the hair may lose pigment, resulting in gray or white hair. These age-related changes can contribute to the appearance of thinning hair or baldness, particularly in combination with other factors.

Nutritional Deficiencies

Proper nutrition is essential for healthy hair growth. Deficiencies in certain nutrients can lead to hair loss or thinning. Iron deficiency, which is particularly common in women, can cause anemia and contribute to hair loss.

Protein is also crucial for hair growth, as hair follicles are primarily made of protein. A lack of protein in the diet can cause the body to ration its protein supply, leading to reduced hair growth.

Other nutrients that play a role in hair health include zinc, vitamin D, and B vitamins.

Hormonal Imbalances and Conditions

Hormonal imbalances can significantly impact hair growth and loss. Thyroid disorders, both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid), can cause hair thinning or loss.

In women, polycystic ovary syndrome (PCOS) is another hormonal condition that can lead to hair loss, due to increased levels of androgens (male hormones). Other hormonal changes, such as those that occur during pregnancy, menopause, or due to certain medications, can also affect hair growth.

Medications

Certain medications can cause hair loss as a side effect. Chemotherapy drugs, which target rapidly dividing cells like cancer cells, can also damage hair follicles and lead to temporary hair loss. Blood thinners, such as heparin and warfarin, can cause hair thinning.

Other medications that may contribute to hair loss include beta-blockers, antidepressants, and high-dose vitamin A supplements. In most cases, hair growth resumes once the medication is stopped.

Stress and Illness

Stress, both physical and emotional, can disrupt the hair growth cycle and lead to hair loss. Severe stress or illness can cause a type of hair loss called telogen effluvium, where a large number of hair follicles enter the resting phase (telogen) and fall out simultaneously.

This can occur several months after a stressful event or illness, such as surgery, severe infection, or significant weight loss. In most cases, the hair grows back once the stressful period has passed.

Harsh Hair Treatments and Hairstyles

Certain hairstyles and treatments can contribute to hair loss, particularly if they cause traction or damage to the hair follicles. Tight hairstyles, such as braids, cornrows, or ponytails, can pull on the hair and lead to traction alopecia.

Harsh chemical treatments, like perms, relaxers, and bleaching, can weaken the hair shaft and cause breakage. Excessive heat styling can also damage the hair and contribute to hair loss. Minimizing these practices and treating the hair gently can help reduce the risk of hair loss from these factors.

Graphic for Male Health Review's 'Best Men's Hair Loss Treatments' article

Treatments for Hair Loss

FDA-approved medications

  • Finasteride: Finasteride (Propecia) is an oral medication that works by inhibiting the enzyme 5-alpha reductase, which converts testosterone to DHT. By reducing DHT levels, finasteride can slow down hair loss and promote hair regrowth in men with androgenetic alopecia. It is FDA-approved for the treatment of male pattern baldness.
  • Minoxidil: Minoxidil (Rogaine) is a topical solution or foam that is applied directly to the scalp. It works by widening blood vessels and improving blood flow to hair follicles, which can stimulate hair growth. Minoxidil is FDA-approved for the treatment of both male and female pattern hair loss.

Low-level laser therapy

Low-level laser therapy (LLLT) uses low-power lasers or LEDs to irradiate the scalp, which is thought to stimulate hair growth by increasing blood flow and cellular metabolism in hair follicles. LLLT devices, such as laser combs, headbands, and helmets, are available for home use and have shown some promise in promoting hair growth, although more research is needed to establish their long-term efficacy.

Platelet-rich plasma therapy

Platelet-rich plasma (PRP) therapy involves injecting a concentrated solution of a patient’s own platelets into the scalp. Platelets contain growth factors that can stimulate hair follicles and promote hair growth. PRP therapy has shown some promising results in treating androgenetic alopecia, but more research is needed to determine its long-term effectiveness.

Hair transplantation

Hair transplantation is a surgical procedure that involves removing hair follicles from a donor area (usually the back of the scalp) and transplanting them to the balding or thinning areas. This can provide a permanent solution for hair loss, but it’s costly, time-consuming, and may require multiple sessions for optimal results.

Nutritional supplements

Several nutritional supplements have been studied for their potential to promote hair growth and reduce hair loss. A systematic review found that supplements with the highest quality evidence for potential benefit include:

Other supplements like vitamin D, kimchi and cheonggukjang, and Forti5 had lower quality evidence. While these supplements show promise, more research is needed to establish their efficacy and safety for hair loss treatment. It’s important to consult with a healthcare provider before starting any supplement regimen.

List of Profollica benefits

Lifestyle changes and stress reduction

Lifestyle factors like stress, poor nutrition, and harsh hair treatments can contribute to hair loss. Adopting healthy habits such as eating a balanced diet rich in protein, iron, and other essential nutrients, managing stress through relaxation techniques, and avoiding harsh hair treatments and tight hairstyles may help reduce hair loss and promote healthy hair growth[5].

Overall, there are several treatment options available for hair loss, ranging from FDA-approved medications to surgical procedures and nutritional supplements. While some treatments have shown promising results, more research is needed to establish their long-term efficacy and safety. Consulting with a healthcare provider can help determine the most appropriate treatment approach based on individual needs and the underlying cause of hair loss.

Conclusion

Although testosterone plays a crucial role in hair growth, the direct link between low testosterone levels and hair loss is not as straightforward as commonly believed. The conversion of testosterone to DHT by 5-alpha reductase enzymes and the sensitivity of hair follicles to DHT are key factors in the development of androgenetic alopecia.

However, studies have shown inconsistent results regarding the association between testosterone levels and the extent of hair loss, with some even suggesting that low testosterone may have a protective effect.

While low testosterone may play a role in hair loss, it’s just one piece of a much larger puzzle. Understanding the complex interplay of hormones, genetics, and other contributing factors is essential for developing effective prevention and treatment strategies.

As research continues to shed light on the underlying mechanisms of hair loss, healthcare professionals will be better equipped to provide personalized, evidence-based care to help individuals maintain healthy hair and overall well-being.

References
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817427/
  2. https://www.vitalityhrt.com/blog/does-low-testosterone-cause-hair-loss/
  3. https://www.healthline.com/health/hair-loss-and-testosterone
  4. https://academic.oup.com/bjd/article-abstract/185/S1/82/6599594
  5. https://xyonhealth.com/blogs/library/does-testosterone-cause-hair-loss
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326161/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3814638/
  8. https://www.nature.com/articles/s41467-023-41231-8
  9. https://www.nature.com/articles/s41591-020-0751-5
  10. https://pubmed.ncbi.nlm.nih.gov/32042192/
  11. https://pubmed.ncbi.nlm.nih.gov/26014426/
  12. https://www.hgspecialist.com/blogs/advice/dht-how-does-it-cause-hereditary-hair-loss
  13. https://www.healthline.com/health/dht
  14. https://www.medicalnewstoday.com/articles/68082
  15. https://www.michelegreenmd.com/does-low-testosterone-cause-hair-loss
  16. https://www.ncbi.nlm.nih.gov/books/NBK557634/
  17. https://www.everydayhealth.com/skin-and-beauty-pictures/ten-causes-of-hair-loss.aspx
  18. https://www.webmd.com/skin-problems-and-treatments/hair-loss/understanding-hair-loss-basics
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719969/

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