Does Testosterone Replacement Therapy (TRT) Cause Hair Loss?

Published by Debbie Luna
Last Updated: December 21, 2021

The endocrinological process of testosterone replacement therapy has become increasingly popular in certain subsections of the population, such as in the case of female to male transgender individuals or men suffering from certain endocrinological disorders that affect their production of androgenic hormones.

And though this particular medical treatment is seen as mostly safe- especially considering the fact that prospective patients are assessed regularly for safety, there are certain potential side effects that many patients undergoing testosterone replacement therapy may find themselves worrying about.

Among these is the potential side effect of hair loss, otherwise known as balding, a condition wherein the individual’s hair follicles located on their scalp will begin to lose their function, no longer producing hair.

The exact role testosterone replacement therapy plays in the occurrence of hair loss in its patients is disputed, with certain evidence suggesting that it is not in fact testosterone replacement therapy itself that acts as a major contributor to this hair loss condition.

What is Testosterone Replacement Therapy?

Testosterone replacement therapy, fittingly, is the subsequent treatment or replacement of a patient’s own internal testosterone production with endogenous androgenic compounds, oftentimes coming in the form of an intramuscular injection, a gel patch, or even an oral pill.

This sort of medical treatment is primarily prescribed for the purposes of treating the symptoms of low testosterone in an individual, such as a reduced sex drive, low muscle body composition, weakened bone density and various other effects normally related to androgenic hormones.

testosterone

The exact causes of low testosterone can vary on a case by case basis, with most ordinary individuals experiencing a minor decline in their total serum testosterone production on a year by year basis after approximately thirty years old.

Consequently, individuals experiencing low testosterone due to their particular life style choices or due to an underlying medical condition may already be experiencing hair loss or are at the least susceptible to it in some shape or form, giving the impression that testosterone replacement therapy possesses some correlation to said balding.

What are the Primary Contributing Factors to Hair Loss?

Whether or not testosterone replacement therapy is directly responsible for hair loss aside – it is entirely possible for individuals to develop this particular condition for a variety of other reasons, some of which may even co-occur alongside testosterone replacement therapy, and others of which are likely unavoidable for the most part.

In both men and women, the presence of genetic factors is the usual culprit for significant hair loss, otherwise known as hereditary androgenic alopecia. This sort of balding susceptibility is rather difficult if not entirely impossible to avoid, especially in the later stages of life wherein such things like high stress levels and the effects of advanced aging begin to affect hair follicles.

Another reason for the development of hair loss in an individual is the presence of excessive dihydrotestosterone, a derivative of testosterone that is among one of the primary reasons why hair loss occurs at all.

The effects of dihydrotestosterone are vital to the healthy function of the human body, and as such simply preventing its formation or the binding of this particular androgenic compound to the hair follicles would be rather unwise and unsafe.

It is theorized that the presence of elevated dihydrotestosterone levels in the human body can directly cause the deactivation or otherwise negatively affect functional hair follicles via the direct binding and blocking of the follicles at a chemical level.

What is Dihydrotestosterone?

As previously mentioned in the last section of this article, dihydrotestosterone is an androgenic hormone responsible for a variety of healthy functions in the human body, regardless of its gender. 

In most healthy individuals, dihydrotestosterone is derived from serum testosterone produced in the body, with an approximate 10% conversion rate by total volume, though this will vary from person to person, with such factors like epigenetics, genetics, external factors and the presence of testosterone replacement therapy all acting to cause a higher or lower conversion rate.

balding male

Thus, it may be inferred that the elevated levels of serum testosterone found in a patient’s body during their treatment with testosterone replacement therapy will therefore convert by some percentage into dihydrotestosterone, increasing their risk of hair loss and similar other direct effects of the androgenic hormone.

This is due to the presence of an enzyme referred to as 5alpha-reductase, of which is responsible for the conversion of testosterone to dihydrotestosterone in the human body, indirectly creating a balding effect in patients undergoing TRT.

Is Dihydrotestosterone Unavoidable During Testosterone Replacement Therapy?

While the majority of prescribing physicians and similar medical professionals do not normally prescribe dihydrotestosterone blockers in tandem with testosterone replacement therapy, it is entirely possible for a patient to request such a drug be added to their endocrinological regimen if hair loss is a significant risk factor for them.

However, without the presence of dihydrotestosterone blockers alongside testosterone replacement therapy, it will be entirely up to the individual’s genetics and lifestyle whether they develop any sort of hair loss or not, making the choice of undergoing testosterone replacement therapy one entirely of personal preference.

Who is More Susceptible to Hair Loss with Testosterone Replacement Therapy?

Though cases of hair loss will always depend on a case by case basis due to the variable nature of the factors contributing to its development, certain groups of the population are more likely to experience this particular condition, placing them at higher risk of hair loss when undergoing testosterone replacement therapy.

Among the largest of these groups of the population is the biological gender of male, being far more likely to experience male pattern baldness or similar hair loss conditions due to their higher volumes of DHT as well as their innate susceptibility to hair follicle deactivation as a natural characteristic of aging.

By extension, it is therefore no surprise that individuals of more advanced age (approximately over 30 years old) are also at a higher risk of hair loss when undergoing testosterone replacement therapy, an unfortunate coincidence considering the fact that men of advanced age are the target patient demographic of the treatment.

Asides from these factors, individuals with a family history of androgenic alopecia, male or female pattern baldness or other forms of the alopecia condition are all also likely to develop hair loss, especially if both parents present the same condition.

In more specific cases, the presence of certain medications, endocrinological changes and conditions or even the occurrence of a traumatic or stressful event in the patient’s life may all trigger significant incidences of hair loss, especially if genetic and demographic factors are also combined.

Is Hair Loss from Testosterone Replacement Therapy Reversible?

Whether or not an individual’s hair loss is reversible depends on the exact reasonings behind the occurrence of such hair loss, with genetic factors or certain diseases making reversing the baldness far more difficult than simply stopping the testosterone replacement therapy treatment.

This is due to the fact that, though testosterone replacement therapy may induce some level of hair loss in certain individuals, if the hair loss is occurring to a factor unrelated or only partially related to the TRT, it is unlikely that stopping the treatment will also stop the hair loss.

However, in instances where the conversion of dihydrotestosterone directly from exogenous volumes of testosterone is the primary cause of the hair loss, it is possible to prevent further hair loss by altering the dosage, dose form or even presence of said exogenous testosterone supplementation.

Can Hair Loss from Testosterone Replacement Therapy be Prevented?

Though hair loss from testosterone replacement therapy has been established to be an individual risk and is often unpredictable due to its case by case incidence, there are certain medications and lifestyle choices that may reduce the risk of such a condition being developed during the treatment of testosterone replacement therapy.

Among these is the concomitant use of dihydrotestosterone blockers with the exogenous testosterone preparation, of which will prevent some level of the 5alpha-reductase conversion factor from occurring, though not without its own drawbacks and side effects.

Other methods may include the more regular occurrence of exercise in the patient’s lifestyle, which will improve blood flow to the scalp and therefore also improve hair follicle health. This may also be combined with a proper diet and adequate sleep, all of which are conducive to proper skin and hair function.

References

1. Swerdloff RS, Dudley RE, Page ST, Wang C, Salameh WA. Dihydrotestosterone: Biochemistry, Physiology, and Clinical Implications of Elevated Blood Levels. Endocr Rev. 2017;38(3):220-254. doi:10.1210/er.2016-1067

2. Marchetti PM, Barth JH. Clinical biochemistry of dihydrotestosterone. Annals of Clinical Biochemistry. 2013;50(2):95-107. doi:10.1258/acb.2012.012159

3. Darwin E, Hirt PA, Fertig R, Doliner B, Delcanto G, Jimenez JJ. Alopecia Areata: Review of Epidemiology, Clinical Features, Pathogenesis, and New Treatment Options. Int J Trichology. 2018;10(2):51-60. doi:10.4103/ijt.ijt_99_17

4. Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J. Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J Am Acad Dermatol. 2018 Jan;78(1):1-12. doi: 10.1016/j.jaad.2017.04.1141. PMID: 29241771.

Debbie (Deb) started powerlifting and Olympic lifting in High School as part of her track team's programming; She continues to train in order to remain athletic. Inspire US allows Deb to share information related to training, lifting, biomechanics, and more.
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