TESTOSTERONE AND HAIR LOSS: How to Get Ahead
Muscular Development|June 2021
The simple fact is that most men are concerned about their looks; for the bodybuilder and fitness enthusiast, appearance is a strong factor in one’s satisfaction. It is undeniable that testosterone (T) directly impacts the physical health, function, and appearance of a man; as well, one’s mental health and cognitive abilities. In the chronology of life, testosterone’s effects produce milestones that easily identify the stages of life: the ultrasound’s shadow of a penis during pregnancy; a wispy mustache during adolescence; a deep voice during adulthood; and with its decline late in life, the loss of muscle, and erectile dysfunction.
Dan Gwartney

Many men also see hair changes related to testosterone. Regional hair overgrowth can result in scary-looking eyebrows, or furry ears. However, the greatest concern is hair loss. There are numerous causes for hair loss, but this article deals primarily with testosterone-related hair loss, called androgenetic alopecia (AA). AA commonly results in loss of hair in an ever-growing patch, typically from the crown of the head. About half of all men (and a fair number of women) will develop “male pattern balding.” For some, this may start in their early 20s, while others will be spared any noticeable hair loss until their mid-50s.

Bodybuilders and other athletes who have used anabolic-androgenic steroids (AAS) and are predisposed to hair loss often see an acceleration during AAS cycles. Testosterone is an androgen, but in the body it can be converted into a more androgenic form called DHT via an enzyme called 5-alpha reductase (5AR); conversely, it can be metabolized into an estrogen via a separate enzyme group called aromatase. During natural testosterone production, an epimer called epitestosterone is produced in near-equivalent amounts. Epitestosterone has anti-androgenic properties, so it probably balances out the effects of testosterone. AAS users suppress natural testosterone production (and thus epitestosterone production), so they lose that protective “check and balance.” The AAS that cause the most pronounced hair loss are those based upon the DHT structure or those that do not aromatize easily; Winstrol and Anadrol 50 are notorious for this effect.

So, it is an inevitable fact of life that half of all men (and possibly a higher percentage of AAS users) will have to deal with the comb-over? Thankfully, not; there is research old and new that offers hope. In the last few decades, relatively effective and scientifically based treatments became available. Of course, there is always HairClub, formerly Hair Club for Men, but there is something “right” about regrowing one’s own hair. It is a sign of youth and health to the masses.

Hair-Raising Options

The first hair-loss drug to be approved was minoxidil (Rogaine). This drug was originally developed to treat high blood pressure, but the “side effect” was discovered incidentally when patients commonly reported hair regrowth. Despite the early promise, minoxidil’s results have not lived up to the “miracle drug” status. It does work in providing hair regrowth to lesser or greater effect in about two out of three men who are in the early stages of hair loss; women suffering from androgenetic alopecia experience better and more consistent results. Of course, women are less affected due to higher estrogen and lower DHT concentrations.

Minoxidil works best on the crown of the head, and is not as effective in treating frontal hair loss (i.e., receding hairline). Its effects are not permanent, requiring daily or twice-daily application. Minoxidil is available as an over-the-counter product, so it is readily accessible. Minoxidil appears to push hair follicles past the “resting” stage (telogen), back into the growth phase of the hair life cycle (anagen). It is presumed that improved blood flow to the scalp may be one route of effect; increased intracellular calcium is another proposed effect.

Another shampoo available over-the-counter has been shown to be nearly equivalent to minoxidil; however, it has not been submitted to the FDA for approval as a hair-loss treatment. This is likely a financial issue, rather than a clinical issue, as the active ingredient (ketoconazole) has been known to affect hair growth for many years. Therefore, any product would not be eligible for patent protection. However, as consumer magazines have reported this effect repeatedly over the years, it is likely that much of the demand for Nizoral and other ketoconazole-based shampoos is for treating hair loss. Ketoconazole is an antifungal drug, and has also been shown to lower testosterone and reduce inflammation. All three of these functions may aid in promoting hair growth.

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