Unfortunately, ageing happens to us all. For many men, hair thinning and the loss of hair are signs that ageing is well underway. As many men will attest, losing your hair can have a huge impact on your confidence as well as on your looks. It’s relatively common knowledge that, alongside hair loss, low testosterone is experienced by many men as they age. But is there a link between the two? Does low testosterone cause hair loss? Let’s take a look.
Low testosterone refers to a condition where the body does not produce enough testosterone, a male sex hormone. Testosterone plays a key role throughout a man’s life and is involved in developing muscle mass, bone density and sex drive. Testosterone is the main reason why male bodies typically have greater muscle mass and bone density than female bodies.
Testosterone levels naturally decline with age. After age 30, it begins to decrease each year at a rate of around 1% [1]. By the time men reach their 60s, one in five of them show androgen deficiency, and this increases to one in two men by their 80s [2].
Aside from ageing, low testosterone can also be caused by other conditions including:
Primary hypogonadism can occur due to either an inherited condition or testicular damage.
Secondary hypogonadism can result from either a disease or inherited condition or via acquired or circumstantial conditions.
Men can experience low testosterone caused by primary hypogonadism, secondary hypogonadism or a mixture of both.
As for the symptoms of low testosterone, these can vary from person to person. Some of the common symptoms include:
There is a common belief that low testosterone levels in men lead to hair loss. However, the relationship between the two is not straightforward. Whilst testosterone is the hormone that’s responsible for the development of male secondary sex characteristics such as facial hair and body hair growth, it is not the sole determinant of hair loss. According to some studies, total testosterone levels are not significantly associated with general hair loss [3].
Male pattern baldness, or androgenetic hair loss, is a complex condition that can be influenced by many factors including age, genetics, hormonal imbalances, medication and medical conditions. Male pattern baldness is primarily caused by a combination of genetics and hormonal factors.
One hormone that has been linked to male pattern baldness is dihydrotestosterone (DHT). This is a derivative of testosterone made by an enzyme (5-alpha reductase) that binds to hair follicles and causes them to shrink. This leads to shorter and thinner hair growth over time. Some studies have suggested that men with male pattern baldness may have higher levels of DHT in their scalp than men without hair loss [4].
However, despite DHT being derived from testosterone, it’s important to clarify that it is not the same thing. DHT is a potent hormone and this is the reason why it has such significant effects on the body. The level of DHT in the body is normally around 10% of the testosterone level [5]. Some hair loss medications such as Finasteride work by blocking the conversion of testosterone to DHT.
The actions of this hormone combined with hair follicle sensitivity is what causes hair loss. As such, DHT can often be considered the culprit when it comes to balding. However, it isn’t the amount of testosterone or DHT that really causes baldness – it’s hair follicle sensitivity.
Unfortunately, that sensitivity is largely determined by your genetics. If the receptors in the hair follicles are more easily stimulated by smaller amounts of DHT, hair loss will happen more readily. In addition, the number of androgenic receptors in hair follicles varies substantially from person to person. This is also genetically determined.
Ultimately, the relationship between low testosterone and hair loss is multifactorial and complex.
The levels of both testosterone and DHT reduce with age. They decline gradually from age 35 onwards with a more marked decline after 80 years of age [6]. The age-related reduction in DHT levels is one of the factors behind the slowing down of hair loss as we age.
The rate of hair loss slows down with age. The growth rate of the remaining hair also reduces, and hair strands become thinner. Therefore, with age, the appearance of thinning hair becomes much more visible. This led to the idea that low testosterone is linked to hair loss.
When we talk of hair loss or balding, we naturally assume that we are talking about males. Whilst hair loss does occur in women, hair loss is much more common in men. Hair loss in men tends to be more noticeable due to the different ways in which men and women lose their hair. Males tend to get androgenetic alopecia, or male pattern baldness, with over 95% of men affected by the time they reach 80 years of age.
In female pattern hair loss, the loss of hair tends to be distributed evenly over the whole scalp. This may show itself as a widened parting or as a general hair thinning where the scalp becomes more visible through the hair.
A study of sex hormones such as testosterone and hair loss in men carried out in Northeast Germany showed that there were no significant associations between sex hormones and the loss of hair [7]. In particular, total testosterone was not associated significantly with hair loss generally or on the Norwood Scale. This study was a cross-sectional population-based study of 373 men.
Another earlier study also found no statistically significant link between serum total testosterone levels in prematurely balding males between 21 and 30 years of age. The testosterone levels were within normal levels and did not differ from controls [8]. A third study also found the same result, thus confirming that low testosterone levels have little to do with male pattern hair loss [9].
Myth: Balding men have higher testosterone levels and are more virile.
There are a few myths that circulate regarding men and hair loss. One of them is that men with male pattern baldness have higher levels of testosterone and are more virile. This is not necessarily true.
Men with male pattern baldness often have lower levels of free testosterone but higher levels of the specific enzyme that converts testosterone to DHT. Alternatively, balding men may have hair follicles that are more sensitive and responsive to DHT or testosterone in comparison with other men.
Myth: Testosterone replacement will cause baldness.
Some men desire testosterone replacement therapy (TRT) to help them with lower testosterone levels. TRT side effects can include a higher sex drive, better mood and improved energy. But does TRT cause hair loss?
As with low testosterone and hair loss, there’s little proof to this myth given that hair loss is not directly related to how much testosterone is in the body. However, the higher the testosterone level, the more DHT is produced. Increased DHT can increase hair loss. However research has shown that it’s the body’s sensitivity to DHT that causes the loss of hair, not the amount of it circulating.
Unfortunately, there is very little that you can do that can influence your thinning hair. Most hair loss is caused by a combination of genetic and hormonal factors that are out of our control. Having said that, diet, lifestyle, stress and illness can play a role.
Research has shown that women with stressful lives are 11 times more likely to lose their hair [11] and science supports that hair loss due to telogen effluvium is linked to stress. That said, there’s no established link that lifestyle changes can reduce or prevent the loss of hair if it’s related to hormonal levels such as testosterone or DHT.
Making positive lifestyle changes may not always prevent hair loss directly, but it can prevent and reduce the risks of other conditions that could lead to the loss of hair. There’s no harm in eating well, getting the right amount of sleep, and doing adequate exercise.
The following treatments are available for those looking to treat testosterone hair loss.
Finasteride is a prescription medicine that is used to combat male pattern hair loss. It works by blocking the ability of enzymes to convert testosterone to DHT. This then allows the hair follicles to enter into the growth phase of the hair growth cycle – the anagen phase. As the levels of DHT reduce, hair loss is slowed and/or prevented.
Minoxidil is usually used as a topical medication and is used in treating hair loss in both men and women. It works by increasing blood flow to the scalp and hair follicles and promotes hair growth as a result.
Learn more about Finasteride vs. Minoxidil.
Often a last resort, a hair transplant is a surgical procedure that involves removing donor hair follicles from a site on the scalp (usually the back and/or sides of the head) and transplanting them to the balding or thinning areas. The hair grafts will continue to grow hair in their new location and will give the appearance of a fuller head of hair.
There are two types of hair transplants: FUT and FUE. In an FUT hair transplant, a strip of the skin on the scalp is removed from the back of the head and the hair follicles are then extracted from it. The follicles are then implanted into the recipient area of the scalp.
In an FUE transplant, the individual grafts are removed directly from the donor area and transplanted into the recipient area.
Hormone replacement therapy is something that many menopausal or perimenopausal women take. Research shows that almost 70% of women over 50 are using HRT [12]. Both menopause and perimenopause can cause hair loss by triggering some conditions like female pattern baldness and telogen effluvium. When oestrogen levels drop, some women experience hair thinning, an uneven hairline or an increase in facial hair.
HRT can help with female pattern baldness. However, some women are prescribed testosterone to boost their libido after menopause and this can increase the loss of hair due to it metabolising into DHT [13].
Testosterone replacement therapy (TRT) is the male equivalent of hormone replacement therapy. TRT does not tend to increase hair growth or reduce hair loss in males, but it can help alleviate other symptoms of low testosterone.
Stress-related hair loss is often called telogen effluvium. This kind of sudden hair loss usually occurs two to three months after a stressful life event [14]. When a person is stressed, more of their hairs enter the telogen phase, meaning that there is more widespread hair loss at once than you wouldn’t normally see. However, testosterone levels are not thought to play a part in this.
As explained above, whilst low testosterone causes a multitude of symptoms in men, one of them is not typically the loss of hair. If you are experiencing hair loss, the cause is much more likely to be genetic and not linked to low testosterone.
The symptoms of low testosterone in men include the following:
Low testosterone has not been proven to cause male pattern hair loss though hormonal factors are at play to some degree – largely with DHT.
Research has shown that low testosterone is not linked to the loss of hair. If you are suffering from male pattern baldness, this is most likely down to genetic factors. Sadly, this kind of hair loss is usually permanent unless treatments are undertaken such as medications like Finasteride and Minoxidil or hair transplantation.
Abnormally high testosterone levels in men can result in many symptoms such as low sperm counts and impotence as well as damage to the heart, prostate enlargement and liver disease. It does increase muscle mass and can affect behaviour including impaired judgement and aggression [15].
If the conversion of testosterone to DHT remains unaffected, high testosterone can increase the rate of hair loss. But, as mentioned previously, the level of DHT is only one of the factors influencing the loss of hair.
Whilst commonly thought of as a male sex hormone, women also need testosterone in their bodies. Testosterone helps produce new blood cells, enhances the libido and influences follicle-stimulating hormone (FHS) which is important in female reproduction. Symptoms of low testosterone in women usually include:
Low testosterone is not thought to affect hair growth or hair loss in women to any great extent. Having too much testosterone, on the other hand, can cause excessive facial and body hair and male pattern hair loss [16].
Given that the research has proven that testosterone is not directly linked to hair loss, increasing your testosterone levels naturally or through testosterone replacement therapy will likely not have an impact on reducing your hair loss. Higher testosterone will lead to higher DHT, and thus higher risk of hair loss. However, there is a significant interpersonal variability in the strength of this effect.
If you are suffering from symptoms of low testosterone, there are things that you can do to try and give yourself a testosterone boost. Losing weight, adopting a healthier lifestyle, consuming healthier fats including omega-3 and reducing alcohol can all have positive effects on your testosterone levels or perceived low testosterone-related symptoms.
If you are worried about hair loss and want to do something about it, contact one of our hair loss specialists who can diagnose the cause of your thinning hair and work with you to create a treatment plan tailored to your goals and needs.
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