Does Low Testosterone Cause Hair Loss?

Hair loss is a common condition that affects a significant number of men worldwide. By the age of 35, approximately 85% of men will experience some degree of hair thinning, and by the age of 50, about 50% of men will have noticeable hair loss. Male pattern baldness, also known as androgenetic alopecia, is the most common form of hair loss in men.

The prevalence of hair loss in men increases with age, and it can have a profound impact on a person's self-esteem and emotional well-being.

If you suspect that there is a hormonal imbalance in your body and that a lack of testosterone may be causing hair loss, we will resolve this dilemma for you.

A doctor assessing a patient for androgenetic alopecia, commonly known as male pattern baldness

What is Testosterone and DHT?

Testosterone is a steroid hormone that belongs to the androgen group. It is primarily synthesized in the testes of males and the ovaries of females, although a smaller amount is also produced by the adrenal glands.

As a key male sex hormone, testosterone plays a crucial role in the development of male reproductive tissues, such as the testes and prostate, as well as promoting secondary sexual characteristics including increased muscle and bone mass, and the growth of body hair.

It regulates various physiological processes, including libido, energy levels, immune function, and the maintenance of homeostasis.
Abnormal levels of testosterone, whether excessive or deficient, can have significant health implications.

Low testosterone levels, or hypogonadism, can lead to symptoms such as reduced libido, erectile dysfunction, decreased muscle mass, and osteoporosis. High levels of testosterone, on the other hand, may contribute to conditions such as polycystic ovary syndrome (PCOS) in women and increased risk of prostate cancer in men.
A molecular model of the testosterone hormone

Testosterone exists in the body in various forms, including free testosterone, which is not bound to proteins and is biologically active, and bound testosterone, which is attached to proteins such as sex hormone-binding globulin (SHBG) and albumin. The majority of testosterone in the bloodstream is bound to SHBG and albumin, with only a small fraction existing as free testosterone.

Dihydrotestosterone (DHT) is a potent androgen, a derivative of testosterone, synthesized primarily in the hair follicles, prostate gland, testes, and adrenal glands. The conversion of testosterone into DHT is facilitated by the enzyme 5-alpha-reductase. This process occurs in several tissues, including the skin, liver, and brain, but is particularly significant in the hair follicles and prostate gland.

DHT is structurally similar to testosterone but exhibits a significantly higher affinity for androgen receptors, making it more potent in its biological effects.

The Role of Testosterone in Hair Growth

Testosterone plays a complex and multifaceted role in hair growth, influencing various stages of the hair growth cycle and impacting both the development and maintenance.

Anagen Phase: This is the active growth phase, during which hair shafts are produced. Testosterone can stimulate the growth of body and facial hair during this phase but may have a paradoxical effect on scalp hair in individuals with a genetic predisposition to androgenetic alopecia.

Catagen Phase: This is a transitional phase that lasts for a few weeks, during which the hair structure shrinks and detaches from the dermal papilla. Testosterone does not have a significant direct impact on this phase.

Telogen Phase: This is the resting phase, lasting around three months, after which the hair falls out. Testosterone levels can influence the duration of this phase, particularly in the scalp, where higher levels of dihydrotestosterone (DHT) may shorten the anagen phase and prolong the telogen phase, leading to increased hair shedding.

Illustration depicting the four stages of hair growth: Anagen (growing phase), Catagen (transition phase), Telogen (resting phase), and Exogen (shedding phase)

The Impact of DHT

DHT binds to androgen receptors with greater affinity than testosterone. In individuals genetically predisposed to androgenetic alopecia, DHT can cause miniaturization, leading to progressively thinner and shorter hair strands, and eventually hair loss.

The sensitivity to androgens varies between different regions of the body. Scalp areas, particularly in the frontal and vertex regions, can be more sensitive to the effects of DHT. Conversely, in other areas such as the face and chest, the response to androgens may be positive, resulting in increased hair growth.

Causes of Hair Loss in Men

Hair loss in men, medically known as androgenetic alopecia, can be attributed to a variety of factors. So let's discover why men go bald.

Genetics: Androgenetic alopecia, is primarily influenced by genetics, with the androgen receptor (AR) gene playing a key role in determining hair follicle sensitivity to dihydrotestosterone (DHT), a derivative of testosterone. Variations in the 5-alpha reductase genes (SRD5A1 and SRD5A2) also contribute to the condition by affecting DHT production.

Medications: Drugs used to treat cancer (chemotherapy), high blood pressure, arthritis, depression, and heart disease can all potentially cause hair to thin or fall out.

Stressful Events: Prolonged exposure to stress, whether due to workplace tension, relationship issues, physical shock, or traumatic events, can trigger temporary hair loss. This condition, known as telogen effluvium, results in widespread thinning of the hair.

Hairstyles and Treatments: Certain hairstyles that pull tightly on the hair can lead to traction alopecia, a type of hair loss caused by continuous tension. Additionally, harsh chemical treatments such as hot oil treatments, perms, and bleaching can also contribute to hair loss.

Lifestyle Choices and Habits: Poor nutrition, lacking essential vitamins and minerals, rapid changes in weight, the use of hair dyes, wearing hats,  excessive alcohol consumption, and smoking can also negatively impact hair health.

Hormonal Imbalances: Hormonal changes due to conditions like thyroid disease, diabetes, or testosterone deficiency can disrupt the normal hair growth cycle.

What are the signs of low testosterone?

Hypogonadism is characterized by a variety of symptoms that can significantly impact a man's quality of life.

Symptoms of low testosterone may include:

  • Erectile dysfunction
  • Decreased sex drive (reduced libido)
  • Fluctuations in energy levels, often feeling a lack of positive energy
  • Tiredness and fatigue despite adequate rest
  • Increase in body fat and weight gain
  • Hair loss, development of bald spots, and thinning hair
  • Mood swings, depression, anxiety, and irritability
  • Sexual dysfunction

How Low Testosterone Levels Affect Hair Loss?

Low testosterone itself does not directly cause hair loss.

However, it can indirectly influence the process, especially in the case of androgenetic alopecia. The primary hormone implicated in this type of hair loss is dihydrotestosterone (DHT), a more potent derivative of testosterone.

While not the direct culprit, low testosterone can contribute to a hormonal imbalance that may exacerbate hair loss. For example, the body might react by increasing the activity of the enzyme 5-alpha-reductase, which converts testosterone to DHT.

This does not universally lead to hair loss unless there is a genetic predisposition for sensitivity to DHT.

Reduced testosterone can disrupt the hair growth cycle, leading to a shortened anagen (growth) phase and an extended telogen (resting) phase. This alteration can result in increased hair shedding and noticeable thinning.

Fatigue, depression, and anxiety, which are often associated with men with low testosterone, can exacerbate stress-related hair loss (telogen effluvium).

Testosterone Baldness Myth

The myth that high testosterone levels directly cause hair loss is a common misconception. In reality, the relationship between testosterone and hair loss, particularly androgenetic alopecia, is much more complex and involves several factors, primarily the hormone dihydrotestosterone (DHT), rather than testosterone itself.

Does High Testosterone Cause Hair Loss?

The idea that "more testosterone equals more hair loss" oversimplifies the biological processes. Many men with high testosterone levels do not experience hair loss unless there is a genetic predisposition for sensitivity to DHT. 

Effective Strategies for Combating Hair Loss

Red light therapy

Red light therapy, also known as low-level laser therapy (LLLT), has emerged as a promising non-invasive treatment option for androgenetic alopecia. This therapy utilizes specific wavelengths of light to stimulate cellular activity in the hair follicles.

Mechanism of Action:

Increased Blood Flow: Red light therapy may enhance blood circulation in the scalp, providing essential nutrients and oxygen that support healthy hair.

Stimulation of Cellular Activity: The therapy is thought to stimulate the mitochondria within scalp cells, increasing their energy production (ATP).

Reduction of Inflammation: By reducing inflammation in the scalp, red light therapy can create a healthier environment that is conducive to maintaining hair health.

Regulation of Growth Factors: The therapy may influence the expression of growth factors and signaling molecules involved in hair cycling and regeneration.

One of the key advantages of red light therapy is its safety profile. Unlike some medical treatments for hair loss, such as oral medications or surgical options, red light therapy presents minimal risk of side effects. It is a painless, non-invasive treatment that can be easily administered at home.

Several studies have shown that red light therapy can be effective in treating androgenetic alopecia. Patients undergoing treatment often experience increased hair density and thickness, with improvements usually becoming noticeable after several months of consistent use.

Home devices, such as red light therapy caps, are becoming increasingly popular.

Red light therapy laser cup

For optimal results, it is advisable to use red light therapy in combination with hair growth serums. When used together, red light therapy can enhance the absorption and effectiveness of these serums, leading to synergistic effects that may further stimulate growth and reduce hair loss.

How to increase testosterone for hair growth

Testosterone Replacement Therapy (TRT): TRT is primarily used to treat low testosterone levels, which can indirectly affect hair growth. However, it's important to note that TRT might not directly address hair loss and could potentially exacerbate it if it leads to increased levels of dihydrotestosterone (DHT).

DHT Blockers (Minoxidil, Finasteride): These medications are commonly used to treat male pattern baldness. Minoxidil (Rogaine) is a topical solution that promotes hair health by widening blood vessels in the scalp, thereby improving nutrient delivery and oxygen supply. Finasteride (Propecia) is an oral medication that effectively reduces DHT levels, addressing one of the root causes of hair thinning.

Detailed Overview of Various Approaches

Inhibitors (Caffeine, Green Tea): Natural inhibitors like caffeine and green tea extract are believed to stimulate hair growth by blocking DHT.

Hair Transplantation: This surgical procedure involves transplanting hair follicles from one part of the scalp (usually the back or sides) to the balding areas. It's a more permanent solution for those with significant hair loss.

Surgical Procedures: Besides hair transplantation, other surgical options like scalp reduction or flap surgery are available but less commonly performed.

Treatment for Alopecia Areata: Specific treatments are required for hair loss due to conditions like alopecia areata, such as steroid injections or immunotherapy.

Platelet-Rich Plasma (PRP) Injections: PRP therapy involves injecting a concentration of the patient's own platelets into the scalp, which is believed to stimulate hair growth by releasing growth factors.

Supplements: Biotin and vitamin B supplements are often recommended to support hair health.

Diagnosing Testosterone Deficiency

The diagnosis of testosterone deficiency involves a combination of clinical evaluation, symptom assessment, and laboratory testing.

The doctor will inquire about symptoms, such as reduced libido, erectile dysfunction, fatigue, loss of muscle mass, and mood changes. A physical examination can provide additional clues, such as reduced body hair, changes in testicular size, and the presence of gynecomastia (enlarged breast tissue in men).

The definitive diagnosis relies on blood tests to measure hormone levels. Total testosterone levels are typically measured in the morning when they are at their peak. If the total testosterone level is borderline low or if there are conditions that might affect testosterone binding to proteins, additional tests for free or bioavailable testosterone may be necessary.

These can include measurements of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to determine whether the testosterone deficiency is primary (originating from the testes) or secondary (originating from the pituitary gland or hypothalamus).

Is Hair Loss From Low Testosterone Reversible?

Hair loss resulting from reduced testosterone is not directly reversible because this condition itself is not typically the direct cause of hair loss. However, if decreased testosterone levels lead to increased dihydrotestosterone (DHT), which then contributes to hair loss, managing the hormonal imbalance may help slow down or stop further hair loss.

Is DHT hair loss reversible?

The answer depends on various factors, including the levels of DHT and the duration of hair loss. Dihydrotestosterone (DHT) is a form of testosterone that is more potent and often implicated in both male and female pattern hair loss. Men with high levels might experience significant loss of hair, especially if they are genetically predisposed to male pattern baldness. Similarly, women can suffer from female pattern hair loss due to high levels of DHT.

How do you fix low testosterone?

Fixing low testosterone involves a comprehensive approach that targets the underlying causes of the hormonal imbalance and manages the symptoms associated with it.

Testosterone replacement therapy (TRT) is one of the primary treatments used to enhance hormone levels in men suffering from this deficiency. TRT can help restore balance, which can alleviate symptoms such as fatigue, low libido, muscle loss, and the various challenges related to hair loss.

For men experiencing hair loss as a result of hormonal deficiencies, TRT may help in reducing the rate of hair thinning and potentially allowing their hair to regain its previous density. This is because restoring balance can help rebalance the body’s hormonal environment, making it less conducive for the conversion of testosterone to DHT, the hormone primarily responsible for male pattern hair loss.

Can you fix low testosterone naturally?

Naturally boosting testosterone levels can be achieved through lifestyle changes and dietary adjustments. Regular physical activity, particularly strength training and exercises like squats and deadlifts, has been shown to increase testosterone production. Incorporating a diet rich in proteins, essential fats, and nutrients like zinc and vitamin D, which are crucial for testosterone synthesis can also help.

While these natural methods can be effective, they may not be sufficient for everyone, especially those with clinically low testosterone. In such cases, medical testosterone treatment may be necessary.