Anabolic Steroids and Hair Loss
Hair loss (alopecia) affects both men and women due to a variety of causes.
The most common type is androgenetic alopecia, also known as male pattern baldness.
This form of hair loss can begin at any age after puberty and progresses gradually.
Most men are affected by it at some point in their lives.
This post will focus on male pattern baldness, explaining the different types of hair loss and the evidence-based treatments available.
Types of Hair Loss
Androgenetic Alopecia (Male Pattern Baldness)
By age 50, approximately half of all men are affected by male pattern baldness (androgenetic alopecia).
Men produce testosterone, which can be converted into dihydrotestosterone (DHT) by the enzyme 5-alpha reductase (of which there are three types).
Hair follicles in certain areas of the scalp suffer inflammatory damage from DHT. Over time, these follicles weaken, the hair thins, and hair loss progresses.
Men experiencing male pattern baldness exhibit varying levels of total and free testosterone.
The occurrence of hair loss is linked to the expression of 5-alpha reductase in the scalp.
Regardless of testosterone and exogenous DHT levels, if the scalp does not significantly express this enzyme and remains undamaged by DHT, the hair follicles will stay healthy.
The level of 5-alpha reductase expression is the primary factor determining if a man will go bald.
Exogenous testosterone and other anabolic-androgenic steroids (AAS) typically accelerate hair loss in men who are genetically predisposed to it.
While they can hasten the onset of hair loss, they are not the definitive cause for most men.
Treatments targeting 5-alpha reductase will not prevent hair loss from DHT-derivative AAS, and even non-DHT related AAS can be associated with hair loss.
The old wives’ tale that “hair loss is only inherited from your mother’s side” is false.
Telogen effluvium is defined as shedding more than 100 hairs per day and can be caused by chronic illness, extreme stress, or medications (including AAS).
It usually resolves once the underlying cause is removed.
Alopecia Areata
This is an autoimmune reaction that creates localized patches of hair loss.
T-cells cause inflammation in the scalp, leading to bald spots, while other hair remains unaffected.
Anagen Effluvium
Caused by chemotherapy, it typically resolves after treatment ends.
Traction Alopecia
This is caused by pulling forces on the hair, with hairstyles like tight ponytails being a primary factor.
Other causes of hair loss include scarring alopecia, trichotillomania, infections, and thyroid disorders.
Treatments for Male Pattern Baldness
Finasteride (5-alpha Reductase Inhibitor)
Commonly used to treat male pattern baldness, it is an FDA-approved medication.
It reduces plasma DHT levels by over 70%, showing symptom improvement within 3-4 months and reaching maximum effect after 6 months.
The success rate for hair regrowth can be over 60%, with a hair loss prevention rate as high as 90%.
Side effects can include sexual dysfunction, orthostatic hypotension, and mood changes.
Dutasteride is a more potent 5-alpha reductase inhibitor but is not FDA-approved for this purpose.
Minoxidil
A topical medication used to stimulate or preserve hair growth.
An initial shedding phase may occur, but this typically improves after a few months.
Effects can be seen in as little as 8 weeks.
The primary side effect is skin irritation.
Ketoconazole Shampoo
As a DHT inhibitor, this shampoo is approved for treating dandruff and may show positive effects on hair loss.
Hair Transplant
The closest thing to a “cure” for hair loss, this procedure involves transplanting hair follicles to grow new hair.
The transplanted hair is permanent.
Platelet-Rich Plasma (PRP) Injections
Used to promote hair growth, it has shown some efficacy, but more research is needed.
Saw Palmetto
A potential 5-alpha reductase inhibitor, it may be effective for mild hair loss.
Caution should be exercised when using it with anticoagulants.
Biotin
While biotin deficiency can cause hair loss, there is little evidence that additional supplementation is effective for improving it.
Oils
- Pumpkin Seed Oil: May lower 5-alpha reductase and promote hair growth.
- Coconut Oil: Can reduce protein loss, but its effectiveness in preventing hair loss is uncertain.
- Castor Oil: Has anti-dandruff properties, but there is little evidence for its role in hair loss prevention.
- Peppermint Oil: May increase blood flow, potentially promoting hair growth.
Other Supplements
- Beta-Sitosterol: Potential as a 5-alpha reductase inhibitor, but there is no clear evidence for its use in treating hair loss.
- Capsaicin + Isoflavones: Some studies have shown a hair growth-promoting effect.
- B Vitamins: There is no evidence that supplementation promotes hair growth.
Hair loss can be mentally distressing, and male pattern baldness affects the majority of men.
The effectiveness of each treatment varies, so it’s crucial to consult with a doctor to choose an evidence-based therapy.
