Hair loss can be caused by several factors, such as hormonal imbalances in men and women. But it all goes to the question, does ...

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Will Testosterone Replacement Therapy (TRT) Make You Go Bald?

does testosterone replacement cause hair loss I'm Dr Reina Malik urologist and pelvic surgeon and today I'm going to break down exactly why people think testosterone replacement causes hair loss and will it cause hair loss for you so let's talk about the typical type of hair loss that we see in Men in general that can also happen with testosterone and it's called androgenic alopecia and typically it affects the hair across the temples and around the front part of the scalp and so what causes male pattern hair loss or endogenic alopecia so and male pattern hair loss or endogenic alopecia is exceedingly common in fact 80% of 70-year-old Caucasian men will have some degree of male pattern hair loss and interestingly Asian Native American and African men tend to have a lesser degree of hair loss and less proportion of men who develop hair loss so they when they do develop it it's also less thinning of the hair and less significant now why do men develop hair loss well there's a whole host of issues that can lead to hair loss very commonly it's genetic so if you have a dad that had a male pen on hair loss it's very likely that you will develop it also now it's not exactly as well defined in terms of if your mom has hair loss if that will affect you as well but we do know some genes are passed on the ex chromosome which are definitely from the mom but there's a whole host of factors that can affect the hair growth cycle and can cause shedding and this can be due to stress which is a very common one poor nutrition it can be due to using tight hairstyles so if you're a man with long hair or even a woman with long hair and you tend to do really tight buns or pull your hair back very severely or tightly it will cause hair loss particularly in the areas where there's more traction certain infections or medications can also lead to hair loss and abnormalities in certain hormones like your thyroid or certain things like deficiency or other deficiencies can also lead to hair loss now why does this hair loss occur so when you have androgenic alcia there's a few things that happen to your hair based on the hair growth cycle so when you think about the hair growth cycle there's the antigen phase or the phase where your hair is growing actively which then goes to the catagen phase where it's transitioning and sort of stabilizing the hair growth starts to slow down or the teagen phase which means it's not growing and it's also not shedding but but less hair is going through the growth phase so it starts appearing that you're having less hair overall because you're getting less active growth and also the follicles of the hair tend to become smaller so what this means that the hair is actually getting thinner and finer than it used to be so how is testosterone related to hair loss well first of all it's because of an enzyme called five Alpha reductase so five Alpha ruus has two isoforms or two types and type two is the form form that actually active in the hair follicle it's actually present in the sheath or the outer root sheath of the hair as well as in the proximal follicle meaning the very deepest part of the hair follicle dihydrotestosterone is made in men's bodies by conversion from testosterone every day a man's body makes about 5 milligrams of testosterone now a very small percentage of that about 6 to 8% is converted to a hormone called dihydrotestosterone now this hormone has some important functions particularly in young men it can lead to secondary sex characteristics like getting body hair getting pubic hair deepening of The Voice or even some acne formation and so it's important in young men and as you age sometimes that DHT can contribute to other issues like having an enlarged prostate or hair loss interestingly early on in the 1980s in small studies they found that men who had alopecia compared to men who didn't had lower levels of sex hormone binding globulin but normal levels of testosterone so they actually had higher levels of free testosterone if you want to learn more about sex hormone binding globuline check out my video on that but basically sex hormone binding globulin binds up some of the testosterone so there's less of it that's freely available so when you have lower shbg you have more free testosterone so from that study a link was created from free testosterone if you have higher amounts of free testosterone you may be more likely to have alopecia but what's the actual truth future studies particularly a 2017 study looking at about 373 men from Northeastern Germany they looked at men with energenic alopecia compared to those who didn't have it and when they compared them they found no significant difference in any sort of Androgen concentrations between those who had hair loss and those who didn't so from this study and other sort of theories about this they've theorized that probably it's not that the increase in testosterone actually leads to hair loss for everybody it's probably that in men who are predisposed they have a genetic abnormality that makes them more likely to have hair loss when they get that increase in DHT related to higher testosterone levels they're more likely to see that male pattern hair loss when they may not have without it so meaning if you don't have genetic predisposition to hair loss like your father has a great head of hair at the age of 80 then it's unlikely that testosterone is going to cause your hair loss but again hair loss is very multifactorial and it can be caused by a whole variety of things now the most interesting data about this actually comes from transgender men because they actually looked at people who started testosterone and they followed them for years to see how many actually developed hair loss on their head and so when looking at a whole bunch of prospective studies meaning looking at people moving forward after they've started testosterone replacement therapy so women who want to become men who take testosterone replacement therapy in that particular study now other studies as I mentioned have seen hair loss as high as 12 to 177% in people starting hormone replacement therapy for the purposes of becoming a transgender male now in one of these studies they actually looked at the severity of hair loss now take this again with a grain of salt because it was only 20 individuals when they looked at the people who developed hair loss after starting testosterone replacement therapy only about 30% developed moderate to severe alopecia so the large majority were mild to moderate which is encouraging so ultimately bottom line is could testosterone replacement speed up male pattern hair loss absolutely but likely it's because you're already genetically predisposed to getting hair loss now ultimately there are a whole host of benefits about testosterone and I've made a whole bunch of videos about testosterone and why it's beneficial and why it may be helpful if you are truly low in terms of your testosterone levels so if hair loss is a big concern for you it's important to know that yes it may speed up your hair loss and maybe one in five or less will develop some hair loss when starting testosterone hair loss can be caused by a whole host of factors so if you are suffering from hair loss and either you're on testosterone or not I strongly encourage you to see a dermatologist who is specialized in hair loss so they can help you uh one uncover any medical reasons for the hair loss and two treat you for hair loss itself if you're curious and learning more about treatment options for hair hair loss uh let me know in the comments below we can get a dermatologist on the podcast to help us talk about those things in more detail and if you didn't already know I do have a podcast now I release those videos every Friday here on YouTube but I also have them as audios on all the major podcast platforms Apple Spotify and any other podcast platform you might use so if you guys are enjoying my content please be sure to check out our podcast and leave us a rating or review if you're enjoying the podcast because we greatly appreciate it the best compliment you can give me is by sharing my content with others so people can find it all over the world and as always we going to take care of yourself because you are worth it

Dr.

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