The Truth About Testosterone and Hair Loss: What You Need to Know

One of the most common questions people ask when dealing with hair loss or thinning is, "Does testosterone cause hair loss?" While it might seem like a straightforward question, the answer is not so simple. Testosterone, as a hormone, can play a role in hair health, but it's far from the sole factor. In this blog, we are going to cover the relationship between testosterone and hair loss, the role of DHT, and what other factors can contribute to hair thinning or shedding.

Does Testosterone Cause Hair Loss?

The short answer: not necessarily. Testosterone itself does not directly cause hair loss. However, testosterone can contribute to hair shedding or thinning under specific circumstances. Here's why:

Testosterone can be converted into dihydrotestosterone (DHT), a more potent androgen, through the action of the 5-alpha reductase enzyme. DHT is known to shrink hair follicles, leading to thinning hair or hair loss, especially in areas like the scalp. This is a key factor in androgenic alopecia, a type of hair loss commonly seen in both men and women.

For some women, the body's natural process of converting testosterone into DHT can lead to hair thinning. It doesn’t take high levels of testosterone for this to happen—even normal or low levels of testosterone can lead to increased DHT production, contributing to hair loss.

Does High Testosterone Always Lead to Hair Loss?

Not necessarily. While high testosterone levels can increase the likelihood of hair thinning, it's not a requirement for hair loss. Some women with normal or low testosterone levels may still experience hair shedding if their body is converting testosterone into DHT at higher rates.

Furthermore, DHT sensitivity plays a significant role. Some individuals are more sensitive to the effects of DHT, meaning their hair follicles may be more susceptible to shrinking, even with moderate or low testosterone levels.

Other Hormonal Changes and Their Role in Hair Health

Hormonal fluctuations throughout different stages of life can significantly affect hair growth and shedding. The estrogen and progesterone levels in a woman’s body play a particularly important role in the health of her hair.

I want to start with an example of what happens during pregnancy. I think this really sets a nice stage over of how sex hormones can really creat this impact. During pregnancy, women experience a significant increase in estrogen, which often leads to thicker, fuller hair and less shedding. This is due to the fact that high estrogen levels help prolong the anagen phase of the hair growth cycle, resulting in more hair staying in the growth phase for a longer time. However, after childbirth, estrogen levels drop sharply, which can lead to postpartum hair loss amongst many other symptoms such as mood and sleep changes. This type of hair loss is usually temporary as hormone levels gradually return to normal, and the hair growth cycle stabilizes. That said, let this be a call to action to keep an eye on other symptoms. Remember hormones don’t work in isolation.

In addition to estrogen, progesterone also has a significant impact on hair health. Progesterone helps inhibit the enzyme 5-alpha reductase, which is responsible for converting testosterone into DHT (dihydrotestosterone). DHT is a potent androgen that can shrink hair follicles and lead to hair loss. When progesterone levels are elevated, such as during pregnancy, it protects hair follicles from the effects of DHT, contributing to fuller, thicker hair. However, as progesterone levels decrease during perimenopause and menopause, this protective effect lessens, which can lead to increased hair thinning due to reduced inhibition of DHT.

Now, I want to pause here and highlight something important. While I’ve mentioned specific life stages, such as pregnancy and menopause, many women we work with as health coaches experience non-specific, yet common issues. For example, low energy availability, suboptimal hormone profiles, nonovulatory cycles, or amenorrhea (the absence of menstruation) can all play a role in hormonal imbalance and hair thinning. These factors often don’t get the attention they deserve, but they are key pieces to consider when looking at the bigger picture of hair health–respecfully overall health but I am trying to stay to topic today.

The Impact of Perimenopause and Menopause:

For the sake of simplicity assuming a woman has had a low dieting history , stunning hormonal profile and is overall in good health—as she enters mid-late perimenopause and then becomes menopausal, estrogen and progesterone levels naturally decline. This hormonal shift can result in thinning hair and even noticeable hair loss. The decrease in progesterone during perimenopause and menopause contributes to this process because there is less suppression of DHT. As a result, even if testosterone levels remain stable, the body’s reduced ability to regulate DHT may accelerate hair loss. That said, even if testosterone levels drop you must remember the individuality I mentioned previously regarding sensitivity.

What Are the Other Contributing Factors?

Testosterone and DHT are not the only culprits when it comes to hair loss. There are multiple factors at play that can influence hair health. Here are some key contributors:

• Blood Sugar Imbalances and Insulin Resistance: Poorly managed blood sugar or insulin resistance can create an environment in the body that supports hair loss. These imbalances can impact hormone levels, including testosterone and DHT, and contribute to hair shedding.

• Inflammation: Chronic inflammation, whether due to stress, diet, or underlying health conditions, can negatively affect hair growth. Inflammatory processes can damage hair follicles and inhibit healthy hair production.

• Other Hormonal Imbalances: Besides testosterone, estrogen, progesterone, other hormones like thyroid hormones, and cortisol play a role in hair health. High cortisol, or thyroid dysfunction can also lead to hair thinning.

• Nutrient Deficiencies: Lack of essential nutrients such as Omega Fatty Acids, zinc, vitamin D, and B vitamins can lead to hair shedding. 

• Gut Health: Poor digestion or gut dysbiosis can affect nutrient absorption, further impacting hair health.

What Can You Do About Hair Loss?

If you're dealing with hair thinning or shedding, it’s important to take a holistic approach to address the underlying causes first and/or in conjunction with other support methods should you so choose. Here are steps to consider in no specific order, although I'd consider 1-4 the priority:

1. Test and Assess: The first step is to test hormone levels, including testosterone, DHT, and other relevant hormones. Blood work is a go to because you can assess insulin resistance, thyroid health and get some idea about nutrient status. A DUTCH Complete Test is one tool that can also provide comprehensive insight.

2. Address Insulin Resistance and Blood Sugar: Insulin resistance and blood sugar dysregulation can wreak havoc on your hormones, overall health and hair health. 

3. Improve Digestion and Gut Health: If you have digestive issues, it can affect nutrient absorption, which in turn can impact hair health. Improving gut health through probiotics, digestive enzymes, and other digestive aids can support your overall well-being and hair growth.

4. Reduce Inflammation: Chronic inflammation can exacerbate hair loss. Implementing an anti-inflammatory diet, managing stress, and using anti-inflammatory supplements (like omega-3 fatty acids) can help reduce inflammation and support healthy hair follicles.

5. Consider Topical Treatments for DHT: If DHT is at play, treatments like Nizoral shampoo (which contains ketoconazole) may help reduce DHT on the scalp. Ketoconazole has anti-androgenic properties and may help slow hair loss by inhibiting the action of DHT on hair follicles.

6. Herbal and Prescription Options: Some women find herbal remedies, such as stinging nettles, helpful in reducing DHT production. If the issue persists, prescription medications like spironolactone or dutasteride may be needed to block DHT and prevent further hair thinning. These should be used under the guidance of a healthcare provider.

7. Be Cautious with Hair Growth Supplements: Many hair growth supplements on the market claim to improve hair health, but many of these are not adequately dosed and can have negative side effects. Some have even been linked to liver strain or other health concerns. Before using any supplement, do your research and consult with your healthcare provider.

8. Minoxidil: After addressing lifestyle and hormonal factors, you may consider using Minoxidil, typically a treatment that helps stimulate hair regrowth--that said the best outcomes for women seem to be a low dose oral amount (NOT the same as a male would be dosed). Minoxidil is often recommended after all other options have been explored. This needs and any interventions of the like MUST be discussed with your provider . If you or your spouse have fertility goals use this as a call to action to have an open dialogue about what you both are or are not taking as we have seen someone harmlessly taking something to stimulate hair growth at the cost of sperm quality.

Testosterone can play a role in hair loss, but it’s just one piece of possibilities. Hair shedding or thinning can occur due to DHT conversion, sensitivity to androgens, and other factors like blood sugar imbalance, nutrient deficiencies, and inflammation. To address hair loss effectively, you must look at the big picture, including testing, assessing underlying factors, and correcting hormonal imbalances and lifestyle issues. I do think it is worth mentioning that having a genetic predisposition to hair loss, balding, etc is something that does need to be considered. 

If you're dealing with hormonal uncertainty or other health concerns and want to dive deeper into understanding how these issues are connected, it's exactly these types of discussions we facilitate in our Group Mentorship and 1-on-1 Consultations.

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