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High testosterone is often blamed for hair loss, but the reality is that elevated testosterone levels do not directly cause hair loss. The root cause is the formation of dihydrotestosterone (DHT), an androgenic derivative of testosterone produced by 5-alpha reductase. But here is what most people miss: not everyone with high testosterone loses their hair. The deciding factor is genetic sensitivity, specifically how your androgen receptor gene responds to DHT.
High testosterone does not directly cause hair loss. Instead, hair loss is primarily linked to dihydrotestosterone (DHT), a hormone derived from testosterone, and your genetic sensitivity to it. Not everyone with elevated testosterone will experience hair loss; your genes play the deciding role.
In this article, we discuss the biology of DHT and follicle miniaturisation, high testosterone symptoms, and what its levels in both men and women actually mean; contributing factors such as high-testosterone foods and lifestyle; and explore some concepts on how to treat high testosterone.
Testosterone vs. DHT: What really causes hair loss?
While high testosterone is commonly thought to cause hair loss, the truth lies further inside. The important thing about testosterone is not testosterone itself, but what your body does with it, particularly at the follicular level.
How does testosterone become DHT?
10% of all testosterone in the body is changed into DHT (dihydrotestosterone) by the action of an enzyme called 5-alpha reductase. This enzyme is located within the skin, hair follicles, and liver. Since DHT has a far greater influence on androgen receptors than testosterone, DHT has a greater effect on hair loss.
Why does DHT cause hair loss: The miniaturisation effect
Miniaturisation is a slow process caused by DHT. Here is how it works:
- Hair follicles gradually shrink after every hair growth cycle.
- As hair follicles shrink, the hair produced by those follicles gets thinner and shorter.
- Eventually, the hair follicles cease producing hair entirely.
How does DHT affect hair growth?
In addition to causing hair follicles to shrink, DHT alters the natural hair growth cycle. As a result of this alteration, the rate of hair loss increases and the rate of hair regrowth decreases:
- Anagen phase (growth period) reduces.
- Telogen phase (hair resting prior to being shed) is prolonged.
- The time it takes for the same amount of hair to grow back is longer than the time it took previously for the same amount of hair to fall out.
Role of Genetics: Why do some men go bald while others don’t?
While genetics will determine just how much your hair follicles respond to the presence of DHT, DHT itself serves as a catalyst for this reaction.
For example; two men that have the same level of testosterone in their bodies could end up with drastically different results. If one man has a very high amount of testosterone in his body but he does not possess very sensitive hair follicles, then he would be unlikely to ever experience any type of male pattern hair loss. On the other hand, if another man had moderately high testosterone in his body and additionally possessed highly sensitive hair follicles, he may begin experiencing some form of hair loss before reaching the age of thirty.
Role of the Androgen Receptor (AR) gene
A very responsive AR gene means that you can expect to see miniaturisation occur when you are exposed to relatively small amounts of DHT; whereas an unresponsive AR gene allows your hair follicles to remain resistant to DHT even after DHT reaches extremely high levels.
Can someone have high testosterone but not be balding?
Yes. The reason why someone with high levels of testosterone can still maintain a full head of hair depends entirely upon how their body metabolises hormones and reacts to them. There are several scenarios where this could happen:
- Low 5-alpha-reductase activity keeps testosterone from converting into DHT.
- Low sensitivity of hair follicles means that even high amounts of DHT cannot cause miniaturisation.
- Genetic influences exceed hormonal levels as determinants.
Patterns of inheritance for male pattern baldness
Male pattern baldness is polygenic, drawing from genes on both parental sides. The maternal grandfather is often cited due to the X chromosome link, but the paternal side matters too. A broad family history of hair loss remains the most reliable risk indicator.
Recognising symptoms of male pattern baldness: How important is early diagnosis?
By age fifty, approximately 85% of men generally experience noticeable thinning of their hair. Detecting male pattern baldness as early as possible is crucial. Some signs to look out for are:
- Receding Hairline: The first sign of balding occurs when the temples recede to create the classic "M" shape.
- Thinning on top of the head (crown): Hair thinning begins around the top area of the head (crown). Rather than occurring in clumps (patches), individual hairs become sparse.
- Miniaturisation of hair follicles: Hairs become thinner and shorter over time. These signs indicate that DHT has started affecting these individual hairs.
Common high testosterone symptoms in men and women
A hormone like testosterone is a vital part of many aspects of our physical well-being. However, unbalanced amounts of testosterone may produce multiple different symptoms for each gender due to their differing hormone levels and body sensitivities.
Symptoms of high testosterone levels in a man
Elevated testosterone levels in males produce the following signs:
- Increase in muscle mass and increase in muscle strength
- Skin becomes oily and produces more acne on the face and back
- Increased libido (sex drive)
- Some individuals may experience an emotional or aggressive behavioral change
High testosterone levels in women
Levels of high testosterone in women are more likely to be associated with various health conditions, such as PCOS:
- Excessive facial hair
- Irregular menstrual cycles or missed period(s)
- Breakouts around the jaw area
- Hair loss on scalp but excess body hair growth
How to Treat High Testosterone and DHT-Related Hair Loss
Effective treatments target DHT reduction or follicular health. Some FDA-approved options to discuss with your doctor include:
- Finasteride: Reduces DHT by approximately 70% by inhibiting 5-alpha reductase. Taken orally with strong long-term evidence.
- Dutasteride: A more potent option that blocks both type I and II 5-alpha reductase enzymes.
- Minoxidil: Does not target DHT but enhances scalp blood flow and extends the hair growth phase. Available over-the-counter.
Some supportive options you can try alongside primary treatments:
- Ketoconazole shampoo: Mild anti-androgenic effect, best used alongside primary treatments.
- Saw palmetto: Shows some evidence of weak 5-alpha reductase inhibition, but considerably less effective than finasteride. A supplement to a broader routine, not a replacement.
Are high testosterone foods or other lifestyle factors important?
High-testosterone foods such as eggs, red meat, nuts, and other choices rich in zinc will facilitate the production of testosterone. However, there is quite a large step between increasing testosterone levels and inducing hair loss.
Unless you are already predisposed to genetic factors and DHT levels are elevated, diet alone cannot cause a significant shift in your hair loss trajectory.
Improper nutrition, i.e., iron, biotin, vitamin D, or protein deficiencies may aggravate poor hair quality resulting in greater hair shedding. Chronic stress, poor sleep patterns, and obesity can also create disturbances in hormone balances that lead to increased DHT levels indirectly. In combination with traditional treatment, supplements such as Traya’s Ultimate Hair Supplement can provide the necessary support to address these nutrient deficiencies.
At the end of the day, acting sooner provides a much greater opportunity to slow down or reverse the process. With proper understanding of what you need at this point, you can influence what happens next and allow your hair to be as strong, thick, and long as possible over time despite the effects of high testosterone and/or DHT. A dermatologist or trichologist can help you establish a specific plan of attack prior to the progression of this condition.
Frequently Asked Questions
1. When does hair loss caused by DHT start happening?
It can start as early as late teens, but it often starts manifesting in one’s 30s. Again, this mostly depends on the person's genetic makeup.
2. Is hair loss from DHT reversible?
If it is at an early stage, it definitely is. Finasteride and minoxidil can help stop hair loss, delay it, and even reverse it to some degree. However, if follicles are already significantly damaged already, reversal would be difficult.
3. Will lowering my testosterone levels stop hair loss?
Unfortunately, no. The issue lies with DHT itself, and not with testosterone directly. Although lower testosterone = lower DHT production, your sensitive follicles will still be vulnerable to DHT damage unless they are actively protected against DHT using medications.
4. Can blood tests assist me in determining if I am experiencing hair loss due to high testosterone levels?
Yes. Blood tests can assist with identifying whether you have elevated levels of testosterone, etc., but will tell you nothing regarding how sensitive your follicles are to DHT – which is the primary cause of hair loss.
Can Testosterone Replacement Therapy (TRT) or steroids increase my risk for hair loss?
Both Testosterone Replacement Therapy and steroids can raise the level of DHT and lead to accelerated hair loss, especially those genetically prone to it. Not everyone is susceptible to this effect, though.
References:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11931090/
- https://ishrs.org/DHT-blockers-hair-loss/
- https://my.clevelandclinic.org/health/articles/24555-DHT-dihydrotestosterone
- https://www.ncbi.nlm.nih.gov/books/NBK557634/
- https://medlineplus.gov/genetics/condition/androgenetic-alopecia/
- https://www.ncbi.nlm.nih.gov/books/NBK278957/
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https://pubmed.ncbi.nlm.nih.gov/10765065/
https://tau.amegroups.org/article/view/111026/html\
https://www.ncbi.nlm.nih.gov/books/NBK430924/ - https://www.healthline.com/health/hair-loss-and-testosterone
