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 start at any age after puberty and progresses slowly over time.
During their lifetime, most men will be affected by this form of hair loss.
The focus of this article is to explore the different types of hair loss and evidence-based treatments for androgenetic alopecia, with an emphasis on male pattern baldness.
Types of hair loss
Androgenetic alopecia (androgenetic alopecia)
By the age of 50, about half of men will be affected by male pattern baldness (also known as androgenetic alopecia) [1].
When men produce testosterone, a 5-alpha reductase enzyme (there are three types) can convert it to dihydrotestosterone (DHT) [2].
The hair follicles (those that express this enzyme) in certain areas of the scalp then suffer inflammatory damage from the DHT.
This degrades the follicles themselves over a relatively long period of time, leading to thinning hair and progressive hair loss [3].
Men with androgenetic alopecia have varying levels of total and free testosterone.
Whether or not hair loss actually occurs is related to 5-alpha reductase expression in the scalp.
Regardless of testosterone and external DHT levels, if the scalp does not express this enzyme and is ultimately not damaged by DHT, the hair follicles will remain healthy.
The level of 5-alpha reductase expression is one of the main reasons why men go bald at varying rates and times [4].
External use of testosterone and other anabolic steroids (AAS) typically causes baldness in men who are already genetically predisposed to baldness.
It basically accelerates the onset of hair loss, but it is not a definitive trigger for most men.
It's important to remember that treatments that target 5-alpha reductase are not effective in preventing hair loss caused by DHT-derived AAS.
There is also anecdotal evidence that certain AAS are associated with hair loss even though they are not derived from DHT.
"Hair loss is only inherited from the mother: The hair loss gene can only be inherited from the mother.
This is completely false."
Resting hair loss
The average person can lose more than 100 hairs per day.
Any significant increase over this number can be defined as telogen effluvium.
There are many causes of this condition, including chronic medical problems, severe stress, and medications (including AAS).
Once the cause is stopped, the hair loss usually recovers [5].
Alopecia areata
This condition leads to focal areas of hair loss (bald patches) due to autoimmune effects.
It is believed that T cells induce an inflammatory effect that is localized to the scalp.
Bald spots/patches develop, but the rest of the hair is unaffected [6].
Anagen hair loss
This form of hair loss is caused by chemotherapy.
It is usually reversible after the treatment is completed [7].
Traction alopecia
As the term suggests, this is caused by a force pulling on the hair.
Effectively, this affects people with ponytails or styles that put excessive force on the hair [8].
Other causes of hair loss include scarring alopecia, trichotillomania (hair pulling), bacterial and fungal infections (tinea capitis), hypothyroidism and hyperthyroidism, and a number of other less common causes.
Androgenetic alopecia treatments
There are a variety of treatment options and therapies for androgenetic alopecia.
Treatments typically involve directly stimulating hair growth by inhibiting 5-alpha reductase and preserving current hair and its thickness.
Because it takes a significant amount of time for hair to grow, all effective treatment methods are known to take several months to take effect.
Finasteride (5-alpha reductase inhibitor)
-The most commonly used medication for the treatment of male pattern baldness, with a high degree of therapeutic efficacy demonstrated in the literature.
It is approved by the US Food and Drug Administration (FDA) for the treatment of androgenetic alopecia and reduces plasma DHT levels by more than 70%.
It does this by inhibiting 5-alpha reductase types 1 and 2 [9].
-The commonly prescribed dose is 1 mg/day, as opposed to 5 mg/day used for benign prostatic hyperplasia (BPH) [10].
Symptoms typically improve in three to four months, with full effectiveness seen after six months of treatment.
The success rate for hair regrowth can be just over 60%, but the effectiveness in preventing further hair loss and thinning can be close to 90% [9,11,12].
-Side effects are a major concern among potential users of this drug.
Sexual dysfunction-related side effects occur in 2-4% of male users at doses prescribed for androgenetic alopecia, although some literature reports higher rates.
Other side effects may include orthostatic hypotension and mood changes [9].
The decision to take this medication should be discussed with a physician and should not be based on anecdotal information [13].
A more potent 5-alpha reductase inhibitor than finasteride is dutasteride.
This drug blocks all three types of 5-alpha reductase, removing almost all DHT from the body.
Dutasteride is not FDA-approved for androgenetic alopecia (although it is approved in some countries) and has the same side effect profile as finasteride [14].
Minoxidil
An old blood pressure medication, this drug (used topically) promotes hair growth or preserves current hair.
Minoxidil is FDA-approved for the treatment of androgenetic alopecia and is typically used in a 5% strength.
Users may experience hair loss initially, but the majority of users notice an improvement from baseline after a few months.
Initial improvements can be seen as early as 8 weeks.
Initial hair loss is also known as minoxidil-induced telogen effluvium.
This occurs because the anagen phase of hair growth is shortened upon starting treatment.
Minoxidil acts as a hair growth stimulant by increasing blood flow to the hair follicles and increasing growth factors, and it works through several mechanisms, although the mechanism of action is not fully understood.
Side effects of minoxidil include skin irritation [15].
Ketoconazole shampoo
This compound is a known DHT inhibitor and has variable but generally positive (off-label use) effects on androgenetic alopecia when used topically.
It is used in 1%, 2%, and 5% concentrations and is ultimately approved primarily for the treatment of dandruff and fungus [16,17].
Hair transplantation
Considered the closest option to a "cure" for male pattern baldness, this minimally invasive procedure is an option for those who have failed medical treatments or are out of options.
Under local anesthesia, your doctor will harvest hair follicles from areas of your scalp that are resistant to hair loss and transplant them into the balding area.
Soon afterward, the transplanted hair will fall out.
After a few months, new hair will grow from the transplanted follicles.
These new hairs are permanent [4].
Platelet-rich plasma (PRP) injections
PRP injections, in which blood is centrifuged to obtain concentrated platelets, have been used for a variety of purposes, but the evidence is limited.
Aesthetic physicians have used topical targeted PRP injections to stimulate hair growth.
The current literature shows some efficacy with minimal side effects.
More research is needed before this treatment can be widely recommended for hair loss [18,19].
Saw palmetto
This herbal supplement has been used classically to help treat BPH.
Saw palmetto is a 5-alpha reductase inhibitor and should theoretically lower the levels of DHT expressed in the scalp.
However, it is questionable whether it can lower DHT levels sufficiently.
There is limited evidence, but it is possible that saw palmetto may be somewhat effective for mild androgenetic alopecia [20,21].
As for side effects, it may increase bleeding time, primarily in people on anticoagulation therapy.
Other immediate side effects are not well known in healthy men without medical problems.
Biotin.
Biotin deficiency can directly cause hair loss, but there is no real evidence that excessive supplementation with biotin increases hair growth.
Biotin deficiency is very rare in healthy adults without a genetic metabolic disorder (biotinidase deficiency) [22].
Oils
Pumpkin seed oil- There is some evidence that it lowers 5-alpha reductase and promotes hair growth [23].
Coconut oil- can potentially lower protein loss in hair, but there is limited evidence on whether it prevents hair loss [24].
Castor oil- May contain anti-dandruff properties, and there is little to no evidence that it helps with male pattern baldness.
Peppermint oil- Some evidence that it promotes hair growth; most likely due to the menthol component that increases blood flow [25].
Other.
-Beta-sitosterol may lower 5-alpha reductase and DHT levels, but there is no evidence that it helps treat hair loss; long-term evidence of safety is also questionable.
-Capsaicin + isoflavones - This combination treatment, especially capsaicin, has shown some evidence of therapeutic benefit in promoting hair growth [26].
-B vitamins - There is no evidence that supplementing with B vitamins increases hair growth in people without nutritional deficiencies.
-For men or women of any age, hair loss of any kind can be an emotionally distressing process. Male pattern baldness is a pathologic process that affects most men at some point. Many prevention and treatment options exist, but the level of evidence supporting each treatment varies. It is important to work with your doctor to develop an evidence-based approach to hair loss treatment.
Disclaimer
The content of this article is provided for general information and educational purposes only.
Nothing herein should be considered medical advice in any form.
For medical advice and/or product use, please consult your physician.
reference
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