Written by George N. Touliatos, MD
21 June 2022

 DrT article62222

 

 

 

Hypogonadism, TRT, and Thinning Hair

 

By George Touliatos, MD

 

Q: Recently I was diagnosed with hypogonadism and have to start TRT. However, I’m concerned about my possible hair thinning. Is there any way to protect my hair?

 

A: It’s a fact that when testosterone is reduced to DHT this can lead to male pattern baldness, also known as androgenic alopecia. However, this is also linked to genetic predisposition, meaning that some men don’t develop MPH/AA (hair thinning). Nevertheless, you are able to stop the reduction of T=> DHT by blocking the enzyme responsible for it – the so-called 5 alpha-reductase. This is done by the anti-androgens finasteride (Propecia) and dutasteride (Avodart). Finasteride blocks type I receptor (prostate), while dutasteride blocks I and II receptors (scalp and prostate). Meaning that dutasteride is more potent. As a matter of fact, dutasteride can actually make hair follicles to grow new hair, while finasteride can just stop hair thinning. The combo of testosterone with anti-androgens can thicken hair, since the hormone is capable of thickening hair in the body. Hence, in cases where we block DHT, instead of alopecia, new thick hair can grow.

 

Another local application of compounds is the shampoo containing ketoconazole (Nizoral) and the foam minoxidil (Rogaine). Nizoral is mainly for dandruff, but it’s able to lower DHT in scalp. Also minoxidil can improve blood flow in scalp. An alternative use of dutasteride is in foam with minoxidil. In this way, we avoid the systemic circulation of dutasteride, minimizing the potential side effects in mood (depression) and sex drive (lack of libido).

 

 

 

WATCH EPISODE 169 OF ASK DR TESTOSTERONE:  Is Low Dose Deca Safe in the Long Run?

 

Note that only testosterone is blocked by anti-androgens; no other AAS can be blocked by them. So synthetic DHT (mesterolone, drostanolone) or DHT derivatives (stanozolol, oxandrolone, oxymetholone, methenolone) shouldn’t be used. Nandrolone is a rare case of AAS that metabolizes to DHN, a less androgenic compound than DHT.

 

George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book “Anabolics, 11th Edition” (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/

 

 

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