Testosterone Levels & Baldness In Men

Are you aware that androgenic alopecia (or male pattern baldness) affects approximately 70% men and more than 40% women during their entire lifetime (1)? Experts define androgenic or male-pattern baldness as; overall thinning of scalp hair, vertex balding and hairline recession (1).

It is interesting to mention that androgenic alopecia is reported in both men and women; however, the pathophysiology and management options differs significantly.

Testosterone Levels & Baldness In Men – Are They Related?

It has been observed that androgenic alopecia is very commonly associated with high testosterone levels. There are several biochemical forms of testosterone in our body. For example, free testosterone that circulates freely in the blood; and bound testosterone that is carried by special proteins (such as albumins) and so is not readily available for usage. Needless to say that any condition that increases the levels of free testosterone in the blood can lead to baldness in men.

According to a new report, investigators suggested that the effects on scalp hair are mediated by DHT – dihydrotestosterone; a 5-times more potent form of testosterone that has much higher affinity for the receptors on scalp and prostate. Little is known about the exact biochemical processes that leads to baldness in men due to high testosterone levels, yet a possible explanation proposed by scientists entails that testosterone is a direct precursor of DHT and have a stronger affinity for receptors on the hair follicles. Once these receptors are activated, the production of certain cytokines is greatly increased, such as TGF beta1 and 2. Several clinical studies indicates that these cytokines leads to senescence of dermal papilla cells and loss of hair.

The mystery of why certain areas of scalp are more frequently involved can be explained by the fact that the concentration of DHT receptors varies throughout the scalp. Certain areas of scalp such temporal region or frontal region are much more heavily concentrated with DHT receptors than occipital region; hence a more defined and expected pattern of baldness.

Besides high testosterone, other factors that may aggravate your risk of developing androgenic alopecia are:

• Genetics: Genetics also play a very strong role in the onset and severity of androgenic baldness. For example, according to a new study, the hair follicles in the scalp of males with genetic alopecia, are overly sensitive to the male hormone - dihydrotestosterone (DHT). The genes that control the metabolism or expression of certain hormones (such as, sex hormone binding globulin (SHBG), aromatase and 5α reductase can make you more vulnerable to androgenic alopecia than your normal counterparts.
• Aging: It is believed that about 33% males develop some degree of alopecia after age 45. Experts suggests that aging causes shrinkage of hair follicles; thereby shortening the growth cycle of scalp hair. Hair that erupt from shrunk follicles are thinner and finer (thus more vulnerable to environmental damage). In the absence of heroic measures, the hair follicles eventually becomes dormant and overall volume and strength of scalp hair decreases, leading to baldness.
• Obesity: According to a new study reported in the Journal of the American Academy of Dermatology (2), investigators suggested that higher body mass index (or obesity) is very frequently associated with worsening of androgenic alopecia.

How To Manage Baldness Secondary To High Testosterone Levels?

Although, you can always sport a complete bald look since ‘bald is the new beautiful’; yet it is very important to ensure if you are experiencing baldness due to high testosterone levels. This is mainly because, persistently high testosterone levels are associated with other complications as well. Depending upon the pathophysiology, your doctor may advise you one of the many treatment options available. Such as:

Medical treatment:

• Pharmacological agents like minoxidil and finasteride yield promising results. Minoxidil exert its action by promoting the formation of new blood vessels in the affected region, dilation of existing vessels and maintenance of healthy circulation; thereby culminating in enhanced cellular proliferation
• Other pharmacological options include; dutasteride and ketoconazole are also helpful in some individuals.
• According to a new study, investigators are also studying the benefits and potential role of prostaglandin analogues such as bimatoprost and latanoprost in improving the growth and strength of scalp hair.

Surgical Approach:

• Micro-invasive surgical procedures such as hair transplantation yield promising results in men who are refractory to pharmacological regimens.
• Laser treatments are also fairly successful in the long term management of androgenic alopecia.

References

1. McElwee, K. J., & Shapiro, J. S. (2012). Promising therapies for treating and/or preventing androgenic alopecia. Skin Therapy Lett, 17(6), 1-4.

2. Yang, C. C., Hsieh, F. N., Lin, L. Y., Hsu, C. K., Sheu, H. M., & Chen, W. (2014). Higher body mass index is associated with greater severity of alopecia in men with male-pattern androgenetic alopecia in Taiwan: a cross-sectional study. Journal of the American Academy of Dermatology, 70(2), 297-302.

3. Traish, A. M., Haider, K. S., Doros, G., & Haider, A. (2015). Finasteride, not tamsulosin, increases severity of erectile dysfunction and decreases testosterone levels in men with benign prostatic hyperplasia. Hormone molecular biology and clinical investigation, 23(3), 85-96.

4. Narad, S., Pande, S., Gupta, M., & Chari, S. (2013). Hormonal profile in Indian men with premature androgenetic alopecia. International journal of trichology, 5(2), 69.

5. Choi, M. H., Kim, S. J., Lew, B. L., Sim, W. Y., & Chung, B. C. (2013). Hair steroid profiling reveals racial differences in male pattern baldness between Korean and Caucasian populations. Journal of Investigative Dermatology, 133(3), 822-824.