Testosterone and androgenic alopecia

Dear Dr. G,

I am emailing you on behalf of my husband, as his energy in bed is diminishing even though he is in his early thirties.

It would be natural to assume that he is at the peak of life in and out of the bedroom, with thriving youthful energy and an enormous appetite for sex.

However, he has rock-bottom libido and his hairline has also begun to recede.

Judging from what his father looks like, I guess his balding days are also coming.

I read somewhere male pattern baldness is associated with high testosterone and as such am perplexed as to how he is also suffering from a shrinking sex drive.

As such I would like to put Dr G on the spot to clarify the link between testosterone and male pattern baldness.

What exactly is male pattern baldness and what is the role of testosterone? Also, is male pattern baldness genetic and can both the libido and balding get worse with age?

What would be the treatment for both conditions?

Please help.

Regards

Androgenic Alopecia Alex

Male pattern baldness or androgenic alopecia is a common condition characterised by loss of hair in the head due to hormonal changes and it affects around 50 million men and 30 million women in the USA.

Some sufferers will get a single bald patch in the middle, others may experience a receding line from an “M” shape which often continues until all the hair is gone. This common type of hair loss can affect more than 50% of men over the age of fifty, and is closely linked to hereditary factors. Although baldness is likely to occur in adulthood, the onset of male pattern baldness can even begin in the teenage years.

Testosterone levels are closely linked to male pattern baldness, but the association is not a simple equation of high testosterone resulting in thinning hairlines. The correlation is a complex association of circulating testosterone, receptor susceptibility and genetic influences.

Therefore, the old wives tale claiming that bald men are more virile is only partially true, as a complex involvement of multiple factors will determine hair growth and a person’s sex drive.

98% of total circulating testosterone itself is generally bound to Sex Hormone binding Globulin (SHBG) and largely remains inactive. The remaining unbound free testosterone needs to be further converted to the active substance, dihydrotestosterone (DHT), and that is believed to shrink the hair follicles in the scalp leading to baldness. Each hair on the head has a growth cycle, and repeated stimulations of DHT are known to weaken the hair follicles, producing shorter and finer strands of hair.

Eventually the growth cycle for each hair ends and no hair growth will occur, leading to overall baldness.

Apart from androgenic alopecia, other medical conditions can also lead to hair loss.

Dermatological complaints such as eczema and psoriasis on the scalp are well recognised to induce the loss of hair and thyroid function disorder and nutritional deficiencies are also common reasons for hair loss.

Other common causes also include poor hygiene and malnutrition also resulting in regular scalp infections, rashes and the peeling of scalp causing patchy hair loss mimicking male pattern baldness.

Therefore, it is crucial to rule out common medical reasons for hair loss before blaming testosterone.

When it comes to treatments, medications that are used in the treatment of alopecia include minoxidil and finasteride. Minoxidil is applied by rubbing into the scalp twice a day to stimulate hair regrowth. This can take between one to six months to be evident. On the other hand, finasteride is responsible for the depletion of the conversion of testosterone into its active form. This has the effect of increasing hair retention and regrowth. The drug is reported to have a 2% risk of decreasing sex drive and inducing erectile dysfunction, but this figure is believed to be higher.

Most men should harbour between 100,000 to 150,000 follicular hairs in the head.

That said, an average hair loss of 100 strands per day is considered healthy.

Men typically associate a full head of hair with youth and vigour, and therefore the thinning crown is often a sensitive issue of discussion. The first sign of excessive hair loss is often noted in the bathroom and wide-parting thinning crown. This is well recognised to be the source of psychological distress, as hair is often considered an essential part of the individual identity.

Men losing the crowning glory often put Dr. G on the spot for answers. His advice is to live a healthy lifestyle as hair growth and sex drive are not always equally gifted by God to all people.