Tag Archive for: testosterone

Dealing with Hair Loss? Get These Hormones Under Control.

Here’s a fun fact: hormonal imbalances are the leading cause of hair loss.  At least 50 percent of men are affected by the age of 50. (01)  Ladies, this is true for you too.  Those chemicals that send messages to your organs, skin, muscles, and other tissues are pretty powerful.  They rule your emotions, your weight, your sleep patterns, and, yes, your hair.  If your hairline is receding, or you’re starting to see bald patches on the crown of your head, it may be a sign that you need to get those hormones under control.  Not sure how?  Here are some tips and tricks to help.  

Hormonal Hair Loss Triggers

Before we get into the nitty-gritty, let’s talk about the different types of hormonal hair loss.  Not all hair loss due to hormonal imbalances is the same.  Some hair loss is short-term. Once balance is restored, your hair will grow back.  Other types are a bit more challenging to manage.  In this case, medication can help stop your hair loss and jump-start the growth process.  Fortunately, great progress has been made researching and developing medications designed to treat hair loss due to hormonal imbalances.  Many effective oral and topical options are now available.  So, what hormones cause temporary hair loss, and which create more long-term issues?


We’ll start with testosterone.  Testosterone is the hormone that stimulates the development of male sexual characteristics.  Testosterone affects men’s sex drive and sperm production.  It also plays a role in bone and muscle mass, fat storage, blood cell production, and mood.  Women also produce testosterone, but in much smaller amounts.  

Typically, about ten percent of testosterone in men and women converts to an androgen called dihydrotestosterone (DHT) due to an enzyme called 5-alpha reductase (5-AR).  Once DHT flows through your bloodstream, DHT attaches to the receptors on your hair follicles.  The hair follicles then shrink, making your hair thin and eventually fall out, causing what’s known as male or female pattern hair loss.  

Solution:  Successfully treating male or female pattern hair loss often takes a multi-faceted approach.  Enlarging the hair follicles while blocking the testosterone from converting to DHT is usually the best strategy.  It can, however, take some trial to determine which medications and strengths are most effective for each person.  Minoxidil is often used to open the follicles.  Commonly used DHT blockers include Finasteride, Dutasteride, and Spironolactone.  All of these medications are available in oral or topical formulas.  Many people prefer topicals since they eliminate the risk of systemic side effects.  


Who isn’t stressed out these days?  Pressure at work, rising costs, and keeping peace at home can be a lot to handle.  When you get stressed out, your body generates extra cortisol.  Cortisol is produced and released in your adrenal glands which are located on top of your kidneys.  Its job as a steroid hormone is to tell your body, ”Hey, you need to chill out!” When your cortisol level gets high, it can reduce the synthesis and speed up the breakdown of hyaluronic acid and proteoglycans in your scalp.  The increase interrupts your hair’s growth cycle, which can lead to hair loss.

Solution:  Breathe.  Hair loss due to stress is usually temporary.  Your hair will grow back on its own once the stressors are gone.  Head outside for a walk, sign-up for a yoga class, or download a meditation app to listen to before bed.  If the usual tricks for restoring calm in your life don’t work, seeking help from a counselor or therapist may be the way to go.  

Triiodothyronine (T3) & Thyroxine (T4)

T3 and T4 are hormones produced in the thyroid gland.  They control how your body uses energy and help regulate many functions from your metabolism to brain development.  T3 and T4 are the markers typically used to help diagnose thyroid disorders.  Too high or too low can be signs of hyper or hypothyroidism.  Both hyperthyroidism and hypothyroidism can lead to hair loss with specific patterns.  People who lose their hair due to thyroid issues usually see thinning over the entire scalp.  

Solution:  Treating the thyroid disorder usually leads to regrowth over several months.  If you think your hair loss may be thyroid related, you’ll need an appointment with an endocrinologist.  Once your thyroid is treated, your hair will slowly grow back.   

Estrogen and Progesterone 

Decreases in estrogen and progesterone levels have been proven to affect women’s hair growth cycles. (02)  That’s why women tend to see their hair thinning or shedding after childbirth or during menopause.  During menopause, a decrease in these hormones also causes an increase in androgens that produce DHT.  DHT conversion happens for women as it does for men, resulting in female pattern hair loss.  Hair lost after childbirth usually resolves itself and grows back over time.  Hair loss due to menopause requires treatment.

Solution:  If you’ve recently had a baby or are nearing menopause age, visit your dermatologist for a consultation and diagnosis.  Postpartum hair loss and female pattern baldness can usually be diagnosed through a visual exam.  There are very specific patterns of hair loss.  You don’t want to assume that your hair loss is hormone-related, just in case another cause requires different treatment.   

How to Treat Hormonal Hair Loss

If your hair loss is due to hormones, treatment options will be based on your condition.  In some cases, your hair will grow back on its own.  Other cases will require treatment.  Here’s an idea of the different types available: 


Minoxidil, a popular hair loss medication, is sold over the counter and in stronger doses by prescription.  It helps enlarge your hair follicles and allows healthy hair to grow.  It’s best to have a board-certified dermatologist monitor your Minoxidil use.  The reason why is because the medication must be continued once you start using it.  If you discontinue Minoxidil, the hair you grow while using the medication can fall out.  

DHT Blockers

When male or female pattern hair loss is an issue, preventing testosterone from converting to DHT is one of the most effective ways to stop thinning and shedding.  A few different types are available, including Finasteride, Dutasteride, and Spironolactone for women.  Prescription DHT blockers are available in pill or topical formulas.  Each have pros and cons, so it’s important to work with your dermatologist to determine which medication and formula is best for you.  


Supplements alone won’t regrow your hair, but they can help treat the root cause of your hair loss.  Iron and vitamin D deficiencies are common among people with hair loss due to hormonal imbalances.  Collagen, probiotics, and other supplements can also help strengthen your hair and scalp.

Thickening Shampoo & Conditioner

The right shampoo and conditioner can help make your hair thicker, shinier, and healthier.  Look for products infused with collagen, saw palmetto, keratin, biotin, and other ingredients that have been proven to support hair growth.


Whether you’re 15, 50, or 70, dealing with hormone imbalances can be a nuisance.  However, thanks to research and technology, you have more reliable and accessible options than ever to deal with associated hair loss.  You don’t even have to leave your sofa.  Simply answer a short hair loss questionnaire and our licensed dermatologist will review your case.  If you are a candidate for hormone-induced hair loss, we can make recommendations and deliver customized prescription medications directly to you.  Want to learn more?  Get in touch with us for an evaluation and personalized treatment plan.  



(01) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817427/

(02) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/


Side Effects of Topical Finasteride: Review of Current Medical Literature

Oral finasteride, also known as Propecia, is an oral medication that has been prescribed by physicians for decades for hair loss. It works in the majority of patients by reducing hair loss and stimulating hair growth however there are side effects. One of the most concerning side effects are the sexual side effects, which occur in 1.8% to 3.8% of patients who take it. As a result, many physicians have been switching to topical finasteride as an alternative. In recent years, there have been many studies on the efficacy and side effects of topical Finasteride. In this article, we will review the clinical trials and scientific data to evaluate the side effect profile of topical finasteride. 

In one of the first single-blind, placebo-controlled clinical trials of topical finasteride, Mazarella et al.1 (1997) published a study of 52 subjects ranging from 19 to 28 years of age. The patients were treated with topical finasteride 0.005% vs placebo for 16 months. Here were the results.

  • There was a significant reduction in the rate of hair loss after 6 months of treatment.
  • There were no reports of local or systemic side effects.

In another double blind, randomized clinical trial study of 45 male patients, Hajheydari et al.2 (2009) compared oral finasteride 1mg vs topical finasteride 1% for a total of 6 months.

  • Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.”
  • 1 person had erythema of the scalp after application of the topical finasteride. 

In a prospective pilot study conducted in 15 patients for 9 months by Rafi and Katz3 (2011), patients applied a topical solution called NuH Hair, which is a novel topical combination of finasteride, dutasteride, and minoxidil, with the option to add oral finasteride, minoxidil and/or ketoconazole shampoo for 9 months. 

  • Significant growth was demonstrated after 3 months of use of the topical solution.
  • There were no reports of sexual side effects or irritation or redness reported. 

In a randomized clinical study by Tanglertsampan C.4  (2012), 33 male patients ranging between 27 to 49 years old were enrolled to compare the efficacy and safety of a 24 weeks application of minoxidil 3% lotion versus minoxidil 3% combined with 0.1% finasteride lotion.

  • This study showed that finasteride combined with minoxidil is superior to minoxidil alone by itself.
  • Contact dermatitis and redness was observed in 4 patients (24%) using the finasteride + minoxidil combination. No sexual side effects were observed. 

Caserini et al. conducted two pharmacokinetic studies on topical finasteride. In a randomized clinical study of 23 males, Caserini et al.5 (2014) compared topical finasteride 0.25% twice daily vs oral finasteride 1mg once daily for 7 days. They measured DHT and testosterone levels in the serum (systemic DHT levels).

  • Similar reduction in serum DHT was observed by the use of topical 0.25% finasteride twice daily  (68-75% ) and oral finasteride 1mg (62-72%).
  • No sexual side effects were observed. 

In another randomized clinical trial, Caserini et al.6 (2015) did another study involving 50 male patients studying DHT in both the serum and the scalp. 

  • This pharmacokinetic study confirmed that topical finasteride 0.25% (1ml application twice daily) and oral finasteride 1mg (once daily) both have similar reduction in scalp (47-51%) and serum DHT levels (74-76%). No changes in testosterone were observed.
  • In the portion of the study where patients used 1ml of topical finasteride 0.25% twice daily, there were 2 patients (11%) that had the following side effects. Elevated ALT levels, pollakiuria and testicular pain. 
  • about 37-54% when 0.1ml, 0.2ml, 0.3ml and 0.4ml of topical 0.25% finasteride was used, showing relatively similar results to 1ml twice a day application of topical 0.25% finasteride. Serum DHT was reduced by 24% with the use of 0.1ml, 26% with 0.2ml, 44% with 0.3ml and 48% with use of 0.4ml of 0.25% topical finasteride. This testing suggests that lower dosage of topical finasteride may lead to lower reduction of serum DHT levels and thus lower sexual side effects (assuming that serum DHT is solely responsible for the sexual side effects).  
  Scalp DHT Serum DHT
Oral FInasteride 1mg 51% 76%
1ml (twice daily) of 0.25% Topical finasteride 47% 74%
1ml (once daily) of 0.25% Topical finasteride 71% 76%
0.1ml (once daily) of 0.25% Topical finasteride  52% 24%
0.2ml (once daily) of 0.25% Topical finasteride 47% 26%
0.3ml (once daily) of 0.25% Topical finasteride 37% 44%
0.4ml (once daily) of 0.25% Topical finasteride 54% 47%
Oral vs Topical Finasteride

In a retrospective assessment and prospective crossover cohort study of 50 male between 20 to 40 years old by Chandrashekar et al.7 (2017), all 50 patients used minoxidil 5% and oral 1mg finasteride for 2 years.They then stopped and their treatment differed.

  • Results showed that 80% to 84.4% of these patients maintained good hair density while on the topical combination of minoxidil 5% + finasteride 0.1% treatment for 1 year.
  • No sexual side effects were reported. 

The studies8 above demonstrate that topical finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair and that it has a lower side effect profile compared to oral finasteride. Out of the 7 clinical studies reported above, only one study showed one event with sexual side effects (testicular pain). This is 1 out of 268 subjects in all of the studies, which equates to a rate of 0.37%. In contrast, oral finasteride is associated with sexual side effects in 1.8% to 3.8% of patients, which means that in the above 268 subjects, there should have been about 5 to 10 subjects experiencing some form of sexual side effects. However, this was not the case. Only 1 person had sexual side effects as opposed to 5 to 10 individuals. 

Pharmacokinetic studies by Caserini et al. suggest that lower doses of topical finasteride result in lower reduction of serum DHT compared to oral finasteride and thus lower sexual side effects. No study has conclusively shown the reason of how finasteride can cause sexual side effects. Certainly serum DHT is a contributing factor but may not be the only factor. The reason for this conclusion is because there are studies that patients were on high dosage of topical finasteride and still had no sexual side effects. 

In conclusion, the majority of studies on topical finasteride show no to only a few sexual side effects. However, this does not mean that sexual side effects can not happen. It just suggests that risk of sexual side effects are lower due to the fact that the finasteride is not taken orally. Additional larger clinical studies are needed to address the sexual side effects of topical finasteride. 


1. Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. GF Mazzarella, GF Loconsole, GA Cammisa, GM Mastrolonardo & Ga Vena; Pages 189-192 | Received 23 Aug 1996, Accepted 18 Mar 1997, Published online: 12 Jul 2009

2. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Hajheydari Z1, Akbari J, Saeedi M, Shokoohi L. .Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

3. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. Rafi and Katz. SRN Dermatol. 2011;2011:241953. doi: 10.5402/2011/241953. Epub 2011 Apr 11.

4. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. Tanglertsampan C1. J Med Assoc Thai. 2012 Oct;95(10):1312-6.

5. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Caserini M, Radicioni M, Leuratti C, Annoni O, Palmieri R.  Int J Clin Pharmacol Ther. 2014 Oct;52(10):842-9. doi: 10.5414/CP202119.

6. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R. Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27. doi: 10.5414/CP202467.

7. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. B. S. Chandrashekar, T. Nandhini, Vani Vasanth, Rashmi Sriram, and Shreya Navale. Indian Dermatol Online J. 2015 Jan-Feb; 6(1): 17–20. Doi: 10.4103/2229-5178.148925

8. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Sung Won Lee, MD,1 Margit Juhasz, MD,1 Pezhman Mobasher, MD,1 Chloe Ekelem, MD,1 and Natasha Atanaskova Mesinkovska, MD, PhD1. J Drugs Dermatol. 2018 Apr 1; 17(4): 457–463.

The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment.