Hormones and Hair Loss: The Medical Management of Androgenetic Alopecia in the Presence of Androgen Replacement Therapy

Hereditary hair loss or Androgenetic Alopecia affects approximately 40 million men in the United States. In 2017 it was estimated that 2.3 million American men receive testosterone replacement therapy. Numerous clinical trials have supported and confirmed that the progression of hair loss is an often-unwanted sign of aging and a significant trigger for decreased Quality of Life in the affected population. In men, the chronic progressive miniaturization of hair follicles and hair loss in response to an inherited sensitivity to endogenous, normal levels of dihydrotestosterone (DHT) can begin to occur soon after puberty, and eventually affecting more than half of all men by the time they age to 50. Because DHT, the primary trigger for androgenetic alopecia, is created from testosterone through the 5-alpha reductase pathway, actions/activities and treatments that are designed to beneficially replace or enhance testosterone levels are often associated with accelerated hereditary hair loss as DHT levels rise. Unwanted, unexpected and accelerated hair loss may be a barrier for continued androgen replacement therapy, resulting in patient’s cessation of therapy. An understanding of the stratagems used to elucidate risk factors, diagnose, measure/monitor signs and symptoms, as well as the initiation of therapeutic interventions for Androgenetic Alopecia, can be used to avoid and-or manage this increasingly common unintended and unwanted consequence of androgen replacement therapy and ensure continued patient compliance with their androgen replacement therapy regimen.