Testosterone itself doesn't cause hair loss; rather, DHT (dihydrotestosterone), a hormone derived from testosterone, binds to receptors in genetically susceptible hair follicles and causes them to miniaturise over time, which is why some men with high testosterone have full heads of hair while others with lower levels go bald. Understanding this distinction is crucial for effective treatment.

The relationship between testosterone and hair loss is widely misunderstood. Many men fear that higher testosterone means inevitable baldness, or that treating hair loss requires lowering testosterone. Neither is accurate.

In this evidence-based guide, we'll explain exactly how hormones affect hair loss, why genetics matter more than testosterone levels, and what this means for treatment options.

The Testosterone-DHT-Hair Loss Connection

Step 1: Testosterone Converts to DHT

Your body produces testosterone, primarily in the testes. An enzyme called 5-alpha reductase converts some of this testosterone into DHT (dihydrotestosterone).

DHT is a potent androgen (male hormone) that plays important roles in:

• Male development during puberty

• Prostate function

• Body hair growth

• Sex drive

Step 2: DHT Affects Susceptible Follicles

DHT binds to androgen receptors in various tissues. Hair follicles on the scalp have these receptors, but here's the key point: not all follicles respond the same way.

In men genetically predisposed to male pattern baldness:

• Follicles on the top and front of the scalp are DHT-sensitive

• DHT binding triggers follicle miniaturisation

• Over successive hair cycles, the follicle produces thinner, shorter hairs

• Eventually, the follicle may stop producing visible hair entirely

Step 3: Genetics Determine Susceptibility

Whether your follicles are DHT-sensitive depends primarily on genetics. This is why:

• Some men with high testosterone have full hair

• Some men with lower testosterone go bald

• Hair loss patterns run in families

• Brothers often have similar hair loss patterns

The genetic component is complex, involving multiple genes from both parents. The old belief that baldness comes only from your mother's side is a myth.

Why Testosterone Levels Don't Predict Baldness

The Evidence:

Studies measuring testosterone levels in bald versus non-bald men consistently find no significant difference in testosterone levels. What differs is:

1. DHT sensitivity of follicles (genetic)

2. 5-alpha reductase activity (how much testosterone converts to DHT)

3. Androgen receptor density in scalp follicles

Real-World Examples:

• Bodybuilders using testosterone (dramatically elevated levels): Some go bald rapidly, others retain full hair

• Men with hypogonadism (low testosterone): Can still experience pattern baldness

• Identical twins: Usually have very similar hair loss patterns, regardless of lifestyle differences

The bottom line: Your testosterone level doesn't determine whether you'll lose hair. Your genetic blueprint for follicle DHT sensitivity does.

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Does Lowering Testosterone Help Hair Loss?

No. And here's why that approach is problematic:

Lowering testosterone would have severe negative effects:

• Reduced energy and motivation

• Loss of muscle mass

• Increased body fat

• Depression and mood changes

• Reduced libido and sexual function

• Bone density loss

• Cognitive decline

There's no medical scenario where reducing testosterone is recommended for hair loss.

What does work: Blocking the conversion of testosterone to DHT, or blocking DHT's action on follicles. This preserves testosterone's beneficial effects while reducing follicular damage.

Treatments That Address the DHT Pathway

Finasteride (Propecia)

• Blocks 5-alpha reductase enzyme

• Reduces DHT production by ~70%

• Preserves testosterone levels

• Proven effective in clinical trials

• Requires prescription

Dutasteride

• Blocks both types of 5-alpha reductase

• More potent DHT reduction (~90%)

• Not officially approved for hair loss but used off-label

• Requires prescription

Topical Finasteride

• Applied directly to scalp

• Lower systemic absorption

• May reduce side effect risk

• Emerging option

PRP (Platelet Rich Plasma)

• Doesn't directly affect DHT

• Stimulates follicles through growth factors

• Complements DHT-blocking treatments

• Helps regenerate already-miniaturised follicles

At The Wellness, we often combine PRP with DHT-blocking treatments for comprehensive results.

The Role of Testosterone in Women's Hair Loss

Women's hair loss works differently:

Lower testosterone levels: Women have much lower testosterone than men, but can still produce enough DHT to affect hair.

Different pattern: Women typically experience diffuse thinning rather than receding hairline or crown baldness.

Other hormones involved: Oestrogen is protective for hair. The hormonal shifts of menopause (declining oestrogen) can trigger or worsen hair loss.

Treatment differences: Finasteride is not approved for premenopausal women (affects fetal development). Alternative approaches include:

• Anti-androgens (spironolactone)

• Minoxidil

• PRP

• Addressing underlying hormone imbalances

Should You Get Your Testosterone Tested?

When testing is useful:

• You have symptoms of low testosterone (fatigue, low libido, depression)

• Hair loss is accompanied by other hormonal symptoms

• You want baseline data before treatment

• You're considering testosterone replacement therapy

What we test:

At The Wellness, our hair loss blood panel includes:

• Total testosterone

• Free testosterone

• SHBG (sex hormone binding globulin)

• DHT (when indicated)

• Thyroid function

• Nutrients affecting hair

This provides a complete picture of hormonal influences on your hair.

Important note: Finding "normal" testosterone doesn't mean hormones aren't involved in your hair loss. It means the issue is DHT sensitivity and local conversion, not testosterone levels themselves.

Testosterone Replacement Therapy (TRT) and Hair Loss

The concern: Many men considering TRT worry it will accelerate hair loss.

The reality: TRT can potentially worsen hair loss in genetically susceptible men because:

• More testosterone available for conversion to DHT

• Particularly if supraphysiological doses are used

• Individual response varies significantly

Managing this risk:

If you're on TRT and concerned about hair loss:

• Monitor your hair and take baseline photos

• Consider finasteride alongside TRT

• PRP can help protect against DHT-related damage

• Work with a doctor experienced in both TRT and hair loss

Some men on TRT use preventive finasteride from the start to protect their hair.

Common Myths About Testosterone and Hair Loss

Myth: High testosterone = baldness

Reality: No correlation between testosterone levels and hair loss. Genetic DHT sensitivity determines outcomes.

Myth: Bald men have more testosterone

Reality: Studies show no difference in testosterone levels between bald and non-bald men.

Myth: Lowering testosterone prevents hair loss

Reality: Dangerous and ineffective. The target is DHT, not testosterone.

Myth: If my father is bald, I will be too

Reality: Genetics are complex. You can inherit baldness genes from either parent, and expression varies.

Myth: Hair loss treatments will reduce my masculinity

Reality: Finasteride doesn't lower testosterone. Most men experience no side effects. Libido and masculine characteristics are preserved.

Myth: Only men need to worry about hormones and hair

Reality: Women's hair is also hormonally influenced, just through different mechanisms.

Frequently Asked Questions

If testosterone doesn't cause hair loss, why do some steroid users go bald?

Steroid users often take supraphysiological doses, dramatically increasing DHT. This accelerates hair loss in genetically susceptible individuals. It doesn't cause hair loss in those without genetic susceptibility.

Will finasteride affect my testosterone levels?

Finasteride slightly increases testosterone (because less is converting to DHT). It doesn't reduce testosterone or cause "low T" symptoms.

Can I have high testosterone and not go bald?

Absolutely. Many men with high testosterone retain full hair throughout life because their follicles aren't genetically sensitive to DHT.

Is there a test to know if I'll go bald?

Genetic tests exist but aren't commonly used clinically. Family history provides reasonable indication. If your father and grandfathers experienced pattern baldness, you're at elevated risk.

Does masturbation or sexual activity affect hair loss?

No. This is a complete myth with no scientific basis.

Can exercise affect hair loss through testosterone?

Exercise slightly increases testosterone but doesn't meaningfully affect hair loss. The benefits of exercise far outweigh any theoretical hair concerns.

Getting Help for Hormone-Related Hair Loss

Understanding the testosterone-DHT relationship empowers you to seek appropriate treatment. The key points:

1. Testosterone levels don't determine baldness

2. Genetic DHT sensitivity is the actual cause

3. Effective treatments target DHT, not testosterone

4. Comprehensive assessment guides optimal treatment

At The Wellness, we provide thorough evaluation including hormone testing, then create personalised treatment plans combining medical therapy and regenerative treatments like PRP.

Understand your hormones and your options. Book a consultation via WhatsApp

Medically reviewed February 2026

Last updated: February 2026