About Hair Loss
The most common cause of hair loss is genetic or familial. Circulating androgen hormones cause a progressive decrease in hair length and caliber, a process termed miniaturization, and eventual hair loss. In such cases, the principle treatment is hair restoration surgery, although this can be complemented by medical treatment. Certain medical conditions, such as iron deficiency, are associated with hair loss. For patients with a medical condition, treating the underlying condition and considering medical therapy is an appropriate first step. If hair loss persists, then hair restoration surgery can be considered as a second step.
Female Patterns: In contrast to men, women tend to thin more diffusely but rarely become totally bald:
Male Patterns: Baldness progresses over time, but even severely bald men have a rim of permanent hair that can be used for hair transplantation
Testosterone Replacement Therapy
In the field of hair loss, scant attention is given to the role of testosterone replacement therapy (TRT) in accelerating hair loss. TRT is an effective treatment for the rare patient that has low testosterone due to a genetic or medical condition. However, in recent years it has been prescribed in dramatically increasing frequency to older men who have a combination of low testosterone and non-specific symptoms such as fatigue, decreased sexual function, decreased bone density, and decreased muscle mass and strength: in other words, normal expected aged-related changes.
Is there a holy grail to youth? Patients hope there is. Physicians would rather solve a problem than admit defeat. Companies would gladly leverage this vulnerability to market the concept of “andropause”.
Yet, the truth is that TRT has not been shown to impact sexual function, strength, fatigue, or cognition, although it most certainly accelerates hair loss.
