Steroid Use and Hair Loss

More Plates Less Hair? 

We know that a celebrity's physical appearance often isn't achievable for someone outside the limelight. Behind what might seem like effortless perfection are stylists, make-up artists, nutritionists, and many other specialists. 
Advice found online can be well-researched and genuine, but it can also be harmful disinformation used to sell a product or grow a following. Liver King's posts belong to the latter category. His muscular and lean physique has little to do with eating raw liver, eggs, testes, and maple syrup (as he had previously claimed) and turns out to be a consequence of taking steroids.
We will go over how performance-enhancing steroids and supplements can affect one's health and appearance, especially in regards to hair loss. 

Why do some people use steroids?

Steroid use isn't always harmful and can be prescribed by a healthcare provider as a medical therapy. For example, to reduce inflammation after an adverse reaction to a synthetic hair transplant. Using steroids as performance-enhancing drugs to improve muscle mass and appearance is often illegal and dangerous.
A desire to improve our physical performance is nothing new. Ancient Greeks, like the Liver King, ate sheep hearts and testicles because they believed they improved male performance. They also drank an opium juice called 'doop' or 'dope.' The Romans used hallucinogenic mushrooms, plants, and sesame seeds to improve their performance. During WWII, testosterone derivatives might have been given to German soldiers to increase their aggression and endurance.
Today, people turn to steroids and supplements to improve their performance and appearance. Purchasing steroids without a prescription is illegal, and using them can lead to adverse physical and psychological side effects. Physical side effects include liver damage, high blood pressure, increased heart attack and stroke risk, and hair loss. Some psychological effects are aggression, mood swings, and depression. 

What are anabolic steroids?

Anabolism refers to metabolic processes that build and repair tissue in the body. Anabolism happens when nitrogen is retained in lean body mass through the stimulation of protein synthesis and/or the decrease of the breakdown of protein in the body. The process is affected by hormones such as insulin and testosterone. 
Anabolic steroids or anabolic-androgen steroids (AAS) are drugs that increase protein synthesis and mimic the effects of testosterone. They lead to cellular tissue build-up in muscles. These steroids are controlled substances and can only be taken as prescription medication to treat certain medical conditions. They can be used for medical purposes, such as stimulating bone growth. Some obtain anabolic steroids to stimulate muscle growth, increase strength, and enhance performance.

How do anabolic steroids affect hair loss?

Current anabolic steroids are derivatives or structural modifications of testosterone and can increase DHT levels. Testosterone is converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT can cause hair follicles to shrink by binding with androgen receptors, leading to hair loss. A study showed that out of 50 men on long-term testosterone therapy, 16 experienced frontotemporal hair loss, and 15 developed moderate-to-severe androgenic alopecia. 

Is hair loss the only negative consequence of AAS?

Over-the-counter supplements and anabolic-androgenic steroids can aid in improving athletic performance and boosting confidence, but they come with potentially severe consequences. 
In a group of 600 males who take gym steroids, 77% reported experiencing side effects. Out of this 77%, 14% experienced hair loss. Serious adverse side effects also included: 
  • endocrine dysfunction
  • hepatic (liver) dysfunction
  • cardiovascular changes
  • behavioral changes

Do anabolic supplements cause hair loss?

Anabolic and other performance-enhancing supplements are dietary supplements taken in order to improve strength and appearance. Many view them as a cheaper, over-the-counter alternative to steroids. They are also considered "safer" since they are less potent than anabolic steroids. 
In reality, the adverse physical and psychological side effects of anabolic supplements are similar to those of steroids. Although supplements are less potent than AAS, they can be contaminated with anabolic androgenic steroids and stimulants. Another issue is that many supplements don't consistently contain the active ingredients they claim. 
Anabolic supplements can lead to hair loss by contributing to the rise of DHT levels. The increase can be due to IGF-1. IGF-1 (insulin-like growth factor-1) can be found in anabolic supplements and growth hormones. DHT blockers don't always solve the issue of hair loss since there can be other causes apart from increased DHT levels.
Creatine is a supplement used to increase muscle mass. So far, studies have not consistently found that creatine leads to increased total testosterone, free testosterone, and DHT or that it causes hair loss. Still, further research is needed to ensure that creatine is safe to use.

Q&A with Dr. Linkov

Q: Would steroid hair loss be preventable with finasteride?
A: For most people, the answer is yes. In fact, supplementing testosterone (or a derivative) will often lead to a rise in DHT levels at the follicular unit and may require higher doses of finasteride to help prevent progressive hair loss.

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.

Written by Aleksandra Božović | Edited by Dr. Gary Linkov
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