Testosterone and hair during the menopause

Your questions on this important hormone and its impact on hair growth – answered

What happens to testosterone during the menopause?

Testosterone is an important hormone that’s made by your ovaries, as well as your adrenal glands and brain. It’s the most biologically active steroid in women throughout the lifespan – you produce three times as much testosterone than oestrogen when you are younger [1, 2]. Levels of testosterone decline as you get older production, and this this fall can lead to symptoms such as a lack of energy, brain fog and low libido.

Does testosterone cause hair thinning and loss?

In the UK, over 20% of women under fifty experience hair thinning, and this number rises to about 65% during and after menopause.

Hair thinning can be genetic and is caused by a sensitivity to a form of testosterone called dihydrotestosterone (DHT). If you have an inherited follicle sensitivity to DHT, thinning is most likely to begin around the time of menopause.

Oestrogen can support hair growth but as levels decline during menopause so can hair growth, and there can be shrinkage in hair follicles. For some women, the decline in oestrogen means the balance between oestrogen and androgen (a group of sex hormones including testosterone and DHT) is altered, which can worsen female pattern hair loss.

DHT, not testosterone, is thought to be the active androgen in hair loss.

Jane Martins, a trichologist at Philip Kingsley, says: ‘Although it has been well established that DHT plays a significant role in male pattern hair loss, the role of DHT in female pattern hair loss remains unclear.’

What about hair gain?

Unlike DHT, testosterone can play a role in stimulating hair growth, and a study has shown testosterone therapy has a beneficial effect on scalp hair growth in female patients treated for symptoms of androgen deficiency [3].

While testosterone replacement can support hair growth, the dose and subsequent monitoring of levels is important as higher levels can have the opposite effect, as Jane explains: ‘In my experience, I find that in females with elevated testosterone levels, for example PCOS, this will exacerbate female pattern hair loss. A similar effect is seen in some women taking testosterone as part of their HRT. In the latter situation it is important to find a balance between the benefits and the potential negative effects.’

Can HRT affect hair?

It can but it’s complicated. A small number of women notice that synthetic types of HRT can worsen hair loss whereas body identical HRT is usually beneficial for hair growth.

HRT isn’t usually prescribed for symptoms of hair loss alone but some women who take testosterone as part of their HRT for menopausal symptoms have reported scalp hair growth as a side effect. One paper found two thirds of women treated with subcutaneous testosterone implants have scalp hair re-growth on therapy [4].

Jane adds: ‘In our clinic we have not seen a positive impact as a result of taking testosterone in terms of scalp hair growth. The impact of testosterone will differ depending on the individual, with some not experiencing a deterioration in hair density.  However, unfortunately in others, hair thinning may be exacerbated. 

‘From a hair perspective, choice of progestogen as part of an HRT regime is important since some can have an androgenic-like action, which may adversely affect hair loss.’

Will taking testosterone give me a beard or moustache?

Testosterone is usually given as a gel or cream on your skin or sometimes an implant. Some women  experience hair growth on the site of application (which is usually the skin of your upper thigh) – in this case it’s advised to rotate the site of application and to spread thinly. The dose of testosterone is very low so it will not usually cause facial hair growth. It is usually advised to have initial blood tests taken before starting testosterone and then three to six months after or following any dose change, with bloods then monitored annually to ensure levels remain in the female range.

Jane Martins is a trichologist at Philip Kingsley, philipkingsley.co.uk 

References

1, 2 Rebecca Glaser, Constantine Dimitrakakis. (2013), ‘Testosterone therapy in women: Myths and misconceptions,’ Maturitas, 74 (3), pp 230-234, https://doi.org/10.1016/j.maturitas.2013.01.003

Panay, N., & Fenton, A. (2009), ‘The role of testosterone in women,’ Climacteric, 12(3), pp185–187. https://doi.org/10.1080/13697130902973227

3, 4. Glaser RL, Dimitrakakis C, Messenger AG. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 2012 Feb;166(2):274-8. doi: 10.1111/j.1365-2133.2011.10655.x