Diet Protocols That Help With Hair Loss From Testosterone Cypionate

What the label says

Male pattern baldness appears in the adverse reactions section of the Depo-Testosterone (testosterone cypionate) label, along with hirsutism, seborrhea and acne [2]. The same label notes that in many tissues the activity of testosterone appears to depend on its reduction to dihydrotestosterone [2]. Androgenetic alopecia is progressive miniaturization of scalp hair, with DHT implicated as a key androgen in the male form [3]. Variation in the androgen receptor gene is the major determinant of early-onset androgenetic alopecia; the gene is on the X chromosome, which stresses the importance of the maternal line in inheritance [4].

What the nutrition research shows

A review of diet and hair loss says documented nutritional deficiencies should be corrected, that research is needed to determine whether supplementing without a documented deficiency helps, and that some supplements carry a risk of worsening hair loss or toxicity [1].

Twenty-eight healthy men aged 30 to 59 took 60 mg of soy isoflavones daily for 3 months. Total testosterone and estradiol were unchanged; SHBG rose, and free testosterone and DHT fell significantly [8]. A meta-analysis of 15 placebo-controlled treatment groups found no effect of soy protein or isoflavones on total testosterone, SHBG, free testosterone or the free androgen index [9].

Zinc sulphate inhibited 5-alpha-reductase in human skin samples at 3 and 9 mmol/L, laboratory concentrations rather than dietary amounts [10]. In a study of 312 patients with hair loss (alopecia areata, male and female pattern hair loss, and telogen effluvium) and 30 controls, mean serum zinc was lower in the hair loss group (84.33 vs 97.94 µg/dL) [11].

EGCG and epicatechin-3-gallate inhibited type 1 but not type 2 5-alpha-reductase in laboratory assays [5], and EGCG promoted growth of human hair follicles in ex vivo culture [12].

In a six-month trial of 120 healthy women, a supplement combining omega-3 and omega-6 fatty acids with antioxidants improved hair density and reduced the telogen hair percentage compared with a control [13]; because the supplement was a combination, the effect of omega-3s alone is not separated out.

A systematic review of saw palmetto-containing supplements (100 to 320 mg) in androgenetic alopecia and telogen effluvium found five randomized trials and two prospective cohort studies reporting positive effects, including a 27% improvement in total hair count, but said robust high-quality data are lacking and called for larger trials of saw palmetto alone [14].

What has the strongest trial evidence

In two one-year trials that enrolled 1,553 men aged 18 to 41 with male pattern hair loss, finasteride 1 mg increased vertex hair counts versus placebo by 107 hairs at one year (P<0.001); in the blinded extension studies that 1,215 of those men continued into a second year, the difference was 138 hairs [6]. In a 48-week trial of 393 men, topical minoxidil 5% was superior to 2% and to placebo on nonvellus hair count, with 45% more hair regrowth than the 2% solution at week 48 [7].