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Accelerated male-pattern hair loss on Testosterone Cypionate: Incidence, Severity, and Realistic Expectations

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At a glance

  • Label status / 'Male pattern of baldness' is listed among skin reactions reported with some androgens [1]
  • Incidence / No rate given in the Depo-Testosterone label [1]
  • Mechanism / Testosterone converts to DHT, which miniaturizes genetically susceptible follicles [3][2]
  • Background / Pattern hair loss affects up to 80% of men in a lifetime [2]
  • Treatments / Minoxidil and finasteride are FDA-approved for pattern hair loss and beat placebo in randomized trials [4]

Does the label list hair loss as a side effect?

Yes. The Depo-Testosterone label, which covers intramuscular testosterone cypionate, lists 'male pattern of baldness' among skin and appendage reactions reported with some androgens, alongside hirsutism, seborrhea and acne [1]. It gives no frequency [1].

Why testosterone can be linked to pattern loss

Testosterone is converted to dihydrotestosterone (DHT) by 5-alpha reductase. One review puts the share of the body's testosterone converted to DHT at up to about 10% [3]. Excess DHT miniaturizes hair follicles, shortening the growth (anagen) phase and increasing the resting (telogen) phase [3]. The label notes that in many tissues testosterone's activity depends on reduction to DHT [1]. The follicle also has to be genetically susceptible [5]; androgenetic alopecia affects up to 80% of men over a lifetime [2].

How common is it, and how fast does it progress?

The label gives no incidence, severity grading or progression rate for hair loss [1]. Pattern hair loss tends to worsen over time [2], and a 2017 review of testosterone therapy in transgender men notes that alopecia continues to develop after the first year [6].

What has evidence behind it

Minoxidil and finasteride are FDA-approved for androgenetic alopecia. A meta-analysis of randomized trials found that both promoted hair growth in men with androgenetic alopecia compared with placebo [4]. Finasteride inhibits type II 5-alpha reductase, which converts testosterone to DHT [5]. In a 24-week phase III trial of 458 men with pattern hair loss, topical finasteride spray increased target-area hair count by 20.2 hairs versus 6.7 with placebo (P<0.001) [7]. Oral finasteride is associated with decreased libido, sexual dysfunction and gynecomastia [5]. These studies evaluated treatments for pattern hair loss in men generally; they did not test them in men taking testosterone cypionate [7][4].

Frequently asked questions

Does testosterone cypionate cause hair loss in men with no family history of baldness?
Pattern hair loss depends on follicles that are genetically susceptible to DHT [2][5]. The label does not give hair-loss rates by family history [1].
How soon after starting injections would thinning show up?
The label gives no timeline [1]. A 2017 review noted that alopecia continued to develop beyond the first year of treatment [6].
Does hair grow back after stopping testosterone cypionate?
The label does not report whether hair regrows after stopping. Pattern hair loss tends to worsen over time [1][2].
Can finasteride be taken with testosterone cypionate?
Finasteride lowers DHT and improved hair counts in men with pattern hair loss, but that trial did not report results for men taking testosterone cypionate [7]. Oral finasteride is associated with decreased libido, sexual dysfunction and gynecomastia [5].
Does switching to a different testosterone ester change hair loss risk?
The label gives no comparison of hair-loss risk between testosterone esters. Cypionate and enanthate are both testosterone esters, and the testosterone they release can be converted to DHT [1][3].

References

  1. U.S. National Library of Medicine, DailyMed. Depo-Testosterone (cypionate) intramuscular, Pharmacia & Upjohn/Pfizer (testosterone cypionate) prescribing information. Depo-Testosterone (cypionate) intramuscular, Pharmacia & Upjohn/Pfizer (testosterone cypionate) label
  2. Piraccini BM, Alessandrini A. Androgenetic alopecia. G Ital Dermatol Venereol. 2014;149(1):15-24. Androgenetic alopecia
  3. Dhariwala MY, Ravikumar P. An overview of herbal alternatives in androgenetic alopecia. J Cosmet Dermatol. 2019;18(4):966-975. An overview of herbal alternatives in androgenetic alopecia
  4. Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(1):136-141.e5. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis
  5. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride - PMC. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride - PMC
  6. Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2017;5(4):301-311. Testosterone therapy for transgender men
  7. Piraccini BM, Blume-Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, et al. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2022;36(2):286-294. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial
Evidence overview for Accelerated male-pattern hair loss on Testosterone Cypionate: Incidence, Severity, and Realistic Expectations