Testosterone Cypionate and Hair Loss: When to Call Your Doctor
At a glance
- Label reaction / Male pattern baldness is listed under skin and appendage adverse reactions [1]
- Typical pattern / Bitemporal recession of the frontal hairline, then diffuse thinning at the vertex [3]
- Driver / DHT acting on androgen-sensitive follicles [3]
- Course / Androgenetic alopecia tends to worsen with time [3]
- Sudden diffuse shedding / Telogen effluvium is nonscarring and noninflammatory; hair typically regrows once the cause is removed [2]
- Patchy loss / Alopecia areata is diagnosed by typical patches and is self-limited [2]
- Scaly patches / Tinea capitis can be erythematous and scaly, and must be treated systemically [2]
- Hair pull test / 2 or fewer hairs per pull was normal in 97.2% of 181 people [4]
What the label says about hair loss
Testosterone cypionate is an injectable testosterone ester. The Depo-Testosterone label lists male pattern of baldness with hirsutism, seborrhea, and acne under skin and appendage adverse reactions [1]. It gives no rate for hair loss [1].What ordinary pattern loss looks like
Androgenetic alopecia is the most common form of hair loss, caused by a progressive reduction in the diameter, length and pigmentation of the hair, through the effect of dihydrotestosterone on androgen-sensitive follicles [3]. The male pattern is bitemporal recession of the frontal hairline, followed by diffuse thinning at the vertex [3]. Androgenetic alopecia is progressive and tends to worsen with time [3]. The label notes that in many tissues testosterone's activity appears to depend on reduction to dihydrotestosterone [1].When to call
Patchy bald spots, scaly or red areas, and scarring changes are what call for evaluation. Telogen effluvium is a nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress, and once the precipitating cause is removed the hair typically regrows [2]. Alopecia areata is diagnosed by typical patches of hair loss and is self-limited [2]. Tinea capitis causes patches of alopecia that may be erythematous and scaly and must be treated systemically [2]. Scarring alopecia is best evaluated by a dermatologist [2].The hair pull test
A hair pull test is a bedside check with a low normal threshold: in a study of 181 people the mean number of hairs removed per pull was 0.44, and 2 or fewer was normal for 97.2% of participants [4].Frequently asked questions
Does testosterone cypionate cause hair loss?
The Depo-Testosterone label lists male pattern baldness among the skin and appendage adverse reactions reported with some androgens, without a rate [1].
What does ordinary male pattern hair loss look like?
Bitemporal recession of the frontal hairline, followed by diffuse thinning at the vertex, is the male androgenetic pattern, and it tends to worsen over time [3]. The label lists male pattern baldness among reported reactions [1].
What kind of shedding is not ordinary pattern loss?
Telogen effluvium is a nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress, and the hair typically regrows once the precipitating cause is removed [2].
What do patchy or scaly bald spots suggest?
Alopecia areata is diagnosed by typical patches of hair loss and is self-limited, while tinea capitis causes patches that may be erythematous and scaly and must be treated systemically [2]. Scarring alopecia is best evaluated by a dermatologist [2].
How is a hair pull test read?
In a study of 181 people the mean number of hairs removed per pull was 0.44, and 2 or fewer hairs per pull was normal for 97.2% of participants [4].
References
- 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
- Phillips TG, Slomiany WP, Allison R. Hair Loss: Common Causes and Treatment. Am Fam Physician. 2017;96(6):371-378. Hair Loss: Common Causes and Treatment
- Piraccini BM, Alessandrini A. Androgenetic alopecia. G Ital Dermatol Venereol. 2014;149(1):15-24. Androgenetic alopecia
- McDonald KA, Shelley AJ, Colantonio S, Beecker J. Hair pull test: Evidence-based update and revision of guidelines. J Am Acad Dermatol. 2017;76(3):472-477. Hair pull test: Evidence-based update and revision of guidelines