Testosterone therapy in men considering hair transplants : Do I worry about more than just hair loss?

Testosterone therapy in men considering hair transplants : 


There is a marked rise in the number of my male hair loss and hair transplant patients using testosterone therapy, especially men over 50.  Testosterone is also used at increasing rates in younger men as well.  Testosterone therapy is used in healthy men to counteract age-related reduction in serum testosterone and the diminished strength and physical function that accompanies the reduced testosterone.


Testosterone therapy and hair loss

In men with genetic hair loss, testosterone, as well as other androgen hormones (like anabolic steroids), have the potential to accelerate genetic hair loss. Some men notice increased hair shedding en route to developing worsening hair loss.  In my patients who use testosterone, we need to carefully plan for possible future hair loss. A hair transplant patient using testosterone may need a more conservative approach than a hair transplant patient not using testosterone.  A careful discussion and plan needs to be put in place. 


Testosterone therapy and heart attacks

Several studies have addressed the concern that testosterone therapy might lead to adverse cardiovascular outcomes.  In fact,  a small randomized trial of testosterone gel on muscle function in men 65 years of age or older was discontinued in 2010  because there were too many cardiovascular events in the group of men using testosterone.  A review of a number of  trials in predominantly older men also showed that men using testosterone had increased risk of cardiovascular problems. In addition, a recent study of men average age over 60 reported an excess of death and cardiovascular disease in those being treated with testosterone therapy.  In two studies, it appears that the risk of heart events (heart attacks, etc) starts very soon following starting therapy. 


Study findings of a new research study

A new study published this week in the Journal PLOS ONe showed that  older men, and in younger men with pre-existing diagnosed heart disease, the risk of having a heart attack after starting testosterone therapy is  substantially increased.

In fact, in men 65 years and older, the researchers observed a two-fold increase in the risk of heart attacks in the first three months after starting testosterone therapy. The risk actually  declined to baseline from month 3 to 6 in those who stopped therapy again.  The researchers also showed that among younger men with a history of heart disease, there was a two to three-fold increased risk of heart disease in the first three months after starting testosterone and no increased risk in younger healthy men without history of heart disease. 



While my main focus is on my patient's hair, I consider it critically important to be aware of the broad scope of medical research. My patients often need to make decisions about starting testosterone therapy for their physical health vs not starting on account of hair loss. At least 2-3 times daily in my hair transplant practice I have these important discussions. The scientific data are showing us time and time again that testosterone therapy increases the risk of heart attacks and other cardiovascular problems in men with a history of heart disease.



    1. Finkle et al. Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men. PLOS one. Published Jan 29

    2. Hensen LG, Chang S (2010) Health research data for the real world: The Thompson Reuters Marketscan Databases. White paper. Ann Arbor, MI.

    3. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS (2013) Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Internal Medicine: 1–2.Page ST, Amory JK, Bowman FD, Anawalt BD, Matsumoto AM, et al. (2005) Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. 90: 1502–1510.  

    4. Xu L, Freeman G, Cowling BJ (2013) Schooling CM (2013) Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med 11: 108. doi: 10.1186/1741-7015-11-108.

    5. O'Connor A (2013) Men’s use of hormones on the rise. New York Times.

    6. Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, et al. (2010) Adverse Events Associated with Testosterone Administration. New England Journal of Medicine 363: 109–122. 

    7. Seeger JD, Walker AM, Williams PL, Saperia GM, Sacks FM (2003) A propensity score-matched cohort study of the effect of statins, mainly fluvastatin, on the occurrence of acute myocardial infarction. Am J Cardiol 92: 1447–1451.

    8. Vigen R, O’Donnell CI, Barón AE, Grunwald GK, Maddox TM, et al. (2013) ASsociation of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 310: 1829–1836. doi: 10.1001/jama.2013.280386.

    9. Bremner WJ (2010) Testosterone Deficiency and Replacement in Older Men. New England Journal of Medicine 363: 189–191.

    10. Jackson G, Montorsi P, Cheitlin MD (2006) Cardiovascular safety of sildenafil citrate (Viagra): an updated perspective. Urology 68: 47–60. doi: 10.1016/j.urology.2006.05.04

    Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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