Anabolic-androgenic steroids (usually just called anabolic steroids) are man-made versions of testosterone, which some bodybuilders and gym-goers use against medical advice to supercharge their gains in the gym. But their use comes with some pretty serious health risks, which can include cardiovascular issues, liver damage and psychological problems.
We’ll be speaking about the association between steroid misuse and hair loss, which is arguably one of the least serious potential side effects. Even so, hair loss can have a big impact on self-esteem and confidence.
What are anabolic steroids and why do people use them?
More commonly known as just “roids” or sometimes “juice” in everyday life, some bodybuilders, professional athletes and average gym-goers alike use them as a cheat code to put muscle on quickly, build strength and enhance their physique.
They can be prescribed by doctors to treat legitimate medical problems, like delayed puberty, low testosterone or muscle wasting, but doctors will not prescribe them to improve athletic performance or physical appearance. So, users usually get their hands on them through illegal sellers, meaning they’re often taken without medical guidance or official guidelines on dosages, safety or long-term risks.
Anabolic steroids can speed up muscle growth by upregulating the expression of genes related to muscle growth and repair. But they don’t just have an effect on muscle cells and then stop there – they can have widespread negative effects on cells across the entire body.
Hair loss can be a visible consequences of steroid use, but it's far from the most concerning. Other potential risks include:
- Cardiovascular disease
- Liver damage
- Breast enlargement in men (gynecomastia)
- Fertility issues
- Psychological and behavioural changes
What’s the link between steroids and hair loss?
The medical term for male pattern baldness is ‘androgenetic alopecia’.
That’s because it’s a form of alopecia, aka hair loss; it’s genetic; and it’s driven by ‘androgens’, the group of male sex hormones.
One androgen in particular plays a major role: dihydrotestosterone (DHT).
DHT attaches to susceptible hair follicles on the scalp and gradually causes them to shrink, a process known as miniaturisation. As follicles become smaller, they produce thinner, weaker hairs and spend longer in the shedding phase of the hair growth cycle. Over time, this leads to visible thinning and balding.
A portion of a man’s testosterone is naturally converted into DHT by an enzyme called 5a-reductase. As anabolic steroids work by boosting testosterone levels, it’s reasonable to ask:
“If steroids increase testosterone, does that mean they also increase DHT and therefore increase the risk of hair loss?”
Are higher testosterone levels associated with male pattern baldness?
Researchers have looked into this question for decades, with mixed findings.
Studies that found a link
One study involving 315 men compared participants with no hair loss, frontal hair loss, and vertex (crown) hair loss.
Researchers found:
- No significant difference in testosterone or DHT levels between men with no hair loss and those with frontal hair loss.
- Men with crown hair loss had significantly higher levels of both total and free testosterone than men without hair loss.
Another study comparing 22 men with hair loss to 11 controls found higher testosterone and DHT levels in the hair loss group.
Studies that didn’t find a link
Other studies came to the opposite conclusion.
One study examining 50 men with severe balding before the age of 30 found no significant difference in testosterone levels when compared with similarly aged controls.
A larger study of 373 men also found no significant association between testosterone levels and male pattern hair loss.
So what’s the verdict?
The picture is mixed. While some studies find a correlation between testosterone levels and hair loss, others struggle to find a significant association. The overall evidence suggests that testosterone levels alone don’t determine whether someone develops androgenetic alopecia.
This points to a more complex picture in which genetics likely play a much bigger role than hormone levels alone.
Do steroids increase the risk of hair loss?
For men who are genetically predisposed to male pattern baldness, the answer is probably yes.
Extra testosterone from steroid use can potentially be converted into additional DHT. Higher DHT exposure may speed up the miniaturisation process, causing male pattern baldness to develop sooner or progress more quickly.
The key point is that steroids don't necessarily cause hair loss in everyone. Instead, they may act as an accelerant in men who are already susceptible.
Research specifically looking at anabolic steroid users suggests that hair loss can become more common during use.
A review of anabolic steroid users reported that approximately 14% experienced hair loss.
Another study of 100 men found that reports of alopecia increased from 2% before steroid use to 12% after around 3.5 months of use.
However, not all studies have found a strong association. A Danish anti-doping programme reported only five cases of alopecia among 1,189 male steroid users, compared with 11,890 controls.
It's important to interpret these findings with a pinch of salt. Most of the available evidence relies on retrospective studies and self-reported symptoms, which can be affected by recall bias and inaccurate reporting. To date, there have been very few controlled studies directly examining the relationship between anabolic steroid use and hair loss.
Will the hair grow back?
In many cases, yes.
If hair shedding is being driven by steroid use, stopping steroids may allow your hair to recover and start growing normally again. The sooner you stop, the better the chances of regrowth.
That said, it depends on how much damage has already been done to the hair follicles. If steroid use has accelerated male pattern baldness and the follicles have become significantly miniaturised, some of that hair loss may be difficult to reverse.
In simple terms, temporary shedding is often recoverable. But if steroids have sped up an underlying tendency towards male pattern baldness, some of the lost hair may not come back.
That's why men with a family history of male pattern baldness are generally at a higher risk of experiencing long-term hair loss when using anabolic steroids.
The bottom line
Anabolic steroids increase testosterone levels, which may lead to greater DHT exposure in the scalp. For men genetically prone to male pattern baldness, this could accelerate hair loss and bring it forward earlier than it would have occurred naturally.
The evidence isn't strong enough to say that steroids directly cause hair loss in every user, but they may increase the likelihood and speed of androgenetic alopecia in those who are already vulnerable to it.
All of our blog articles are reviewed by our Medical Director before publication.
