How Steroid Use Causes Hair Loss

Tagged in: Hair Health

by Dr. Bryan Do, D.O. Last Updated: February 03, 2020

While they are often associated with building muscles and improving athleticism, steroids are actually just a type of chemical that your body naturally produces. Synthetic steroids offer a wide range of uses outside of sports and physical training, but overusing steroids can result in potential unwanted side effects, including hair loss. Read on to learn more about steroids and how they can cause hair loss.

What Are Steroids?

To understand why steroids may negatively affect hair growth, we need to first understand what steroids are. There are two commonly used types of steroids that can potentially affect hair growth: anabolic steroids and anti-inflammatory steroids.

Anabolic Steroids

Anabolic steroids are a synthetic form of the natural hormone testosterone, the main male sex hormone. In men, testosterone contributes to the development of male characteristics during puberty, like a deep voice, facial hair, and muscle composition. Past puberty, testosterone may help to regulate sex drive, muscle mass, red blood cell production, and bone mass.¹ Women also produce testosterone, though in smaller amounts, which contributes to the maintenance of bone mass and reproductive tissue.²

Due to its chemical similarity to testosterone, anabolic steroids are sometimes prescribed for hormone issues in men, as well as cases of delayed puberty, muscle loss and weight loss from certain diseases like HIV, and certain types of severe anemia. However, some athletes and bodybuilders misuse anabolic steroids to expedite muscle growth and improve athletic performance.^{3, 4}

Anabolic steroids come in various forms of administration, including injections, pills, creams, and patches.⁴

Anti-inflammatory/Autoimmune Steroids

Anti-inflammatory/autoimmune steroids, commonly known as corticosteroids, also mimic hormones that you naturally produce, but instead of testosterone, corticosteroids are similar to chemicals released by the adrenal glands. Common corticosteroids include prednisone, prednisolone, cortisone, and hydrocortisone. When these steroids are prescribed in doses higher than your body’s usual levels, they can produce an anti-inflammatory effect, making corticosteroids useful in reducing the symptoms of certain inflammatory conditions, including rheumatoid arthritis and asthma. Corticosteroids may also be prescribed for Addison’s disease, a disorder characterized by a lack of natural corticosteroids produced by the adrenal glands.⁵

Corticosteroids also have an immunosuppressive effect. In the body, corticosteroids can alter lymphocyte recirculation while also inducing lymphocyte death. They can also inhibit cytokines, reducing T cell activation in the process.⁶ While altering immune functions may seem counterintuitive, sometimes the immune system mistakenly attacks tissues and organs. This is known as an autoimmune reaction, a malfunction that causes the immune system to see benign elements or even healthy tissue as a potential threat. In these cases, suppressing the immune system with steroids is desirable and may help to mitigate an overactive immune response. Doctors may prescribe corticosteroids to reduce the symptoms of lupus, rashes, asthma, psoriasis, and other autoimmune issues. They may also be prescribed following an organ transplant, suppressing the immune system to prevent a potential organ rejection.⁵

Corticosteroids are available as oral tablets and capsules, topical creams and ointments, and injections. They can also be taken via inhaler or nasal spray for inflammation involving nasal allergies.

How Anabolic Steroids Cause Hair Loss

Anabolic steroids can potentially have a variety of hormonal side effects in men, including infertility, reduced libido, and hair loss. Studies on the effect of anabolic steroids on hair growth remain inconsistent as male pattern baldness does not appear to be a common side effect. However, some research does suggest that androgenic alopecia caused by anabolic steroid use may be more common in men who already have a predisposition to hair loss.⁷

The potential still remains as anabolic steroids naturally result in increased testosterone levels. High testosterone leads to a higher concentration of DHT. Excess levels of DHT are known to cause hair loss in men and women. A genetic sensitivity to DHT causes hair follicles to gradually shrink. As the hair follicles slowly get smaller, the hair’s active growth phase (anagen phase) becomes shorter, while the resting phase (telogen phase) extends. The result is thinning hair and eventual hair loss.

How Anti-Inflammatory/Autoimmune Steroids Cause Thin Hair

Anti-inflammatory/autoimmune steroids are generally not known to cause hair loss, but they may potentially cause hair thinning. Certain anti-inflammatory/autoimmune steroids may inhibit the growth of rapidly dividing cells. Many of these cells are found in the immune system, and anti-inflammatory/autoimmune steroids can keep these cells under control to prevent overactive immune responses resulting in autoimmune disorders. However, rapidly dividing cells are also common in the skin, mucosa, and hair. While taking anti-inflammatory/autoimmune steroids can inhibit fast-growing immune cells, they may also cause cells in the hair follicles to stop growing or dividing normally. This mainly applies to immunosuppressive drugs in general.⁸

Cases Where Anti-Inflammatory/Autoimmune Steroids May Help with Hair Loss

More research suggests that anti-inflammatory/autoimmune steroids may actually help to reduce hair loss. The body can sometimes develop an autoimmune reaction to hair follicles in the scalp, resulting in immune cells attacking the hair follicles and preventing them from functioning properly. Alopecia areata is the most common example of this. Alopecia areata is an autoimmune disease that is characterized by sudden, unpredictable hair loss on the scalp, face, and sometimes the body. This hair loss is usually patchy with hair falling out in clumps and without any discernible pattern.⁹

In these cases of hair loss caused by an overactive immune system, a clinician may be able to reverse the baldness by injecting the scalp with autoimmune steroids. This suppresses the immune reaction, prevents damage to the hair follicles, and allows them to return to normal function. In one study, 71 percent of patients with subtotal alopecia areata treated with triamcinolone acetonide (a synthetic steroid) injections reported hair regrowth, compared to just 7 percent of the placebo group.¹⁰

Research also shows that topical steroids may be effective in reducing and reversing alopecia areata. In one study, 61 percent of patients using a 0.1% betamethasone valerate topical foam achieved hair regrowth of at least 75 percent. About 27 percent of patients using a 0.05% betamethasone dipropionate lotion achieved similar results. However, topical steroids were found to be far less effective when treating alopecia totalis and alopecia universalis.¹⁰

In another study, researchers compared the effects of topical steroids, topical tretinoin, dithranol paste, and a control (petroleum jelly) on 80 patients with alopecia areata for a three-month treatment period followed by a three-month follow-up. The results found that 70 percent of the topical steroid group showed significant hair regrowth, while 55 percent of the topical tretinoin group achieved similar favorable results. Just 35 percent of the dithranol paste and 20 percent of the control groups showed any positive results. This suggests that topical steroids may be effective in treating alopecia areata.¹¹

However, autoimmune steroids may be less helpful when it comes to male and female pattern baldness, which is caused by excess DHT.

How to Minimize Hair Loss When Using Steroids

When prescribed by doctors, anabolic steroids and anti-inflammatory/autoimmune steroids are normally only meant for the short-term. Patients who do require long-term treatment with steroids should talk to their doctors about potential adverse side effects and determine the minimum effective dosage to prevent those side effects.

If you are using anabolic steroids, using a DHT blocker along with it may help reduce the production of DHT, regulate hormone levels, and reduce hair loss. Pharmaceutical DHT blockers like finasteride are available with a prescription. A number of natural herbs and foods also have the potential to block DHT naturally. We have compiled a list of natural DHT blocking ingredients. Consider incorporating these herbs and foods into your diet or finding a supplement that contains these ingredients.

If you are using anti-inflammatory/autoimmune steroids prescribed by your doctor and are experiencing hair loss then you should consult with your doctor. Steroid usage needs to be carefully balanced. Having too high of a dose will ensure that the underlying autoimmune condition is treated but can lead to hair loss and other problems. Having too little of a dose will help with hair loss but will not sufficiently treat the underlying condition. Your doctor may alter your dosage to reach a happy medium.

If you do experience hair loss while using anti-inflammatory/autoimmune steroids, a DHT blocker will not help as the underlying problem is not related to DHT. However, taking nutrients that support hair growth may be helpful in maintaining healthy hair follicles and preventing hair loss. We have compiled a list of vitamins for hair growth.

Other Potential Side Effects of Steroid Use

As they are designed to mimic and affect natural hormones, steroids can come with some potential unwanted side effects. Misuse of anabolic steroids may lead to:

Acne
High blood pressure (hypertension)
Fluctuating cholesterol
Kidney damage
Liver problems
Heart problems³

Potential side effects of taking anti-inflammatory/autoimmune steroids may include:

High blood pressure
Fluid retention (resulting in swelling in the lower legs)
Mood swings, memory issues, and behavioral changes
Confusion, delirium, and other psychological effects
Weight gain, particularly in the abdomen, face, and back of the neck⁵

Sources:

About the Author:

Dr. Bryan Do, D.O.

Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.

Back to DrFormulas Research