PEDs & Hair Loss
TL:DR A complex action, but due to high levels of DHT, IF you are predisposed to hair loss. This article is going to to skip the ‘how’ DHT and focus on the ‘why’ as well cover ‘what’ to do to mitigate.
Hair Loss Common In Our Community
There are many types of hair loss, but we’re really only interested in the one that is of most concern to us. Male androgenetic alopecia (MAA) is the most common form of hair loss, affecting 30-50% of men by age 50. It impacts hair around the temples, vertex and scalp.
It’s widely thought that DHT is the main culprit behind MAA. Men lacking balls, as in actually lacking testicles and not just having handed in their man card to their wife like myself, do not experience MAA. Or specifically, men with androgen-insensitivity syndrome and 5 alpha-reductase deficiency do not go bald. This suggests that MAA is induced by activation of androgen receptors at the scalp by DHT. It is further shown that increased levels of DHT have been found in balding scalps compared to non-balding scalps.
SARMs are not testosterone however, and so do not convert into DHT. Yet there are many reports of SARMs impacting hair loss. So what gives? Let me get to that in the next section.
What is DHT?
DHT is a steroid formed by 5a reductase from testosterone. As you increase forms of testosterone in your body, this will in turn increase the amount of DHT beyond the normal range of 20-60 n/mol for men, and 40-120 n/mol for women. It is also a more potent agonist of the androgen receptor than test.
DHT also binds well with SHBG. In fact, it LOVES SHBG like /u/natty_fuck_face loves DMSO, with 5 times the affinity that SHBG has for testosterone. Thanks to MAS (though let’s be real, we’ve always known this), we know that SHBG absolutely tanks in SARM only cycles.
Putting this together: my hypothesis is that low SHBG means more free DHT because of a lack of SHBG to bind to. Your SARM only cycle is causing hair loss in a similar way steroids do, though not nearly to the same extent.
Predicting If You Are Predisposed
There is a diagnostic test that will predict the chances of future androgenetic alopecia, by reporting the presence or absence of a specific variation in the androgen receptor (AR) gene found on the X chromosome. It's not reliable, with a 30% error rate - don't bother.
Instead an Australian study that examined frequency of baldness showed that 81.5% of balding sons had balding fathers. But that was an Aussie study, that was probably conducted upside down while they were shitposting on Reddit, so don’t blame you for ignoring it.
But we do know that MAA is ~80% determined by genetics. Looking at the men on your mothers side of the family was thought to be indicative of risk for MAA, but that’s since been revised as the gene can still be passed down on your father’s side too. Essentially, it’s complicated, as there is not a single specific gene, but a combination. See the Australian study above as correlation.
Look around you - does your father and grandparents all have thick, glorious hair? Congrats, you're probably not going to be predisposed to lose hair. Or they don't, and well shit, you're stuck rocking out a Homer Simpson haircut.
What Can Be Done
Minoxidil & Finasteride prevent further hair loss. -ish. Personal experience with both showed me that neither are perfect in their function, and some hair loss is inevitable if predisposed as you age. At 1mg ED Finasteride reduced scalp DHT by 64%. Dutasteride is apparently more effective but has a higher incidence of side effects which for both include impotence and trouble having orgasm. Minoxidil works differently, by opening potassium channels and reduction of calcium. None will prevent complete balding, but will initially encourage regrowth, drastically slow future hair loss, and reduce impact of DHT.
Hair transplantation is safe, reliable and effective, while expensive. Again, speaking from experience. Hair transplanted from the back of the head to the top is not genetically susceptible to follicle death caused by DHT. I.e. it’s a permanent solution.
SERMs increase SHBG, which would bind with DHT, and lower the impact it has on the hairline. Tbh I’m skeptical whether or not it would actually increase SHBG on cycle or not. MAS does not have enough data to help me make a determination either way. This could be explored in future.
The most important conclusion to draw here is dispelling the myth that SARMs do not cause hair loss. Even if my hypothesis that low SHBG increases free DHT is wrong and hair loss is caused by a different action (and there are many potentially causes of hair loss), there are too many anecdotal reports complaining of hair loss to ignore.
I had one young man reach out to me recently who had started a SARM only cycle, devastated about the hair he was losing on his first ever cycle. If you’re new and evaluating the pros and cons, definitely factor potential hair loss as a con. For the more experienced, I think we all know it’s something you deal with, and we just do what you can.