Do Steroids Cause Hair Loss?

Medically reviewed by Dr. Ahmad Chaudhry M.B.B.S.

Written by Our Editorial Team

Last updated Oct 25, 2023

Steroids are synthetic forms of natural human hormones. From athletes and bodybuilders to the ones suffering from chronic inflammatory disorders, steroids have myriads of benefits associated with their use. Anabolic and corticosteroids are the major types of steroids that have different uses.

Do steroids cause hair loss? Concerning hair health, both have opposing effects on the growth and wellbeing of hair.

While anabolic steroids promote an increase in mass and strength of muscles, corticosteroids help combat inflammation and alleviate the related symptoms.

Read more:

What are Steroids?

Steroids are man-made derivatives of hormones produced by the cortex of adrenal glands, located superior to the kidneys. The synthetic analog of adrenal cortical hormones, steroid medications are used to treat inflammation and modulate the function of the immune system. The steroid is employed in nasal sprays to reduce asthma-associated inflammation of the airways. Steroids are also used to alleviate joint pain in arthritis.

Types of Steroids

Steroids are classified into two main types based on the physiologic functions and the type of receptors these steroids bind. The two types are corticosteroids and anabolic-androgenic steroids. The first class of steroids binds to the glucocorticoid receptors whereas the second type of steroid drugs binds to the androgen receptors in the target tissues throughout the body.

Anabolic-Androgenic Steroids

Anabolic-androgenic steroids (AAS) mimic the action of testosterone. The term 'anabolic' signifies the muscle-building property, whereas, 'androgenic' refers to the masculinizing effects of these steroids. AAS bind to the androgen receptors, which usually bind testosterone and dihydrotestosterone (DHT), and exert similar effects on the target tissues.

AAS are commonly referred to as anabolic steroids and include trenbolone, oxandrolone, and nandrolone. They are available in the form of tablets and hypodermic needles. They're prescribed or consumed for the following reasons:

Increase rapidly in muscle mass as the steroids promote protein synthesis.
Increased muscle mass leads to endurance and improved muscle strength.
Increased muscle to fat ratio.
Accelerate healing after injury, usually during exercise.
Promote mineralization of bones, increasing bone density, strength, and resistance to stress.
Doctors prescribe AAS to anemia patients as the steroids increase the production of red blood cells.
Beneficial for delayed puberty and other conditions associated with hormonal; imbalances.
Develop male secondary sexual characteristics including hair growth, deep voice, and enlargement of external genitalia.

Misusing and obtaining this steroid without prescription have the following outcomes in men:

Oligospermia or decreased sperms in the ejaculate and reduction in the size of the testes.
Increase the risk of prostate cancer and cause abnormal growth of breast or gynecomastia.
Stimulate the sebaceous glands and give rise to severe acne.
Individuals who use these steroids tend to be hair loss patients.

Corticosteroids

Corticosteroids, commonly known as steroid, are synthetic anti-inflammatory drugs that mimic the action of cortisol, a hormone produced by the adrenal glands. The corticosteroids are available in the form of intravenous injections, intramuscular injections, topical skin creams, eye drops, nasal sprays, ear drops, and oral medications.

Examples of corticosteroids include hydrocortisone and prednisone. Corticosteroids modify the inflammatory mediators and the activity of white blood cells, thus, suppressing inflammation and the immune response. This is useful in treating or managing conditions like rheumatoid arthritis, multiple sclerosis, asthma, systemic lupus erythematosus, vasculitis, and eczema.

Corticosteroids are highly important for protecting internal organs from inflammation-mediated damage and promoting the overall wellbeing of an individual.

Common side effects of this steroid are listed below:

Weight gain, primarily due to accumulation of fluid and resultant swelling.
Corticosteroids may have neurologic symptoms such as insomnia, nervousness, and restlessness.
Blurring of vision
Muscle weakness
Corticosteroids may also cause irritation of the digestive tract.

What Is Alopecia Areata?

In order to understand how steroid affects hair loss, we'll need to understand what is hair loss.

Alopecia areata (or AA) is described as an autoimmune disorder in which the body's immune system attacks the hair follicles and causes hair loss. The disease may also affect the nails and pigment layer of the retina of the eye. Hair loss or baldness occurs anywhere on the body, however, the hair loss and regrowth patterns are not well-defined. The sites of hair loss according to the percentage of affected individuals are scalp (60%-90%), beard (28%), eyebrows (3.8%), and limbs (1.3%). This alopecia is further divided into two types - alopecia totalis and alopecia universalis.

Alopecia areata - this indicates patchy hair loss that can occur anywhere in the body
Alopecia totalis - a person is said to suffer from this if he or she loses all the head skin (scalp) hair
Alopecia universalis - this is a rare condition characterized by complete loss of body hair

AA most commonly occurs in genetically susceptible individuals. Under normal conditions, the surface molecules that present autoantigen to the immune cells, which might elicit an immune reaction, are suppressed. In AA, surface antigens are no longer suppressed and elicit an immune response against the hair follicles.

The inflammatory mediators signal the cells to attack hair follicle cells in the anagen phase and cause the follicles to proceed into a premature catagen phase followed by telogen and exogen phases, where the hair falls out. Nevertheless, the hair stem cells are not damaged and are capable of regrowth of hair.

Role of Corticosteroids in Alopecia Areata

Corticosteroid therapy is one of the best management strategies for alopecia areata. Corticosteroids can be administered in the following forms:

Intralesional Corticosteroids

This treatment yields the best response in alopecia areata patients. Triamcinolone acetonide is a widely used corticosteroid for intralesional therapy. Triamcinolone acetonide is used within the concentration range of 2.5-10 mg/mL and administered via hypodermal or intradermal injections.

Topical Corticosteroids

Creams, gels, lotions, and other forms of topical corticosteroids are employed to manage AA. This type of therapy is common among children owing to the low tolerance of pain at the injected site. Betamethasone valerate foam and betamethasone propionate lotion are for topical therapy with the foam producing a more effective response.

Anabolic Steroids and Hair Loss

Anabolic steroids stimulate the production of DHT in the target tissues. While the androgenic and anabolic effects of steroids increase the mass of the muscle and help men achieve their desired physique, it has negative outcomes as well.

High levels of DHT have adverse effects on hair growth. DHT attaches to the receptors on hair follicles and causes the hair follicles to shrink. This process is known as miniaturization. DHT also disrupts the human hair growth cycle.

The normal hair growth cycle is comprised of the following four phases:

1. Anagen Phase

Anagen or growing phase reflects the cell proliferation in hair follicles leading to growth and lengthening of the hair strands. Almost 90% of an individual's hair is present in this phase at a given time, and this phase lasts for about two to seven years.

2. Catagen Phase

Catagen or transition phase is about two to three weeks long. In this phase, the hair follicle cells do not divide and the melanocytes also cease the melanin production. The hair follicles shrink in size and lose contact with the underlying dermal papilla.

3. Telogen Phase

Telogen or resting phase of the hair cycle occurs as the hair does not shed and remain in the follicle. Hair in the telogen phase is gradually pushed outwards by the new hair in the anagen phase. This phase is approximately three to four months long.

4. Exogen Phase

This is the phase where the hair falls out from the hair follicles. Manipulation of hair such as during combing, washing, or massaging hair also facilitates the loss of hair in this phase. Losing 50 to 100 hair strands per day is the normal rate of hair loss in this phase and it lasts for two to five months.

As AAS mimic the action of androgens, testosterone, and DHT, they hinder the normal hair growth cycle by shortening the anagen phase, thus, reducing the amount of time available for the hair follicles to grow. Moreover, the telogen phase elongates, further aggravating hair loss. These steroids play a very significant role in causing male pattern baldness in genetically susceptible individuals.

Treatment of Anabolic Steroid-Induced Hair Loss

Hair loss caused by anabolic steroids such as prednisone regresses after discontinuing the medication. However, it takes about six to twelve months to observe visible regrowth of hair and reduction of hair loss. Dietary supplements rich in omega fatty acids and antioxidants are also beneficial for combating medication-induced hair loss.

Minoxidil, sold under the brand name Rogaine, is a famous over-the-counter medication for treating hair loss caused by increased androgen stimulation in anabolic steroids. Finasteride or Propecia is a prescription medicine also used to treat hair loss. Finasteride reduces the levels of DHT by inhibiting the activity of the enzyme, 5-alpha reductase.

This reverses the effects of DHT on hair follicles and the hair growth cycle, observed in individuals consuming anabolic steroids. Reduced DHT also decreases the risk of prostate cancer.

Is There A More Natural Solution To Steroid Injections?

These products are formulated with all-natural vegan ingredients which help to nourish the hair follicle cells and improve the natural balance of the scalp. Various active components in this formula including amino acid complex, Curcuma longa, and caffeine have shown promising results in various studies.

Other benefits of these products stem from the presence of various moisturizing and protecting ingredients such as niacinamide, sodium PCA, and zinc PCA that play a vital role in maintaining scalp health.

A multipurpose approach involving a combination of various topical and oral medications is usually advised for a better response against alopecia.

Conclusion

Steroids are collectively known as the synthetic derivatives of adrenal cortical hormones - androgens and cortisol. The two types of steroids have varying effects on hair growth. The corticosteroids are commonly used to treat alopecia areata in adults and children, suppressing the destruction of hair follicles by the immune system.

In contrast to that, anabolic steroids are functionally similar to testosterone and DHT, resulting in hair loss and male pattern baldness in genetically susceptible individuals and drug abusers. Treatment for steroid-induced hair includes finasteride, a 5-alpha reductase inhibitor, and minoxidil, supplemented by a healthy diet.

References

Dr. Ahmad Chaudhry M.B.B.S. is a House Physician in the Medical Unit 3 Allied Hospital, Faisalabad, and deals with hepatic, cardiac, neurological, and dermatological issues daily. He did his MBBS from Punjab Medical College, Faisalabad. He believes that a good haircare routine is one where you nourish it naturally. During his free time, he works as a dermatologist for Scandinavian Biolabs.