Hair loss treatment: Is hormone testing essential?

There is a question I hear from almost all male patients who visit the clinic for hair loss. “Director, shouldn’t you check your testosterone or DHT levels through a blood test? I heard that if your levels are high, your hair will fall out.” Although I fully empathize with the desperate desire to find the cause of hair loss, I usually tell male patients, “It’s not necessary.” On the other hand, I recommend to female patients, “Yes, I recommend getting a test.” Why do I give such different answers to the same hair loss problem? This is due to the difference in the mechanism of hair loss between men and women, and contains my clinical judgment on the actual effectiveness of the test.

 

Male pattern hair loss: ‘Receptor sensitivity’ is the key, not hormone levels

Many people accept the formula ‘high DHT levels = severe hair loss’ as the truth. But this is only half true. Of course, it is clear that the DHT hormone is a factor that causes hair loss, but its absolute amount does not determine everything. The reasons why I do not actively recommend hormone testing to male patients are as follows:

The real cause is ‘receptor sensitivity’

The more important factor that determines the progression of hair loss is not the amount of DHT floating in the blood, but how sensitive the 'androgen receptor' in the scalp hair follicle cells reacts. Even if exposed to the same concentration of DHT, people whose receptors are less sensitive will not be greatly affected, while people whose receptors are highly sensitive will react violently to even small amounts of DHT, resulting in hair follicle shrinkage and rapid hair loss. In other words, the problem is not the ‘number of bullets (DHT)’ but the ‘target sensitivity (receptor)’.

Receptor sensitivity cannot be measured with a blood test.

Unfortunately, this ‘receptor sensitivity’ cannot be measured using current blood testing techniques. Therefore, hair loss can progress even if the DHT level in a blood test is within the normal range, and this is the biggest reason why the test is less effective.

Changes in levels do not indicate treatment effectiveness

Even if the test confirms that your testosterone level is high or low, it will not have a significant impact on the direction of treatment. Additionally, even if hormone levels fluctuate during the treatment process, it is difficult to be a direct indicator of the success of hair loss treatment.

For this reason, I advise my male patients to focus on more fundamental treatments, such as managing scalp inflammation and restoring hair follicle health, rather than spending unnecessary money and time on hormone tests.

Hair loss in women: an important clue to finding ‘hormonal imbalance’

On the other hand, I recommend hormone testing to female hair loss patients. This is because you have to approach it from a completely different perspective than men. In the case of women, the cause of hair loss is often a disruption of the ‘relative balance with female hormones’ rather than the absolute level of male hormones. A small amount of male hormones (androgens) also exist in the female body and function normally. However, sufficient amounts of female hormones (estrogen) suppress its action and maintain balance. If this balance is broken for any reason, the influence of male hormones becomes relatively stronger, which can lead to symptoms similar to male pattern baldness.

Differentiating diseases that cause hormonal imbalance

Polycystic ovary syndrome (PCOS), thyroid disease, pituitary abnormalities, and menopause are the main causes of hormonal imbalance in women. A blood test can confirm the possibility of these underlying conditions and provide clues to the cause of hair loss.

Helps set treatment direction

If a clear hormonal imbalance is confirmed through the test results, a better prognosis can be expected by combining medical and gynecological treatments to correct the imbalance rather than limiting it to scalp treatment.

Therefore, for women, sex hormone testing is a process to diagnose the cause of hair loss, comprehensively understand the overall health condition, and establish the right treatment plan.

In conclusion, the reason I make different recommendations regarding hormone testing stems from the differences in causes of hair loss in men and women. Hair loss treatment must be approached differently depending on gender and individual characteristics, and reducing unnecessary tests and focusing on essential diagnoses is the first step to wise treatment.