Androgenetic alopecia is the most common cause of baldness in men. In the sporting environment there are many fears around it: won't heavy training, creatine or protein «knock out» your hair. The editorial team breaks down what really determines hair loss, where the risk is real and where it is a myth, and which treatment methods have an evidence base.
How androgenetic alopecia arises
Androgenetic alopecia is a genetically determined sensitivity of the hair follicles of certain scalp zones to androgens. Under the action of dihydrotestosterone (DHT), the follicles in the area of the crown and the frontal recessions gradually miniaturize: the growth phase (anagen) shortens, the hair becomes thinner, shorter and lighter, until it turns into vellus hair.
DHT is formed from testosterone under the action of 5-alpha-reductase, primarily the type 2 isoenzyme, which is present in the hair follicles. Men with a congenital deficiency of this enzyme do not go bald in the male pattern — this classic observation became the basis for the development of finasteride.
The key word is genetics. The blood testosterone level in most men with baldness is normal. The difference lies in the sensitivity of the androgen receptors of the follicles, which is determined, in particular, by variants of the androgen receptor gene on the X chromosome and numerous other loci. That is why under identical hormonal conditions one man keeps a thick head of hair while another goes bald from the age of 20.
Baldness progresses gradually, and its degree is assessed on the Hamilton–Norwood scale. By the age of 50, certain signs of androgenetic alopecia are present in about half of men of European descent, so it is rather a variant of the norm than a disease, although for many it significantly affects self-esteem.
Training, testosterone and hair
A popular argument goes like this: strength training raises testosterone, and therefore accelerates baldness. In reality, after a heavy workout the testosterone level rises insignificantly and returns to baseline within an hour or two. Such short-term fluctuations do not change the chronic androgen background on which the condition of the follicles depends.
There are no studies that would show that regular training in healthy men accelerates androgenetic alopecia. If a man began to go bald in the same period when he actively took up sport, most often this is simply a coincidence: the peak onset of baldness falls at the same age when many people come to the gym.
A different situation is telogen effluvium, that is, diffuse thinning due to physiological stress. It can be provoked by sharp weight loss, a harsh deficit of calories and protein, iron deficiency, an illness with high temperature, strong psychological stress. Hair loss usually begins 2–3 months after the trigger and passes over time if the cause is removed.
Therefore athletes who «cut» or maintain an aggressive deficit for a long time should watch their nutrition: sufficient protein, iron, zinc, energy availability. This concerns primarily telogen effluvium, not androgenetic alopecia, but the two processes can overlap and intensify the visible hair loss.
Creatine, protein and other supplements
The most well-known fear concerns creatine. It is based on one study by van der Merwe and co-authors (2009) involving rugby players: after a week of creatine loading the DHT level and the ratio of DHT to testosterone rose. Hair loss was not measured in that study, and the result was not reproduced.
Most other creatine studies that measured testosterone found no significant changes in the androgen profile. A review by experts of the International Society of Sports Nutrition (Antonio et al., 2021) concluded that current data do not confirm a connection between creatine and baldness. At the same time there are still few direct long-term studies of hair parameters specifically, so people with a pronounced predisposition can simply monitor the condition of their hair — without panic.
Whey protein does not affect androgens in a way that could contribute to baldness. Occasionally on forums there are claims about «hormones in protein» or a connection with acne; for protein there is no quality evidence of a role in alopecia. An ordinary protein supplement only helps cover the need for protein, which is useful for the hair as well.
| Factor | Effect on androgenetic alopecia | Level of evidence |
|---|---|---|
| Strength training | Does not accelerate | No direct evidence of harm |
| Creatine | No convincing connection found | One DHT study (2009), without hair data |
| Whey protein | Does not accelerate | No data on harm |
| Harsh calorie deficit | Can cause telogen effluvium | Clinical observations |
| Anabolic steroids, prohormones | Accelerate in predisposed people | Consistent clinical data |
Caution is needed with «testosterone boosters» and «prohormones» of dubious origin: some of them contain undeclared androgens. It is precisely they, not creatine or protein, that can really affect the hair.
Anabolic steroids: a real risk
Supraphysiological doses of androgens are the most real «sporting» factor of accelerating baldness. A review of the consequences of using doping drugs, published by the Endocrine Society (Pope et al., 2014), notes androgenetic alopecia among the typical dermatological effects alongside acne.
The degree of effect depends on the drug. Testosterone is partly converted into DHT in the follicles. Some synthetic steroids are DHT derivatives and act on the androgen receptors directly, bypassing 5-alpha-reductase — which is why finasteride is ineffective against them.
In people without a genetic predisposition steroids may not cause baldness, but in predisposed people the process can accelerate significantly. Miniaturized follicles that have already stopped producing terminal hair may not recover after discontinuing the drugs.
For women androgens pose an even greater risk: besides male-pattern baldness, hirsutism and irreversible changes of the voice are possible. This also applies to so-called «mild» steroids.
Treatment and care for those who train
The treatment of androgenetic alopecia with the best evidence base is minoxidil topically and finasteride orally. Both agents are approved by regulators for this indication and are described in European guidelines (Kanti et al., 2018). They slow progression and in some men partly restore density, but the effect lasts only as long as the treatment continues.
Finasteride is a prescription drug, a 5-alpha-reductase inhibitor. It is prescribed by a doctor after assessing contraindications; the instructions describe possible side effects, in particular sexual ones, and the effect on the PSA level. It is not worth starting to take it on your own. For athletes it is important to know that finasteride is not on the current WADA Prohibited List (it was removed in 2009).
Other methods — low-level laser therapy, plasma therapy (PRP), hair transplantation — have varying evidence. Transplantation is suitable for a stabilized process and a sufficient donor zone. Ketoconazole shampoos are sometimes used as an auxiliary agent.
- consult a dermatologist-trichologist at the early stages — it is easier to preserve follicles than to restore them;
- in case of sudden diffuse hair loss, check ferritin, TSH and recall whether there was sharp weight loss or illness;
- keep protein in the diet at the level of your needs, especially during a calorie deficit;
- do not buy «hormonal» supplements without a transparent composition.
Ordinary care after training — daily washing of the head, use of hats or helmets — does not affect androgenetic alopecia. Tight hairstyles with constant pulling of the hair can cause traction alopecia, but that is a different mechanism.
Editorial conclusions
Androgenetic alopecia is determined by the genetic sensitivity of the follicles to DHT. Training itself, protein and, according to available data, creatine are not a cause of baldness.
The real risks for hair in athletes are supraphysiological doses of androgens and prohormones, as well as harsh diets that provoke telogen effluvium.
Effective treatment methods exist, and the best results are achieved by those who start them early and under a doctor's supervision.
Related topics on the blog: «Obesity and Estrogen in Men», «Andrological Examination: What It Includes» and «Stress and Libido».
References
- van der Merwe J, Brooks NE, Myburgh KH. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clin J Sport Med. 2009;19(5):399–404.
- Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021;18(1):13.
- Kanti V, Messenger A, Dobos G, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men — short version. J Eur Acad Dermatol Venereol. 2018;32(1):11–22.
- Pope HG Jr, Wood RI, Rogol A, et al. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocr Rev. 2014;35(3):341–375.
- Imperato-McGinley J, Guerrero L, Gautier T, Peterson RE. Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science. 1974;186(4170):1213–1215.
- World Anti-Doping Agency. The World Anti-Doping Code: International Standard — Prohibited List. Montreal: WADA; актуальна редакція.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
