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Q:  If androgenic alopecia is caused, in part, by scalp hair follicles being "supersensitive" to testosterone, does that mean ANY amount of testosterone is risky? I was given Estratest to treat low libido -- unfortunately it was much more than I needed (full strength Estratest) and more than 50 percent of my hair fell out. I quit for a number of months but after doing some reading tried one-quarter of an Estratest pill every other day (one-eighth the original dose), which has restored the libido benefit. But I'm concerned about long-term risk in losing more scalp hair.

A: Testosterone acts on the scalp hair follicles to make them inactive. Individuals vary in how sensitive their follicles are to testosterone. For those with sensitive follicles, it appears that very small amounts can cause shedding. I have seen this occur with Estratest. However, with menopause another factor arises: falling estrogen levels. Without estrogen, the hair does not stay on the head as long and so thinning occurs. How estrogen and testosterone are involved in alopecia is discussed in my website article on alopecia.

Hope this is helpful.

Geoffrey Redmond, MD

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