Beating Hair Loss on TRT – the Big 3

Beating Hair Loss on TRT – the Big 3

Written by Alex Eriksson

Testosterone Replacement Therapy or TRT is a new treatment option for men suffering from low testosterone, with modes of treatment ranging from transdermal (using gels or patches) or through injections and implants. Many men undergoing TRT report significant changes in many dimensions of their life, all within a very short amount of time from starting TRT. While TRT is indeed effective in treating low testosterone, it is not without male-pattern-hair-losspotential side effects, the most common of which is hair loss.

TRT and Hair Loss – What’s the Connection?

TRT treatment increases testosterone levels in the body, and a certain percentage of that is converted into dihydrotestosterone or DHT. This androgen is touted as the main culprit for hair loss in men.

More About DHT

However, before you go out and look for DHT blockers, you should understand that androgens only play part of a bigger picture. Whether or not you lose hair will ultimately depend on genetics – particularly on how sensitive your hair follicles are to concentrations of DHT on the scalp.

Thus, it’s not necessarily a good idea to take supplements or medications, like Finasteride, to lower or block DHT in the body. Other than the fact that it is not really addressing the root cause, drugs that lower DHT have a history of systemic side effects for many users.

That said, it’s important to deal with hair loss right where it is located – on the scalp. Here are three of the best topical solutions to treat hair loss caused by TRT:

  1. Spironolactone

Spironolactone is a drug that has been in the market for more than thirty years. Initially created to treat hypertension, it has also recently gained popularity to treat hair and skin issues caused by excess androgens in the body. It is, for example, used to treat hirsutism or excess body hair in women.

That may sound contradictory, considering the fact that we’re trying to solve hair loss, but it does make sense since hirsutism is caused by testosterone as well.

Taken orally, spironolactone works very well as an anti-androgen. So effective in fact, that even though it is a very potent anti-hypertensive drug, it is not generally prescribed for men because of its feminizing properties.

When applied topically on the scalp, it produces the opposite effect. It prevents DHT from binding to receptors on the hair follicles, preventing shrinkage and hair loss. Topical spironolactone is not absorbed by the bloodstream, thus not affecting overall DHT levels in your body and causing any systemic side effects.

S5 Cream is one such product, providing the DHT blocking benefits from spironolactone without adverse systemic effects. It comes in two forms, S5 Daytime and S5 Bedtime. Both products contain 5% spironolactone and other hair growth stimulating ingredients like caffeine.

If there is one thing to note about spironolactone lotions and creams however, it is that  they’re known for their offensive smell – a little bit like rotting cabbage or eggs. This smell is natural because of how most spiro creams and lotions are formulated. From our own experience of use at Anabolic Health we don’t find the smell a problem. But the good news for people who do is that there is also a possibility to get your hands on odorless spironolactone lotions.

  1. Ketoconazole

Ketoconazole – the active ingredient in Nizoral – is one other drug that shows beneficial effects for hair loss sufferers. While formulated to treat fungal infections, some studies show that it blocks the synthesis of DHT in the scalp and stimulates hair growth as well.

If you’ve been looking at products for hair loss in the market, you may notice some products that integrate this ingredient into their list. Those are options worth considering. We have reviewed most good hair loss shampoos on the market, including ones combining Ketoconazole with other effective ingredients. Check out our articles about hair thickening shampoos as well as shampoos for thinning hair. Or, you can simply use Nizoral shampoo instead.

On a side note, some forms of hair loss are caused by fungal infection on the scalp,  ketoconazole also addresses this problem.

  1. Minoxidil

Minoxidil was originally formulated as a medication to treat high blood pressure. When used for that purpose, it was seen to cause hypertrichosis, or excessive hair growth among patients.

This side effect led to its popularity as a topical treatment option for hair loss. The exact mechanism as to how and why Minoxidil works is still unknown, but the main hypothesis is that it increases blood flow to the scalp and follicles because of its vasodilatory effects.

What’s the Best Option?

Between the three options above, there’s really no one best solution when it comes topill-food-pantogar-manipulado-vitamina-para-cabelo-415811-mlb20634598019_032016-f treating hair loss on TRT. In fact, what we really recommend is that you combine all three, to cover all your bases and give you a full spectrum treatment for hair loss.

Spironolactone, as a cream or lotion, blocks DHT and reduces the effect of androgen hormones on the scalp. This keeps your hair follicles healthy and prevents hair from shedding. Ketoconazole works the same way, and only needs to be used every now and then, especially if you’re dealing with dandruff or fungal problems on your scalp. Lastly of course, is Minoxidil. As it is a hair growth stimulant and does not block DHT to begin with – it has to be used in conjunction with either of the other two DHT blocking treatments.

Natural alternatives

If you’re a bit wary about pharmaceutical products, you might want to consider natural alternatives to the big three. Caspiacin and soy, for example, can be used instead of Spironolactone, since they have DHT blocking and growth promoting properties. Both can be taken orally, or applied topically on the skin. You might want to be careful of oral soy intake though, as it can systemically lower DHT levels in the body.

To replace Minoxidil or Ketoconazole, L-Carnitine and topical Raspberry Ketones have also shown hair regrowth effects. A study has found L-Carnitine to be effective in promoting human hair in-vitro by improving cellular metabolism and slowing follicular cell death. It’s worth noting though that there are limited studies on Raspberry Ketones, so as to how effective or how quick it works has yet to be established. As a good natural routine against hair loss, we would recommend using all of the ones mentioned above as alternatives to pharmaceutical products.


When it comes to creating an effective routine against TRT hair loss, we definitely recommend the “The Big 3” treatments Spironolactone, Ketoconazole and Minoxidil. They may be pharmaceutical, but because they are all topical and come in the form of creams, lotions and shampoos, you can use them to treat hair loss due to TRT without worrying about any systemic or long term side effects.

Authors Bio
“Alex Eriksson is the founder of Anabolic Health, a men’s health blog dedicated toimg_3932 provide honest and research backed advice for maintaining optimal male hormonal health. Anabolic Health aspires to become a trusted resource where men can come and learn how to fix their hormonal problems naturally, without pharmaceuticals.                                                                                      Check out to learn more about Alex and his work.                                                                                        You can also find him on TwitterPinterest and Facebook.”
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