Low Anabolic Profile
Low Anabolic Profile in Assessing a Patient's Overall Hair Loss Program
AUTHOR: Dr. Lawrence J. Shapiro, D.O.P.A. Hair Transplant Surgeon (Address: 5050 West Atlantic Avenue, Delray Beach, FL 33484-3475. Phone: 1-561-414-4509) www.DrShapirosHairInstitute.com
DATE: June 1, 2011Introduction
In more than 2 decades of practice, I noticed an acceleration of hair loss with the use of certain lifestyle products. So as part of my H&P, I usually review with patients their history of workout and lifestyle products.Premise
As part of an overall hair loss program, I put them on a low anabolic profile by telling them to consider eliminating or reducing certain supplements in their diet. A review of the common supplements possibly causing hair loss includes:
- Anabolic Steroids (Chart Pathway 1)
- Creatine (increases DHT ) (Chart Pathway 3)
- Growth Hormone (Chart Pathway 2)
- Androstenedione or similar prohormones (Chart Pathway 1)
- Whey Protein Isolate (WPI) (Chart Pathway 1)
- Weight gainers (Chart Pathway 1)
- Arginine and Orthonine (Chart Pathways 2, 3)
- DHEA (Chart Pathway1, 2)
- HCG diet (Chart Pathway 1)
- "Anabolism" is defined as "any state in which nitrogen is differentially retained in lean body mass, either through stimulation of protein synthesis and/or decreased breakdown of protein anywhere in the body."(1) Anabolic steroids are extremely common and almost 1.5% of 12th graders have tried them at least once(2). Anabolic steroids are technically called anabolic-androgen steroids (AAS).(1)
- The BCAA's in whey protein isolate(WPI) are the real culprit in raising the testosterone levels during and after exercise as shown in the Sharp(3) study. In the Sharp study, subjects consumed high branched chain amino acids (BCAA) with high-intensity total-body resistance training. Blood serum was analyzed for testosterone. "Serum testosterone levels were significantly higher in the BCAA group during and following resistance training."(3)
- Homeopathic concentrations of HCG is a new fad weight loss diet that has been banned by the federal government.(4) Regular concentrations of HCG have been shown to increase testosterone levels. (5,6,7)
DHEA is a supplement used mostly by pre- and post-menopausal women. DHEA is extremely anabolic because it raises testosterone AND androstenedione, and DHT levels.(8)
In women, but not in men, serum A, T and DHT were increased to levels above gender-specific young adult ranges.(9) This is due to peripheral conversion(10) because DHEA is a precursor to androstenedione.
DHEA has also been shown to raise IGF-1 levels(11) which has been shown to raise DHT(11) and testosterone( ) but had no effect on GH or IGFB-3.(11)Pathway 2:
There is a secondary pathway referred to as a "parallel axis" which consists of both GH and insulin-like growth factor-I (GH-IGF-I).(11) Growth hormone is another very common supplement and is synergistic with testosterone(14,15).Both boost IGF-1(15,16) levels which can affect DHT directly by increasing 5AR.(12) IGF-1 is increased in men with vertex baldness.(17)
Both increased GH(18) and IGF lower Sex Hormone Binding Globulin (SHBG) and release free testosterone (T)(19,20,21) into the bloodstream to produce an anabolic effect. Hair loss can occur from growth hormone because the serum levels of elevated IGF-1 cause hair loss directly through increased DHT(12) even though the cytokines papilla are producing their own IGF-1 independently(22,23) of serum IGF-1 and may cause growth.(24,25,22). There is no evidence that growth hormone affects the dermal papilla directly, however, "there is mounting evidence that suggests that GH exerts its anabolic affect mainly by locally produced IGF-1 rather than liver - derived circulating IGF-1."(15)
Growth hormone increases both serum IGF-1(15,26) and IGFBP-3(27) and this binding molecule binds both serum(27) and cellular IGF-1 to reduce the concentration of IGF-1 cellular available for hair stimulation. (28,29,30) IGFB3-1 is less sensitive than IGF-1 to growth hormone stimulation.(26)Pathway 3:
Some workout products can lead to hair loss. Creatine is a common OTC product used by weight lifters to gain muscle mass and in addition, it is used as a weight gainer.(31,32) Creatine is made up of three amino acids: arginine, glycine and L-methionine. It raises DHT directly without affecting serum testosterone levels(30,33) although IGF-1 is elevated.(32)
The effect of IGF-I was about 100x that of androgen.(12)
Even though IGF-1 increases DHT(18) and T(19) there may be an increased rate of conversion from T to DHT since IGF-1(30,18) increases 5AR.Pathway 3:
Androstenedione is a naturally occurring OTC drug used by muscle builders. This is the most common performance enhancing drug on the market in professional sports. "Androstenedione appears to be a major prehormone of plasma dihydrotestosterone, accounting for at least two-thirds plasma dihydrotestosterone by peripheral conversion in adult females."(10) Testosterone conversion accounts for at least 70% of plasma DHT in the male, but less than 20% in the normal female.Pathways 2, 3:
Arginine and ornithine are extremely anabolic amino acids and increase both growth hormone and IGF-1 levels. However, leucine, found in WPI had no affect on GH and IGF-1 levels.(34,35,36)
Arginine is one of three amino acids found in creatine which affects DHT directly (30). Interesting though is Arginine and orthonine decreased IGFBP-3 levels.(35)
Photos below: Typical examples of changes in hair in patients taking supplements: Change of texture of hair and even diffuse thinning throughout affected areas.
This 27 year old used creatine for 4-5 months. The hair loss is very typical of anabolic creatine use since it has a very even, diffuse pattern and the hair has a change in texture.
Took anabolics (creatine) Did not take anabolics
Identical twins. Twin on the left took creatine and had more hair loss than his identical twin brother, right.Discussion
In summary, younger patients should be warned of supplements that affect hormone levels , especially WPI and creatine and older patients who go to men's/women's health clinics that prescribe growth hormone or other anabolic precursors that can cause hair loss. Reviewing a patient's Anabolic Profile and removing or eliminating supplemental use is a further step in preventing hair loss.
© 2011 Dr. Larry J. Shapiro
1 "Anabolic Steroids" by Cynthia M. Kuhn. Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA Recent Progress in Hormone Research 57:411-434 (2002)
2 "Steroids (Anabolic)." National Institute on Drug Abuse website from the National Institute of Health
3 "Amino Acid Supplements and Recovery from High-Intensity Resistance Training." by Sharp C, Pearson DR. Journal of Strength and Conditioning Research 2010 April vol. 24 num. 4 pp. 1125-1130.
4 "Feds Crack Down on Homeopathic Weight Loss Remedy." Associated Press. December 6, 2011.
5 "Testicular responsiveness to hCG during infancy measured by salivary testosterone." by Dunkel L, Huhtaniemi I. Children's Hospital, University of Helsinki, Finland. Acta Endocrinol (Copenh). 1990 Dec;123(6):633-6.
6 "Androgen action on the restoration of spermatogenesis in adult rats: effects of human chorionic gonadotrophin, testosterone and flutamide administration on germ cell number." by Meachem SJ, Wreford NG, Robertson DM, McLachlan RI. Prince Henry's Institute of Medical Research, Monash Medical Centre, Clayton, Victoria, Australia. Int J Androl. 1997 Apr;20(2):70-9.
7 "Testicular response to HCG stimulation and sexual maturation in mice." by Jean-Faucher C, Berger M, de Turckheim M, Veyssière G, Jean C. Horm Res. 1983;17(4):216-21.
8 "The effects of oral dehydroepiandrosterone on endocrine-metabolic parameters in postmenopausal women." by Mortola JF, Yen SS. Department of Reproductive Medicine, School of Medicine , University of California-San Diego, La Jolla, CA, USA. J Clin Endocrinol Metab. 1990 Sep;71(3):696-704.
9 "The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women." by Morales AJ, Haubrich RH, Hwang JY, Asakura H, Yen SS. Department of Reproductive Medicine, School of Medicine, University of California San Diego, La Jolla, USA. Clin Endocrinol (Oxf). 1998 Oct;49(4):421-32.
10 "The Source of Plasma Dihydrotestosterone in Man." by T. Ito and R. Horton. Department of Medicine, University of Southern California, School of Medicine, Los Angeles, CA, USA. J Clin Invest. 1971 August; 50(8): 1621-1627.
11 "Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age." by Morales AJ, Nolan JJ, Nelson JC, Yen SS. Department of Reproductive Medicine, University of California School of Medicine, La Jolla, CA, USA. J Clin Endocrinol Metab. 1994 Jun;78(6):1360-7.
12 "Androgen induction of steroid 5 alpha-reductase may be mediated via insulin-like growth factor-I." by Horton R, Pasupuletti V, Antonipillai I. Department of Medicine, University of Southern California School of Medicine, Los Angeles. Endocrinology. 1993 Aug;133(2):447-51.
13 "Short-term exposure to insulin-like growth factors stimulates testosterone production by testicular interstitial cells." by DeMellow JSM, Hendelsman DJ, Baxter RC. Acta Endocrinol (Copenh). 1987 Aug;115(4):483-9.
14 "Synergistic effects of testosterone and growth hormone on protein metabolism and body composition in prepubertal boys." by Mauras N, Rini A, Welch S, Sager B, Murphy SP. Nemours Children's Clinic Division of Endocrinology and Nemours Research Program, Jacksonville, FL 32207, USA. Metabolism. 2003 Aug;52(8):964-9.
15 "The Effects of Growth Hormone and/or Testosterone on Whole Body Protein Kinetics and Skeletal Muscle Gene Expression in Healthy Elderly Men: A Randomized Controlled Trial" by Manthos G. Giannoulis, Nicola Jackson, Fariba Shojaee-Moradie, K. Sreekumaran Nair, Peter H. Sonksen, Finbarr C. Martin, and A. Margot Umpleby. J Clin Endocrinol Metab. 2008 August; 93(8): 3066-3074.
16 "Growth hormone increases IGF-I, collagen I and collagen III gene expression in dwarf rat skeletal muscle." by Wilson VJ, Rattray M, Thomas CR, Moreland BH, Schulster D. Division of Biochemistry and Molecular Biology, UMDS, Guy's Hospital, London, UK. Mol Cell Endocrinol. 1995 Dec 29;115(2):187-97.
17 "Vertex balding, plasma insulin-like growth factor 1, and insulin-like growth factor binding protein 3." by Elizabeth A. Platz, Michael N. Pollak, Walter C. Willett, and Edward Giovannucci. Journal of the American Academy of Dermatology Volume 42, Issue 6 , Pages 1003-1007, June 2000.
18 "Continuous subcutaneous infusion of low dose growth hormone decreases serum sex-hormone binding globulin and testosterone concentrations in moderately obese middle-aged men." by Oscarsson J, Lindstedt G, Lundberg PA, Eden S. Department of Physiology and Pharmacology, Sahlgrenska Hospital, Goteborg University, Goteborg, Sweden. Clin Endocrinol (Oxf). 1996 Jan;44(1):23-9.
19 "Acne vulgaris: a disease of Western civilization." by Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA. Arch Dermatol. 2002 Dec;138(12):1584-90.
20 "Acne vulgaris: a disease of Western civilization." by Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA. Arch Dermatol. 2002 Dec;138(12):1584-90.
21 "Effect of D-thyroxine on serum sex hormone binding globulin (SHBG), testosterone, and pituitary-thyroid function in euthyroid subjects." by Yosha S, Fay M, Longcope C, Braverman LE. J Endocrinol Invest. 1984 Oct;7(5):489-94.
22 "The Role of Insulin-Like Growth Factor I in the Regulation of Growth." by D.R. Clemmons, M. Dehoff, R. McCusker, R. Elgin and W. Busby. University of North Carolina, Chapel Hill, NC, USA. Journal of Animal Science 1987, 65:168-179.
23 "The influence of testosterone propionate on the expression of several growth factors in scalp dermal papilla cell" by Kyung-Ho Kim, Yong-Jun Piao, Ki-Beom Suhr, Jeung-Hoon Lee, Jang-Kyu Park. Department of Dermatology, Chungnam National University College of Medicine, Daejeon, Korea. Korean Journal of Investigative Dermatology. 2002; vol. 9, No. 1. pp. 29 - 34.
24 "Purification of Androgen Receptors in Human Sebocytes and Hair" by Marty E Sawaya. University of Miami School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, U.S.A. Journal of Investigative Dermatology (1992) 98, 92S-96S
25 "The control of hair growth." by Slobodan M. Jankovic and Snezana V. Jankovic. From the Center for clinical and experimental pharmacology Clinical Hospital Centre, Kragujevac, Serbia, Yugoslavia. Dermatology Online Journal 4(1): 2 1998
26 "Growth hormone increases IGF-I, collagen I and collagen III gene expression in dwarf rat skeletal muscle." by Wilson VJ, Rattray M, Thomas CR, Moreland BH, Schulster D. Division of Biochemistry and Molecular Biology, UMDS, Guy's Hospital, London, UK. Mol Cell Endocrinol. 1995 Dec 29;115(2):187-97.
27 "Dose-response study of GH effects on circulating IGF-I and IGFBP-3 levels in healthy young men and women" by E. Ghigo, G. Aimaretti, M. Maccario, G. Fanciulli, E. Arvat , F. Minuto, G. Giordano, G. Delitala, and F. Camanni. Accepted in final form 23 February 1999. American Journal of Physiology - Endocrinology and Metabolism..
28 "The control of hair growth." by Slobodan M. Jankovic and Snezana V. Jankovic. From the Center for clinical and experimental pharmacology Clinical Hospital Centre, Kragujevac, Serbia, Yugoslavia. Dermatology Online Journal 4(1): 2 1998
29 "Acne vulgaris: a disease of Western civilization." by Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA. Arch Dermatol. 2002 Dec;138(12):1584-90.
30 IGFBP-3 the most abundant IGFBP type in dermal papilla cells forms a complex with free IGF-I to reduce the concentration of IGF-I available for stimulation of hair elongation and maintenance of the anagen phase. Hembree JR, Harmon CS, Nevins TD, et al. Regulation of human dermal papilla cell production of insulin-like growth
31 "Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players." by van der Merwe J, Brooks NE, Myburgh KH. Department of Physiological Sciences, Stellenbosch University , Stellenbosch , South Africa . Clin J Sport Med. 2009 Sep;19(5): 399-404.
32 "Creatine monohydrate supplementation on body weight and percent body fat." by Kutz MR, Gunter MJ. Department of Physical Education and Athletic Training, Palm Beach Atlantic University, West Palm Beach, FL, USA. J Strength Cond Res. 2003 Nov;17(4):817-21.
33 "Effect of creatine supplementation and resistance-exercise training on muscle insulin-like growth factor in young adults." by Burke DG, Candow DG, Chilibeck PD, MacNeil LG, Roy BD, Tarnopolsky MA, Ziegenfuss T. Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada. Int J Sport Nutr Exerc Metab. 2008 Aug;18(4):389-98.
34 Supplements as Ergogenic Aids. Understanding Nutrition" 2005 by Whitney, E., & Rolfes, S.
35 "Arginine increases insulin-like growth factor-I production and collagen synthesis in osteoblast-like cells." Chevalley T, Rizzoli R, Manen D, Caverzasio J, Bonjour JP. WHO Collaborating Center for Osteoporosis and Bone Diseases, Department of Internal Medicine, University Hospital, Geneva, Switzerland. Bone. 1998 Aug;23(2):103-9.
36 "Arginine and ornithine supplementation increases growth hormone and insulin-like growth factor-1 serum levels after heavy-resistance exercise in strength-trained athletes." by Zajac A, Poprzecki S, Zebrowska A, Chalimoniuk M, Langfort J. Department of Sports Training, Academy of Physical Education Katowice, Poland. J Strength Cond Res. 2010 Apr;24(4):1082-90.