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Testosterone Enanthate Hair and Skin Changes: What the Evidence Actually Shows

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At a glance

  • Drug and route / testosterone enanthate injection, intramuscular, 50 to 400 mg every 2 to 4 weeks [1]
  • Skin and hair reactions on the label / acne, hirsutism, male pattern baldness, with no rates given [1]
  • Androgen implicated in pattern hair loss / DHT, converted from testosterone by 5-alpha-reductase [2][3]
  • Body and facial hair / androgens drive beard, pubic, chest and axillary hair, per the label [1]
  • Injection frequency / more often than every 2 weeks rarely indicated [1]
  • Pattern hair loss mechanism / androgen-dependent miniaturization of scalp follicles, with scalp DHT implicated [3]

What the enanthate label lists

The prescribing information for intramuscular testosterone enanthate lists, under skin and appendages, hirsutism, male pattern baldness and acne [1]. That section gives no percentages, no time to onset and no breakdown by dose.

The same label's clinical pharmacology section states that endogenous androgens are responsible for normal male hair distribution, naming beard, pubic, chest and axillary hair [1].

Testosterone, DHT and hair

Testosterone enanthate is an ester that releases free testosterone slowly after an intramuscular injection. Testosterone can be converted to DHT, a potent androgen, by 5-alpha-reductase isozymes [2].

In affected 46,XY individuals with 5-alpha-reductase type 2 deficiency, DHT levels are decreased despite high-normal to elevated testosterone; facial and body hair is absent or decreased, and balding has not been reported [2].

Scalp hair and male pattern baldness

The enanthate label lists male pattern baldness as a reported reaction [1]. Pattern hair loss is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp DHT implicated as a contributing cause [3].

Finasteride, which lowers serum and scalp DHT, improved hair counts versus placebo in trials of men with male pattern hair loss [3]. In two 1-year trials, 1,553 men aged 18 to 41 with male pattern hair loss took finasteride 1 mg a day or placebo, and 1,215 continued into a blinded second year. Hair counts in a 5.1 square centimeter patch of balding vertex scalp rose by 107 hairs at 1 year and 138 hairs at 2 years compared with placebo (P<0.001), while men on placebo lost hair progressively [3]. These were finasteride-versus-placebo trials in men with male pattern hair loss, not trials testing finasteride alongside testosterone enanthate [3].

Body and facial hair

The label ties androgens to male hair distribution, including beard, pubic, chest and axillary hair [1], and hirsutism appears in its list of reported skin reactions [1].

Acne

Acne results from pores clogged by shed skin cells and sebum within the hair follicle [4].

The enanthate label lists acne but does not say how often it occurs [1].

Frequently asked questions

Does testosterone enanthate cause hair loss?
The label lists male pattern baldness among reported skin and hair reactions, without a rate [1]. Pattern hair loss itself is androgen-dependent miniaturization of scalp hair follicles, with scalp DHT implicated as a contributing cause [3].
How often does acne occur on testosterone enanthate?
The intramuscular enanthate label lists acne but gives no frequency [1]. Acne results from pores clogged by shed skin cells and sebum in the hair follicle [4].
Will body or facial hair increase?
The label states that androgens are responsible for male hair distribution such as beard, pubic, chest and axillary hair [1], and it lists hirsutism as a reported skin reaction [1].
Can finasteride be taken with testosterone enanthate?
Finasteride is not listed in the enanthate label's drug interactions section, which names oral anticoagulants, diabetes medicines and insulin, ACTH and corticosteroids, and oxyphenbutazone [1]. The finasteride hair-count trials did not test it alongside testosterone enanthate, so they cannot show how the combination affects hair [3].
Does injection frequency change skin reactions?
The label gives 50 to 400 mg every 2 to 4 weeks, says total doses above 400 mg a month are not generally required, and that injections more often than every 2 weeks are rarely indicated [1]. It lists acne, hirsutism and male pattern baldness without separating them by dose or schedule [1].

References

  1. U.S. National Library of Medicine, DailyMed. Testosterone enanthate injection USP intramuscular, Hikma prescribing information. Testosterone enanthate injection USP intramuscular, Hikma label
  2. Imperato-McGinley J, Zhu YS. Androgens and male physiology the syndrome of 5alpha-reductase-2 deficiency. Mol Cell Endocrinol. 2002;198(1-2):51-9. Androgens and male physiology the syndrome of 5alpha-reductase-2 deficiency
  3. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998;39(4 Pt 1):578-89. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group
  4. Draelos ZD. The effect of a daily facial cleanser for normal to oily skin on the skin barrier of subjects with acne. Cutis. 2006;78(1 Suppl):34-40. The effect of a daily facial cleanser for normal to oily skin on the skin barrier of subjects with acne
Evidence overview for Testosterone Enanthate Hair and Skin Changes: What the Evidence Actually Shows