Doc: Testosterone can influence loss of body hair

Keith Roach
To Your Health

Dear Dr. Roach: I’am a 63-year-old man. A visit to my urologist did not answer questions I have. I was told by my regular doctor that aging is a factor in men losing leg hair. Is that true?

I am losing pubic hair, and even hair up to the navel. Why is that? Years ago, I found that I had lost the hair between my legs. A medication I was prescribed (Lexapro/Celexa) had bad side effects for me. I could not get a decent erection, and had loss of perineum hair. Could there be a connection?

It is funny that I have only slight chest hair reduction and little back hair loss. Maybe the urologist brushed me off, but it is important to me. I had been under a lot of stress during the summer.

T.K.

Dear T.K.: When I see leg hair being lost, the first thing I worry about is the circulation in the legs. This can be an early sign of peripheral vascular disease, which is important to recognize because it is treatable and also predicts greater risk of heart attack and stroke. If you have any risk factors for vascular disease, I would talk to your doctor about getting this tested, which is easy and noninvasive.

However, the loss of pubic hair makes me concerned about a drop in testosterone. This can cause sexual troubles as well, but it sounds like your sexual issues were related to the medication, which is not uncommon with both Lexapro and Celexa. That’s a simple blood test.

Severe stress can rarely cause loss of all body hair, alopecia universalis, but that is really ALL hair, including eyebrows and eyelashes, which is not what you have.

Dear Dr. Roach: I’m confused. While it may be true the majority of men having prostate cancer may never be bothered by it, what about the minority whose lives will be threatened by it? If they aren’t screened and treated, many will die.

G.F.

Dear G.F.: I had a professor in medical school, Dr. Larry Wood, who used to say, “If I have confused you, you’re probably paying attention.” You have identified a major issue with prostate cancer screening (and screening in general): If screening harms some, but saves the lives of a few, is it worth doing? That answer may be different if you are coming from a public policy perspective versus an individual perspective.

Although we don’t know the exact numbers, it is estimated that about 47 men need to be treated for prostate cancer in order to save one life. Put another way, 46 out of 47 men are treated for prostate cancer, with its attendant risk of side effects, such as loss of sexual function and incontinence, without reducing their likelihood of dying of prostate cancer. We can’t predict with certainty whose prostate cancer is destined to kill them and whose is destined to be more indolent and slow-growing. The Gleason score, a measure of pathologic appearance of the cancer, helps, but it is not completely accurate.

Ninety percent of men with screening-detected prostate cancer elect to get it treated. Based on the many letters I get, all of them feel like they were the lucky ones to have had their lethal cancer removed — even if, statistically, most of them were not destined to die from prostate cancer.

Because it is likely that the harms of screening outweigh the benefits, the U.S. Preventive Service Task Force has recommended against prostate cancer screening in general. However, there are certainly cases in which I feel prostate cancer screening (remember that “screening” means that there are no symptoms or signs of cancer) is appropriate, which is why it’s important to have an individualized discussion of the risks and benefits of screening.

Email questions to ToYourGoodHealth@med.cornell.edu.