AGA Treatment and Gray Hair: Does It Increase or Decrease Gray Hair? (Physician-Supervised)

The Relationship Between AGA (Hair Loss) and Gray Hair | A Physician Explains the Difference in Mechanisms

Most people who search for “AGA gray hair” are either struggling with both thinning hair and gray hair, or have started noticing gray hair after beginning AGA treatment. In reality, while AGA and gray hair are both hair-related problems, they develop through entirely different mechanisms.

AGA is a form of hair loss caused when DHT (dihydrotestosterone), a type of male hormone, disrupts the hair cycle. Gray hair, on the other hand, occurs when the function of melanocytes (pigment cells) declines, so that melanin – the pigment that gives hair its color – is no longer produced.

In other words, thinning hair is a problem of “hair becoming thinner and shorter,” while gray hair is a problem of “hair losing its color.” The cells and pathways involved are completely different. Here, we first explain each mechanism in detail, and then discuss why the two can occur at the same time.

The Mechanism of AGA | Disruption of the Hair Cycle by DHT

AGA (Androgenetic Alopecia) develops when testosterone, a type of male hormone, binds with an enzyme called 5-alpha reductase present in the dermal papilla cells of the scalp and is converted into DHT (dihydrotestosterone), a more potent male hormone.

When DHT binds with the androgen receptor (male hormone receptor) inside the dermal papilla cells, it sends a signal that suppresses the proliferation of hair matrix cells. As a result, the anagen (growth) phase of the hair cycle is dramatically shortened, contracting from the usual 2 to 6 years down to as little as a few months to about a year.

When the hair cycle is disrupted, hair shifts into the catagen and telogen phases before it can grow to a sufficient thickness and length, and eventually thin, short vellus hairs (fine hairs) become predominant. This is the mechanism by which “thinning hair progresses.”

AGA is a progressive condition, and if left untreated, the hair follicles themselves shrink (miniaturize) and lose their ability to grow hair. The key point is that AGA is a problem related to the “amount” and “thickness” of hair and is unrelated to hair “color.” At present, there is no established medical evidence that testosterone or DHT affects the function of melanocytes.

The Mechanism of Gray Hair | Loss of Melanocyte Function and Melanin Pigment

Hair color is determined by the melanin pigment produced by the melanocytes (pigment cells) located right next to the hair matrix cells. As long as the melanocytes are functioning normally, melanin is delivered to hair in the anagen phase, and black hair grows in.

Gray hair occurs when these melanocytes decline or stop functioning, so that melanin is no longer supplied to the hair. The following are known causes of gray hair.

• Aging: The most common cause of gray hair. From the late 30s onward, melanocyte activity gradually declines, and by the 50s most people have developed gray hair.
• Genetics: Genetic factors play a major role in when gray hair appears and how much there is. Premature graying is also thought to have a genetic background.
• Oxidative stress: UV radiation and reactive oxygen species damage the stem cells of melanocytes, accelerating graying.
• Nutritional deficiency: A lack of copper, zinc, vitamin B12, folic acid, and similar nutrients impairs melanin synthesis.
• Psychological stress: A 2020 study from Harvard University confirmed in animal experiments that intense stress depletes melanocyte stem cells.

The important point is that gray hair is a problem of “hair pigment production,” arising through a completely different mechanism from AGA’s “hair growth and loss” problem. For this reason, it is considered theoretically unlikely that AGA medications would increase or decrease gray hair.

Do Gray Hair and Thinning Hair Occur Together? | Why More Men Experience Both

Many people wonder, “Do gray hair and balding progress at the same time?” To put the conclusion first: because gray hair and thinning hair have different mechanisms, there is no causal relationship between them. However, it is indeed common for both to start becoming noticeable around the same time.

The following shared risk factors help explain why.

• Aging: AGA tends to start becoming noticeable from the late 20s to the 30s, and gray hair also begins to increase around the same period. For both, aging is the greatest risk factor.
• Stress: Psychological stress is a factor that accelerates the progression of AGA, and at the same time it depletes melanocyte stem cells and triggers gray hair.
• Disrupted lifestyle habits: Lack of sleep, an unbalanced diet, smoking, and excessive drinking adversely affect both hair growth and melanin synthesis.
• Poor circulation: Reduced blood flow in the scalp not only impairs nutrient supply to the hair matrix cells but also leads to reduced melanocyte activity.

In short, gray hair and thinning hair “have different causes, but share the factors that make them worse.” This is why so many people in their 30s and 40s struggle with both, and being mindful of gray-hair care alongside AGA treatment leads to comprehensive improvement of hair concerns.

There is also a popular myth that “people with gray hair don’t go bald,” but this is a misconception with no medical basis. Many people develop AGA even while having gray hair, so if you are concerned about thinning hair, please consult a physician early, regardless of whether you have gray hair. It is also worth correctly understanding the relationship between AGA and thinning hair (common misconceptions).

Does AGA Treatment Increase or Decrease Gray Hair? | A Thorough Explanation of How Medications Affect It

Many people search using keywords such as “does AGA treatment increase gray hair” or “AGA medication gray hair,” and changes in gray hair during AGA treatment are one of patients’ major concerns.

To state the conclusion first, there is no medical evidence that the main AGA medications in use today (finasteride, dutasteride, and minoxidil) directly increase gray hair. However, it is also true that some people feel that “their gray hair seems to have increased since starting treatment.”

In this section, we organize whether each AGA medication affects gray hair in a single overview, and then offer a scientific explanation of why some people feel their gray hair has “increased.”

Types of AGA Medications and Their Effects on Gray Hair: An Overview

Below is a comparison of the three main medications and their effects on gray hair (AGA medication and gray hair).

As shown above, there is no clear evidence that any of these AGA medications increase or decrease gray hair. Concerns about AGA treatment and gray hair are understandable, but there is no medication whose package insert lists “increased gray hair” as a side effect.

In addition, organizing the duration of use of each AGA medication and its effect on gray hair by product name gives the following.

The Truth About Cases Where People Feel “AGA Treatment Increased My Gray Hair”

So why do some people feel that AGA treatment increases gray hair? There are three main factors to consider.

1. Visual change due to regrown hair after initial shedding

When you begin AGA treatment, “initial shedding (dread shedding)” can occur in the first 1 to 3 months. This is a normal reaction in which old telogen-phase hairs are pushed out by new hairs. In cases where the new hairs that grow in after this initial shedding are thin vellus hairs, they contain little melanin and can appear whitish.

This is different from gray hair: typically, as the hair cycle normalizes and the hairs thicken, the pigment also becomes darker.

2. Overlap with the natural increase in gray hair due to aging

People who begin AGA treatment are mainly in their 30s to 50s. Because this is precisely the age range when gray hair naturally begins to increase, it is easy to feel that “gray hair has increased since starting AGA treatment.” In reality, gray hair increases with age regardless of whether you are receiving treatment.

3. Bias from paying more attention to the scalp

Once people begin AGA treatment, many develop the habit of checking their scalp and hair in the mirror every day. As a result of “starting to notice” gray hair they hadn’t paid attention to before, they may perceive it as having “increased.” This is a kind of cognitive bias and differs from an actual increase in the number of gray hairs.

In any case, there is no medically established causal relationship in which AGA medications cause gray hair to increase. If you become concerned about gray hair during treatment, do not stop treatment on your own judgment; consult your physician. You may also find the progress of hair growth with oral AGA treatment helpful.

The Relationship Between Minoxidil and Gray Hair | Does It Improve Gray Hair?

“Minoxidil gray hair,” “minoxidil gray hair improvement,” and “minoxidil gray hair effect” are among the most common search keywords from people undergoing AGA treatment. Minoxidil is one of the few ingredients with proven hair-growth effects, but does it actually work on gray hair?

In this section, we explain everything from minoxidil’s mechanism of action to whether it affects gray hair, based on scientific evidence.

The Action of Minoxidil and the Limits of Its Effect on Gray Hair

Minoxidil was originally developed as a vasodilator for treating high blood pressure, and it was repurposed as a hair-growth agent after hypertrichosis (excess hair growth) was observed as a side effect. Its main actions are as follows.

• Vasodilation: Dilates the capillaries of the scalp, increasing blood flow and nutrient supply to the hair matrix cells
• Activation of hair matrix cells: Opens the potassium channels of the hair matrix cells, promoting cell proliferation and differentiation
• Normalization of the hair cycle: Shifts telogen-phase hair follicles into the anagen phase and prolongs the duration of the anagen phase
• Suppression of follicle miniaturization: Re-enlarges shrunken hair follicles and promotes the regrowth of thick hair

The important point here is that the targets of minoxidil’s action are the hair matrix cells and blood vessels, and it has not been confirmed to have any function that directly controls melanocytes (pigment cells) or melanin production.

In other words, expecting that gray hair will “turn black” as a minoxidil gray-hair effect is, based on current medical knowledge, difficult to justify. Minoxidil is ultimately a drug that “grows and thickens hair,” not one that “changes hair color.”

That said, it is not impossible that improving blood flow throughout the scalp via minoxidil’s vasodilatory action could indirectly improve the nutrient supply to melanocytes. In the next section, we touch on cases that have actually been reported.

Reports That Minoxidil Improved or Reduced Gray Hair

On the internet you can find anecdotes such as “minoxidil reduces gray hair” and “my gray hair turned darker after I started using minoxidil.” These cannot be dismissed entirely, and a number of case reports do in fact exist.

A report published in the International Journal of Trichology in 2017 observed that in some patients using topical minoxidil, gray hair returned to a darker color. The researchers proposed the following hypotheses regarding the mechanism.

• Indirect effect via improved blood flow: The possibility that minoxidil’s vasodilatory action improved circulation throughout the scalp, partially reactivating dormant melanocyte stem cells
• Activation of the Wnt signaling pathway: The possibility that, in the process of minoxidil activating Wnt signaling in the hair follicle, melanocyte differentiation was also affected
• Effect of resetting the hair cycle: Cases in which the melanocytes in the hair bulb resume pigment production during the transition from the telogen phase to the anagen phase

However, all of these are at the stage of a small number of case reports or hypotheses, and it cannot be medically concluded that “minoxidil improves gray hair.” A gray-hair-improving effect of minoxidil has never been confirmed in a large-scale clinical trial, nor is it recognized as an indication of the drug.

It is not appropriate to begin using the drug with excessive expectations of minoxidil gray-hair improvement. The original purpose of minoxidil is the treatment of AGA (thinning hair), and a different approach is needed for gray hair. If gray hair concerns you, we recommend using cosmetic measures such as hair dye in parallel while continuing AGA treatment as AGA treatment.

Finasteride/Dutasteride and Gray Hair | Does Taking Them Increase Gray Hair?

The most widely prescribed oral medications for AGA treatment are finasteride and dutasteride. Both are 5-alpha reductase inhibitors that halt the progression of AGA by suppressing the production of DHT (dihydrotestosterone).

As you can tell from how many people search for “does finasteride increase gray hair” and “dutasteride gray hair,” the relationship between these drugs and gray hair is a topic many patients worry about. Here, we explain the relationship between each medication and gray hair in detail.

The Relationship Between Finasteride and Gray Hair

Finasteride (brand names such as Propecia®) is a drug that selectively inhibits type II 5-alpha reductase. It suppresses the conversion of testosterone to DHT by about 70%, helping to halt the progression of AGA.

To state the conclusion about the relationship between finasteride and gray hair: there is no medical basis for the idea that finasteride increases gray hair. The main side effects listed in the finasteride package insert are as follows.

• Sexual function: Decreased libido (1-5%), erectile dysfunction (less than 1%), ejaculation disorder (less than 1%)
• Liver function: Elevated AST/ALT (frequency unknown)
• Hypersensitivity: Rash, urticaria (frequency unknown)
• Other: Breast enlargement, breast tenderness (frequency unknown)

As you can see, “increased gray hair” is not included in the list of side effects. Finasteride is a drug that suppresses the production of DHT, and because it does not act on the pathways involved in the metabolism of melanocytes or melanin, a causal relationship with gray hair is considered medically unlikely.

As noted above, most people who feel that “finasteride increases gray hair” are likely experiencing an overlap between the timing of starting AGA treatment and the age-related increase in gray hair. If you stop taking finasteride on your own out of concern about gray hair, AGA may progress again, so be sure to consult your physician before deciding on your treatment plan.

The Relationship Between Dutasteride and Gray Hair

Dutasteride (brand names such as Zagallo®) is a drug that inhibits both type I and type II 5-alpha reductase. Its DHT-suppressing effect is stronger than finasteride’s (about 90% suppression), and it is used as an option for people who did not achieve sufficient results with finasteride.

As for the relationship between dutasteride and gray hair, as with finasteride, there is no medical evidence that it increases gray hair. The side effects listed in the dutasteride package insert are broadly similar to those of finasteride, with no mention of gray hair.

Because dutasteride also inhibits type I 5-alpha reductase, it contributes to improving the scalp environment by suppressing the activity of type I, which is abundant in the sebaceous glands. However, this action does not directly affect melanocytes either.

In fact, regarding dutasteride, some animal experiments have reported that a decrease in DHT may have a favorable effect on the maintenance of melanocyte stem cells. However, this is knowledge at the level of basic research only, and we are not yet at the stage where we can say that “dutasteride improves gray hair.”

The relationship between testosterone and gray hair is also a point of interest, but there is no definitive evidence that testosterone itself directly affects melanocyte function. Testosterone decreases with age while gray hair increases with age, so a correlation is observed, but this is not a causal relationship – both stem from the common factor of “aging.”

In summary, neither finasteride nor dutasteride has been confirmed to have a side effect of increasing gray hair, so you can continue AGA treatment with peace of mind.

Can You Use Hair Dye During AGA Treatment? | Precautions and Recommended Methods

If you are concerned about gray hair during AGA treatment, “AGA and hair dye” and “hair dye during AGA treatment” are unavoidable topics. To state the conclusion first, you can basically use hair dye even during AGA treatment. However, there are a few precautions, especially if you are using topical minoxidil.

Here, we explain in detail how to choose hair dye and coloring agents during AGA treatment, and what to watch out for when combining them with topical minoxidil.

How to Choose Hair Dye and Coloring Agents During AGA Treatment

When using hair dye during AGA treatment, the impact on the scalp differs depending on the type of coloring agent. Below we introduce the types of hair dye recommended for people undergoing AGA treatment, in order of least burden on the scalp.

During AGA treatment, maintaining a healthy scalp environment is important. For hair dye during AGA treatment, we recommend choosing hair color treatments or hair manicures as your first option, as they are gentle on the scalp.

If you use an oxidative hair dye (a typical standard gray-hair dye), please keep the following in mind.

• Always perform a patch test: Because AGA medications may have changed the condition of your scalp, do a test every time
• Apply in a way that avoids getting the dye on your scalp: Rather than applying right at the roots, keep the dye 1-2 mm away from them
• Limit how often you dye: Keep it to once a month or less to minimize the burden on your scalp
• Care for your scalp after dyeing: Use a moisturizing lotion or similar product to prevent dryness and inflammation of the scalp

Precautions When Combining Topical Minoxidil With Hair Dye

If you are using topical minoxidil and want to dye your hair, managing the timing is especially important. By following the rules below, you can combine them safely.

Using minoxidil on the day you dye your hair

• Before dyeing: Do not apply minoxidil. Applying it the previous evening is fine
• After dyeing: Wait at least 12 hours before applying minoxidil
• If your scalp is abnormal: If you have redness, itching, or stinging, temporarily stop using minoxidil until the symptoms subside

The reason for this precaution is that applying minoxidil while the cuticle is open from dyeing, or while coloring agent remains on the scalp, may increase irritation to the scalp or change the absorption pattern of minoxidil.

For the oral medications finasteride and dutasteride, there is no interaction with hair dye. Because oral medications are absorbed through the digestive tract, they follow a different route from hair dye, which is applied directly to the scalp. Therefore, people taking oral medications do not need to worry about the timing of dyeing their hair.

If you are concerned, it is reassuring to tell the physician at the clinic that prescribes your treatment about the type and frequency of your hair dye and to receive their advice.

How to Approach AGA Treatment if You Have a Lot of Gray Hair | Points for Choosing a Clinic

For people who struggle with both gray hair and AGA, a major question is which clinic to choose and what kind of treatment to receive. AGA treatment is ultimately a treatment for thinning hair, but choosing a clinic that can provide comprehensive care – including for gray-hair concerns – leads to more satisfying treatment.

Here, we explain how to approach AGA and gray-hair treatment suited to people with both gray hair and thinning hair, along with specific points for choosing a clinic. Please also see details about AGA treatment here. How to choose an AGA clinic may also be helpful.

A Treatment Plan Suited to People With Both Gray Hair and Thinning Hair

For people who have both gray hair and AGA, the basic approach is to make AGA treatment the central pillar while addressing gray hair in parallel. This is because AGA is a progressive condition that becomes difficult to improve if left untreated, whereas gray hair can be handled with cosmetic measures such as hair dye.

A specific treatment plan for people with a lot of gray hair is as follows.

Step 1: Get an accurate diagnosis at a specialized AGA clinic

First, have your physician accurately determine whether the cause of your thinning hair is AGA or another form of hair loss (such as alopecia areata or diffuse alopecia). It is important to have your AGA progression and gray-hair condition evaluated comprehensively through microscope scalp examinations and blood tests.

Step 2: Begin AGA treatment based on pharmacotherapy

Depending on the degree of AGA progression, begin treatment combining oral finasteride or dutasteride with topical (or oral) minoxidil. You may also find at what age you should start AGA treatment helpful. As noted earlier, these medications have no adverse effect on gray hair, so even people with a lot of gray hair can use them with peace of mind.

Step 3: Address gray hair in parallel using scalp-friendly methods

If you dye gray hair alongside AGA treatment, choose options that are gentle on the scalp, such as hair color treatments or hair manicures. Also follow the rules for combining them with topical minoxidil (see the previous section).

Step 4: Reduce shared risk factors by improving lifestyle habits

• Sufficient sleep: Promotes the secretion of growth hormone and contributes to both hair growth and the maintenance of melanocyte activity
• A balanced diet: Zinc, iron, B vitamins, biotin, and copper are essential for hair health
• Stress management: Chronic stress promotes both AGA progression and increased gray hair
• Quitting smoking: Smoking worsens scalp blood flow and raises the risk of both thinning hair and gray hair
• Moderate exercise: Effective for both promoting circulation and relieving stress

AGA Treatment at Men’s Care Clinic (3 Locations, Online Consultation Available)

At Men’s Care Clinic, we have a system in place so that people who are concerned about both gray hair and thinning hair can receive AGA treatment with peace of mind.

• Three locations: Three sites – Shinbashi, Akihabara, and Omotesando. Convenient locations let you continue AGA treatment
• Online consultation available: Even if it’s hard to visit in person, you can start AGA treatment from home with an online AGA consultation. Online is OK even for your first visit
• Pay-as-you-go option: No expensive course contracts required. With pay-as-you-go billing for each visit, you can start AGA treatment with ease
• Combination-tablet prescription from 6,900 yen/month: We prescribe a minoxidil x finasteride combination tablet at a reasonable price. People with gray hair can also take it with peace of mind
• Affiliation with Toyosu Hospital (Showa University group): A reassuring medical system that can respond promptly through an affiliated hospital in the unlikely event of side effects

Starting AGA treatment early maximizes its effect. Even if you have gray hair, you can receive AGA treatment without any problem. Our physicians provide thorough consultations, including advice on combining treatment with hair dye and on lifestyle habits.

Even if you think, “AGA treatment is pointless because I have so much gray hair,” please feel free to consult us first. We will propose the best measures for both thinning hair and gray hair.

Frequently Asked Questions (FAQ)

Summary | AGA Treatment Is Effective Even if You Have Gray Hair

In this article, we have comprehensively explained the relationship between AGA and gray hair, from the difference in mechanisms to the effects of each medication, combining treatment with hair dye, and choosing a clinic. Finally, let’s summarize the key points.

• AGA and gray hair have different mechanisms: AGA is a disruption of the hair cycle by DHT; gray hair is reduced melanin production due to loss of melanocyte function. Because the causes differ, AGA treatment generally does not affect gray hair
• AGA medications do not increase gray hair: None of finasteride, dutasteride, or minoxidil has been confirmed to have a side effect of increasing gray hair
• The gray-hair-improving effect of minoxidil is unconfirmed: There are some reports of gray hair improving, but it has not been proven by large-scale trials, and use for the purpose of improving gray hair is not recommended
• Hair dye is possible during AGA treatment: Scalp-friendly types such as hair color treatments and hair manicures are recommended. Be mindful of timing when combining them with topical minoxidil
• You can receive AGA treatment even with a lot of gray hair: The presence or absence of gray hair does not affect the efficacy of AGA treatment. If you are concerned about thinning hair, it is important to start treatment early
• Improving lifestyle habits is effective for both thinning hair and gray hair: Sleep, diet, stress management, and quitting smoking contribute to both suppressing AGA progression and preventing gray hair

Thinning hair and gray hair are both “hair concerns,” but their causes and approaches differ. AGA is a condition that progresses if left untreated and becomes difficult to improve. If you have been hesitant about AGA treatment out of concern over gray hair, please consult a specialist physician once.

At Men’s Care Clinic, our physicians propose treatment plans tailored to each individual’s condition so that you can start AGA treatment with peace of mind even if you have gray hair. We look forward to seeing you at one of our three locations in Shinbashi, Akihabara, and Omotesando, or via online consultation.

*This article was created under the supervision of Men’s Care Clinic. The medical information here is based on general knowledge; for individual symptoms and treatment plans, always consult a physician.