In this article, discover what PCOS hair loss is exactly, what drives it and how to manage it naturally.
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What is PCOS hair loss?
PCOS hair loss is a pattern of hair loss seen in women with PCOS (PCOS stands for polycystic ovary syndrome). This PCOS symptom, like all PCOS symptoms, is a result of the hormonal imbalance of androgen excess and the metabolic dysfunction associated with PCOS.
Hair loss can be a particularly distressing symptom for those with PCOS but luckily addressing the root cause can help prevent and reduce this symptom.
Reminder: PCOS is a condition involving high levels of androgens (sometimes incorrectly referred to as ‘male hormones’), which suppress ovulation. In fact, our preferred term at FUTURE WOMAN for PCOS is “anovulatory androgen excess” as this classifies PCOS as a condition which must have both androgen excess AND irregular cycles present. You cannot diagnose PCOS through ultrasound alone.
How common is it?
PCOS hair loss was thought to be a relatively uncommon symptom of PCOS but recent studies suggest that it is found in 20% to 30% of women with PCOS.
Hair loss can also be seen in hypothalamic amenorrhea (HA) which is a different condition from PCOS but with many of the same symptoms. HA needs to be treated differently to PCOS.
Signs of PCOS hair loss
Whilst male-pattern baldness usually is defined by a receding hairline and thinning of the crown, PCOS hair loss is often seen around the temples and front region of the scalp. The central parting may also appear wider and the scalp may seem more visible.
High levels of DHT (a metabolite of testosterone) can shrink the hair follicles in this region, shortening the life cycle of the hair which can lead to hair which not only sheds more easily but also looks more brittle and thin in these areas.
Other types of hair loss including alopecia, hair loss from strong medications or hair loss from extreme stress and trauma will often be seen all over the head and hair may fall out in clumps.
Main cause of PCOS hair loss
High androgens
The main driver of PCOS hair loss and other PCOS symptoms is elevated androgens, particularly DHT. DHT is a potent metabolite of testosterone and can only be detected in urine based hormone testing (not blood serum).
Excess androgen production can lead to virilization: the development of masculine characteristics. This can include hair growth in areas such as chin, chest and torso but can also cause female pattern hair loss (FPHL), also known as androgenic alopecia (AA).
Why does this happen? Elevated androgens act on androgen receptors at the hair follicle. When androgens bind to their receptors they can cause changes in the way the hair follicles behave – from stimulatory to inhibitory. Androgens have a stimulatory effect on hair follicles in places like the face and chest but have an inhibitory effect on the hair follicles in the scalp.
What are androgens?
You may be familiar with the androgen, testosterone, but there are other androgens too, all (and any) of which can be raised in women with PCOS hair loss. In addition, testosterone can also be metabolised in a way which increases the severity of PCOS. If your testosterone prefers the 5a pathway then you are likely to have more severe symptoms of PCOS like hair loss. That’s because this pathway converts testosterone into DHT, which is THREE times more potent than testosterone.
Even clients with normal androgen levels can experience PCOS hair loss as a result of a preference for the 5a pathway.
Other causes of PCOS hair loss
High androgens aren’t the only drivers, let’s have a look at a few others.
- Low estrogen and progesterone. Estrogen increases the amount of time that hair spends in the growing phase and progesterone decreases the conversion of testosterone to DHT (through the inhibition of 5-alpha reductase activity) so low levels of estrogen and progesterone can lead to thinner hair that falls out more easily. Additionally, androgenic effects of testosterone and DHT can be intensified when estrogen and progesterone levels are low, creating a feedback loop for hair loss.
- Insulin resistance. The majority of women with PCOS (50%-90%) are insulin resistant. Cells become less responsive to insulin so glucose will not be taken from the blood effectively. This causes the pancreas to release more insulin which can stimulate the ovaries to release more androgens and inhibit sex hormone-binding globulin (SHBG), which binds testosterone making it inactive.
- Inflammation – PCOS is associated with chronic low-grade inflammation in the body. Chronic inflammation causes the ovaries to release more testosterone which can result in androgen excess and this disrupts normal hormonal regulation and contributes to PCOS hair loss.
- Stress – Stress causes the release of cortisol (a stress hormone) which can increase blood sugar levels, insulin resistance and inflammation, all of which can contribute to an excess of androgens and possible hair loss. Stress can also lead to a type of hair loss called telogen effluvium which can impact the growth cycle of the hair.
- Gut dysbiosis- higher levels of bacteroides and gram negative bacteria (LPS toxins) have been seen in women with PCOS and are linked to an increased risk of insulin resistance, inflammation and increased androgens all of which can lead to losing hair.
Other causes of hair loss in women could be due to vitamin deficiencies, aging, illness, sudden weight loss, stopping birth control and autoimmunity such as a thyroid condition. To identify what is causing your hair loss hormone testing is recommended.
Check your PCOS symptoms now
How we approach treatment of PCOS hair loss at FUTURE WOMAN
Do I actually have PCOS?
First of all, it’s important to determine that you definitely have PCOS. Many women with PCOS have received a PCOS diagnosis based on ultrasound alone, without a test to confirm elevated testosterone or other androgens. This leads to a lot of overdiagnosis of PCOS.
Testing with our easy at home urine-based Advanced Hormone Test will help to determine if your androgens or androgen metabolites are raised, and if not, whether something else is driving your symptoms. We assess all androgens in the Advanced Hormone Test, including the androgen metabolite 5a DHT, which can be three times more potent than testosterone, and is only detectable in urine testing.
What type of PCOS do I have?
Secondly, it is important in PCOS to determine which type of PCOS you have so that your practitioner can address the underlying root causes of your PCOS hair loss. For example, insulin resistance is the most common PCOS type, and we would treat this differently to Inflammatory PCOS (driven by inflammation) or adrenal PCOS (driven by stress). The Advanced Hormone Test assesses the full range of adrenal hormones, like cortisol, as well as many markers for inflammation to help us determine your PCOS type.
What factors are contributing to my PCOS hair loss?
As we’ve seen above, there are many factors that could be driving your PCOS symptoms, including PCOS hair loss. In the Advanced Hormone Test, we assess both free and metabolised cortisol and cortisone for a comprehensive assessment of your stress response and HPA (hypothalamus pituitary adrenal) axis functioning. This is especially important in PCOS as increased cortisol can increase overall inflammation in the body, which in turn increases androgen production resulting in the worsening of symptoms. Estrogen and progesterone are also measured.
Other possible root causes of PCOS hair loss that would show up in functional testing include gut dysbiosis and some nutrient deficiencies (B12, B6 and Biotin).
PCOS hair loss and supplementation
Once we establish the drivers of your PCOS hair loss through testing, one of our expert nutritionists will create a personalised healthplan for you. This will include evidence based supplement, diet and lifestyle recommendations to address your unique drivers and symptoms.
Supplements can be helpful for PCOS in general but only if they are right for you. For example the supplement myo-inositol has been shown to be hugely beneficial for insulin resistant PCOS but may worsen hormonal symptoms for people who do not need it. That is why it is so important to test first and determine which supplements and dietary changes are right for you.
3 tips to help banish PCOS hair loss for good
To bring about lasting change with PCOS hair loss, here are our top 3 recommendations.
- Confirm if you really have PCOS by testing. We see many women who have been misdiagnosed with PCOS based on ultrasound alone. You need irregular or non ovulatory cycles AND raised androgens to confirm if you have PCOS.
- Test ALL androgens and androgen metabolites. It’s not just about testosterone! PCOS can be present if ANY of your androgens or androgen metabolites are raised. Metabolites can only be tested in urine, not blood serum.
- Check other hormonal drivers of your PCOS belly. Every woman with PCOS is different. As we’ve covered in this article, there are many possible hormonal drivers of PCOS belly. Testing with the Advanced Hormone Test can help you understand your unique hormone picture and we can then address those drivers in your free personalised plan.
References
Carmina, E., Azziz, R., Bergfeld, W., Escobar-Morreale, H. F., Futterweit, W., Huddleston, H., Lobo, R., & Olsen, E. (2019). Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. The Journal of clinical endocrinology and metabolism, 104(7), 2875–2891.
Carrington, A. E., Maloh, J., Nong, Y., Agbai, O. N., Bodemer, A. A., & Sivamani, R. K. (2023). The Gut and Skin Microbiome in Alopecia: Associations and Interventions. The Journal of clinical and aesthetic dermatology, 16(10), 59–64.
Grant P. (2010). Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytotherapy research : PTR, 24(2), 186–188
Grymowicz, M., Rudnicka, E., Podfigurna, A., Napierala, P., Smolarczyk, R., Smolarczyk, K., & Meczekalski, B. (2020). Hormonal Effects on Hair Follicles. International journal of molecular sciences, 21(15), 5342.
Klein, E. J., Oh, C. S., Karim, M., Shapiro, J., & Lo Sicco, K. (2023). A practical approach to the management of hair loss in patients with polycystic ovary syndrome. Journal of the European Academy of Dermatology and Venereology : JEADV, 10.1111/jdv.18842.
Parker, J., O’Brien, C., & Hawrelak, J. (2022). A narrative review of the role of gastrointestinal dysbiosis in the pathogenesis of polycystic ovary syndrome. Obstetrics & gynecology science, 65(1), 14–28.
Wu, C., Wei, K., & Jiang, Z. (2017). 5α-reductase activity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive biology and endocrinology : RB&E, 15(1), 21.
