PCOS hair loss

PCOS Hair Loss Explained: Common Patterns, Triggers, and Treatment Options

Dr. Jolene BrightenPublished: Last Reviewed: Hair Loss, PCOS Leave a Comment

Women with PCOS are more than twice as likely to experience hair loss compared to non-PCOS women of the same age. That is because PCOS is associated with a higher level of androgens, like testosterone, which plays a central role in PCOS hair loss.

Here's a snapshot of what to know about PCOS and hair:

  • Elevated androgenic hormones are common in PCOS and can lead to hair loss on the head and excessive hair growth on the face, along with body hair.
  • Dihydrotestosterone (DHT) is the primary hormone responsible for female pattern hair loss (formerly known as androgenic alopecia), a specific form of hair loss associated with PCOS.
  • PCOS hair loss is often treated with spironolactone, oral contraceptives, and topical medications.
  • Natural therapies like saw palmetto, myo-inositol, topical rosemary oil, and specific dietary interventions discussed in this article can support hair regrowth and alleviate hair loss symptoms in some people.
  • If you've been diagnosed with polycystic ovarian syndrome (PCOS) and find that the hair on your head is thinning, you may be experiencing hair loss from PCOS hormone imbalances.
PCOS Hair Regrowth

The reason women with PCOS may experience hair loss is because they have an excess of androgens affecting the hair follicle. Although androgens play an essential role in our physiology, in excess amounts they can unfortunately cause female pattern hair loss (androgenic alopecia), or hair loss.

PCOS Hormones and Hair Loss:

  • Elevated androgens shrink the hair follicle and lead to permanent hair loss.
  • Progesterone can lower DHT production, but is often low in PCOS.
  • Elevated insulin stimulates androgen production in the ovaries.

Let's explore this in depth, but first, it’s important to understand the phases of hair growth.

Hormonal Imbalances and Hair Growth Cycle

The hormone imbalances associated with PCOS can disrupt the hair growth cycle.

The hair cycle has three phases:

  1. Anagen phase, or the growth phase
  2. Catagen phase, when the growth slows down and eventually stops
  3. Telogen phase, or resting phase, when the hair eventually sheds

The Influence of Androgens on Hair Loss

Elevated levels of androgens, including DHT can cause your hair follicle to shrink, as well as alter the growth cycle. This leads to thin, brittle hair that falls out easily.

Your hair follicles – whether on your scalp or on your body – have androgen receptors, which are like “parking spots” for androgens. When androgens park in these receptors on your scalp, they cause the hair follicle to shrink, also known as miniaturization. They also shorten the growth phase of your hair, which is why PCOS hair thinning and loss go hand in hand. 

Under healthy conditions, about 90% of your hair follicles should be in the anagen phase (growth phase). Excessive androgens reduce this number significantly, so hair is lost more quickly than it can grow back.

Oddly enough, androgens have the opposite effect when they park in hair follicles on your body. In characteristic places like the upper lip and chin, androgens can actually cause more hair to grow. This is why hair loss and hirsutism, abnormal hair growth on the body, often coexist for women with PCOS.

Does PCOS Increase DHT?

Testosterone is converted to DHT through the action of an enzyme called 5-alpha-reductase. Women with PCOS have higher levels of testosterone and elevated 5-alpha-reductase, so more testosterone gets converted to DHT. They also have lower levels of SHBG, a protein that reduces the amount of DHT in circulation.

DHT has five times higher potency compared to testosterone.

DHT is a major cause of both male and female pattern hair loss because of its high affinity for the androgen “parking spots” in your hair follicles.

Estrogen and Progesterone’s Role In Hair Health

Cyclical hormones like estrogen and progesterone can directly affect hair growth. You may know that during pregnancy, hair becomes thicker and fuller. Normally this is attributed to high levels of estrogen influencing the hair to stay longer in its growing cycle. Estrogen has the ability to lengthen the growth phase of hair, also known as the anagen phase. It can also increase levels of SHBG (sex hormone binding globulin), a protein that binds androgens to take them out of circulation.

Progesterone can also influence hair growth, by slowing down synthesis of androgens. It does this by inhibiting the action of 5-alpha reductase, which converts testosterone into DHT. 

While estrogen levels may be normal or elevated in PCOS, progesterone is often low. That is because the primary way progesterone is made by the ovary is following ovulation. A hallmark of PCOS is anovulation (no ovulation), which means the ovary is unable to produce progesterone. Lack of ovulation or irregular ovulation is why patients with PCOS experience irregular periods.

The Role of Insulin Resistance

Many women with PCOS have insulin resistance as well, although it isn’t always diagnosed.

Elevated levels of insulin cause the ovarian cells to produce more androgens. The elevation of testosterone coupled with increased 5-alpha reductase activity leads to more DHT being produced and increased hair loss.

This is why one of the main focuses in treating PCOS and addressing hair loss includes optimizing insulin levels. Exercise, a low glycemic diet, myo inositol, chromium, and metformin are some of the ways to improve insulin resistance.

Myoinositol Plus

Symptoms of PCOS Hair Thinning and Hair Loss

As many as 30% of women with PCOS experience hair loss. 

PCOS hormone imbalances can lead to female pattern hair loss (also known as androgenic alopecia), which often presents as:

  • Hair loss in the front and side areas of the scalp.
  • Hair strands appear thinner or smaller.
  • The hair part begins to widen.
  • The hairline above the temples begins to recede.

Gradual Thinning of Hair

You may have noticed that your part-line is getting wider, or that the hair on the top of the scalp is thinning, especially towards the forehead. This is because excess androgens bind to receptors in the hair follicle and cause it to shrink. At first, the hair itself becomes thinner in diameter and less healthy.

Increased Hair Fall

Eventually, the hair follicle gives up altogether. There is also a decrease in the length of the growth phase. Hair progresses more quickly to the resting stage, where the end of the strand is pushed out of the follicle until it falls out.

PCOS and hair fall are commonly seen together. The loss of hair may be gradual, which sometimes makes it difficult to notice at first. 

You can read more about different patterns of hair loss and what they might signify.

Foods for Thicker Hair

Diagnosis of PCOS Hair Loss

PCOS can be a confusing and frustrating diagnosis, and is estimated to affect between 5% to 20% of people worldwide. 

Part of the reason for the confusion is that the diagnosis of PCOS has changed over the years. Today, PCOS is most commonly diagnosed using the Rotterdam criteria, after other potential conditions have been ruled out. There are three criteria , and in order to fit the diagnosis, you have to meet at least two of them. They are:

  1. Hyperandrogenism either evaluated clinically or via lab testing
  2. Oligo-ovulation (infrequent) or anovulation (lack of ovulation)
  3. Polycystic ovaries on an ultrasound (that cannot be explained by another disorder)

Anti-mullerian hormone or AMH can now also be used as part of making the diagnosis.

The exact cause of PCOS is unknown, but epigenetics play a role. That means that environmental factors during fetal development and childhood, including diet, lifestyle, and exposure to chemicals, can contribute to the activation of underlying genetics.

Elevated Androgen Levels

Elevated androgens in women can result in a clinical manifestation of acne or abnormal hair growth in places like the face or chest, called hirsutism. Those same androgens also cause a type of hair loss called androgenetic alopecia, or female pattern hair loss. This usually presents as thinning on the mid-scalp, with an accentuation on the front of the scalp – so you might see your part-line widening, especially close to your forehead.

Your doctor can use these symptoms as part of making the diagnosis of PCOS.

While not as common as acne and hirsutism, female pattern hair loss is nonetheless estimated to affect up to 28% or more of women with PCOS. 

Medical Diagnosis of Hair Loss

Hair loss can be diagnosed using clinical and laboratory methods. A magnified scalp examination can help identify markers like hair follicle shrinkage, or a wide variation in the diameter of the hair shaft.

For PCOS hair loss cases, measuring total and free testosterone, androstenedione, DHT, and DHEA-S can help your doctor understand the specific extra androgen production happening in your body. However, lab testing for androgens is not necessary to diagnose PCOS as symptom presentation is enough to meet the criteria.

It is also useful to look at baseline micronutrients like zinc, ferritin, and vitamin D. Even in the absence of PCOS, nutritional deficiencies can cause or worsen hair loss. For example, in one study, medication was able to improve hair growth only in patients with adequate baseline levels of ferritin, a protein that stores and releases iron. 

In many cases, it is useful to combine medical treatment with additional support, such as supplements specific to support PCOS and hair health.

Nutrients for Hair Growth

Treatment Of PCOS Hair Loss

There are several treatment options available for PCOS hair loss. In many cases, using a combination of therapies that have an anti-androgen effect and address the underlying PCOS hormone imbalances that lead to hair loss is the most effective strategy.

The goal of treatment should be:

  • Reduce further hair loss and prevent PCOS balding.
  • Employ therapies that encourage PCOS hair regrowth.
  • Correct nutritional deficiencies that further contribute to PCOS hair thinning and loss.
  • Provide mental/ emotional support.

Natural Methods for PCOS Hair Regrowth

There are herbal remedies that are clinically effective for stopping or reversing hair loss. In some instances, combining natural hair regrowth methods along with medications can be the most effective way to improve outcomes.

PCOS hair regrowth is possible if you catch it early.

Saw Palmetto

The berries of the saw palmetto tree contain an oil that is rich in fatty acids (lauric acid, myristic acid, and oleic acid). These fatty acids have been shown to inhibit activity of 5-alpha reductase, which may result in less circulating DHT, the hormone responsible for androgenic hair loss associated with PCOS.

Our Saw Palmetto Plus contains standardized 45% fatty acids of Saw Palmetto, along with other nutrients to support healthy testosterone levels and hair growth.

Myo Inositol

Inositol or myo-inositol is a common recommendation for women with PCOS‘ due to the high amount of research showing benefits with little side effects. Research has shown myo-inositol to improve testosterone levels, support ovarian function and restore irregular ovulation, and reduce symptoms of hirsutism.

While myo-inositol for hair loss has not been a primary focus of much of the research, it has been hypothesized that through its effect on testosterone reduction, improved metabolic health, and supporting progesterone production via regular ovulation, it may be an effective way to manage PCOS hair loss.

Inositol Benefits for PCOS Hair Loss:

  • May help reduce hair loss. Inositol may help lower DHT, the hormone responsible for hair loss.
  • Thicker, healthier hair. May improve the health of the hair shaft, leading to thicker hair and less hair breakage.
  • Reduce dandruff. Inositol may be an effective way to reduce seborrheic dermatitis or dandruff. Improving the health of the scalp is vital to the health of the hair.

Our Myoinositol Plus combines 2,000 mg of myo-inositol with 50 mg of d-chiro inositol to provide the ideal 40:1 balance of these nutrients. In addition, it contains green tea extract, zinc, vitamin D, and spearmint to provide comprehensive support for those who experience elevated androgens.

PCOS inositol for hair loss

Licorice

Licorice extract is found to have compounds like glycosides, terpenoid, phenolics, and flavonoids, which can have anti-androgenic effects, especially in women with PCOS when combined with spironolactone .

Some phytosterols present in licorice may also act as 5-alpha-reductase inhibitors, preventing the conversion of testosterone to DHT. In some studies, licorice was shown to be more effective than Minoxidil at promoting hair growth. 

Green Tea

Green tea is another natural source of 5-alpha-reductase inhibitors. It contains a powerful catechin called EGCG. EGCG not only works to inhibit the conversion of testosterone to DHT, it also stimulates hair growth by acting on the dermal papilla cells. These are cells deep within the hair follicle that play an important role in hair growth.

Non-caffeinated green tea leaf extract is included in our Myoinositol Plus formulation. 

Spearmint Leaf Tea

Spearmint has anti-androgenic properties, which is why it is commonly used by women with PCOS who want to eliminate both hirsutism and hair loss. In one randomized control trial, it was shown that among women with PCOS who consumed spearmint tea, there was an reductionin hirsutism.

Spearmint leaf can be consumed as a tea or taken as a supplement.

Zinc

Zinc is a nutrient that supports healthy testosterone levels and may reduce the activity of 5-alpha-reductase. It has been shown to improve symptoms of PCOS, including hair loss. 

Because of its essential role, zinc is included in both the Saw Palmetto Plus and Myoinositol Plus formulas.

Food sources of zinc include:

  • Meat
  • Shellfish
  • Legumes
  • Pumpkin seeds
  • Eggs

While it can be effective in supporting optimal testosterone levels, zinc toxicity can develop, which is why more is not better when supplementing.

Topical Rosemary Oil

Clinically, rosemary oil is found to be as effective as the pharmaceutical Minoxidil in promoting hair growth.

Rosemary oil contains compounds such as caffeic acid, 1,8‐cineole, and rosmarinic acid. When applied topically, these compounds improve vascularity and blood flow to the scalp in order to regenerate hair follicles.

Scalp Massage

Scalp massage can promote more blood flow to the scalp. You can try massaging rosemary oil into the scalp to enhance the effect.

Omega-3 Fatty Acids

Omega-3 fatty acid, particularly those found in fatty fish, can improve the health of hair and the follicle. Studies investigating supplementation with Omega-3 fatty acids and hair loss have found them to be effective.

Low Level Laser Light Therapy

Low level laser light therapy has been shown to be effective at improving circulation to the hair follicle. It has a low side effect risk in treatment for female pattern hair loss.

Platelet Rich Plasma (PRP)

PRP involves drawing blood from the patient, and centrifuging it to obtain the platelet-rich portion. The concentrate can then be injected into the scalp where the hair is thinning.

Although some research suggests that it may be effective, clinical trials are still needed to confirm its ability to treat PCOS hair loss.

Melatonin

Melatonin is a hormone naturally produced by the body, which helps to regulate sleep timing. Some research suggests that melatonin may be helpful in restoring normal menstrual cycles as well as hyperandrogenism in women with PCOS.

Saw Palmetto Plus for Hair Loss

Medications for Treating PCOS Hair loss

The standard treatment protocol for hair loss often involves hormonal contraceptives, including the pill or intra-uterine devices, spironolactone, 5-alpha-reductase inhibitors, and metformin.

Common Medications for PCOS Hair Loss:

  • Minoxidil or Rogaine
  • Oral contraceptive Pills
  • Spironolactone
  • Metformin

Minoxidil

Minoxidil (Rogaine) is an FDA approved drug for the treatment of PCOS balding and hair thinning. This daily topical treatment helps increase circulation to the hair follicle to improve hair regrowth. It generally takes about 2 months to see results, with the most notable effects happening at 4 months of consistent use.

Hormonal Birth Control

Hormonal birth control or oral contraceptives are often used in the treatment of PCOS symptoms like acne and irregular periods. Most providers will use this along with an anti-androgen medication to address hair loss.

Depending on the composition, hormonal contraceptives (like the pill or intra-uterine devices) may increase PCOS hair loss.

Up to 13.6% of requests to remove IUDs are a result of hair loss. If you are going to begin hormonal birth control, make sure you are clear about your symptoms, so your provider can prescribe a formula that is right for you.

It is important to track your symptoms and speak with your provide if issues arise.

Spironolactone

Spironolactone and other 5-alpha-reductase inhibitors work by preventing the conversion of testosterone to DHT – so that DHT cannot wreak havoc on your hair follicles. It is often used for acne and hair loss because of its anti-androgenic effects.

These can be effective, but both cannot be used if you are pregnant or at risk of becoming pregnant due to the risk of fetal harm. This is why you’ll be asked to use a form of birth control like the pill or an IUD while on this medication.

Metformin

Metformin helps to re-sensitize the body to insulin and is a common medication prescribed to PCOS patients. While not specifically a hair loss medication, it can address the insulin issues that accompany PCOS.

By reducing insulin resistance, metformin reduces insulin levels in the blood – which in turn, may reduce androgen levels. However, metformin is most effective when used in combination with lifestyle changes.

Lifestyle Changes to Manage PCOS Hair Loss

Lifestyle interventions, including nutrition and exercise, are primary interventions in the treatment of PCOS.

The Importance of a Balanced Diet

A balanced diet can have powerful effects on your PCOS symptoms. Remember that PCOS has a significant metabolic component. Elevated insulin levels can cause the ovaries to produce more testosterone – worsening the symptoms of hirsutism, acne, and hair loss.

Learn more about how you can optimize your diet to rebalance your hormones and regrow your hair.

Exercise and its Effects on PCOS

Exercise is a powerful way to help manage symptoms of PCOS, including hair loss. Improving muscle mass helps sensitize the body to insulin, lower inflammation, and improve hormone health.

Exercise (and weight loss) are not always straight-forward when it comes to PCOS. Weight gain can be a symptom of PCOS, along with the metabolic disorders that can accompany it.

Learn more about how to approach exercise with PCOS.

Coping strategies for PCOS-induced Hair Loss

Although hair loss can be reversed in some cases, the length of the hair cycle itself means that it can feel like a long wait until you see improvement. Make sure you get the support you need so that you can feel reassured and at ease.

Psychological Support and Counseling

When your hormones are out of whack, it can feel like everything is spiraling out of control. PCOS can make you more susceptible to anxiety – especially when you are having to cope with challenging symptoms.

You should know that an effective treatment plan can help you not only manage your hair loss, but soothe the emotional symptoms that come along with it. This is another reason why it’s so important to address what’s really going on in your body, and not take a one-size-fits-all approach.

Self-Care Tips and Techniques

Remember: stressing over hair loss never brought anyone’s hair back. But understandably, it’s difficult to not worry.

 Take a deep breath, be patient with yourself, and make time for some self-care.

Conclusion: Managing PCOS Hair Loss

If you are suffering from PCOS and hair loss, you are not alone. Hair loss is a relatively common symptom of PCOS due to the elevated levels of androgens. In particular, elevated levels of DHT can act on the hair follicle to disrupt the natural growth cycle of hair.

Hair loss cannot always be fixed or reversed, but you can stop it from progressing. If you are feeling lost or unsure of where to begin, please don’t hesitate to reach out to a professional for support.

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References

  1. Carmina, Enrico et al. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. The Journal of clinical endocrinology and metabolism. 2019.
  2. Christ, Jacob P, and Marcelle I Cedars. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel, Switzerland). 2023.
  3. Dhariwala, Maria Yusuf, and Padmini Ravikumar. An overview of herbal alternatives in androgenetic alopecia. Journal of cosmetic dermatology. 2019.
  4. Girijala, Raghavendra L et al. Platelet-rich plasma for androgenic alopecia treatment: A comprehensive review. Dermatology online journal. 2018.
  5. Grymowicz, Monika et al. Hormonal Effects on Hair Follicles. International journal of molecular sciences. 2020.
  6. Jamilian, Mehri et al. Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Biological trace element research. 2016.
  7. Klein, Elizabeth J et al. A practical approach to the management of hair loss in patients with polycystic ovary syndrome. Journal of the European Academy of Dermatology and Venereology. 2023.
  8. Le Floc'h, Caroline et al. Effect of a nutritional supplement on hair loss in women. Journal of cosmetic dermatology. 2015.
  9. Malkud, Shashikant. Telogen Effluvium: A Review. Journal of clinical and diagnostic research. 2015.
  10. Siddiqui, Sana et al. A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). Journal of assisted reproduction and genetics. 2022.
  11. Tagliaferri, Valeria et al. Melatonin Treatment May Be Able to Restore Menstrual Cyclicity in Women With PCOS: A Pilot Study. Reproductive sciences (Thousand Oaks, Calif.). 2018.
  12. Thom, Erling. Stress and the Hair Growth Cycle: Cortisol-Induced Hair Growth Disruption. Journal of drugs in dermatology. 2016.
  13. van Zuuren, Esther J et al. Interventions for female pattern hair loss. The Cochrane database of systematic reviews. 2016.
About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.