PCOS Hair Loss: Why It Happens And What Actually Helps
One of the more alarming side effects of polycystic ovary syndrome (PCOS) is the increasing amount of hair in your hairbrush or the widening of your part. Unlike the hair loss associated with male pattern baldness, the hair loss associated with PCOS is more of a gradual thinning around the top of the head and the temples. This has led many people to dismiss the problem as nothing more than a normal part of the aging process.
Women are usually told that it is due to genetics or stress, but there is a lack of guidance on what to do next. This guide will explain how hair loss due to PCOS is caused through hormonal imbalances, how blood tests can help clarify this, and then look at what can be done to help hair regrowth through naturopathic, dietary, lifestyle, and medical means. However, if you'd like to talk to a practitioner who understands PCOS from a holistic naturopathic point of view, then Floralia Wellness can help.
How PCOS causes hair thinning on your scalp
If there is an excess of androgen hormones being produced in your ovaries, this can manifest in unexpected places, such as on your scalp. Androgens are a normal part of hormone development in women, but an excess of them can affect the hair growth cycle, changing the structure of hair follicles on your scalp.
The role of androgens and DHT in follicle miniaturisation
Androgens control the cycle of hair growth. However, when there is an increase in the level of androgens, it overstimulates the hair follicles, resulting in miniaturisation. Dihydrotestosterone (DHT) is a potent form of testosterone, which is converted from testosterone by an enzyme known as 5-alpha reductase. DHT is more potent than testosterone. When it binds with the receptors in the scalp follicles, it results in a reduction of the growth phase of the hair, as well as the thickness of the hair.
This process, called follicle miniaturisation, is what eventually causes the widespread thinning pattern characteristic of female AGA. A consensus report published by the Androgen Excess and PCOS Society suggested that AGA in women should actually be termed female pattern hair loss, indicating two common thinning patterns: centrifugal expansion of hair loss in the mid-scalp area, and a frontal accentuation pattern. The hair follicles do not die, but rather, gradually start to weaken, eventually stopping their production of hair altogether if left untreated. That is why early intervention is so important.
Why insulin resistance makes hair loss worse
It is estimated that between 50% and 70% of PCOS patients develop insulin resistance. This is a major contributor to the androgen levels in the body. When your body is unable to respond to insulin, it will start producing more of it. This increase in insulin will then trigger your ovaries to produce even more testosterone. This is the same process discussed above that results in the production of DHT.
In addition to this, insulin resistance will also lead to a reduction in the amount of sex hormone-binding globulin (SHBG) in the body. This is the hormone that binds with testosterone in the body and renders it inactive. When the amount of SHBG is reduced, the amount of free testosterone in the body increases. This free testosterone is the one that can go and cause harm to your hair. Therefore, even if your testosterone is at borderline levels, it is the free testosterone in your body that is causing the harm.
How to tell if your hair loss is caused by PCOS
The thinning pattern is usually the first sign. You may notice that your part is gradually widening or that you can see more scalp at the top of your head. Your hair may be thinning overall, but not in any specific bald spots. It is usually diffuse rather than patchy, which is what sets it apart from alopecia areata.
Other signs that indicate that PCOS is the cause of these symptoms include the presence of other symptoms of PCOS, such as irregular menstrual cycles, weight gain, especially around your midsection, acne on your jaw, or even too much hair growth on your face and body. The presence of thinning hair on your scalp, accompanied by facial hair, is a classic sign of androgen.
A study of 254 women with PCOS noted that those with androgenetic alopecia were more likely to also develop acne or hirsutism. Again, this highlights the importance of the full picture and consulting with a specialist in PCOS. If you are experiencing all of these symptoms, it is worth getting blood tests done rather than putting it down to stress or the effects of getting older.
Blood tests and markers worth checking with your practitioner
A basic blood test with your GP may not detect all the markers that are the most important in relation to PCOS hair loss. Understanding the tests you need, as well as the results, gives you the foundational understanding of getting the right care for your condition.
Ferritin, vitamin D, zinc, and selenium
PCOS is often associated with decreased levels of ferritin, Vitamin D, and zinc. Iron deficiency can cause hair thinning, and it can exacerbate hormonal hair thinning. Therefore, if you're iron-deficient, you must correct it simultaneously with any other hormonal treatments. Ideally, it is recommended that ferritin levels are above 70 µg/L for optimal hair growth, well above the lowest end of the reference range.
Vitamin D is also involved in follicle cycling and immune regulation, and Vitamin D deficiency is a known cause of PCOS. Zinc and Selenium are also involved in thyroid function, and deficiencies of both can cause hair thinning. These can be easily investigated by performing thyroid tests.
SHBG, free testosterone, and fasting insulin
These three markers give you more information than just your total testosterone alone when it comes to your PCOS hair loss. SHBG is the binding protein that determines the amount of testosterone that is active. Low SHBG means that more of your testosterone is converted into DHT, regardless of your normal levels of testosterone. This is one of the most common pieces of the puzzle that is missed.
With free testosterone, you're getting a direct read on what is immediately available to interact with your tissues, including your scalp follicles. When it comes to testing your testosterone levels, having a comprehensive test that includes free and total levels, as well as SHBG, will give you the most accurate picture. Fasting insulin, on the other hand, will let you know if the insulin resistance is fueling the entire process. When fasting insulin is out of whack, making changes to it through diet and exercise, as well as targeted supplementation, will create a cascade effect on your androgens and your eventual hair density. Without it, you're just treating the symptom without knowing the underlying cause.
Why nutrient deficiencies should be given as much consideration as hormones
While most methods for handling hair loss in women with PCOS focus almost exclusively on androgens, the thinking is simple: block the androgens, regrow the hair. However, in the real world, some of the biggest breakthroughs occur when deficiencies in nutrients are recognised and treated as an equally important consideration.
Your hair follicles are metabolically active tissue, meaning that you need iron to deliver oxygen, zinc to provide structure to your keratin, vitamin D to regulate your hair growth cycle, and selenium to protect your hair from oxidative damage. If any of these nutrients are lacking, your hair follicles simply cannot respond to your hormonal treatments as well as they could. A woman could do everything right, hormonally speaking, but if her ferritin is sitting at 20 µg/L, she is not going to see much regrowth.
This is where the naturopathic approach brings a dimension that the purely medical approach tends to overlook. At Floralia Wellness, nutrient status is tested and measured against optimal ranges (not normal ranges that are often far below what is optimal for health). Iron supplements, B vitamins, zinc, and vitamin D are prescribed in the right dosage based on your pathology results and any deficiencies that are identified. Working with a clinical nutritionist familiar with PCOS will ensure that your supplements are tailored to your individual nutrient deficiencies. This is where many women find the turning point and start to notice a difference.
Naturopathic and integrative approaches to PCOS hair regrowth
Herbal medicine support
Several herbs have anti-androgen properties that may help minimise the effects of raised levels of testosterone and DHT on your hair follicles. Saw palmetto blocks the 5-alpha-reductase enzyme that is involved in the production of DHT from testosterone. Spearmint tea has shown a small degree of ability to decrease free testosterone in clinical trials. Peony and liquorice root combinations have traditionally been used in a formula to support the normal production of hormones and minimise androgen effects.
These herbs should be used in conjunction with other therapies, not in isolation. It's important to work with a qualified naturopath who will select herbs in a combination that is right for your individual biochemistry and symptom presentation, not based on what you've read on the internet.
Dietary changes that target insulin and inflammation
A low glycemic index diet is possibly the most potent weapon in the fight against insulin resistance in women with PCOS. This is because it helps prevent the surge in insulin levels that leads to an increase in androgens. A Mediterranean-type diet is rich in anti-inflammatory agents such as oily fish, olive oil, leafy green vegetables, and nuts. This is important in reducing the low-grade inflammation in women with PCOS that further damages the hair follicles.
A weight loss of even as little as 5% of overall weight can have a major impact on increasing insulin sensitivity as well as lowering circulating androgens. This does not mean you need to follow an extremely strict diet. Small but significant modifications to the way you eat can be much more effective in the long term compared to any fad diet. Floralia Wellness provides a weight management program that is based on gradual weight loss.
The role of stress and cortisol in hair cycling
Cortisol and human reproductive hormones use similar pathways. When you are stressed, more energy is expended on the production of cortisol. This can cause more problems with hormonal imbalances, affecting the hair growth cycle regardless of the effects of androgens. High levels of cortisol force more of your hair into the telogen phase, resulting in excessive hair loss and slowing down of new growth.
The interesting thing about this, particularly about PCOS, is the compounding factor. You already know that you're dealing with high levels of androgens, which are essentially shortening your growth cycle. When you then add chronic stress into the mix, it's as if you're thinning from both sides. This is, in many cases, the "aha" moment for women. They're taking care of their diet, they're taking care of their supplements, but it's the busyness and chronic stress from their lifestyle that is affecting them.
A regular regimen of aerobic and resistance training has been shown to reduce levels of cortisol and androgens while also regulating blood sugars. Yoga and meditation, and implementing good sleep hygiene practices, can make a significant impact on hormone levels. If stress and exhaustion are major players in your life, consider seeking out adrenal fatigue support as well as your PCOS treatment. Getting your stress under control can have a profound impact on any adverse health condition you are experiencing.
Medical treatments for PCOS-related hair loss
Minoxidil and topical treatments
Minoxidil is a topical solution that is TGA-approved for the treatment of hair loss in both men and women. It is known to prolong the active growth phase of the hair growth cycle, as well as increase blood flow to the hair follicles. It is available over-the-counter and is applied once a day directly to the affected areas of the scalp. It takes three to six months for results to appear, but if you stop using it, hair loss will resume.
Spironolactone, oral contraceptives, and metformin
Spironolactone is an anti-androgen that essentially blocks the effects of testosterone in your tissues. In a study published in Cureus, spironolactone was shown to help with hair loss in around 57% of patients as a whole. Combination therapy was shown to have higher success rates than monotherapy. It is also often used in combination with hormonal birth control, as this decreases androgen levels and increases SHBG levels, thus lowering testosterone.
Metformin works by addressing insulin resistance head-on. This has the net result of lowering androgen levels and helping hair cycling. For women with PCOS caused by metabolic issues, metformin can be an effective tool. Your doctor or endocrinologist will be able to help you determine the best medical interventions for your case. These are also effective in combination with naturopathic interventions.
What to realistically expect from treatment (and when)
Hair growth is a slow process. The growth cycle of your hair means that even if your hormonal and nutrient levels are trending in the right direction, it will take at least three to six months to see any noticeable changes in the density of your hair. Some women may even see a reduction in shedding within the first couple of months. This is a good sign, but it will take longer for the growth and thickening of your hair.
It’s also important to realise that the hair loss caused by PCOS is something that needs to be managed on an ongoing basis. This is because, as mentioned, PCOS is a chronic condition, which means the hormonal imbalance that causes the hair loss doesn’t simply go away as the hair growth increases. Most women need to continue with some sort of management, be it through changes in eating, taking herbal medicine, supplements, or medication, to continue the benefits they are seeing. This doesn’t mean you’ll be doing everything you are now forever, just that this is an ongoing process, not something with a definitive end date.
Having realistic expectations from the very beginning helps you continue with the process, even during the early stages when you don’t seem to be seeing any changes. The women who tend to have the best results are the ones who are willing to commit to the process for six to twelve months, even though they may need to make changes along the way, rather than constantly changing programs every few weeks.
Gentle hair care habits that protect thinning hair
As you continue to work on your internal triggers, it is also important to add some simple hair care practices to your routine that will prevent your hair from more damage. Firstly, it is important to avoid tight hairstyles such as high ponytails and braids that may cause your hair to break more. It is also important to avoid excessive use of heat styling and blow-drying your hair with hot tools that may damage your hair. When washing your hair, it is important to use a sulphate-free shampoo that will not deprive your scalp of the oil it produces.
Massaging your scalp will stimulate blood flow to your hair follicles and is a simple process that you can do at home by massaging your scalp for two to three minutes while washing your hair.
When to seek help from a naturopath or integrative practitioner
If you have been experiencing hair loss for more than a few months, or if other PCOS symptoms are also present along with hair loss, it may be worth seeing a practitioner who can look at the entire picture. A naturopath can help you understand your blood results, identify any nutrient deficiencies, help to restore optimal hormone levels through herbal medicine, supplementation and dietary modifications, as well as coordinate treatment with other health professionals if necessary. A comprehensive hormone testing panel is often the first step in building a treatment plan to help address hair loss due to PCOS.
At Floralia Wellness, we take an integrative medicine approach to addressing hair loss due to PCOS, addressing hormones, metabolism, and nutrients as part of a holistic treatment protocol rather than in isolation. If you are ready to understand more about what is really going on with your hair loss, then a consultation is a good first step.
