TL;DR

• Excess androgens cause both excess hair growth and hair thinning in PCOS patients
• Your sensitivity to excess androgens and where the follicles are in the body determine the severity of PCOS hair loss or growth. Other factors like genetic predisposition and insulin resistance are contributing factors.
• Common types of hair loss in PCOS include androgenic alopecia (scalp thinning) and diffuse thinning (telogen effluvium), alopecia areata (less common)
• Effective treatments involve addressing hormonal imbalances through medications like oral contraceptives, anti-androgens, and lifestyle changes such as diet, exercise, and stress management. Over the counter products are suggested (see OTC section)

Introduction

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting millions of women worldwide. Among hormonal and metabolic issues, women can experience a host of symptoms over the course of a lifetime. Among these, hair loss might be the most challenging and emotionally taxing for several reasons. Although it’s not a major symptom, it does occur.

Whether you’re seeing some more than usual loose strands in the shower or more severe alopecia, let's figure out the underlying causes and treatments that can be effective.

Does PCOS cause Hair Loss?

Yes. Although it’s not the most common symptom, PCOS hair thinning or balding does occur in some people due to hormonal imbalances.

Specifically, elevated levels of testosterone which converts to DHT, leads to hair related symptoms. Depending on where the follicles are in the body (scalp, face, chest, other areas), they will react differently to excess androgens by either increasing or decreasing hair growth.

Scalp Hair Follicles: These are more prone to miniaturization under androgen influence, leading to androgenic alopecia.

Body Hair Follicles: In contrast, hair follicles in androgen-sensitive areas of the body (such as the face, chest, and back) respond to androgens by transitioning from producing fine, peach fuzz like hairs to producing thick, coarser, darker terminal hairs (leading to hirsutism, a common PCOS symptom).

A patient’s susceptibility to these fluctuations in androgens is also a factor in the severity of symptoms experienced.

Why do Some Women Experience Hair Loss and Others Don’t?

There’s a complex interplay between genetic predisposition, hormonal environment, and local scalp conditions which is crucial in understanding why excess androgen can cause hair loss in some women but not others.

Genetic Predisposition

Women with a family history of androgenic alopecia are more likely to experience hair loss due to inherited genetic factors that affect androgen receptor sensitivity and enzyme activity.

Hormonal Fluctuations

Conditions like PCOS, which cause significant hormonal fluctuations and increased androgen production, can exacerbate hair loss in genetically susceptible individuals.

Additionally, dysregulated insulin levels lead to excess androgen production and increased inflammation which further exaggerates the problem.

External Factors

Stress and Lifestyle: Chronic stress and unhealthy lifestyle choices can amplify the effects of androgens on hair follicles, making hair loss more pronounced.

Local Scalp Conditions

Sebum Production: Elevated androgen levels increase sebum production by sebaceous glands in the scalp. Excess sebum can clog hair follicles, leading to inflammation and an unhealthy scalp environment that hinders hair growth

Microbial Activity: An oily scalp due to increased sebum can foster the growth of certain bacteria and fungi, contributing to scalp conditions like seborrheic dermatitis. These conditions can cause itching, flaking, and inflammation, further damaging hair follicles.

Scalp Inflammation: Chronic scalp inflammation, exacerbated by hormonal imbalances, can impair hair follicle function and contribute to the scarring and miniaturization of hair follicles, ultimately leading to hair loss.

All of this information underscores the importance of personalized approaches in diagnosing and treating androgenic alopecia, especially in the context of PCOS.

Types of Hair Loss with PCOS

Androgenic Alopecia (Female Pattern Hair Loss)

Causes scalp thinning, particularly along the crown and frontal hairline. Elevated androgens like testosterone and DHT shorten the hair growth phase and prolong the resting phase, leading to miniaturized follicles and finer, shorter hair over time

Diffuse Thinning (Telogen Effluvium)

Characterized by diffused hair shedding across the scalp, is typically temporary, even for PCOS patients. It's triggered by factors such as hormonal imbalances, stress, and inflammation, causing hair follicles to enter a resting phase prematurely. Elevated androgens and insulin resistance can exacerbate this condition temporarily.

Alopecia Areata (Less Common)

An autoimmune condition causing patchy hair loss, is less common in PCOS. Its exact cause involves immune system attacks on hair follicles, creating bald patches. Though not directly caused by PCOS, systemic inflammation in PCOS can exacerbate its autoimmune nature.

Diagnosing Hair Loss in PCOS

Hair loss related to PCOS can be identified with a combination of a scalp examination, PCOS diagnosis, and/or lab tests after other causes are ruled out.

It's normal to shed between 50 and 100 hairs a day. Visible deviations from this can be considered abnormal and you should consult your doctor or a dermatologist for a comprehensive examination. Use the chart below to quickly tell if your shedding is normal.

Medical Evaluation

Medical History: if you haven’t been diagnosed with PCOS, a thorough examination will be the first step to confirm a diagnosis. Here’s a deep dive into how PCOS is diagnosed. If you’ve already been diagnosed, doctors will try to understand underlying family history for hair loss patterns. They may assess the scalp for hair thinning and follicle miniaturization, often including a hair pull test to evaluate shedding. Typically a dermatologist will be able to screen for all these concerns.

Lab Tests: Lab tests are the best way to get root cause answers. Testing for testosterone, DHEAS, LH, FSH, and prolactin will help identify androgen levels and sensitivity related to hair loss with PCOS.

Assessing insulin levels and thyroid function is also essential to uncover underlying insulin resistance or thyroid disorders, both of which can contribute to hair loss. In rare cases where diagnosis is uncertain, a scalp biopsy may be considered.

If diagnosis is still uncertain, multiple healthcare providers, including dermatologists and endocrinologists, might be needed for a comprehensive evaluation and tailored treatment plan addressing both hair loss and PCOS management.

Differentiating from Other Causes

Hair loss is associated with many imbalances so it’s important to rule out other potential causes of hair loss such as nutritional deficiencies, other hormonal disorders (like thyroid disorders), autoimmune conditions (ie. Hashimoto’s disease) or medication side effects.

Managing and Treating Hair Loss in PCOS

Treating hair loss associated with PCOS involves addressing both the underlying hormonal imbalance and the hair loss directly. Here are some ways to treat PCOS hair loss.

Nutrition and Supplementation

Diet and Nutrition is the first step for managing hormonal imbalances. Ensuring adequate intake of protein, essential nutrients like Vitamin D, Biotin, Zinc can support overall hair health. Here’s a longer list of science backed supplements for PCOS.

Over the Counter Solutions

• Minoxidil or Rogaine (improves hair density)
• Biotin (for healthy, stronger hair with regular use)
• Anti-Hair Loss Shampoos and Conditioners (to reduce hair thinning and improve scalp health)
• Rosemary Oil (promotes hair growth according to some studies)
• Nizarol Shampoo (targets inflammation to prevent and treat dryness of the scalp)

Regular scalp massages either using your own fingers or a physical massager a few minutes a day can improve circulation, support hair growth, and scalp health.

Alternative Therapies

Combining treatment in Ayurveda,Traditional Chinese Medicine, herbal supplements, with conventional medical care can provide a holistic approach to managing PCOS related hair loss. Be sure to consult your healthcare provider before starting treatment