Information and Solutions for Men and Women

Hormones and Female Pattern Hair Loss

Female patterned hair loss can be caused by hormone levels controlled by the endocrine system.

Both men and women produce testosterone and estrogen, commonly referred to as male and female sex hormones respectively. Testosterone is an androgen hormone commonly considered the male sex hormone because men produce much more of it than women. However, testosterone is also used to make estrogen—a predominately female sex hormone—so women produce testosterone androgens as well.77, 84-85

Ovaries produce about 25% of the testosterone in women, and the adrenal gland produce an equal amount. The rest is produced in other organs and tissues when weaker androgens (e.g., androstenediones) from the ovaries and adrenal gland are converted at the tissue and organ level, such as in hair follicles. Estrogen is metabolized from the androgens testosterone and androstenedione by aromatase enzymes:77,84-85


Do Androgen Levels Affect Female Hair Loss?

Androgen hormone levels do play a role in female pattern hair loss (FPHL), especially in some women with high levels of androgens due to an underlying medical condition (such as polycystic ovary syndrome). However, current research suggests that androgens may have less of a direct effect than they do in male pattern balding.2 For example, while the potent testosterone metabolite DHT causes substantial miniaturization of hair follicles in men with androgenetic hair loss (AGA), follicle size is not reduced to nearly the same extent in women with AGA and is often only significant in women with severe hair loss.30, 86 And some women with extremely high androgen levels have insignificant levels of hair loss.22

The hair loss effects of androgens may be lessened in women by the hair-protective effects of estrogen.30 Ratios of estrogen to androgens may be a better way of understanding the impact of androgens in FPHL.86 Levels of other substances (e.g., sex binding hormone globulin and aromatase enzymes) affect these ratios by preventing free testosterone from converting to DHT.30, 85

Too Much Testosterone and DHT?

Some women produce higher levels of the androgens testosterone, DHT, and androsterones than normally found in females, which can contribute to female balding. Excess androgen production can be due to heredity, and is also caused by adrenal and ovarian disorders that stimulate androgen hormone secretion (e.g., polycystic ovary syndrome (PCOS) and Cushing’s syndrome). Other common health conditions that also stimulate excess androgen secretion by the ovaries are insulin resistance and diabetes, both of which are characterized by excess levels of insulin in the blood (if uncontrolled).22, 100, 102

Hair loss is often a symptom of these endocrine disorders, and is linked to their hyperandrogenetic nature. Evidence suggests there may also be a genetic component of these disorders since they tend to run in families. Hirsutism, a condition caused by high androgen levels where too much terminal-type hair grows in places females normally don’t grow any (e.g., facial and back hair), is also considered a symptom of these conditions.22, 102-103

However, many women with female pattern hair loss (FPHL) do not appear to have an endocrine disorder or high androgen levels. Researchers suggest that in these women the androgen receptors on the scalp hair follicles may be hypersensitive to even normal levels of androgens.22 This theory may explain why some women with FPHL and normal androgen levels respond so well to flutamide treatment, since this anti-androgen works by blocking the bond between hair follicle androgen receptors and DHT.104

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Also known as female androgenetic alopecia.