Information and Solutions for Men and Women

Polycystic Ovary Syndrome and Female Androgenetic Hair Loss

One of the symptoms of PCOS in women can be hair loss that resembles male pattern baldness.

Hair loss due to excess androgens in women is most often due to polycystic ovary syndrome (PCOS), which is an endocrine disorder that occurs in 5-10% of all adolescent girls and women. In fact, evidence of hyperandrogenism (e.g., hirsutism, acne, high serum levels of androgen or luteinizing hormones, but not necessarily all of these) is one of the three diagnostic criteria for PCOS. The other two are menstrual irregularities and imaging evidence of multiple cysts in the ovaries, although according to recent protocols the presence of cysts are not required. Women with PCOS often present with symptoms of metabolic syndrome (e.g., obesity and insulin resistance or diabetes), which has also been linked to hair loss.22, 87, 102, 105

thinning_hair_polycystic_ovary

Treatments for PCOS involve correcting hormonal imbalances that cause excess androgens, some of which mirror treatments used for female pattern hair loss without PCOS:15, 30, 102, 106-107

  • Combination oral contraceptive pill—the estrogens in oral birth control pills reduces ovarian production of testosterone and increases production of sex hormone binding globulin (SHBG), which binds free testosterone before it can convert to DHT and attach to hair follicles
  • Gonadotropin releasing hormone (GnRH)—suppresses luteinizing hormones; when used in combination with birth control pills and cyproterone acetate it also improved insulin sensitivity
  • GnRH agonists—drugs that stimulate production of GnRH (e.g., metformin)
  • Spironolactone—most commonly used anti-androgen, inhibits androgens from binding to receptors (such as those in hair follicles)
  • Weight management—losing as little as 2-7% of weight reduces androgen levels
  • Herbal options—consuming spearmint herbal tea twice a day was shown in a one month randomized, controlled clinical trial to significantly reduce free and total testosterone levels

Antioxidant supplements may also be beneficial. Research indicates that oxidative stress in PCOS is directly linked to excess androgen secretion—which is also the trigger for scalp hair loss.60 Dermatologists have successfully treated hair loss in women with PCOS with oral contraceptives, anti-androgens, and combination treatment regimens of 5-mg/day of finasteride and the hair growth promoter 5% topical minoxidil (by prescription).30

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Excess hair growth in areas atypical for females (e.g., face, chest, and back).
Produced in the pituitary gland gonadotrophs, luteinizing hormone triggers testosterone production by the ovaries and testes.