PCOS Hair Loss: What Causes It and How To Treat It
PCOS hair loss may be one of the most difficult symptoms to live with. Losing your hair can be devastating and it may even damage your confidence and self-esteem. The process of losing your hair may seem like the end of the world.
But it doesn't have to be.
A common question I get asked is:
Can hair loss from PCOS be reversed?
Hair loss is a symptom that some women with PCOS experience. I understand that it can leave you feeling self-conscious and helpless, but I want you to know that hair loss from PCOS can be reversed. PCOS is at its core caused by an imbalance of sex hormones. PCOS women are producing too many male hormones and this can occur for various reasons including, high insulin levels, chronic stress and inflammation. It is the excess male hormones that can lead to hair loss. So by making diet and lifestyle changes, you can begin to rebalance your hormones, improve your PCOS and reverse symptoms like hair loss. Unfortunately there is no quick fix but if you are consistent and patient you will results.
In today's post, you will find out everything you need to know about PCOS hair loss. You are going to learn what causes it and how to treat it naturally so you can grow your hair back.
Let’s get started.
The Hair Cycle
Before we investigate the causes of PCOS hair loss and talk through the natural remedies to reverse PCOS hair loss. Let’s look at the stages of the hair cycle.
We, as humans, go through 3 normal phases of hair growth and shedding, such is the natural cycle of hair.
- The Anagen Phase
- The Catagen Phase
- The Telogen Phase
The hair cycle begins with the anagen phase (the growth phase) where new hair is formed. Hair follicles
The length of your hair depends on how long you are in the anagen phase and this varies from person to person.
The catagen phase is the second stage which lasts between 2 to 3 weeks. During this phase the hair stops growing and is separated from the blood supply (dermal papillae). The follicle then shrinks in size which makes it easier for the hair shaft to be pushed out of the scalp.
During the telogen phase (resting phase), the hair rests in the root until the new hair growing beneath it pushes it out. This phase lasts around 3 months.
Normally only 10% of your hair is shed in the telogen phase. The other 90% of your hair will be in the Anagen phase.Do not be alarmed, hair follicles go through the growth cycle at different times so you don’t lose patches of hair all at once!
On average, a human loses between 50-100 hairs a day during the exogen phase.
What is Female Pattern Hair Loss?
Female pattern hair loss (FPHL), also known as androgenetic alopecia, is the most common form of hair loss in women. The hairs of the damaged follicles shorten until they eventually shrink completely and no longer grow. Experts describe female hair loss as a decrease in the hair around the center and front of the head. But also a receding frontal hairline.
Why does hair fall out with PCOS?
PCOS is a complex metabolic and hormonal condition that affects 10-20% of reproductive-age women. Women with PCOS produce too many male hormones. The high male hormones interrupt the production of female hormones (estrogen and progesterone). In turn causing PCOS symptoms, like hair loss.
High Levels of DHT Cause PCOS Hair Loss
Testosterone is either converted to DHT or estradiol (an estrogen) by the enzyme 5α-reductase (5α-R) and aromatase.
But get this.
A study found women with PCOS have low aromatase activity. This may, therefore, explain the increased levels of DHT and low estrogen.
The excess DHT then attaches itself to the hair follicle and damages it to the point where the follicle is unable to produce new hair.
But wait there’s more.
Excess Male Hormones Increase Bad Skin Bacteria
A recent study found the shrinking hair follicles, of women with androgenic alopecia, contained bad bacteria.
So, here’s the thing.
The skin is covered in hair follicles, even if you can’t see them. The base of the hair follicle is found deep within the skin and is attached to sebaceous glands. These glands produce sebum (an oily substance) which acts as a protective barrier against infections.
The rise in male hormones leads to unnecessary amounts of sebum, swollen sebaceous glands and clogged pores.
This environment creates the perfect conditions for bad bacteria to grow and multiply. The bacteria feed off the skin’s oils, causing follicle damage and hair loss.
But wait, you might be wondering.
What causes high testosterone in women with PCOS?
So, what the heck causes high testosterone in women with PCOS?!?
First’s things first. All women have small amounts of testosterone, but women with PCOS are producing too much testosterone and below are some of the reasons
High Insulin Levels Cause PCOS Hair Loss
One of the most common reasons for the excess production of testosterone, in women with PCOS, is high insulin levels.
Our bodies main source of energy is glucose (sugar) and we get this from the food we eat. The sugar we get from food enters our bloodstream after digestion. Insulin, a hormone released by the pancreas, shuttles the sugar out of the bloodstream to the cells of the body where it is used as fuel.
What Causes High Insulin Levels?
The primary cause of high insulin levels in women with PCOS is insulin resistance. This the most common root cause of PCOS, with about 70% of women suffering from insulin resistant PCOS.
Insulin resistance is a condition where the cells don't respond to the signal insulin is giving. As a result, there is a build-up of sugar in the bloodstream.
Due to the rise in blood sugar levels, the pancreas starts producing even more insulin to lower them. High levels of insulin in the body then has the unwanted side effect of telling the ovaries to produce more androgens. Which then causes the PCOS symptoms women experience.
The Link Between Chronic Stress and PCOS Hair Loss
When we are stressed, our body goes into fight or flight mode. Stress triggers the adrenal glands to release cortisol and adrenaline.
In addition to these stress hormones, the adrenals produce male hormones, including DHEA, DHEA-S, and androstenedione. These male hormones try to protect the body from the damaging effects of too much cortisol. However, the longer cortisol stays high, the more androgens are released, causing a hormonal imbalance in women and leading to the PCOS symptoms like hair loss.
Around 20-30% of women with PCOS suffer from adrenal androgen excess. Meaning a percentage of women with PCOS produce high levels of male hormones from their adrenals.
A study found DHEA can also be converted into the hair destroying hormone DHT causing PCOS hair loss.
But here’s the thing.
Stress isn’t just Psychological
We often associate stress as running late for work or studying for an exam. But stress isn’t just psychological. Below are examples of non-psychological stressors
- Over-exercising and High-Intensity Exercise
- Lack of Sleep
- Low-calorie dieting
- Environmental toxins
- Over consuming caffeine
- Autoimmune disease
Our body can handle some level of stress. The problem occurs when this stress becomes chronic. Your body cannot distinguish between a real imminent threat and the stress caused by over-exercising or low-calorie dieting. The body responds in the same way, with the adrenals releasing cortisol into the bloodstream.
High Levels of Inflammation Can Cause PCOS Hair Loss
Researchers have found that PCOS women suffer from chronic inflammation.
Inflammation is a response the immune system takes in an attempt to defend itself from outside invaders, such as viruses and bacteria.
While insulin resistance is a root cause of PCOS, studies have found obesity-induced inflammation can lead to insulin resistance. The inflammation and insulin resistance can then lead to the development of PCOS and its symptoms like hair loss.
To find out what the root cause of your PCOS may be, check out my 'Types of PCOS: Ultimate Guide'.
So, you now know why PCOS can cause hair loss and why testosterone levels may be high in women with PCOS. But before we get into how to treat it, let’s look at some other possible causes.
Other causes of Female Pattern Hair Loss
Hypothyroidism and Hyperthyroidism
Hypothyroidism and hyperthyroidism are 2 conditions which can cause hair loss by triggering the condition telogen effluvium.
The thyroid is known as the ‘hormone powerhouse’ because it provides the organs in your body with energy.
So, you might be wondering.
Hypothyroidism is a condition where the thyroid is underactive. Meaning the thyroid is not producing enough of the hormone. As a result, bodily functions like metabolism and heart rate slow down.
Symptoms of hypothyroidism include hair loss, dry skin, weight gain, fatigue, depression, constipation, brittle hair and nails.
But get this.
The Link Between Hypothyroidism and PCOS
Hypothyroidism is a hidden cause of PCOS. This means hypothyroidism often goes undiagnosed in women with PCOS because women with hypothyroidism also show high levels of testosterone and polycystic ovaries. As well as symptoms like hair loss, weight gain, fatigue and irregular periods.
Hyperthyroidism is a condition where the thyroid is producing too much of the thyroid hormone. This, therefore, accelerates functions such as metabolism. Symptoms of hyperthyroidism include trouble sleeping, anxiety, mood swings, diarrhoea and muscle weakness.
While both thyroid conditions can cause hair loss, once the thyroid is treated, the hair can grow back.
Estrogen is a major female sex hormone and is responsible for hair growth. During pregnancy, when estrogen levels are high, women notice their hair looks beautiful.
Women going through pre-menopause, however, when estrogen levels are low, can experience hair loss.
As you can see, there is a connection between estrogen levels and the health of our hair. Women who suffer from low estrogen levels may experience hair loss.
Other symptoms of low estrogen levels include irregular or absent periods, hot flashes, mood swings and fatigue.
Low-fat dieting may cause low estrogen
The low-fat diet became popular in the 1970s, but it is still followed by many today. People were made to believe fat was the cause of many chronic diseases. But fat is not bad! Fat is an essential macronutrient everyone should include in their diet.
Above I discussed the importance of estrogen in maintaining healthy hair. But did you know without consuming enough fat you will not produce this crucial hormone?
Our hormones, estrogen, progesterone and testosterone are all steroid hormones. But for them to be produced and function properly, they need a significant amount of fat.
So, if you are following a low-fat diet, you are causing serious hormonal problems. Also, fat is needed for the absorption of certain vitamins like A, D, E and K. Which means a low-fat diet can lead to nutrient deficiencies.
Our hair needs certain nutrients to grow and be healthy. A deficiency in nutrients like magnesium, vitamin B12, vitamin D, zinc, selenium, iron and folate can cause hair loss.
Despite following a whole food diet and eating fruit and vegetables, you can still be nutrient deficient. Chronic stress, eating a high sugar diet, a lack of sunlight and environmental toxins may cause nutrient deficiencies.
How do I know if my hair is thinning out?
As I mentioned above in the hair cycle section, a human loses between 50-100 hairs a day. If your hair loss is more than this, you must visit your doctor immediately for a formal diagnosis. Below are some of the tests your doctor will do.
The Hair Pull Test
One simple way doctors assess for female pattern hair loss is the hair pull test. The hair pull test involves holding some hairs using the thumb and index finger and pulling firmly but gently upwards. If the doctor removes 3 hairs, it is considered a ‘positive pull test’. A positive result indicates the patient is suffering from hair loss or telogen effluvium. However, Doctors must run further tests to find out which condition the patient is experiencing.
Along with the pull test, there are other ways to diagnose female pattern hair loss. These include Ludwig's Classification, Savin' scale and Sinclair's grading system. The scales mentioned are based on the visible patterns of hair loss.
Ludwig's Classification uses 3 grades to show female pattern hair loss:
Type 1 shows minimal thinning, which the individual can hide with hair styling.
Type II identifies the widening of the mid-line parting and a decrease in hair volume.
Type III shows the hair thinning more and spreading throughout the head.
Savin created a scale using 9 images which show female pattern hair loss. Eight images show the stages of increasing hair loss. The 9th image is a special subcategory which shows the detection of receding hair at the front.
Sinclair's grading system
Sinclair designed a scale based on the patient’s observations of hair loss.
Patients are given 5 numbered and colored photographs of women's scalps with their hair parted through the middle.
Photograph 1 shows a normal scalp while photographs 2-5 show the scalps of women with severe hair loss.
The female patients respond by circling the photo number that resembles their hair when parted in the middle.
But here’s the thing.
While all the above scales and classifications are helpful for clinicians and patients for showing female pattern hair loss, there is still a problem. The scales describe female pattern hair loss that begins from the crown. However, some women suffer from chronic hair loss but do not show a visible decrease in hair density over the crown. Therefore, clinical assessments such as these may not be suitable in diagnosing female pattern hair loss.
What can be done to ensure a correct diagnosis?
To diagnose female pattern hair loss, that does not show a visible reduction in the crown region, clinicians use Trichoscopy.
The trichoscopy uses magnification to assess the patient's hair and scalp. Because of the larger image, clinicians are better able to examine the hair and measure hair diameter diversity (HDD), a feature of female pattern hair loss in a non-invasive way.
You now know how doctors diagnose female pattern hair loss.
But do you want to hear the best part?
PCOS hair loss is reversible and you can grow your hair back!
So, let’s get into how to treat PCOS hair loss and regrow hair naturally.
What helps PCOS hair regrowth?
First things first, while PCOS hair loss may be reversible, it takes time, so you must be patient and consistent.
Now, I am going to split this section up into two parts, medication (pills and drugs) and natural treatment (diet and lifestyle changes).
So, let’s begin.
Doctors often offer pills as the first route of treatment for PCOS hair loss. Common drugs given to PCOS patients are anti-androgens and 5 alpha-reductase enzyme inhibitors.
The purpose of anti-androgens is to stop the conversion of testosterone to DHT. They do this by blocking the androgen receptor where testosterone binds and causes male features.
Popular synthetic anti-androgens include; Spironolactone, Flutamide and Cyproterone acetate.
A study found that a 200 mg/day dose of Spironolactone stopped further PCOS hair loss and helped with hair regrowth.
Despite this evidence, Dr. Lara Briden, a naturopathic doctor, says spironolactone may not a safe drug for PCOS. She says it disrupts ovulation and causes an imbalance in estrogen. But it also hinders the functioning of the adrenal glands (which produce both stress and sex hormones).
Results from a study showed very low doses (62.5mg/day) may help female pattern hair loss. However, flutamide is not often used for female pattern hair loss because of its link to liver toxicity.
Cyproterone acetate is said to be an effective drug for preventing PCOS hair loss because it can act like the female hormone progesterone. Progesterone is known to have anti-androgenic properties which means it can block testosterone.
Here’s the deal.
Researchers discovered cyproterone acetate can help reduce hair loss but they found no notable impact on hair regrowth.
Despite the potential benefits of cyproterone acetate, studies indicate it may cause liver damage. Therefore, it may not be the safest option.
Minoxidil 2% Solution
Minoxidil is one of the most common forms of medication prescribed to female pattern hair loss patients. This is because it helps the telogen hairs (hair which sheds) to enter the anagen phase and extends the anagen duration.
Studies advise applying topical minoxidil solution indefinitely, at a dose of 1ml twice a day, to the area of the scalp which is affected.
5 alpha-reductase enzyme inhibitors (5aR)
Finasteride and Dutasteride are 5aR inhibitors. Meaning they prevent testosterone from being converted to DHT.
Taking either Finasteride or Dutasteride, requires you to use it indefinitely to ensure hair regrowth. But, studies have found they can cause severe health risks, including breast cancer and infertility.
Now, while the above pills may help PCOS hair loss, they do not address the hormone imbalance.
When treating PCOS hair loss, you must get to the root cause of the problem. Anti-androgen pills do not do that.
Natural PCOS Hair Loss Treatments
The right PCOS hair loss treatment approach for you will be dependant on the root cause of your PCOS. So, treatment will vary based on whether your PCOS is caused by high insulin levels, chronic stress or inflammation.
Lower Insulin Levels
To lower insulin levels, you must manage your blood sugar. Some of the ways you can do this:
- Combining carbohydrates with protein to prevent a huge blood sugar spike.
- Consuming high fibre foods. Studies show fibre can lower blood sugar levels by slowing down digestion and the release of sugar.
- Remove all forms of sugar and artificial sweeteners. Researchers have found artificial sweeteners also raise insulin levels.
In addition to the above diet tips, lifestyle changes can help lower insulin levels and reverse PCOS hair loss. They include exercise and intermittent fasting.
Exercise for PCOS
While all forms of exercise can help treat insulin resistance. Resistance training and High-Intensity Interval Training (HIIT) are said to be better.
What does the research say about Resistance Training?
Resistance training is any type of exercise that causes the muscles to contract, resulting in increased strength, muscle mass and endurance.
Results from a study show each 10% increase in muscle was associated with an 11% relative reduction in insulin resistance. So, the more muscle you have, the better insulin works in the body.
What does the research say about HIIT?
HIIT is a vigorous form of exercise. It involves short bursts of energy followed by less intense recovery periods.
HIIT may be an effective way to increase insulin sensitivity because during HIIT’s intense intervals, your muscles use lots of glucose. During the recovery period, insulin is activated, allowing more glucose to enter the muscles to be used as energy.
Intermittent Fasting Reduces Insulin Levels
Intermittent fasting is a way to schedule you’re eating. It involves not eating for an extended period and then eating all your food in a short and specific time window. Research has found it to be one of the quickest ways to lower insulin levels.
For more about intermittent fasting and how it can help PCOS and insulin levels, check out my post ‘Intermittent Fasting for PCOS: Is it Healthy?’
Lower Stress Levels
Managing your stress is key for hormonal balance and especially important if your PCOS is caused by adrenal androgen excess. So, make it a priority to find ways to lower your stress levels.
Ways to do this include going for a walk-in nature, reading a book, yoga and meditation. Find something you enjoy and helps you to relax.
To lower your stress levels, you may also have to stop both endurance and intense exercise. This is because they both significantly raise cortisol levels. Low-intensity activities like yoga and swimming, however, do not increase cortisol levels as much.
Lower Inflammation Levels
Below are some diet and lifestyle tips on how to lower the level of inflammation in the body.
Avoid Inflammatory Foods
Inflammatory foods are those that cause inflammation in the body. They include sugar, seed oils, gluten and A1 casein (found in dairy). As well as avoiding these foods, you must eat plenty of anti-inflammatory foods like salmon, walnuts, turmeric and ginger.
Lastly, avoid eating foods you are intolerant or allergic too, as they can trigger inflammation in the body.
A second nutrition tip to lower inflammation is to increase the amount of fiber you eat. A study found that the risk of high inflammation was 63% lower in the group which followed a high fiber diet.
Knowing that eating more fibre can reduce the risk of inflammation is incredible for PCOS women looking to lower inflammation.
Aim to eat 25g of fibre a day. Fibre-rich foods include fruits, vegetables, seeds, oats, beans.
When we exercise, we experience acute inflammation. This type of inflammation is short term and happens because of the stress put on the body while exercising.
This acute inflammation can become chronic if the body isn’t given time to rest. So, scheduling rest days is so vital for your health and hormones.
Vitamins and Supplements for PCOS Hair Loss
Researchers found a link between a deficiency in vitamin D3 and female pattern hair loss. A major cause of vitamin D deficiency is a lack of sunlight. If you live in a country that lacks sunlight, include foods like salmon, Cremini Mushrooms, eggs, or take a vitamin D supplement.
Doctors commonly give women with PCOS the birth control pill and/or Metformin. However, research has found both the pill and metformin can cause vitamin B12 deficiency.
A deficiency in B12 can cause hair growth to slow down or stop and for existing hair to fall out. So, while studies have not found a direct link between either the pill or metformin and hair loss. They may be indirectly causing hair loss via vitamin B12 deficiency.
Foods high in vitamin B12 include organ meats, clams, sardines, beef and fortified non-dairy milk. If you are vegetarian, taking a B12 supplement can help.
Magnesium is a vital mineral and it has many roles in the body, such as managing blood sugar and cortisol levels.
An adequate amount of magnesium in the body can help with hormonal balance and excess testosterone.
Increases Insulin Sensitivity
Supplementing with magnesium can increase insulin sensitivity. This can help treat insulin resistance, reduce androgens and reverse PCOS hair loss.
Necessary for the Adrenal Glands
Women with PCOS who suffer from chronic long-term stress can become deficient in magnesium. This is because your body burns through magnesium to support your adrenal glands when making cortisol.
So, including magnesium back into your diet through food or supplementation is important. Magnesium-rich foods include dark leafy greens, avocados, dark chocolate, spinach, almonds, cashews and kidney beans.
Zinc is a popular mineral mentioned on matters to do with hair health.
A study found the group of PCOS women who took 220 mg zinc sulfate for 8 weeks showed an improvement in hair loss.
A deficiency in zinc causes the protein structure of hair follicles to decline, resulting in new hair falling out. Include foods like legumes, nuts, seeds and red meat to your diet to support hair regrowth.
Biotin or Vitamin B7
A study found 38% of the women suffering from hair loss had a Biotin deficiency.
Researchers state Vitamin B7 can help strengthen hair. However, the recommended dose remains unclear.
Small amounts of vitamin B7 can be found in foods like broccoli, cauliflower, cabbage, spinach, almonds, egg yolk, beef liver and sardines.
Evening primrose oil
Evening Primrose Oil contains Gamma Linolenic Acid (GLA), a type of fatty acid that has anti-inflammatory properties. So, it can block the conversion of testosterone to DHT. In turn stopping PCOS hair loss.
Evening Primrose Oil may be a great natural alternative to help PCOS hair loss.
N-acetyl Cysteine (NAC)
Doctors commonly prescribe N-acetyl Cysteine (NAC) which comes from the amino acid L-cysteine. A study found women given 1.6g per day of NAC had increased their insulin sensitivity and lowered their testosterone levels. An improvement in insulin resistance and testosterone levels may, as a result, help with PCOS hair loss.
Saw Palmetto contains phytosterols, a phytochemical, believed to have anti-androgen effects. Researchers believe Saw Palmetto may work in a similar way to finasteride. The research suggests it can block 5aR and prevent testosterone from being turned into DHT and stopping PCOS hair loss.
Best Shampoo for PCOS Hair Loss
Nizoral (ketoconazole) 2% is said to be one of the best shampoos for PCOS hair loss. Ketoconazole, the main ingredient in Nizoral, can stimulate hair regrowth and reduce DHT found in the scalp. This is because it can fight off bad bacteria in the skin. It also has anti-inflammatory properties that can help lower inflammation in the body.
This is encouraging for PCOS women who are looking for a shampoo that can stimulate hair regrowth.
Oils for the Scalp
A 4-week study found a topical application of peppermint oil (PEO) improved hair growth, thickness and length. The research suggests PEO has the properties to induce an extended anagen phase.
The study also revealed PEO resulted in 92% more hair growth compared to Minoxidil, which produced about 55%.
Rosemary oil is a source of antioxidants, it has anti-inflammatory properties and is anti-microbial. Topical application of rosemary oil is said to stop testosterone from turning into DHT.
A study found that topical rosemary oil lotion (3.7 mg/mL) applied was just as effective as Minoxidil 2% Solution (MXD). After 6 months both groups showed a significant increase in hair.
Scalp itching was a common side effect, but mostly in the MXD group.
The results show rosemary oil may be a great and safe alternative to female pattern hair loss.
Is Your Hair Loss Caused By PCOS?
Hair loss caused by PCOS is the result of excess male hormones like testosterone and DHT. This may be due to high insulin levels, chronic stress or inflammation.
But there are also other causes of hair loss in women, including hypothyroidism, hyperthyroidism, low estrogen and nutrient deficiencies.
Get to the Root Cause of your PCOS
Doctors often prescribe drugs like Spironolactone and Dutasteride, but these PCOS hair loss treatments do not address the root cause of PCOS. The hormone imbalance.
Depending on what is causing your PCOS hair loss, making dietary and lifestyle changes may help stop the hair falling out and begin regrowth.
If your root cause is insulin resistance, balancing blood sugar levels is key. You can achieve this by combining protein and carbohydrates and avoiding all forms of sugar, including artificial sweeteners. As well as by doing more resistance and HIIT exercise.
PCOS caused by high cortisol levels will require a focus on lowering stress levels. This includes avoiding high-intensity workouts, getting enough sleep and not following low-calorie diets. Include long walks in nature, yoga or meditation into your daily routine.
PCOS women suffering from inflammation must work on lowering levels of inflammation in the body. You can do this by eating more fibre, avoiding inflammatory foods and not over-exercising.
As well as this, there are several nutrients women with PCOS are deficient in that may stop hair loss. They include magnesium, zinc and biotin. Supplements like evening primrose oil and saw palmetto may help PCOS hair loss by blocking the conversion of testosterone to DHT. Also, Nizoral (ketoconazole) 2% shampoo may help stimulate hair regrowth.
Hair regrowth takes time, so you must be patient.
Hey there! I am Despina Pavlou, founder of PCOS Oracle, certified personal trainer and corrective exercise specialist. I want to share with you the diet and lifestyle changes I made to naturally reverse my PCOS and achieve hormonal balance. I believe using my holistic approach you too can take back control from PCOS.
Please let me know if drinking 2 cups of spearmint tea a day reduces testosterone levels. Do you know anyone who has success with this.