Hi everyone, my name is Lisa Thomas and I’m a trichologist. (Trichologists are specialists in the science of the structure, function and diseases of human hair and the scalp). I have my own clinic in Pembrokeshire and treat many ladies with hair loss caused by PCOS. In this article I will share some information with you on the science behind why this happens and what you can do to treat it.
I hope this will give you some useful information and encouragement on how you can overcome hair loss caused by your condition.
It’s not just unwanted hair!
People with PCOS have to deal with excessive hair growth in unwanted places (called hirsutism). But PCOS can also trigger the scalp hair to thin for some people. You may have heard this being referred to as female pattern hair loss, female pattern thinning, or androgenetic alopecia.
This thinning happens over a period of time and you may notice:
- Reduced volume, especially over the crown
- A receding hairline with a wider parting
- More of your scalp is visible
- Thinning at the temples
- Your ponytail is thinner
Female pattern hair loss is one of the most common reasons why patients contact me for help in my clinic. It goes without saying that this condition can greatly affect your quality of life and self-esteem.
You may think these changes are all part of the natural signs of ageing, especially if you have had PCOS for many years, but this condition can trigger this type of hair loss. It is even more distressing if you are in your 20s or 30s and this type of hair loss is affecting you. This is not something you have to live with! There are lots of ways you can tackle hair thinning.
Firstly I will explain the science behind why PCOS affects your scalp hair in the way it does, then I’ll explain what you can do about it and also how this can be treated in a medical setting.
Why does PCOS cause scalp hair to thin?
The first point to note is that for hair to thin on the scalp you need to have a genetic predisposition – a gene inherited from either parent. This gene will make your hair follicles more sensitive to androgens (the male hormones). We all have androgens in our systems, but only some women will have hair follicles which are sensitive to them.
PCOS causes your system to produce higher levels of androgens. If you have the gene which makes your hair follicles sensitive to these androgens, you may start to experience the hair loss changes mentioned above.
For PCOS sufferers with the genetic thinning gene this is a double whammy. You have follicles which are sensitive to androgens, plus your body is making androgens in excessive amounts! This is the perfect trigger for female pattern hair loss.
How do these changes happen?
Androgens (male hormones) are responsible for the changes listed above. The technical term for this type of hair loss is androgenetic alopecia. Alopecia means hair loss, ‘andro’ comes from the influence of androgens and ‘genetic’ relates to the inherited genes.
The male hormone testosterone is converted to dihydrotestosterone (DHT) by way of an enzyme called 5-alpha-reductase. This enzyme is found in your hair cells along with the androgen receptors that bind DHT.
If your hair follicles are sensitive to DHT you will suffer androgenetic alopecia, even if the levels of androgens in your blood are within normal levels. In other words, you do not need to have excessive levels of androgens to suffer from androgenetic alopecia. It is more to do with the fact that your hair follicles are sensitive. Having PCOS means you are more likely to have higher levels of these androgens.
As we age, oestrogen levels fall which means that male hormones (the androgens) then take a higher ratio in the body, allowing them to have an adverse effect on your follicles.
Androgens attach to the receptor cells in the follicle, causing it to produce smaller and finer hairs with each growth cycle. This is called miniaturisation. As the years go by, and as this process of miniaturisation takes hold, you will gradually notice changes in the volume and thickness of your hair.
Can anything be done?
Yes! Lots can be done.
Hair thinning caused by PCOS is typically treated with anti-androgen therapy, either taken orally or applied topically. A combination of treatments will usually be the most effective.
Supplements and anti-inflammatories:
Supplements: A supplement that may be useful is Saw Palmetto, as this has been shown to reduce the production of DHT.
Anti-inflammatories: It is useful to reduce the inflammation around the hair follicles. Useful ingredients for this are aloe vera, chamomile, cumin, oats, turmeric, neem oil, calamine, quercetin, thyme, rosemary, fennel, and bergamot. Some trichologists will formulate their own anti-inflammatory, hair growth serums, sometimes based on aromatherapy oils. I formulate an alopecia blend and a growth blend. If you use any essential oils on yourself, please do some reading on the subject as some of the oils must not be applied neat on the skin as this will induce a burn! They must be mixed with a carrier oil such as grapeseed or jojoba. If in doubt, buy a ready-made product just to be safe.
This is a huge subject in relation to hair and maybe one I will write another blog post on another day. Adequate intake of protein, carbohydrates and healthy fats are vital. Nutritional deficiencies play a huge part in hair loss. Adequate hydration levels are also essential for healthy hair growth – drink lots of water!
Lower stress levels:
Stress has been shown to have a negative impact on hair growth and can trigger and exacerbate hair loss. Stress affects hormone levels and extreme stress has been shown to trigger female pattern hair loss. Stress causes the production of substance P, which has a negative impact on hair follicles, and can increase the production of androgens. Do all you can to manage your stress levels. Worrying about your hair changes can make it worse. It is easy to then find yourself in a cycle of worry – you worry about your hair and that in itself makes your hair worse, and so you worry more about it, etc, etc. That is a hard cycle to get out of, so do all you can to minimise and manage your stress levels. Easier said than done, I know!
These are medications which can be prescribed by your GP or medical professional and these include:
Cyproterone acetate (also known as Androcur) – this is a progestogen that is also an anti-androgen. It is an androgen receptor antagonist which blocks the DHT binding to its receptors. In the UK the oral contraceptive called Dianette contains cyproterone acetate. Another combination oral contraceptive with a good effect on the hair is Yasmin.
Spironolactone (also called Aldactone) – used for its strong anti-androgen effect because it decreases testosterone levels and blocks the androgen receptors. It has been in use for female pattern hair loss for more than 20 years with good rates of success and it has a good safety profile.
The safe use of the medications mentioned above will need to be assessed for you by your GP and/or medical professional.
Finasteride (Propecia) and dutasteride (Avodart) – these are sometimes prescribed by doctors and there are now several studies which are showing good results for female pattern hair loss. There is the risk of possible side effects which your GP will explain to you.
Topical minoxidil. This is applied to the scalp twice a day. It is not fully known how minoxidil works to grow hair, but we think it is due to the increased blood flow in the hair follicles, and increased hair growth promoters in the part of the follicle that receives nutrients needed for health hair growth – this is called the dermal papilla. Typically available to buy over the counter in strengths of 2% and 5% (although I formulate these in strengths of 2%, 3%, 4% and 5% for patients who wish to increase their topical dosage gradually). Minoxidil can cause irritation on the scalp and cause unwanted facial hair. It may also trigger headaches for some. Topical minoxidil can cause a temporary ‘shedding’ of hair when you first start to use it. This is a good sign because it means that the product is working. This shedding usually lasts for only a few weeks and is caused by the way minoxidil alters the hair growth cycle. This is not to be used if you are pregnant though.
Topical anti-androgen scalp drops. Scalp drops containing anti-androgenic hormones (which tend to be only available from licensed trichologists, who will formulate these drops for you) are vital in stopping the DHT affecting the follicle. A key element to reversing this miniaturisation process is to counter the effects of DHT. Hair follicle stimulants (such as minoxidil) are helpful but are only part of the toolkit. You also need the DHT blocking hormone to stop the miniaturisation happening in the first place. This is why if you have tried Minoxidil on its own before you may have been disappointed – you need the two elements to work together.
I have had great success in my clinic with this treatment and I formulate these drops in varying strengths to suit my patient. I also include methyl nicotinate in my formula, as well as varying strengths of minoxidil, to give the scalp the stimulation it needs. Look for a certified trichologist near you and ask them about anti-androgen scalp drops – they should be able to tailor make, or know of, a product that suits you. Most patients see good results within 3 – 6 months.
Prostaglandin Analogs. Results of clinical trials of these topical treatments have been disappointing and have been shown to be less effective than topical minoxidil in women and men. They are also quite expensive too. However, they could be useful if you develop a contact allergy to minoxidil.
Low level laser therapy (also known as LLLT, cold laser therapy, photobiomodulation):
I use this therapy every day in my clinic to great effect. It works by activating the dormant hair follicles, increasing blood flow and growth factors in the hair follicles. It increases the production of adenosine triphosphate (needed for hair growth at cellular level) and stimulates the growing phase of the hair. Laser therapy also reduces the inflammation in the hair follicles which is caused by androgenetic alopecia. There are now so many studies done on this therapy that if you google LLLT and androgenetic alopecia you will be encouraged at just how effective this treatment is. I can’t recommend it enough and have had incredible results with it. Look for trichology clinics in your area that use lasers with wavelengths between 630nm and 670nm. Of course, laser treatment requires travelling to your trichologist at least weekly for a number of months. For patients who live away from my clinic and cannot make the commitment for regular in-clinic treatments, I provide a portable laser system.
Scalp microneedling and mesotherapy:
Microneedling is a procedure that uses tiny needles to puncture the skin in a controlled way. The purpose of the treatment is to stimulate new hair growth by inducing growth factors and activating hair follicle stem cells. There are different devices which can be used: a microneedling roller, a stamp or a pen device. The pen device usually causes the least discomfort. In the last five years or so, the use of microneedling therapies have increased in popularity and the clinical evidence of its effectiveness continues to grow. Certain studies have shown that scalp microneedling can increase the number of hairs on the head by up to 15%, even without using any other topical treatments. It also increases the absorption of other topical scalp treatments. When combined with a mesotherapy cocktail combining certain, specialist bio-mimetic peptides thicker hair growth can be triggered and the follicles can be strengthened. I like to use certain oligopeptides (GF sh-Oligopeptide-2 (CG-IGF1) is one of them) and a copper tripeptide in my clinic treatments. Please make sure you use someone who is qualified and insured to carry out scalp microneedling. The depths of the needle used for scalp microneedling are very different to microneedling on the body or the face. If the wrong length of needle is used this can damage or even sever the follicle. Choose a therapist who specialises in scalps. Many trichologists will have experience in this area. There are certain people who are not suitable for this treatment, this will need to be assessed by your qualified practitioner, so please don’t try this yourself!
there anything else in the pipeline?
Yes. There are a number of other clinical therapies on the horizon, and one that I am currently keeping my eye on in relation to PCOS is a trial looking at a topical antiandrogen called Cortexolone 17a-Propionate. This drug blocks DHT (Dihydrotestosterone – an endogenous sex steriod and hormone) and also decreases levels of PGD2 (Prostaglandin D2 – prostaglandins are a group of lipids that are made at sites of tissue damage or infection – they control the processes such as inflammation and blood flow). This is important because PGD2 slows hair growth and so anything which decreases this in the scalp is a good thing.
Another interesting therapy being developed is the use of topical finasteride and dutasteride. Topical finasteride has been used effectively to treat hair thinning. Recent studies are underway to develop topical applications of finasteride/dutasteride which allow delivery to the hair follicle with minimal systemic absorption, which will lower the chance of side effects.
Research is encouraging and there are some amazing researchers out there. There are always new developments being made and new trials taking place, so never give up hope!
There are lots you can do to treat female pattern hair loss that has been triggered by PCOS.
- Speak to your GP
- Find a certified trichologist in your area
- Consider topical treatments of anti-androgen scalp drops and topical minoxidil
- Low level laser therapy (LLLT)
- Scalp microneedling with mesotherapy
- Consider supplements and anti-inflammatory ingredients
- Optimise your nutrition and hydration
- Take effort to lower stress levels
I hope that has been of some help.
Never give up hope! Female pattern hair loss can be treated, you just need to have the right tools at your disposal. Find a good trichologist who can help you. They will work with you and work with your GP to make sure that you are getting the most comprehensive treatment plan to battle your PCOS and your female pattern hair loss. You never have to settle for losing your hair as part of your condition, or as part of getting older. There is so much that can be done, and with the right therapy, you can look forward to loving your hair again.
I hope I have given you a bit of knowledge and a lot of encouragement.
With my best wishes, Lisa.