Polycystic Ovary Syndrome (PCOS) is the most common hormonal imbalance affecting women globally. While its impact on reproductive health is well known, one often-overlooked symptom is hair loss—specifically, androgenetic alopecia. This type of hair loss arises from an overabundance of androgen hormones, notably testosterone and its derivative dihydrotestosterone (DHT), which disrupt the normal hair growth cycle, leading to thinning and loss primarily around the crown and part line.
Understanding the connection between PCOS and hair loss is critical. Not every woman with PCOS experiences hair thinning; variations in hair follicle sensitivity to androgens mean that symptoms can range from mild to more pronounced.
This article will highlight the science behind PCOS-related hair loss and explores both medical and natural treatment options.
Table of content
What Is PCOS?
PCOS is a multifaceted endocrine disorder that affects between 5-18% of women worldwide [1] [2]. It is characterized by hormonal imbalances primarily due to elevated levels of androgens—male sex hormones that, while naturally present in both sexes, can have disruptive effects when produced in excess in women. In PCOS, the ovaries produce an abnormally high amount of these hormones, which interferes with the normal ovulation process. This disruption prevents proper egg maturation and release, leading to the formation of fluid-filled cysts around immature eggs.
Beyond its reproductive implications, PCOS also has significant psychological and metabolic ramifications, including insulin resistance and an increased risk for type 2 diabetes. The syndrome is believed to stem from a complex interplay of genetic predispositions and environmental influences. While some women may experience hirsutism (excessive hair growth on the face and body), others notice hair thinning on the scalp—an effect largely influenced by individual genetic sensitivity to androgen exposure [3].
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How Does PCOS Cause Hair Loss?
PCOS-related hair loss, known as female pattern hair loss (FPHL) or androgenetic alopecia, is driven by elevated androgen levels [4]. While androgens such as testosterone play a crucial role in regulating the hair growth cycle, excessive amounts can disrupt this balance, leading to follicular shrinkage, a shorter growth phase, and progressively thinner hair strands.
The primary culprit is DHT—a potent derivative of testosterone. In women with PCOS, excess testosterone is converted into DHT, which binds to receptors on hair follicles [5]. This triggers follicular miniaturisation, where hair follicles shrink, leading to finer, weaker hair. Over time, affected follicles stop producing hair altogether, resulting in diffuse thinning, particularly along the hairline, crown, and part line.
However, not all women with PCOS experience hair loss. The extent of hair thinning depends on genetic sensitivity to DHT—some women inherit follicles that are more susceptible to its effects, making them more prone to androgenic alopecia.
Hormonal Imbalance & Hair Follicles
Hair growth is regulated by a delicate balance of hormones [5]. Key players include:
- Testosterone (T) – A precursor to DHT, which influences follicle health.
- DHT – The primary hormone responsible for miniaturising hair follicles.
- Androstenedione (A) & Dehydroepiandrosterone sulfate (DHEAS) – Prohormones that contribute to androgenic activity.
When androgen levels are excessively high in PCOS, they attach to hair follicle receptors—particularly in androgen-sensitive areas such as the scalp, temples, and crown. This disrupts the normal hair growth cycle, which consists of four key phases:
- Anagen (Growth Phase) – The longest phase where hair actively grows.
- Catagen (Transition Phase) – A short period where hair follicles shrink.
- Telogen (Resting Phase) – Hair remains in the follicle but stops growing.
- Exogen (Shedding Phase) – The final stage where hair falls out.
In PCOS, the anagen (growth) phase is shortened, meaning hair spends more time in the resting and shedding phases, leading to progressive thinning and reduced hair density.
Many women with PCOS also experience insulin resistance, which further worsens hormonal imbalances [6]. Elevated insulin levels stimulate ovarian androgen production, worsening DHT activity and accelerating hair follicle miniaturisation. This creates a cycle where metabolic dysfunction intensifies hormone-driven hair loss.
Because PCOS-related hair thinning stems from both androgen excess and metabolic dysfunction, effective treatment requires a multifaceted approach, including hormonal regulation, DHT inhibition, and metabolic control to restore hair follicle health.
Evidence-Based Treatments
Effective treatment for PCOS-related hair loss requires addressing both hormonal imbalances and hair follicle health. Evidence-based approaches include medical treatments that target androgen excess and natural remedies that support overall hormonal balance and scalp health.
Medical Treatment
There are several medical treatments available for PCOS-related hair loss, depending on specific symptoms. Some options include:
- Hormonal Birth Control
Hormonal birth control or oral contraceptive pills (OCPs) are often used to help reduce androgen levels, thereby slowing hair thinning and enhancing overall scalp health [7]. They also regulate menstrual cycles and improve other PCOS symptoms, such as acne. Combined oral contraceptives containing anti-androgenic progestins like drospirenone are preferred for PCOS-related hair loss due to their ability to block androgen receptors.
- Anti-Androgen Medications
Medications like spironolactone block androgen receptors at the hair follicle level, reducing the effects of DHT on miniaturised follicles. A clinical study has shown that women with female-pattern hair loss who take spironolactone experience a reduction in hair shedding and an improvement in hair density over time [8].
- Topical Minoxidil
Minoxidil is an FDA-approved medication used to treat female pattern baldness and alopecia. It works by dilating small blood vessels in the scalp, enhancing blood flow to hair follicles. This treatment prolongs the anagen (growth) phase of the hair cycle, shortens the telogen (resting) phase, increases hair follicle activity, enhances follicle size, and boosts the production of essential growth factors for hair growth.
- Platelet-rich plasma (PRP)
PRP therapy involves injecting concentrated platelets from your own blood into the scalp to stimulate dormant hair follicles [9]. Clinical studies suggest PRP can:
- Increase hair thickness and density
- Extend the anagen phase
- Improve follicle viability
PRP is often combined with microneedling for enhanced effects.
- Low-Level Laser Therapy (LLLT)
LLLT uses red and near-infrared light to enhance blood flow and cellular activity in hair follicles [10]. By using low-intensity light, LLLT stimulates tissue cellular activity using various laser light wavelengths ranging from red to infrared, promoting tissue repair and regeneration. This treatment increases hair growth by stimulating the anagen phase of the hair growth cycle. Devices like laser caps and combs can be used for ongoing scalp stimulation.
Natural Remedies
In addition to medical treatments, certain natural remedies can help manage and slow the progression of PCOS-related hair loss. Some effective options include:
- Lifestyle Modification
Maintaining a balanced diet, a healthy weight, and managing stress can promote hormonal balance and enhance hair quality. A fiber-rich diet can mitigate the effects of PCOS-induced elevated blood sugar [11]. While this approach may not directly prevent hair loss, it can alleviate PCOS symptoms and side effects, potentially helping to preserve existing hair.
Additionally, shedding excess body fat can help lower androgen levels, thereby reducing PCOS symptoms and hair loss.
- Supplements
Essential vitamins, including C, D, biotin, and B-complex, play a key role in healthy hair growth. Zinc has also been shown to help manage PCOS-related hair loss and hirsutism. Research suggests that dietary supplements may slow the progression of androgenetic alopecia or improve its early stages [12].
- Scalp Massages
Regular scalp massages with essential oils can enhance blood circulation and keep hair follicles active. Research suggests that massaging your scalp twice daily, 12 hours apart, may support hair growth [13]. You can also use a targeted hair serum, such as Bio-Pilixin® Activation Serum, which has been shown in preliminary clinical testing to help reduce hair loss and improve density [15].
Scalp Massage Techniques:
- Pinching: Gently pinch your scalp using one or both hands, keeping your grips at least an inch apart. Apply slight downward pressure, hold for 1-2 seconds, then move to another area.
- Stretching: Place your fingers on your forehead and apply light pressure while moving your scalp up and down in a comfortable motion.
Incorporating these techniques into your routine may improve scalp health and encourage stronger hair growth over time.
- Stress Management
Chronic stress can worsen PCOS symptoms by increasing cortisol levels, which further disrupts hormone balance. Incorporating yoga, mindfulness, and deep breathing exercises can support hormonal equilibrium and reduce stress-related shedding.
PCOS-related hair loss is best managed through a combination of medical treatments, hormonal regulation, and supportive lifestyle changes. While medications like spironolactone and minoxidil can directly target hair loss, addressing insulin resistance and androgen excess through diet, supplements, and stress management is equally important for long-term hair health.
Future Research & Innovations
As our understanding of PCOS-related hair loss evolves, researchers are exploring more targeted and effective therapies to address androgen-driven follicle miniaturisation and hormonal imbalances.
Advancements in Anti-Androgen Therapies
Current treatments such as spironolactone and finasteride inhibit androgen activity, but they may cause systemic side effects. Future research is focusing on developing more selective approaches, including:
- Selective Androgen Receptor Modulators (SARMs): These compounds may help suppress androgen activity at hair follicles while minimising systemic effects.
- Topical Anti-Androgens: Clascoterone, a topical androgen receptor inhibitor currently approved for acne treatment, is being investigated for its potential in managing androgenetic hair loss with fewer systemic risks.
Next-Generation Regenerative Therapies
- Stem Cell Therapy: Early studies suggest that stem cell-derived exosomes may help restore dormant hair follicles and promote hair regrowth in androgen-driven hair loss.
- Advanced Platelet-Rich Plasma (PRP) Techniques: Researchers are optimizing PRP formulations by combining them with growth factors such as VEGF and IGF-1 to enhance follicle stimulation.
- LLLT Improvements: While some studies support its role in stimulating hair growth, others show limited efficacy [14]. Future trials are needed to determine optimal wavelengths and treatment protocols for PCOS-related hair loss.
Gut Microbiome and Hormonal Balance
Emerging research indicates that gut microbiome imbalances may contribute to PCOS symptoms, including insulin resistance and androgen excess. Investigations into probiotic and prebiotic interventions suggest they may help regulate hormone levels and indirectly improve hair growth.
Conclusion
Hair loss in PCOS is a frequently overlooked yet emotionally distressing symptom, primarily driven by androgen excess, insulin resistance, and hormonal imbalance. Managing PCOS-related hair thinning requires a comprehensive approach that includes:
- Medical treatments, such as anti-androgens, minoxidil, and PRP therapy
- Lifestyle modifications, including a low-glycemic diet, weight management, and stress reduction
- Supportive natural remedies, such as scalp massage, essential oils, and targeted supplements
While current treatments can help slow or reverse hair loss, ongoing research into precision anti-androgens, stem cell therapies, and gut-hormone interactions may lead to more effective and personalised solutions for PCOS-related hair loss in the future.
References
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