Excessive scalp hair loss is a severe challenge to a woman’s self image and her standing in business and society. Although we usually think of balding as a man’s problem, women actually make up forty percent of the people in North America experiencing the distress of excessive hair loss. Many women losing significant scalp hair have Polycystic Ovarian Syndrome. Safe, effective, natural therapies that treat the hormone imbalances related to PCOS will also restore your hair to optimal health. I am delighted to offer you these indispensable tools to help you restore your hair and your health.
Women experiencing hair loss lose ground fast in today’s world. At work and in her personal life a woman’s appearance has much to do with her financial and social success. Men may also prefer not to go bald. But since balding is known to be caused by high levels of testosterone, a bald man may be credited with extra virility. There is no such happy story for balding women. The appearance of thinning scalp hair translates to a significant loss of personal power for women.
The medical community in general treats women’s hair loss as a minor health issue. Most physicians have little inclination to address the emotional distress you feel. In many cases physicians treat balding as if it were “only” a vanity issue; they may not recognize hair loss as a red flag pointing to serious metabolic conditions, including PCOS.
The psychological pain of hair loss and its effect on our sense of empowerment is as devastating as any disfiguring disease. If you are a balding woman, your hair loss is a life altering condition with profound consequences for your health. Getting your hands on the wheel and driving yourself toward a solution for hair loss is the first step toward reviving your sense of personal strength and power. If hair loss is part of PCOS, the effort you make to restore your physical health will also renew scalp hair growth.
You need expert help to properly diagnose the cause of your hair loss. Hair loss that could have been merely temporary may become permanent if you have a delayed or incorrect diagnosis. Misdiagnoses is perhaps the most frustrating aspect of hair loss for women. The information I present here will help you identify the cause of your hair loss and ideally lead you and your doctors to proper treatments for your kind of hair loss, sooner rather than later.
Alopecia is the medical term for excessive or abnormal hair loss. There are different kinds of alopecia. What all hair loss has in common, whether it’s in men or women, is that it is always a symptom of something else that’s gone wrong. Your hair will remain on your head where it belongs if hormone imbalance, disease, or some other condition is not occurring. That condition may be as simple as having a gene that makes you susceptible to male or female pattern baldness. Or it may be as complex as a whole host of diseases. Hair loss may be a symptom of a short-term event such as stress, pregnancy, or a side effect of certain medications. In these situations, hair grows back when the event has passed. Substances including hormones and medication can cause a change in the hair growth patterns. When this happens, growth and shedding occur at the same time. Once the cause is dealt with, hairs go back to their random pattern of growth and shedding, and balding stops.
Alopecia: A Common Problem
Today more women than ever are experiencing hair loss — and the causes are typically quite different that what causes balding in men. According to the American Academy of Dermatology, some 30 million women in the United States are experiencing some degree of distressing scalp hair loss. The most common causes of scalp hair loss in women can include:
Mineral or vitamin deficiency – zinc, manganese, iron, vitamin B6, biotin
Essential fatty acid deficiency from a low calorie diet or eating disorders
Protein deficiency, as is common with vegetarian diets
Anemia from a low iron diet, poor digestion or any excess blood loss
Eating disorders, like anorexia, bulimia, even ‘yo-yo’ dieting; also compulsive or excessive physical exercise
Drug toxicity, for instance anesthesia with surgery or chemotherapy for cancer
Many prescription medications have hair loss as a potential ‘side’ effect, including bromocriptine, beta blockers, ACE inhibitors, amphetamines, anti-cholesterol agents
Severe infections, either viral or bacterial
Severe stress, either a sudden extreme event or persistent, long term challenges
Any hypothalamic or pituitary disorder
Any liver, thyroid gland, adrenal gland or ovarian disorder, including PCOS
Any sex steroid imbalance such as low progesterone, estrogen dominance, excess testosterone or insulin
Starting or stopping any hormone therapy, including birth control pills, menopausal hormone replacement treatment or thyroid hormone replacement
Any natural event that causes big hormone changes, like child birth, breastfeeding and weaning or menopause
Perms, hair color, bleach, improper brushing/combing, pulling on the hair
Autoimmune disease such as lupus or multiple sclerosis
Allergies to foods, medicines, environmental chemicals or topical drugs
Recent hepatitis B shot. If you had a Hep B vaccine since this hair loss started, there may be a connection. An article in the Journal of the American Medical Association (278:117-8, 1997) links the Hep B vaccine to increased incidence of alopecia in women.
How does an individual woman figure out why she is losing too much of her hair? To understand that, it’s important to understand how hair grows.
Hair Grows in Cycles
Scalp hair grows about one-half inch per month. An individual strand of hair will grow for two to six years. Eventually each hair “rests” for a while, and then falls out. Soon after, that follicle will start growing a new strand. A healthy scalp will let about 100 of these cycling hairs fall out every day.
In folks with a genetic predisposition to hair loss, and for women with PCOS, hormones called androgens drive this process. Androgen hormones include testosterone, androsteinedione, and dihydrotestosterone (DHT). Men make and use relatively large amounts of androgens. Appropriate, smaller amounts of androgens are essential to women’s health as well.
In those who are genetically susceptible, testosterone activates enzymes produced in the hair cell, which then cause it to be converted into the more potent androgen DHT. DHT then binds with receptors deep within the hair follicle. Eventually, so much DHT builds up that the follicle begins shrinking. It can’t produce new hair reliably. Some of the follicles permanently stop producing new hairs. The end result is significant hair loss. The medical term for this condition is androgenic alopecia. Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha reductase, which is held in a hair follicle’s oil glands. Actually, it’s not the amount of circulating testosterone that is the problem but the amount of DHT clogging up and shrinking scalp follicles, making it impossible for healthy hair to survive.
The process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Usually women have a tiny fraction of the amount of testosterone that men make. It seems that for women with hair loss, the actual level of testosterone is not as crucial as are changes in the amount of testosterone she has. A shift in hormone levels triggered by lifestyle or other factors, will cause DHT- triggered hair loss in women. Even when hormone blood levels remain within what doctors consider “normal”, they can become high enough to cause a problem for an individual woman. The levels may not rise at all and still be a problem if you are very sensitive to even normal levels of chemicals, including hormones.
Because our hormones operate through a delicately balanced feedback system, with signals sent via the blood between the brain and body tissue, androgens do not need to be raised to trigger a problem. If the so-called female hormones, (which also are essential to men’s health) are for any reason shifting in relation to androgens, the resulting imbalance can also cause problems, including hair loss.
Hormones are always changing. Testosterone levels in men drop by as much as 10 percent each decade after age thirty. Women’s hormone levels shift with each menstrual cycle, or due to a lack of regular menses, in pregnancies and menopause. Eating disorders, excessive exercise, drugs and environmental toxins can also impact hormone levels.
Keys To Successful Treatment
Treatment of thinning scalp hair must be grounded in changing the habits you may have that support elevated androgens. Diet and exercise are key to maintaining optimal hormone balance. In fact, for women with PCOS, research is clear- there is no drug therapy more effective than proper diet and regular exercise. First, you get your foundational health habits in order; then, specific targeted therapies have the best chance of being effective for you.
Women with PCOS may also have excess coarse dark hair on their face and body. The only way to address the dark, coarse hair that grows out of follicles that have already been altered by excess androgens, is to destroy the follicle with laser or similar therapy. Once a follicle has changed the type of hair it produces, it will not change back. It is crucial to tame the excess androgens and prevent conversion of additional follicles, before investing in a therapy to permanently destroy facial or body hair follicles.
What Causes Women to Lose Too Much Scalp Hair?
For a long time doctors believed that androgenic alopecia was the main cause of balding in both men and women. Now we know that the process that leads to excessive hair loss in women is different. It is called female pattern hair loss.
An important difference between male and female balding is the pattern in which the hair loss occurs. Female pattern hair loss tends to happen as an overall thinning across all areas of the scalp, including the sides and back. Men lose hair from specific spots, like the temple, the crown, that bald spot in the back of the head. Male and female hormone and enzyme receptor sites are also in different areas of the scalp, causing the different gender related loss patterns of hair loss.
A second major difference is that balding in men is usually caused by a man’s genetics and his age, but for women, balding can happen at any age.
Lifestyle Choices, Illness and Medical Treatments Cause Hair Loss
Most women with hair loss have multiple features of their lifestyle, diet and health-related events that contribute. Sex hormone fluctuations are responsible for most female hair loss, including those who have PCOS, a recent pregnancy, menopause, hormone replacement therapy or birth control drug side effects. Chemotherapy for cancer, anti-coagulant drugs, iron- deficiency anemia, autoimmune disease can cause hair loss. Any disease involving hormone producing glands, including the thyroid, the adrenal and pituitary glands can trigger balding in women. It is essential for all women to learn the true cause of their hair loss before engaging any particular treatment.
The complex hormonal changes that accompany polycystic ovary syndrome (PCOS) often result in scalp hair loss. Sometimes hair loss is the first sign that a woman is suffering the metabolic disorder that also causes problems with acne, facial and body hair growth, irregular menstrual cycles and infertility. PCOS is associated with increased risk of heart disease, type 2 diabetes and some cancers.
Thyroid disorders, anemia, chronic illness or the use of certain medications, particularly any form of hormone replacement therapy or contraceptive prescriptions- should be considered a possible cause of hair loss in women. Autoimmune disorders will result in somewhat different, often less dramatic hair loss known as alopecia areata — an inflammatory condition in which hair comes out in clumps or patches.
Any drop in estrogen levels, as happens after pregnancy, with menopause, or when changing your hormone therapy including birth control pill use, will cause what is called estrogenic alopecia. In contrast to testosterone, estrogen helps scalp hair grow faster and stay on the head longer, resulting in thicker hair. This is the reason women’s hair gets fuller during pregnancy when estrogen levels are quite high, then sheds several weeks after the baby is born.
For women who do not have fertility-related hormone changes, estrogen-deficiency scalp hair loss generally starts around menopause. This form of female hair loss can be the first sign of approaching menopause. Sometimes the alopecia won’t begin until a few months or even years after menstruation has ended. Not all women get noticeable alopecia after menopause but most have a little thinning.
It’s not uncommon to have multiple factors involved in female hair loss. Many women with PCOS have thyroid problems, usually hypothyroidism (low thyroid function). Not only does hypothyroidism contribute to weight problems, it can also contribute to hair thinning. Some women with PCOS have both an excessively high level of testosterone and an under active thyroid.
If your hair is thinning, you may have heavy metals like lead, mercury or cadmium in your tissues. These poisonous residues saturate our environment. If you have lived near what is, or ever was an industrial or mining site, or lived with someone who works in a polluting industry, you may be contaminated. If you have ever smoked tobacco, you have a lot of cadmium in your body.
The majority of women with androgenic alopecia have diffuse thinning on all areas of the scalp. Some women may have a combination of two pattern types. Androgenic alopecia is caused by a variety of factors tied to the actions of hormones including PCOS, using contraceptives, pregnancy, and menopause. Any blood sugar and insulin hormone imbalance will lead to excess androgens. Women with insulin resistance, from chronic over-eating of refined carbohydrate food, will see more impact from androgens. Insulin resistance is associated with PCOS as well as Type 2 diabetes. Chronic stress that depletes adrenal glands can change the levels of androgens a woman produces as well. This is often the source of problems like infertility, acne and hair thinning in lean, athletic women with PCOS. Heredity may play a role in androgenic alopecia.
Any big event like childbirth or breastfeeding, malnutrition from an alteration in your diet, a severe infection, major surgery, or any extreme stress, can suddenly shift much of the 90 percent or so of your hairs that are in the growing phase or resting phase into the shedding phase. You will see this shift in the rate of hair loss 6 weeks to three month after the stressful event. This is called telogen effluvium. It is possible to lose great bunches of hair daily with full-blown telogen effluvium. Usually this type of hair loss is reversible, if major stressors are avoided. For some women however, telogen effluvium is a mysterious chronic disorder and can persist for months or years, without ever completely identifying all of the triggering factors.
Anagen effluvium happens when the hair follicle cells are so damaged they can not recover or reproduce. This is usually due to toxicity of chemotherapy for cancer. Chemotherapy is meant to destroy rapidly dividing cancer cells. Hair follicles in the growing (anagen) phase, are therefore vulnerable. Anagen effluvium means the hair shaft narrows as a result of damage to the follicle. The shaft breaks off at the narrowing and causes the loss of hair.
Traction alopecia is damage from hairstyles that pull at hair over time (braiding, cornrows, ponytails, extensions). If the condition is detected early enough, you can change your styling practice to be gentler on the follicles, and your hair will regrow.
Hormone contraceptives are a leading cause of distressing hair loss and other symptoms in women. Since the birth control pill first began being used in 1960, oral contraceptives, injections, implants, skin patches and vaginal rings have become the most commonly prescribed forms of birth control.
Unfortunately, many young women are given contraceptive hormones even when they are not sexually active, as a ‘treatment’ for irregular menses or acne. This is a mistake. This is not a treatment that addresses the underlying cause of problem periods or pimples. Contraceptive hormones will severely complicate a woman’s hormone balance and can lead to many health problems, including significant hair loss and worsening acne.
All contraceptive drugs use synthetic hormones to suppress ovulation. These drugs cause your ovaries to stop working; they are in a kind of ‘sleep’ state. Instead of having your natural cycles result from a dance of signals between your body and your brain, your tissues are subject to synthetic hormones in amounts much larger than your body normally makes. There are many long and short -term consequences to ovarian suppression. Most women experience side effects using contraceptive drugs, including hair loss either during or several weeks or months after stopping the drug.
An article appeared in the Journal of the American Medical Association (278:117-8, 1997) linking the Hepatitis B vaccine to increased incidence of balding in women.
In order to successfully treat hair loss, it is essential to understand why your hair follicles are not healthy. There are diagnostic tests that may help identify the underlying biochemistry that is contributing to your excess hair loss. However, many women with significant chemical imbalances related to their hair loss will find that these test results are within the “normal” range. That’s because in many cases hair loss represents a stage of ill-health that is an early phase of a disease that will eventually fully develop. The lifestyle and dietary habits that eventually cause Type 2 diabetes and heart disease will also cause scalp hair thinning and facial hair coarsening in young women. It is usually many years before these same women have diagnostic tests that reveal they are diabetic or have coronary artery disease. Many of these women have undiagnosed PCOS.
Selective Sensitivity is the underlying problem
Another reason why diagnostic tests may be confusing is because of something called ‘selective sensitivity’ or ‘selective resistance’. It turns out that some body cells are more sensitive than others to the same amounts of hormone. A major complicating factor for some women is that while her muscle and fat may be insulin resistant, other types of organ cells are not. The pituitary, ovaries, and adrenal glands of an insulin resistant woman are stimulated by higher levels of insulin than is desirable, which causes for instance elevated testosterone. The high levels of androgens in turn increase risk for heart disease, diabetes, and certain cancers.
Despite these possible difficulties, it is important to do our best to determine what is and isn’t the cause of a major symptom like persistent excessive hair loss. Diagnostic tests that can help identify the source of your metabolic imbalance are:
The hair pull test is a simple diagnostic test in which the physician lightly pulls a small amount of hair (approx. 100 simultaneously) in order to determine if there is excessive loss. Normal range is zero to three hairs per pull.
Hormone levels: Dehydroepiandrosterone, testosterone, androstenedione, prolactin, sex hormone binding globulin, follicular stimulating hormone, and luteinizing hormone. It is ideal to sample for FSH and LH on day 19 to 21 of your menstrual cycle, if those days can be identified.
Fasting blood glucose and insulin levels as well as cholesterol and triglyceride levels
A complete blood count plus serum iron, ferritin and total iron binding capacity
Thyroid stimulating hormone plus a thyroid function panel including T3, T4, and T3 % uptake
VDRL to screen for syphilis
A scalp biopsy should be done before choosing surgical transplant
Densitometry, a magnification device, used check for shrinking of the hair shaft.
Conventional Medical Treatments For Hair Loss
You may be very interested in drug therapies of surgery to address the profound distress of excessive hair loss. It is simply human nature to hope for a simple pill or procedure that will permanently free us from our problems. Unfortunately drugs never actually provide a simple solution. Once you swallow a chemical, it is delivered all over your body; it affects your whole body. We cannot control drugs so they have only the effects we want- there are always side effects that are more or less problematic. Using drug therapy means trading one problem for some others. Sometimes this is exactly the right thing to do. Other times it is a personal disaster. Most drugs will act on all your tissues there is a danger of side effects that further damage your health. Topical treatments applied directly to the scalp use the lowest doses, and are the least harmful drug choices.
You will enjoy the best results when you begin any treatment as soon as possible after hair loss begins. Stopping the adverse effects of androgens means you can prevent further hair loss. And you can support regrowth from the follicles that were dormant still healthy. Depending on how the agent you choose works, stopping treatment will result in the hair loss resuming, unless you have also made other changes in your lifestyle that keep androgens at a level that is healthy and not harmful to you.
Below you will find a list of treatments currently being used to treat hair loss in women. Some of these drugs have not been approved by the FDA for this particular application, however they have all been approved for other applications and are used “off label” to treat hair loss. Currently 2% topical Minoxidil is the only FDA approved treatment specifically for female pattern hair loss.
The effectiveness of these agents and methods will vary from woman to woman, but many women have found that using these treatments has made a positive difference in the character of their hair and their positive self-esteem. As always, treatments have the best chance of being effective if they are geared to the cause of the hair loss as well as to triggering hair growth.
Estrogen and progesterone as hormone replacement therapy (HRT), typically prescribed for women undergoing menopause for any reason, is probably the most common systemic form of treatment for androgenic alopecia in women.
Oral contraceptives will decrease the production of ovarian androgens, and thus can be used to treat women’s androgenic alopecia. There are substantial reasons to avoid the use of either synthetic or bio-identical hormone treatments for your hair loss. Some birth control pills actually contribute to hair loss by triggering it or increasing it once it’s been triggered by something else. Any individual woman may have a selective sensitivity to any hormone combination- what is a low androgen effect formula for one woman may be a high androgen effect for another.
I am no longer able to recommend the use of birth control pills or other hormone-based contraception to young women. Decades of evidence suggest there are plenty of known, and possibly as yet unknown health risks associated with the use of ANY from of reproductive hormones, either prescription or over-the-counter forms. It is clear that the benefits of hormonal contraceptives are accompanied by significant risks, including making it much more likely that a woman will experience hormone imbalances that lead to a long list of negative effects. Hormone replacement puts you are risk for:
Depression or other mood disorders; decreased libido
Migraines and headaches
Breast lumps, tenderness and enlargement
Vaginal bleeding between periods
High blood pressure (hypertension)
Blood clot in the leg, felt as: pain in the calf; leg cramps; leg or foot swelling
Blood clot in the lung, felt as: shortness of breath; sharp chest pain; coughing up blood
Heart attack, felt as: chest pain or heaviness
Sudden loss of vision or vision changes, which can be a sign of a blood clot in the eye
Cerebral vascular accident (a stroke): impaired vision or speech; weakness or numbness in a limb; severe headache
Liver damage, seen as: yellow eyes or skin; dark urine; abdominal pain
Allergic reaction: rash; hives; itching; swelling; difficulty breathing or swallowing
Bloating, nausea and vomiting
Changes in your eyes that make it more difficult to wear contact lenses
If you chose a hormone prescription for any reason, you should be sure to use only low-androgen content methods. If you have a strong predisposition for genetic hair loss, insulin resistance, diabetes, heart disease or any female organ cancer in your family I strongly recommend the use of another non-hormonal form of birth control.
Below is a list of birth control pills ranging from lowest androgen index to highest:
Desogen, Ortho-Cept, Ortho-Cyclen, Ortho Tri-Cyclen, Micronor, Nor-Q D, Ovcon-35, Brevicon/Modicon, Ortho Norvum 7/7/7, Ortho Novum 10-11, Tri-Norinyl, Norinyl and Ortho 1/35, Demulen 1/35, Triphasil/Tri-Levien, Nordette, Lo/Ovral, Ovrette, Ovral, Loestrin1/20, Loestrin 1.5/30.
The following hormonal contraceptives have a significant potential of causing hair loss or making it worse:
Progestin implants, such as Norplant, are small rods surgically implanted under your skin. The rods release a continuous dose of progestin to prevent ovarian function.
Progestin injections, such as Depo-Provera, are given into the muscles of the upper arm or buttocks.
The skin patch (Ortho Evra) is pasted onto your shoulder, buttocks, or other location. It releases progestin and estrogen continuously to prevent your ovaries from producing normal cycles.
The vaginal ring (NuvaRing) is a flexible ring that is inserted into the vagina. This method releases the lowest amounts of progestin and estrogen.
Minoxidil 2% Topical Treatment – Minoxidil seems to be more effective for women than men, for increasing scalp hair growth. The manufacturers of minoxidil recommend women use 2% minoxidil. There is a 5% solution available that has been tested and found safe enough for men. Because the makers of minoxidil have not invested in the expense of gaining FDA approval for promoting 5% minoxidil for use by women, it must be prescribed and used under a physician’s supervision. Small clinical trials on 5% minoxidil for women show that the 5% solution is in fact more effective in both retaining and regrowing hair than the 2 % solution.
Spironolactone (Aldactone) is a potassium-sparing diuretic used to treat high blood pressure and swelling. Spironolactone slows the production of androgens in the adrenal glands and ovaries. It prevents DHT from binding to receptor sites in the hair follicles.
Cimetidine (Tagamet) is a histamine blocker, approved to treat digestive tract ulcers. It prevents the stomach from producing digestive enzymes. Cimetidine also has been shown to block DHT from binding to hair follicle receptor sites.