Androgenic Alopecia in Women Who Have PCOS

Even though some women have thicker than normal hair growth on their face or the rest of their bodies, many women with polycystic ovary syndrome (PCOS) have problems with thinning scalp hair, known as androgenic alopecia or more recently, female pattern hair loss. This is usually due to the high levels of androgens in women with PCOS.

Hands holding a comb full of hair
Sol de Zuasnabar Brebbia / Getty Images

What Is Female Pattern Hair Loss?

Female pattern hair loss is characterized by a loss of hair density at frontal and vertex regions of the scalp (the top). Hair ultimately becomes thinner and shorter in these areas—there is not complete baldness, as seen in men.

It's important to note that while androgenic alopecia or female pattern hair loss can be seen in women with medical conditions that promote high androgen levels in the body, like PCOS, this type of hair loss is actually more common in postmenopausal women—and their androgen levels are usually normal.

It's likely that the development of female pattern hair loss involves a complex hormonal interplay including both androgens and estrogen (estrogen is low after menopause). Other factors may play a role as well, like your genes.

The big difference between hair loss in a male and androgenic alopecia in women with PCOS is that in women with PCOS, the hair follicle remains alive. The good news is that this increases the chance that hair loss therapy will work and cause new hair growth.

Your healthcare provider may also test you for issues like thyroid disease or nutritional deficiencies that can cause hair loss. These issues would need to be treated to prevent additional hair loss.

Treatment

Currently, there is only one over-the-counter, a topical treatment for female pattern hair loss in the United States, known as Rogaine (topical minoxidil). Rogaine will not cure PCOS-related hair loss, but it can help manage it. Keep in mind that once you stop using it, the hair loss may re-occur.

Other medications that work directly on the sex hormones are sometimes tried, especially if a person does not notice hair regrowth with Rogaine or if they have high levels of androgens on a blood test. That being said, there are not currently a lot of scientific studies supporting their use in female pattern hair loss yet. These medications include:

  • Spironolactone: A diuretic that also has anti-androgenic properties, spironolactone is commonly used in combination with birth control pills in women with PCOS. It can be used along with Rogaine.
  • Finasteride: A medication most often prescribed to inhibit prostate growth in older men, it is often used off-label for hair loss in women. It works by preventing testosterone from binding to receptors on hair follicles. It's absolutely essential to take finasteride in addition to an oral contraceptive because of the potentially damaging effects on a pregnancy.
  • Flutamide: This is also an anti-androgenic medication that prevents androgens from interacting with its receptors on hair follicles. You should not become pregnant or breastfeed while taking this medication. It's not commonly used in the United States due to the potential risk of toxicity.
  • Topical antifungal shampoos: These can be helpful for women who have an inflammatory fungal infection as the cause or a contributing factor in alopecia.

Some people also choose surgery, called hair transplantation surgery, especially if the cosmetic effect of their hair loss is distressing and medications are not effective enough.

Scalp platelet-rich plasma (PRP), a process in which plasma is collected from your blood and injected into the scalp, has shown promise as a potential hair loss treatment.

A Word From Verywell

If hair loss is bothering you, be sure to speak with your primary care healthcare provider or endocrinologist. They can help find a treatment that will minimize hair loss and maybe even help regrow hair. Your healthcare provider will also want to confirm the diagnosis of androgenic alopecia.

Sometimes, there are other reasons for your hair loss like a thyroid hormone deficiency or nutritional deficiency. Or your healthcare provider may refer you to a dermatologist for further evaluation and therapy. 

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