PCOS NUTRITION CENTER BLOG

Hair loss is one of the most frustrating symptoms reported by women with PCOS. Hair loss is also one of the hardest symptoms to treat.  Early on, women with PCOS tend to report noticeable hair loss in the shower. Other visible signs of hair loss include thinning at the hair line (receding hair line or a more defined part in hair). Androgenic Alopecia is a condition of severe hair loss and balding. New research now shows that hair loss extends beyond menopause as a result of women being exposed to a lifetime of excess androgens. The good news is that newer and effective treatment options are offering hope.  Below I discuss the various treatments for hair loss for those suffering from PCOS.

Why Do Women with PCOS Experience Hair Loss?

Hair loss is common in those with PCOS, affecting approximately 40-70% of women. Hair loss in PCOS occurs due to higher levels of testosterone. Testosterone is a male hormone, called an androgen, which is present in higher levels in women with PCOS. (All women have testosterone, just like all men have estrogen.) When testosterone levels become elevated, testosterone is converted to it’s into its non-aromatizable form, dihydrotestosterone (DHT). DHT then binds to the hair follicles, making them inactive. This process can lead to hair thinning, receding hair line, bald patches, and noticeable hair loss or alopecia. The good news is that in women, inactive follicles can be reactivated with the right treatments (see below).

Keep in mind that hair loss can also be the result of other medical conditions. Thyroid disorders, anemia (iron deficiency), and congenital adrenal hyperplasia can all cause hair loss. Following low-calorie or restrictive diets or having nutrition deficiencies can also lead to hair loss. Certain medications and copper IUDs are associated with hair loss. Menopause, stress and genetics are also culprits.

Treatment Options for Hair Loss for PCOS Women

Below are some of the different treatment options for hair loss for women with PCOS ranging from supplements to medications and cosmetic procedures.

Zinc

If you suffer from hair loss and you have PCOS, supplementing with zinc may help. Women with PCOS tend to have a deficiency in zinc. Zinc works to inhibit the enzyme that converts testosterone into its non-aromatizable form, dihydrotestosterone (DHT) into the hair follicle, which is how it can reduce hair loss as well as other symptoms associated with high testosterone levels in women with PCOS like acne and unwanted hair growth.

In a study published in Biological Trace Elements Research, women with PCOS were randomly selected to receive zinc (50mg daily) or a placebo. After 8 weeks, 41.7% of women who supplemented with zinc saw a significant reduction in hair loss compared to only 12.5% of those taking the placebo. You can learn more about zinc for PCOS here

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Saw Palmetto

Saw palmetto is believed to inhibit the enzyme 5 alpha-reductase which converts testosterone to dihydrotestosterone (DHT). Currently there are no studies that use saw palmetto in PCOS. Most of the studies done on hair loss involve men. Saw palmetto may cause dizziness, headaches, & GI disturbances. It should not be used while taking birth control pills because it can interfere with its effectiveness. It may take 6 weeks of regular use to see noticeable changes.

Vitamin D

Vitamin D deficiency also has been associated with various forms of hair loss. Women with vitamin D deficiency are more likely to suffer from hair loss. Vitamin D replacement therapy has been shown to promote hair regrowth in those with alopecia areata, an autoimmune condition.

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Drink Spearmint Tea

If hair loss is a concern, you may want to start drinking more spearmint tea. Enjoyed iced or hot, Spearmint tea has been shown to have anti-androgen effects in PCOS and can reduce hair loss.  For best results, drink it on a daily basis.

Change Up What You Eat

High levels of insulin can increase the production of androgens, including testosterone. This contributes to hair loss. Eating plenty of anti-inflammatory foods like fruits, vegetables, and omega-3 fats can help to reduce insulin and subsequently testosterone. Omega-3 fats found in fatty fish (tuna and trout), avocados, eggs, nuts and seeds have been shown to reduce testosterone levels in women with PCOS.

Spironolactone

Spironolactone, also known as aldactone, is a diuretic or “water pill” used to lower high blood that can significantly reduce hair loss. Spironolactone is a prescribed medication that works by reducing the body’s production of testosterone and also blocks the testosterone receptors to keep hair loss from coming back.

Spironolactone doesn’t work quickly, however. It’s best to allow three months before results really kick in and can be seen. You should not take spironolactone if you are trying to become pregnant as it has been linked to birth defects. Spironolactone may alter your levels of potassium. For this reason, potassium supplementation and salt substitutes should not be used while taking spironolactone.

Rogaine

Rogaine (Minoxidil) is an FDA-approved over-the-counter medication to treat female pattern baldness. It works by prolonging the growth phase of the hair follicles to slow hair loss. Rogaine is typically applied it to the scalp two times a day, making it inconvenient. It may irritate the skin. Only a small percentage of women will see a difference in hair growth from taking Rogaine. Like spironolactone, Rogaine may take as much as 4 months to even a year to see full benefit.

PRP Treatment

Permanent hair loss can also be treated by medical procedures, such as PRP (platelet-rich plasma). PRP is performed by separating a patient’s blood in a centrifuge to split the platelets and plasma. The plasma is then injected into areas of hair loss on the scalp. This procedure helps to repair blood vessels, stimulate collagen production, and promote cell growth. PRP is not cheap. The cost ranges from $500 and $1,000 per injection session (3 are typically needed) and may take up to two years of treatments. Hair restoration using PRP is at its infancy with clinical evidence is still weak and studies using it on women are lacking.

Wigs and hair extensions

If hair loss is affecting the quality of your life, perhaps you could give hair extensions or even wigs a try. Hair extensions clip into existing hair giving the appearance of a more fuller head of hair. Wigs or hair extensions can be used while waiting to see if treatment options are working.

Bottom line: Hair loss among women with PCOS can be treated. Discuss any of the above treatment options with your doctor to determine what is best for you.

Have you suffered from hair loss? What has made the biggest difference for you?

Angela Grassi, MS, RDN, LDN is the founder of The PCOS Nutrition Center where she provides evidence-based nutrition information and coaching to women with PCOS. Angela is the author of several books on PCOS including PCOS: The Dietitian’s Guide, The PCOS Workbook: Your Guide to Complete Physical and Emotional Health, and The PCOS Nutrition Center Cookbook Recognized by Today’s Dietitian as one of the Top 10 Incredible Dietitian’s making a difference in 2014, Angela is the past recipient for The Outstanding Nutrition Entrepreneur Award, The Award in Excellence in Practice in Women’s Health and The Award for Excellence in Graduate Research, from the Academy of Nutrition and Dietetics. Having PCOS herself, Angela has been dedicated to advocacy, education, and research of the syndrome.

References

Jamilian M, Foroozanfard F, Bahmani F, Talaee R, Monavari M, Asemi Z. Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Biol Trace Elem Res. 2016 Apr;170(2):271-8.

Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010 Feb;24(2):186-8.

Putterman E, Castelo-Soccio L.Response to “Vitamin D deficiency in patients with alopecia areata: A systematic review and meta-analysis” and an investigation of vitamin D in pediatric patients. J Am Acad Dermatol. 2018 Sep;79(3):e43-e44.

Ezeh U, et al. Long-term response of hirsutism and other hyperandrogenic symptoms to combination therapy in polycystic ovary syndrome. 2018; ahead of print. J Womens Health.

Swapna S Khatu. Platelet-Rich Plasma in Androgenic Alopecia: Myth or an Effective Tool. J Cutan Aesthet Surg. 2014 Apr-Jun; 7(2): 107–110.