Given the current epidemiological data regarding alopecia, it’s fair to say it affects more men than women worldwide, especially when it comes to the more severe forms of the condition – approximately 63% of sufferers are men, and 36% are women (R.A. Schwartz, C.K. Janniger. Alopecia areata. 1997; 59:238-41).
In men, alopecia is generally caused by excessive DHT (dihydrotestosterone), an androgen hormone that “clings” to hair follicles, causing them to shrink and eventually die. While this androgen hormone is present in very small quantities in the female body (in the same a man’s body produces female hormones like estrogen, but in very low amounts), in some cases female pattern baldness may develop as a consequence of elevated DHT. This is often accompanied by a number of symptoms such as a deep voice and unwanted facial hair. Therefore, the idea that “hair loss is a man’s problem” is a myth.
However, DHT is certainly not the only cause of female hair loss.
Ovarian cysts (including PCOS – Polycystic Ovary Syndrome), birth control pills, pregnancy and menopause are the most frequent causes of hair loss in women. PCOS and thyroid disorders trigger a number of hormonal imbalances that increase the production of testosterone and other male hormones, including DHT.
According to a study conducted by the University of Oulu, Finland, PCOS is commonly associated with female hair loss and also insulin resistance. Eggs are produced in tiny sacs called cysts, which build up fluid and eventually break open to release the egg through the fallopian tube and into the uterus (ovulation) once it has fully developed. In PCOS, the ovaries are unable to make all necessary hormones for the egg to develop, including progesterone, and therefore the menstrual cycle is irregular or does not occur. This suppresses the production of female hormones in favor of male hormones, and the excess testosterone is converted into DHT. As a consequence, alopecia is rarely the only symptom of PCOS and is accompanied by hair growth in unwanted parts of the body, e.g. face and chest.
By extension, any event or hormonal disorder involving the overproduction of male hormones may trigger hair loss in women, according to the National Library of Medicine:
- adrenal glands disorders and
- pituitary gland disorders.
The Journal of Clinical and Experimental Dermatology also suggests that in some cases, alopecia has no hormonal or biochemical cause, especially if the condition isn’t hereditary.
Apart from excess testosterone, hypothyroidism is another hormonal cause of hair loss in women. As thyroid activity affects everything in your body including energy synthesis, the slow metabolism of a hypothyroid patient slows down hair regrowth and nutrition. Although it is only natural to lose a few hairs every now and then, in this case they won’t be replaced, which leads to an overall hair thinning (telogen effluvium) rather than pattern baldness.
The estrogen and progestin in oral contraceptives suppress ovulation, which may trigger PCOS hair loss symptoms in women with a strong genetic predisposition for hormonal-related alopecia. However, depending on causes and the woman’s physical and biological makeup, certain types of birth control pills are sometimes prescribed to treat hair loss.
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Remember that any medication altering a woman’s hormone production has the potential of causing hair loss, particularly high-androgen index contraceptives:
- Hormone injections
- Progestin implants
- Ortho Evra skin patches
- The vaginal ring
Steps You Can Take to Prevent and Reverse Hormone Related Hair Loss
The use of low-androgen index oral contraceptives is highly recommended:
- Desogestrel (Mircette)
- Ethynodiol diacetate (Demulen)
- Norethindrone (Ovcon 35)
- Norgestimate (Ortho-Cyclen)
If you are genetically predisposed to hair loss, you should avoid all forms of birth control that alter the way your hormones work. Remember to always check this with your doctor first, as he or she will perform all necessary tests and physical examinations to determine the best way to prevent or treat hair loss in your case.
However, diet and lifestyle are in your own hands and the best way to keep your body in good balance is to eat healthily and stay active. According to the Journal of Clinical Endocrinology, women who suffer from obesity experience more frequent and intense symptoms of PCOS, and moderate weight loss improves endocrine functions significantly.
If you’re unsure whether your hair loss is caused by a hormonal disorder, you are strongly encouraged to speak to your doctor and have blood tests done in order to evaluate thyroid hormone and testosterone levels. Your doctor will then advise on the best course of treatment, and it would be best for you to see both an endocrinologist and a dermatologist.
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