PCOS and Hair Loss

By Mona Fahoum, ND
Reviewed by Tori Hudson, ND
September 15, 2023

Polycystic Ovarian Syndrome (PCOS) affects approximately 5 million women in the US many of whom experience excessive hair loss. Additional PCOS symptoms include irregular periods or cessation of menstrual cycles leading to infertility, increased facial or body hair growth, acne, unexplained weight gain or impaired weight loss.

If you’re experiencing hair loss or thinning hair as a result of PCOS, there’s a reason why and the good news is, you have choices help handle the excess hair in your hairbrush.

Your HPTAO-axis (Hypothalamus-Pituitary-Thyroid-Adrenal-Ovarian) is your body’s central command center for hormone production of essential hormones including estrogen, progesterone, and androgens (such as testosterone, 5-dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and androstenedione (A4). In fact, all your hormones work together like a finely tuned orchestra to produce overall harmony and health throughout your body. The most important hormones affecting the health of your hair are androgens, estrogens, thyroid hormones, and cortisol.

The “male” sex hormones, androgens are a group of hormones that, along with estrogens, are meant to help maintain balance in a wide variety of bodily processes. It is normal for women to produce some androgens because they play a key role in your mood, libido, and bone health. Unfortunately, though, for many women, especially women with PCOS, androgen levels are relatively high compared with estrogen levels. Along with other effects, high androgen levels can cause hair loss. 

In women, estrogen levels fluctuate in a regular cyclic pattern throughout the month. When estrogen levels are lower than normal during your reproductive years, there is less estrogen to oppose normal levels of androgens leading to hair thinning.  

The basic role of thyroid hormones is to regulate your body’s overall rate of processing. Both thyroid hormone deficiency and excess production can cause thinning of hair. In cases of deficiency, hair is brittle and falls out in clumps or diffuse thinning (thinning all over the scalp), whereas in cases of excess production individual hairs are very fine and there is an overall thinning pattern.  

Cortisol is a hormone naturally produced in balanced levels in your adrenal glands, and at increased levels during times of stress. Its intended purpose is to help the body maintain a higher level of activity and alertness in situations of short-term stress, but in today’s environment of chronic, long-term and recurring stressors, cortisol can cause dysfunction rather than help survival. Hair responds to high cortisol by actually falling out, and can take from six to nine months to begin growing back.

Doctors often prescribe the birth control pill as a way to provide some hormonal balance, but there are potential health issues associated with it that are a concern. In addition to possible side effects and only masking the cause instead of providing a long-term solution, the pill only works selectively for excess androgen related causes.

Choosing a supplement that supports the balanced production of hormones rather than introducing hormones to the body can be considered. Hormone balancing begins at the brain in the hypothalamus, cascading down through the pituitary, thyroid, adrenal glands, and eventually the ovaries. This signaling then circles back to the hypothalamus, creating a continuous feedback loop for ongoing communication between those organs. This process is referred to as the hypothalamus-pituitary-thyroid-adrenal-ovarian (HPTAO) axis. Depending on your needs, this may result in an increase or decrease in hormone production. However, many factors can cause this communication system not to work as efficiently as it should and therefore, additional support for the HPTAO axis can provide health benefits.

Overall, support of the HPTAO axis is essential. Clinical research on specific phenotype combinations (or colors) of Lepidium peruvianum, commonly known as maca, supports the body’s HPTAO axis. Rather than introducing exogenous hormones into the body to manipulate hormone levels, specific maca phenotypes nourish the endocrine system, supporting the body’s hormone production. However, not just any maca will do. First, research has shown that there are up to 17 colors of maca that have varying DNA and ingredient profiles and, most importantly, can have different physiological effects on the body, meaning some are more beneficial for men than women and vice versa. For example, some maca colors can increase androgen activity, potentially making PCOS and its symptoms worse. One case report showed increased testosterone levels in a woman after taking generic maca supplements. Second, in addition to needing to use specific phenotypes (colors) of maca, the concentration and bioavailability of the ingredient were critical in order to elicit a statistically significant improvement in multiple hormones. Third, even the location where the maca grows, as well as farming, drying, and manufacturing methods impacts the benefits it can provide. Therefore, choosing the right maca is especially important for women with PCOS.

Aldactone is an androgen-suppressing drug used as a prescription medication on its own or as an active ingredient in a few birth control pills that contain progestin that are spironolactone type drugs (Yasmin and Yaz). It’s most commonly used to treat high blood pressure and heart failure and is a diuretic. Aldactone does suppress the production of aldosterone (androgens), but potential side effects include drowsiness, dizziness, stomach upset, diarrhea, nausea, vomiting, and headache.

While research shows that poor diet alone may not be solely responsible for most skin, hair and nail problems, it is essential to provide your body with the nutrition it needs look and feel healthy. There are several factors to keep in mind.

As a general rule, eating a wide variety of fruits, vegetables and whole grains, drinking plenty of water, exercising and maintaining an active lifestyle, and wearing sunscreen are recommended to help skin, hair and nails stay healthy.

There are some vitamins and nutrients essential to skin, hair and nail health that the body may not produce on its own, but these can be obtained in adequate amounts through eating nutrient-dense foods. Some people with deficiencies may need supplementation in addition to the usual dietary intake. Essential vitamins specifically related to skin, hair and nail health are vitamin A, vitamin C, vitamin D, biotin, essential fatty acids and niacin. Additionally, adequate protein intake is necessary for optimal health.

For more information our team of doctors, who specialize in women’s hormone health and PCOS, created a free PCOS Guide you can download here.