The Association Between PCOS and Female Pattern Hair Loss

Polycystic ovary syndrome, commonly known as PCOS, is believed to affect 1 in every 5 women in the UK, according to NHS figures.

It is an endocrine disorder which affects the normal functioning of the ovaries and can cause both hirsutism (excessive hair growth issues), and hair loss.

Although this shedding can be a side effect of PCOS medication, such as Letrozole (Femara), here we explain why PCOS is often linked to the genetic condition, Female Pattern Hair Loss.

Hyperandrogenism and androgenic alopecia

Hyperandrogenism - the term given to excessive male hormone (androgen) production - is a key symptom associated with PCOS. Androgens are the group of steroid hormones, naturally present in both men and women, that regulate the development of male characteristics.

Female Pattern Hair Loss, also known as androgenetic - or androgenic - alopecia, involves the androgen dihydrotestosterone (DHT) binding to susceptible follicles, causing increasingly thinning hair to the top and frontal, temporal regions of the scalp.

Though it can present in those with the relevant genetic predisposition any time following puberty, it is more common for women to develop this type of hair loss when they are in their 30s or 40s.

Due to the fact that stress - whether physical, such as an underlying medical issue eg. PCOS, or emotional - can induce premature hairloss in those with an existing genetic predisposition, there are numerous reports of women now starting to lose their hair in their 20's - something widely blamed on the pressure of modern life.

For those with PCOS who do not have the relevant inherited predisposition towards Female Pattern Hair Loss, excessive androgen production may cause shedding in a similar pattern.

Female Pattern Hair Loss and hyperandrogenism review

The Journal of Clinical Endocrinology and Metabolism published a report into the associations between Female Pattern Hair Loss and Hyperandrogensim in February 2019, which has recently also appeared in the July issue.

Investigations were carried out by a 'task force' of experts in dermatology, endocrinology and reproductive endocrinology, which was appointed by the Androgen Excess and PCOS Society.

The team's evaluations came from an in-depth, intelligence-gathering exercise using agreed-upon, peer-reviewed studies into Female Pattern Hair Loss, up to December 2017, to determine the most important facts that hair loss specialists and medical practitioners in the field should be aware of.

The following conclusions were drawn:

1 "The term “female pattern hair loss” should be used, avoiding previous terms of alopecia or androgenetic alopecia"; this is due to many women finding the latter wording particularly upsetting.

2 "The two typical patterns of female pattern baldness are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern." This essentially means that the key areas of the scalp affected by female pattern hair loss, and typical signs, include hair loss that starts as a widening of the (middle) parting and spreads outwards over time as the follicles along the vertex (top of the scalp from hairline to crown), frontal hair loss at the temples.

3 "Isolated female pattern hair loss should not be considered a sign of hyperandrogenism when androgen levels are normal." Hair loss can be a sign of an underlying health issue, including PCOS. However, as this is an hereditary condition, where there is thinning in the same pattern as genetic hair loss but the patient's androgen levels are normal, PCOS is unlikely to be a factor.

4 "The assessment of patients with female pattern hairloss is primarily clinical." There is no need to carry out a biopsy in order to diagnose genetic hair loss. A trained specialist can spot this condition via a scalp assessment and medical information about the patient.

5 "In all patients [thought to potentially have PCOS] with female pattern hair loss, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended." Belgravia always recommends women worried about losing their hair have a full blood count blood test where possible, specifically covering vitamin levels for vitamin D and vitamin B12, ferritin and zinc, thyroid hormones and diabetes mellitus, before visiting a hair loss specialist for a consultation, and bring their results along with them.

6 "Treatment of female pattern hair loss should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism". Currently, high strength minoxidil is the only women's hair loss treatment that is both MHRA-licensed and FDA-approved for this purpose.

Anyone concerned about thinning hair, with or without an additional diagnosis of PCOS, may find a consultation at a dedicated hair loss clinic helpful. That way, a professional hair specialist can provide a confirmed diagnosis and personalised recommendations for appropriate hair loss solutions based upon their findings and the individual's medical profile.