Our hormones play a very influential role on our hair growth and have the ability to increase or decrease the rate that new hairs grow and old hairs shed. This means that we may experience thinning hair as the result of hormonal imbalances.
In previous articles, I’ve talked about reasons why some women are more likely to experience hair loss after stopping birth control. One of the top reasons could be due to something called “androgen rebound”.
What Is An Androgen Rebound?
First, let’s do a quick refresher on what androgens are. Androgenic hormones (also called just androgens or masculinizing-hormones) include testosterone, androstenedione, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S). Despite being considered masculinizing, women need these hormones too, but only in small amounts. It’s when these hormones become too high (or high relative to other hormones like estrogen) that women may start to notice issues such as irregular periods, acne, unwanted hair growth (hirsutism), and even hair loss.
Androgen rebound refers to the symptoms of high androgens that many women experience after coming off of hormonal birth control – – and it could help explain hair loss after stopping birth control.
Despite the significant impact that this can have, many of the clients I work with say that they feel dismissed by their healthcare providers. When their symptoms persist, often the only option they are presented with is to go back on hormonal birth control as a way to “regulate their hormones”.
Unfortunately, options like these only offer women a way to deal with the symptoms and does nothing to address the underlying root-causes of hormone imbalance. In fact, as I’ll show you in a moment, this could even make the underlying imbalances worse.
How Hormonal Contraceptives Work
Hormonal contraceptives contain a synthetic hormone called progestin. This synthetic hormone should not be confused with our own natural hormone called progesterone, even though you may hear them used interchangeably in research articles, blogs, or even by your healthcare provider. Progestin and progesterone are not the same and have very different effects on the body. Progestin actually suppresses our body’s production of natural progesterone, primarily because it blocks ovulation (which makes sense since the reason that we use progestins are to prevent pregnancy).
Progesterone Not Progestin
Even though we may think that you don’t have to care about ovulation unless you are trying to conceive, this is something that every pre-menopausal woman should be concerned with. Ovulation is how our body makes hormones, like progesterone that play an important part in our overall sense of wellness as well as the health of our hair.
Our own natural progesterone that we produce during ovulation can actually help our body maintain healthy levels of androgens because it inhibits an enzyme called 5a-reductase. This enzyme speeds our body’s production of androgenic hormones like testosterone and its anti-hair metabolite DHT and may on its own cause symptoms of androgen-excess.
With low levels of progesterone up-regulating the enzyme 5a-reductase it would make sense to expect our androgen levels (like testosterone) to be high. But women on hormonal contraceptives typically experience a 50% decrease in androgen levels. This is partly due to the suppression of ovulation that we’ve been talking about, as about 25% of a woman’s total testosterone is produced by the ovaries.
However, another reason androgen levels can be low for women on hormonal contraceptives may be because these forms of birth control increase levels of the hormone-transporter sex-hormone binding globulin (SHBG).
SHBG and Our Hormones
When progesterone levels become lowered by hormonal contraceptives, it can allow our estrogen levels to climb. Additionally, many forms of hormonal contraceptives contain estrogens further raising our levels of these hormones. High levels of estrogens increase our SHBG levels which will then bind to androgens (for example, DHT and testosterone) essentially inactivating them by making them unavailable to our tissues. So, high SHBG results in low free testosterone.
At the time that they stop using hormonal contraceptives, many women may find that they have low levels of progesterone, low levels of androgens (even though the enzyme 5a-reductase may be high), and high levels of estrogens.
As great as it would be to be able to discontinue hormonal contraceptives and have our body’s hormones to instantly return to normal, this is typically never the case. Hormonal contraceptives typically take months for our body to clear and sometimes longer for our hormones to achieve balance. Some women may even experience chronic hormone imbalances, including persistently high levels of SHBG.
With healthy progesterone levels still lagging, our levels of the enzyme 5a-reductase can still be elevated after we get off of hormonal contraceptives. (Also, hormonal birth control can contribute to higher fasting insulin levels which also push this enzyme to produce more potent androgens.) If our previously elevated levels of SHBG decrease, this means that less androgens will be bound and inactivated. That decrease of SHBG coupled with the high levels of 5a-reductase can lead to what is known as androgen rebound as more potent androgens are being produced and less of them are being bound and inactivated.
Read more on SHBG: Why Hormone Tests Can Sometimes Be Misleading
Have you experienced hair loss after stopping birth control? It could be that there are sources of inflammation that are keeping you from achieving balanced hormones and healthy hair.