Maybe It’s Not PCOS Hair Loss..

We’ve all been there… Experiencing a cluster of symptoms and then taking to Google to try and figure out what they mean. No judgment here! However, we have noticed a trend with clients experiencing hair loss who rush to conclude that what they must be experiencing is Polycystic Ovarian Syndrome / PCOS hair loss or high androgen hair loss. 


What is the difference between high androgens and PCOS? 


Mistaking symptoms of high androgens for PCOS is easy to do. Those who are properly diagnosed with PCOS experience high androgens. Hyperandrogenism is one of the key characteristics of PCOS.


But, the reverse isn’t necessarily true: experiencing symptoms of high androgens or finding that you have elevated levels of androgenic hormones on a lab test does not necessarily mean that you do have PCOS. 


What are Androgens or Androgenic Hormones? 


Androgens are a group of masculinizing sex hormones such as testosterone or dihydrotestosterone (DHT), that play many important roles in male and female bodies such as starting puberty, promoting reproductive health and body development. 


To put it plainly: we all need androgens, despite their reputation for being masculinizing. But we can experience issues when our levels of androgens become too high.


Common Symptoms of High Androgens 


  • Hirsutism or unwanted hair growth
  • Acne
  • Oily or combination skin
  • Greasy/oily hair
  • High androgen hair loss
  • Irregular or missing periods


Unfortunately some women who experience symptoms like these may be inappropriately diagnosed with PCOS. Experiencing symptoms of high androgens alone isn’t enough to be properly diagnosed with PCOS.


PCOS hair loss high androgen hair loss


Is It PCOS Hair Loss Or High Androgen Hair Loss? 


Even though androgens aren’t inherently bad and women do still require them, experiencing high androgens (or even androgenic hormones that are high relative to other hormones such as progesterone or estrogens) can cause us to experience those common symptoms we talked about above. 


One of the most serious potential symptoms of high androgens is high androgen hair loss. There are two primary ways that androgens can have a negative impact on our hair health and lead to high androgen hair loss. 


The first way that high androgens can harm our hair health is through the hormone DHT. DHT binds to hormone receptors that exist in the hair follicles and will upregulate the genes responsible for the miniaturization of hair follicles (when the hair becomes fine and thin in appearance). 


The second way that high androgens can harm our hair health is by causing less hairs to be in their growth phase (anagen) and more hairs to be in the rest phase (telogen). When this happens it often leads to reduced hair growth and an increase in hair shedding.


What about androgenic alopecia or androgenetic alopecia? 


In our nutrition practice, we frequently work with clients that have been diagnosed with androgenic alopecia or androgenetic alopecia


Because of their names (both containing the word ‘androgen’) there is the common assumption that this diagnosis means that someone is experiencing high androgen hair loss or PCOS hair loss. 


While that may (emphasis on may) be the case for some, it’s important to understand that a diagnosis of androgenic alopecia or androgenetic alopecia is generally arrived at by an examination of your scalp and an assessment of the distribution of scalp hair NOT by testing an individual’s hormone levels. This means that in theory someone can have completely normal (or even low) serum levels of androgenic hormones and still be diagnosed with either androgenic alopecia or androgenetic alopecia.


Let’s spend a minute longer talking about the diagnosis of androgenetic alopecia. We already covered why you can’t make assumptions about levels of androgenic hormones with this diagnosis, but what about the other word? You know, “genetic”. 


It’s common for the general public and healthcare providers alike to talk about our genes in a very sweeping and misleading way. While “genetics” is often presented as a forecast or fate, we know that in actuality its much more nuanced as our environment (e.g.,microbiome, diet, stress, toxins, etc.) plays a huge role in influencing our genetic expression and health outcomes. A more accurate way to think about genetics may be to characterize it as predisposition versus predestination. 

(Not) High Androgen Hair Loss 


What if you’re experiencing symptoms of high androgen hair loss (or other symptoms of hormonal imbalances) but your lab results show that your androgenic hormones are normal or even low? 


Some of our clients have had their hormones assessed (via blood or urine tests) which show normal or low levels of androgenic hormones. Despite this, their healthcare providers find that they are experiencing many of the common symptoms of high androgens. 


One explanation for this apparent disconnect between lab results and symptoms is that tissues (like our skin or hair follicles) have the ability to maintain their own hormone levels. The enzyme 5α-reductase that is responsible for converting testosterone to DHT functions at a tissue specific level. Where 5α-reductase activity is higher the concentration of androgens like DHT will also be higher and symptoms of androgen excess may exist. 


A functional, root cause approach to high androgen hair loss should be focused on normalizing 5α-reductase activity to balance the tissue levels of androgens as well as to promote balanced serum hormone levels where applicable. 


PCOS hair loss high androgen hair loss

A root-cause approach to high-androgen hair loss 


A key component to balancing our 5α-reductase activity is to work on decreasing stress. Stress can cause excess levels of another hormone called cortisol (you may have even heard this referred to as the “stress hormone”). Excess amounts of cortisol can lead to increased levels of 5α-reductase. 


When we are chronically stressed, it can increase the amount of androgenic hormones such as dehydroepiandrosterone (DHEA) that the adrenals produce and lead to symptoms of excess androgens. Because these androgens can be converted into hormones such as DHT, high adrenal androgens could contribute to symptoms like hair loss. 


Another hormone that we should look at when we think of balancing 5α-reductase is our progesterone. Progesterone can behave as an “anti-androgen” and reduce 5α-reductase activity. If progesterone levels are low (something we see frequently with clients who have a history of hormonal birth control, underactive thyroid, undereating/overtraining), then it may be paving the way for more androgen activity. 


The last hormone we want to look at while trying to balance 5α-reductase is insulin. Insulin, another hormone, is used to transport energy in the form of glucose from the foods that we eat into our cells. 


As we often tell our clients, it is ideal to be “insulin sensitive”. However, many of us are insulin insensitive or have even developed clinical insulin resistance. In fact insulin resistance may impact 50-70% of women experiencing PCOS. 


For many, the process of developing insulin resistance happens gradually. Our cells can become less sensitive to the hormone insulin, increasing the body’s insulin need. In essence, the amount of insulin that used to be enough to transport glucose from our blood is now not enough and so the body responds by increasing how much insulin it releases. This cycle can repeat, worsening the degree of insulin resistance over time. 


Beyond their role in managing our blood sugar, these increasingly higher levels of insulin can push for the production of higher levels of androgens and increased activity of 5α-reductase. 


Next Steps For High Androgen Hair Loss 


We know that a body built on health is set up for success to build healthy hair. Rather than masking the issues you’re struggling with, we apply a functional lens and reframe symptoms as clues. 


If you’re struggling with PCOS hair loss or high androgen hair loss and you are ready to take a whole-body, root cause approach, learn more about working with us here or schedule an introduction consultation today.


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