With so many variables that can lead to hair loss in women, the key to regrowing healthy hair is to address your unique root-causes. In today’s article, I’m going to cover PCOS hair loss and talk more about this hormonal condition and how it impacts your mane.
What Causes PCOS Hair Loss?
PCOS stands for polycystic ovarian syndrome and doctors may diagnose you with it if they find that you have unexplained elevations in hormones called androgens. Androgens are sometimes called ‘masculinizing hormones’ and they 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. Its when these hormones become chronically high that women may start to notice issues such as irregular periods, acne, unusual hair growth (hirsutism), and hair loss (sometimes called female pattern baldness or androgenic alopecia).
Before I explain PCOS hair loss, let’s talk about an important concern related to PCOS: insulin resistance. When we consume foods that can be broken down into glucose, a healthy pancreas responds by releasing a hormone called insulin which helps transport the glucose to our cells so that they can use it for energy. Glucose that is not used immediately, gets stored for later. Managing the amount of glucose in our blood stream is a vitally important task because levels that are too high or too low can cause serious health issues and even death. If our cells become less responsive to insulin, it will become harder and harder for insulin to do its job of carrying the glucose to our cells and maintaining healthy blood glucose levels. Even though insulin may have already been released after our meal of glucose, the body may sense that the insulin isn’t quite up to the task and will tell the pancreas to release more insulin. This is phenomenon is called insulin resistance and it affects an estimated 50-70% of women with PCOS; meaning, if you’re reading this and are struggling with PCOS then this likely affects you.
The reason that it’s important to know about insulin resistance in PCOS is because it is one of the largest factors likely driving the high levels of androgens that women with PCOS experience. You see, there is an enzyme called 17,20-lyase that becomes more active when insulin levels are high. Remember, if someone is experiencing insulin resistance it means that the pancreas will be asked to release more and more insulin when it senses glucose. The higher insulin level upregulates 17,20-lyase which then increases production of the androgenic hormone, testosterone.
One thing it’s important to point out is that it is possible to have normal insulin levels with PCOS. In those cases, inflammation is considered to be the driving factor behind the increased levels of androgenic hormones.
Here’s How PCOS Hair Loss Works
Testosterone can be converted into another androgen called dihydrotestosterone (DHT) by the enzyme 5α-reductase (this will be an important enzyme that we will talk about a little later in this article). DHT is an even more potent and powerful androgen than testosterone and it can bind to the hormone receptors on our hair follicles. When DHT binds to those hormone sites it shortens our hair’s growth phase (called the anagen phase) and lengthens the hair’s rest phase (called the telogen phase). Less growing, more resting leads to thin or sparse looking hair. The increased levels of androgenic hormones may also lead to changes in your scalp’s microbiome and contribute to inflammation around the follicles, potentially worsening hair loss.
Is PCOS Hair Loss Reversible?
If the first question that women who experience PCOS hair loss ask is, “How did this happen?” then the second question would be, “Is PCOS hair loss reversible?”. Depending on the situation, the outcomes will differ. Some women are able to regrow all of their hair (even experiencing thicker, healthier hair than they had previously, in some cases). Other women who have experienced permanent damage to their hair follicles may not be able to achieve the same results. I know that may be disheartening to read, but I always strive to be transparent and honest in the work that I do.
The only way to regrow our beautiful, healthy hair is to address the underlying imbalances that are disrupting our normal hair growth process. Even in women experiencing PCOS hair loss there can be a wide variety of root-cause issues leading to their hormone imbalance. We talked about insulin resistance in PCOS causing androgen excess, but the causes behind insulin resistance can be multifactorial. Sometimes the focus should be making adjustments to your diet, lifestyle, or sleep habits. Other times insulin resistance may be explained by exposure to environmental toxins.
Once you’ve identified the root-causes contributing to your hair loss and you have a plan in place to address them, there can be some additional dietary changes that can help improve PCOS hair loss.
Remember the enzyme 5α-reductase that converts testosterone to the even more potent androgen, DHT? Unsaturated fatty acids, like those found in hemp seeds, evening primrose oil, and borage oil, may help to downregulate this enzyme and decrease levels of DHT. Other foods that may help to reduce the effect of DHT are vegetables from the cruciferous family. Vegetables like broccoli, cauliflower, cabbage, and kale all contain a compound called diindolylmethane (DIM). Even though DIM is most commonly used to help decrease estrogen levels, research in the field of prostate cancer has been demonstrating its anti-androgenic effects.