Even though some women have thicker than normal hair growth on their face or the rest of their bodies, many women with PCOS have problems with thinning scalp hair, known as androgenic alopecia. This is usually due to the high levels of androgens which are found in up to 40 to 70% of women with PCOS. Just as testosterone can cause a male to lose their hair, abnormally high levels in women will have the same effect. The big difference between hair loss in a male and androgenic alopecia in women with PCOS is that in women with PCOS, the hair follicle remains alive. This increases the chance that hair loss therapy will work and cause new hair growth.
Some women find non-prescription treatments effective. Adding a multivitamin can help some women thicken their hair and increase the health of their existing hair. Currently, there is only one FDA approved medication on the market to treat hair loss, known as Rogaine. Available over the counter, this will not cure PCOS-related hair loss, but it can help manage it. Keep in mind that once you stop using it, the hair loss may re-occur. In neither of these work for you, you may want to see your physician about your prescription options.
For androgenic alopecia, medications that work directly on the sex hormones are usually tried first. Birth control pills are often effective in reversing some of the hormonal changes which contribute to the alopecia. They may be used alone or in addition to another medication.
- Spironolactone, which is a diuretic that also has anti-androgenic properties, is often used in conjunction with birth control pills to also control excess androgens.
- Finasteride, a medication most often prescribed to inhibit prostate growth in older men, is often used off-label for this purpose. It works by preventing testosterone from binding to receptors on hair follicles. It is absolutely essential to take Finasteride in addition to an oral contraceptive because of the potential damaging effects on a pregnancy.
- Flutamide is also an anti-androgenic medication that prevents androgens from interacting with its receptors on hair follicles. You should not become pregnant or breastfeed while taking this medication. It is not commonly used in the United States due to the potential risk for toxicity.
Finally, Metformin is a medication that can correct a problem with insulin resistance, common in PCOS. In addition to regulating glucose levels, insulin causes the liver to decrease production of a key molecule known as sex-hormone binding globulin, or SHBG. Testosterone is carried in the blood by SHBG when the molecule is present. If a reduced amount of SHBG is available, more free testosterone (testosterone that isn't carried by SHBG) is in the blood. It is also believed that high levels of insulin can increase the amount of androgens that the ovary produces.
If hair loss is bothering you, make sure to speak with your endocrinologist. He can help find a treatment that will minimize hair loss and maybe even help regrow hair.
Futterweit, Walter. A Patient's Guide: Management of Hair Loss in Polycystic Ovary Syndrome. From OBGYN.net.