Understanding and Reversing PCOS Hair Loss

Among the many shared health conditions between men and women, hair loss is one with few resources available for treatment. Like any symptoms, hair loss can be caused by many reasons, ranging from nutritional imbalances to autoimmunity, and everything in between.

For women in particular, one of the biggest reasons for hair loss on the top of the head relates to hormonal imbalances attributed to a condition called PCOS, which has four different subtypes. When I am working with a woman in a clinical setting, PCOS hair loss is often one of the most frustrating symptoms that she wants addressed as quickly as possible.

In this article, we will be discussing reasons for hair loss, how I evaluate for the causes of hair loss in my functional medicine practice, and how I help my patients reverse PCOS hair loss with natural treatment. We will also cover additional topics, such as how long it takes to reverse PCOS hair loss and whether or not the condition is likely to come back.

Diagnosing PCOS Hair Loss

The condition of hair loss itself is not hard to diagnose. In fact, it’s usually one of the easiest things to identify when a woman is experiencing it because you can see the evidence of it stuck t oyour clothing, clogging your vacuum or your shower drain, and strewn around your house. However, PCOS hair loss can also be insidious because it doesn’t always appear like patchy clumps of hair falling out. In fact, patchy hair loss of that nature is less likely to be related to PCOS and more likely to be related to another condition, like autoimmunity, nutritional deficiencies, or toxin exposure. Instead, PCOS hair loss tends to look more like thinning along the hair line and increased shedding overall.

One of the biggest challenges in diagnosing PCOS hair loss is differentiating the hair loss as specifically PCOS hair los as opposed to hair loss from other conditions. Keep in mind that not all women who have PCOS experience hair loss as a symptom. At the same time, a woman may have PCOS and also be experiencing hair loss due to other factors. Finally, a woman experiencing hair loss (and her doctor) may have suspicions of PCOS because of the hair loss, even though she might not have PCOS at all.

Treating PCOS hair loss means that a couple of things need to first be true: for one, she needs to have diagnosed PCOS and two, the hair loss needs to be because of the PCOS and not the result of other factors. Therefore, it’s important to conduct a thorough workup to make sure that other health conditions are not also at play. If those other health conditions are missed, treating the hair loss through the PCOS paradigm will result in the patient not getting better and maybe even worsening because of delayed diagnosis.

Reasons for hair loss apart from PCOS hair loss:

Here are some other common reasons that I see hair loss in my practice. Please keep in mind that this is not an exhaustive list, and it’s possible for a person to have more than one condition:

1. Hypothyroidism: Hormonal reasons are a big driver of hair loss, but those reasons are not always exclusive to reproductive hormones, such as PCOS hair loss. In fact, when I see a patient experiencing hair loss, my first thought actually is not PCOS, but rather a thyroid conditions. Hypothyroidism is more common among women with PCOS that among thos without it, and the thyroid is actually a big reason that my PCOS patients experience “PCOS hair loss” even though it’s truly driven by the thyroid.
2. Hashimoto’s and other autoimmunity: Hashimoto’s is one type of autoimmune condition, which is commonly responsible for causing hypothyroidism. However, I include it separately on this list because not all cases of hypothyroidism are caused by Hashimoto’s, and not all cases of Hashimoto’s end in hypothyroidism. Because Hashimoto’s involves an autoimmunt inflammatory response agains the thyroid and resultant thyroid damage, many people do end up developing hypothyroidism as a result of Hashimoto’s. However, the inflammation and self-reactivity associated with Hashimoto’s can also result in hair loss, even with normal thyroid function. Other autoimmune diseases such as inflammatory bowel disease (IBD), lupus, Sjogren’s syndrome, rheumatoid arthritis and others can also cause hair loss. Grave’s disease, which is an autoimmune thyroid condition associated with hyperthyroidism can also cause hair loss, all of which should be differentiated from PCOS hair loss.
3. Low Estrogen: Hair follicles don’t last forever. Instead, they experience a growth phase that can last several years and then they transition to a state of dormancy called the telogen phase, which lasts a few months before the follicle atrophies, dies and the hair falls out. Periods of low estrogen in women, such as those seen with hypothalamic amenorrhea, menopause, breastfeeding, and other health conditions shortens the growth phase of the hair, moving it into the telogen stage more quickly. PCOS is classically associated with excess estrogen, particularly when testosterone levels are very high, but other women experience low estrogen for other reasons, despite PCOS. In this case, the PCOS hair loss would be due to low estrogen levels rather than the high androgen levels.
4. Perimenopause: PCOS hair loss is classically understood to be caused by elevated testosterone levels, which cause atrophy of the hair follicles and shorten the growth phase. However, transient elevations in testosterone can also be caused by the early stages of perimenopause. While the causitive factor in the hair loss is the same (testosterone), high androgens in perimenopause that cause hair loss are not the same thing as true PCOS hair loss.
5. Nutrient deficiencies and restrictive dieting: Nutrient deficiencies cause hair loss because multiple micronutrients, like B vitamins, zinc, iron, vitamin C and countless others are essential for creating new hair (along with skin, nails, and maintaining function of the body’s organ systems.) In cases of significant nutrient deprivation, such as extreme dieting or chronic illness, nutrient deficiencies can develop which result in hair loss. (The nutrient deficiencies can also cause other health problems, like hypothyroidism, which contribute to hair loss as well.) It is also not uncommon for the ketogenic diet, vegan diets, and use of semaglutides like Ozempic to cause hair loss.
6. Post-COVID: Severe illness such as that seen from extreme cases of COVID-19 can also contribute to hair loss. The inflammation associated with the inflammatory response, or use of steroids in treatment, contribute to a shortening of the growth phase and resultant hair loss.
7. Inflammation: Apart from COVID-19, infections may trigger widespread inflammatory responses in the body that bring about similar changes to the hair follicles. These too need to be differentiated from PCOS hair loss, though keep in mind that blood sugar disorders including the insulin resistance seen in PCOS also contribute to hair loss.
8. Heavy metals and other toxicity: Heavy metals like arsenic, thallium, cadmium and mercury all contribute to hair loss by interfering with the mechanisms of hair growth. This causes weakening of the hairs themselves, increased breakage and early shedding. Thallium exposure is the most common heavy metal implicated in hair loss. Thallium exposure most typically comes from coal smelters, which release this toxin into the air, and it also becomes deposited in the soil and water. For this reason, it is essential to wash fruits and vegetables and use a high-quality water filter to ensure that what you are drinking is safe.
9. Hormonal birth control: Hormonal birth control is made from artificial progesterone, which tricks the body into not ovulating. This means that the body then is unable to produce natural progesterone, and progesterone deficiency also contributes to hair loss through a similar mechanism to low estrogen. At the same time, some types of these artificial progesterones are derived from testosterone and share characteristics to the hormone testosterone. In PCOS hair loss, testosterone receptors in the hair follicles respond to signaling from testosterone and cause atrophy of the follicles and resultant hair shedding. The artifical progesterones, derived from testosterone in the hormonal ocntraceptives, have a similar effect when they bind to testosterone receptors, causing a similar mechanism of hair loss as seen in PCOS hair loss.
10. Stress: High stress increases adrenal responses, which affect blood flow to the hair follicles. They also result in increased production of androgenic stress hormones which affect hair follicles similarly to high testosterone levels in PCOS hair loss. High stress can also induce an adrenal form of PCOS and contribute to PCOS hair loss through that mechanism.
11. Certain medications: like chemotherapy drugs which notoriously cause hair loss, use of steroid medications, antidepressants such as fluoxetine (Prozac) and lithium, blood pressure medications like ACE inhibitors, blood thinners, seizure medications, and Accutane can cause hair loss on the top of hte head, which need to be distinguished from PCOS hair loss. Many women with PCOS are taking these medications and don’t realize that their hair loss results from the medications instead of being the specific symptom of PCOS hair loss.
12. Eczema, fungal infections and other skin disorders: Inflammatory and infectious skin conditions can create inflamation that is pervasive enough to reach the hair follicles themselves. This inflammation and reactivity damages hair follicles and can cause weakness, breakage, shedding and hair loss. PCOS and the accompanying blood sugar imbalances increase risk of developing fungal infections like candida, including infections on the scalp, which can contribute to hair loss but should be differentiated from true PCOS hair loss.
13. Childbirth: During pregnancy, the body lengthens the telogen stage of hairs. This means that hairs which would ordinarily reach the end of the growth and telogen stages and fall out instead do not. They remain in the telogen stage, not growing necessarily but not falling out either. Then, after the baby is born and the hormone and immune system shift, the hairs finally fall out, all at once. For some women, this effect is delayed until breastfeeding ceases, or until periods return. In women with PCOS, return to menstruation can take much longer and women may incorrectly believe the hair loss is due to PCOS hair loss because so much time has elapsed since childbirth. This is why accurate testing and clinical workup are important for making a diganosis.
14. Hair treatments: Use of hair dye, particularly hair treatments containing bleach, chemical straightening products, and heat treatments like hair dryers, flat irons, curling irons, and even washing hair in very hot water all cause dryness and damage to the hair itself. This weakens the hairs, increasing breakage and making it more difficult for hair to grow long. This can look like hair loss, especially when the breakage occurs close to the scalp. Hair breakage can also be increased with aggressive hair brushing techniques, tight ponytails and hair styles involving the hair pulled back, frequently wearing hats and barrets, sticky elastics or clips can also pull and snap hairs.

PCOS Hair Loss

The “true form” of PCOS hair loss results from elevated androgen levels. However, keep in mind that the condition of PCOS can also contribute to hair loss as mediated through inflammatory changes, blood sugar problems, and changes in other hormone levels. However, when we are talking about the effect of PCOS in causing hair loss, we are referring to the form of PCOS hair loss that is caused by elevated androgen levels.

As I touched on earlier, elevated androgen levels induce a process called “follicular miniaturization,” in which the high androgens bind to testosterone receptors in the hair follicles, causing them the atrophy and break down. The result is thinner hairs, weaker hairs, and eventual death of hte hair follicles. This leads to not only increased hair shedding but fewer healthy and functional hair follicles in general.

Treatment for PCOS Hair Loss

When the hair loss has been proven to be truly the result of high androgens in PCOS, treatment is necessary in order to slow the progression of the condition. Because of the mechanism of testosterone in PCOS hair loss, treatment necessitates strategies for reducing androgens, increasing blood flow to the scalp to restore follicle function, and providing increased nutrients to allow the hair follicles to remain healthy and grow health hair.

In my functional medicine practice, I treat the different types of PCOS differently. Understanding what is driving the high testosterone levels is imperative for lowering them. So, we always start there. However, there is good evidence that the following strategies are also implicated in reversing the testosterone-associated changes that take place in PCOS hair loss:

1. Spearmint Tea: In PCOS hair loss, testosterone converts into a highly androgenic hormone derivative called DHT. Spearmint tea, particularly when enough is consumed, reduces the conversion of testosterone into this highly androgenic form which damages hair follicles. The research shows that drinking at least two cups of tea daily is needed to see effects. I recommend always drinking organic, looseleaf tea to reduce exposure to toxins.
2. Zinc: Similar to spearmint, zinc has been shown to reduce converstion of testosterone to DHT. It also reduces the responsiveness of testosterone receptors in the hair follicles of themselves so that the androgens have less of an effect in causing PCOS hair loss. It’s important to note that the effects of zinc supplementation in PCOS hair loss are not simply the result of correcting zinc deficiency, though many people are unknowingly deficient in zinc. Instead, the supplementation improves PCOS hair loss regardless of deficiency. However, it is possible to overdose on zinc, so it is important not to exceed supplementation past 80 mg daily, and to be mindful of the fact that excess zinc supplementation can create copper deficiency, which may also cause hair loss. In my practice, I recommend starting with 30 mg of zinc bisglycinate or zinc picolinate which are superiorly absorbed compared to other forms.
3. Saw Palmetto: Like spearmint, saw palmetto reduces the conversion of testosterone into DHT via the enzyme 5-alpha reductase. For this reason, it’s not necessary to supplement with both of them in order to control hair loss. Instead, I usually start my patients on one or the other. However, different people respond differently to them, so sometimes we prefer to use multiple strategies on the front end and cut back. Because of the timeline required to control PCOS hair loss, this solution is appealing to some patients.
4. Green Tea: Whereas saw palmetto and spearmint reduce conversion of testosterone to DHT, green tea reduces androgen levels in general. This is important because hair follicles are not the only part of the body impacted by the high androgen levels. Green tea is therefore a good solution because of its ability to treat PCOS, instead of focusing primarily on PCOS hair loss.
5. Red Reishi: This adaptogen funcitons similarly to saw palmetto and spearmint in blocking the 5-alpha reductase enzyme. However, being an adaptogen, it also provides other benefits to the body, particularly in improving the stress response, supporting the immune system, and reducing inflammation. I am inclined to prescribe this to patients when they are dealing with an inflammatory or adrenal form of PCOS, or if they have co-occurring health conditions such as those listed earlier.
6. Topical Rosemary Oil: Rosemary oil has components that block DHT, like many of the herbs listed above. However, the difference is that rosemary oil is applied topically to the scalp and massaged in, instead of taken orally. This allows more direct access to the hair follicles. It also contains compounds that stimulate the hair follicles to increase growth, and antioxidants that reduce the effects of other factors on causing damage to the hair follicles, in addition to the androgens in PCOS hair loss. Finally, topicaly application and massage stimulate blood flow which brings nutrition and oxygen, supporting the health of the follicles. I recommend applying a small amount of rosemary oil directly to the scalp, massaging for about 15 minutes, resting for another 15 minutes to absorb and then washing out. Be mindful that oils such as these may cause the hair to appear greasy, so be mindful when washing.
7. Red Light Therapy: Near infrared and red light laser therapy have excellent research to back up use for promoting hair growtih and slowing hair loss, regardless of cause. This form of light stimulates cells called fibroblasts, which produce hair growth factors and increase blood flow. The result is thicker hairs that grow more quickly, and even reversal of some of the atrophy-related changes in PCOS hair loss. Red light therapy is a great option for PCOS hair loss because it doesn’t require you to take a pill, and the devices used to administer red light therapy can be used for other applications as well. I personally use the NovaaLab red light laser, and this is what I recommend as well. If you want to use the NovaaLab laser and save 10%, use the following code(s) to get started:
   • NovaaLab Red Light Laser for targeted laser spot treatment (more potent)
   • NovaaLab Deep Healing Pad which can more easily be used to apply red light treatment to the whole head at once

How long does it take to heal PCOS hair loss?

Because PCOS hair loss so profoundly affects a person’s quality of life, one of the most pressing quesitons my patients have is how long it will take to heal the condition. PCOS itself is complicated, but the nature of how hair grows and falls out in the first place is even more so. Recall from our discussion above that PCOS hair loss comes from the effects of androgens, which cause atrophy of hair follicles that weaken the strands and death of the follciles themselves. The hormons also shorten the growth phase, and send the hair follicles into the telogen phase more quickly. The telogen stage lasts several months (often around 3) before the hairs fall out.

Treating PCOS hair loss at the root cause itself takes several months. Lowering androgens and lowering production of DHT can take several months, sometimes up to 6, to even start to see changes. Then, once the androgen levels change, the hair follicles themselves take time to heal. Once that happens, there’s still then a delay because of the telogen stage, of around 3 months. After that, we then need even more time to start to see hair regrowth.

Because of these complexities, starting to see changes in PCOS hair loss sometimes take up to a year or more. This will happen more quickly if PCOS has not been a problem for as long, because the longer the hair follicles have been exposed to the testosterone, the more time they will need to heal. It’s also going to take longer if other problems are also at play, such as those seen in the first list, like nutrient deficiencies, toxin exposure, or inflammatory conditions.

Among all the treatments outlined above for PCOS hair loss, I want to share that red light laser therapy produces changes the fastest. This is because rather than waiting for hormone levels to drop, the high-intensity laser directly reverses the effects of testosterone at the level of the hair follicles. This leads to faster healing while the additional time is taken to address the hormonal imbalances that cause PCOS hair loss. Remember, however, that because of the telogen stage of hair, even with red light laser therapy, it will require a minimum of 3 months to start to see changes in hair loss. Hair loss you’re experiencing right now is the result of the chemical state of your body at least three months in the past.

Overall, PCOS hair loss treatment is challenging and takes a long time, but that doesn’t mean it’s impossible, and it doesn’t mean you should give up hope. The fastest and most effective way to help PCOS hair loss is to make sure that you have the right diagnosis (and aren’t missing anything), and to treat the underlying root cause of the PCOS hair loss (high androgens) so that it doesn’t return in the future.

Healing takes time, and there are no quick fixes. Because of the time requirements, remember that there are no drugs or medications that can produce changes faster, so natural treatment really is your best bet. Be patient, have grace on yourself, and do the next right thing!

Don’t miss out! Join the email list.

Sign Me Up!

Love this post? Share it!

• Facebook
• Pinterest
• Instagram

Want more? Check out my new guidebook, The Hormone Hacker!

I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.

I specialize in women’s health & hormones, addressing concerns like fertility, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.

If you’re looking for a new way to approach your health, I’m here to help you through it. Click to learn more.