Hormonal Hair Loss

Hormones really do affect hair: androgens, estrogens, thyroid hormones, prolactin and corticosteroids help decide how long a hair grows and what it becomes. So hair loss after childbirth, after stopping birth control pills, in menopause or with a thyroid disorder is entirely real, but it does not always mean your hormones need treating.

Hair alone cannot show which hormone is responsible, or whether one is at all. Sometimes the tests are normal and the cause lies in the inherited sensitivity of the follicles or in a different condition. This page explains how hormonal changes show up in your hair, what a trichologist checks, and when you need an endocrinologist or a gynecologist.

It draws on Hormones and hair, a publication by Professor Yuliya Ovcharenko, head of the Trichology Institute. Patients are seen by doctors of the clinical trichology department in Kharkiv.

When to suspect hormones

A hormonal cause is worth considering when your hair changes along with other signs or after a specific event:

• shedding picks up 1 to 4 months after childbirth, or between 2 weeks and 3 to 4 months after stopping oral contraceptives;
• hair turns dull, coarse and brittle, the outer part of the eyebrows thins, and your skin is dry;
• hair becomes fine and soft and thins evenly, while you also have palpitations, sweating or weight loss;
• your menstrual cycle changes, or you develop acne or excess hair on the face or body;
• thinning begins in menopause;
• the changes began after starting a hormonal medicine: a contraceptive, hormone replacement, testosterone or DHEA, thyroid medicine, or an aromatase inhibitor.

When you need an endocrinologist or gynecologist

Some signs matter more than the hair. If you have them, see an endocrinologist or gynecologist; you can see a trichologist alongside:

• in a woman, rapidly appearing hair on the face and body, receding temples or a deepening voice: fast virilization can be a sign of an androgen-producing tumor;
• nipple discharge together with periods stopping;
• weight gain, a rounded face, fat on the trunk with thin arms, easy bruising, high blood pressure;
• marked darkening of the skin;
• early puberty in a child: this needs a pediatrician or a pediatric endocrinologist, and hair loss in children has its own page.

With muscle spasm attacks or severe palpitations, do not wait for a routine appointment; seek urgent care.

Which hormones affect hair

The hormones that matter most are androgens, estrogens, thyroid and parathyroid hormones, prolactin and corticosteroids.

The thyroid

Too little thyroid hormone (hypothyroidism) most often comes from chronic autoimmune thyroiditis (Hashimoto's disease) or follows radioactive iodine treatment or surgery. It is about ten times more common in women than in men, especially between 40 and 60. Hair grows more slowly, more hairs move into the resting phase, and in genetically prone people long-standing hypothyroidism may come with androgenetic alopecia.

Too much (hyperthyroidism) is most often linked to Graves' disease, an autoimmune condition; diffuse shedding occurs in 20 to 40% of cases. Thyroid medicines themselves can also cause hair loss. After surgery on the thyroid or neck, hypoparathyroidism can develop, with spasm attacks and thinning or complete loss of hair.

Androgens and the adrenal glands

Androgens act paradoxically: they stimulate the beard, yet on the top of the head in prone people they gradually turn thick hair into fine vellus hair. That is how androgenetic alopecia develops, and it does not require excess androgens in the blood.

True excess occurs with polycystic ovaries and ovarian tumors, congenital adrenal hyperplasia, adrenal tumors and Cushing's syndrome. In women it shows as virilization, including hirsutism and thinning on the head; in men it causes no symptoms. Cushing's syndrome most often results from taking glucocorticoids. In men, free testosterone falls gradually, by about 1% a year, with no sudden drop.

Estrogens: pregnancy, childbirth, menopause

In the second half of pregnancy the share of hairs in the growth phase rises from 85 to 95%. After childbirth those follicles quickly move into the resting phase, and shedding increases about 1 to 4 months later. Something similar happens after stopping oral contraceptives. Contraceptives or hormone replacement with androgenic progestins more often cause thinning in genetically prone women.

In menopause, usually between 45 and 55, estrogen levels fall: hair gets drier and the tendency toward male-pattern loss grows. Similar shedding can occur in prone women on aromatase inhibitors during breast cancer treatment.

Prolactin

Excess prolactin can cause diffuse telogen shedding, androgenetic alopecia and hirsutism: it acts on the follicle directly and by raising adrenal androgens.

What it looks like

Hormonal hair loss mostly has no look of its own: the hair changes are nonspecific, and the accompanying signs give the clue.

• Hypothyroidism: dull, coarse, brittle hair, diffuse thinning that starts gradually, a thinner outer eyebrow; dry, rough skin and a puffy face.
• Hyperthyroidism: fine, soft, straight hair, diffuse shedding, and often thinner underarm hair. How much hair is lost does not track how severe the thyrotoxicosis is.
• Androgen excess: thinning on the top of the head along with hirsutism, meaning dark, coarse hair on the face and body.
• Excess prolactin: shedding with nipple discharge, cycle changes, seborrhea and acne.
• Menopause: dry, more brittle hair and thinning, along with dry, itchy, less elastic skin.

When the cause is probably something else

Round bald patches look more like alopecia areata, although it often occurs with autoimmune thyroiditis (see Comorbidity in alopecia areata). Redness and burning of the scalp may point to red scalp syndrome. Very slow thinning after 50 may be age-related thinning.

Diagnosis at the Trichology Institute

The first trichologist consultation includes digital trichoscopy on FotoFinder equipment. The doctor asks what came before the changes: childbirth, starting or stopping contraceptives, hormone replacement, thyroid surgery, medicines, your cycle, hair loss in relatives. Bring any test results you have and the names of the medicines you take.

Trichoscopy shows the type of hair loss but not its cause: the signs of telogen shedding are the same whatever triggered it. It does, however, separate telogen shedding from androgenetic alopecia, and the whole plan depends on that. Our doctors set out the criteria in Trichoscopic differential diagnostic algorithms for non-scarring alopecias. A TrichoScale phototrichogram and TrichoLab quantitative trichoscopy measure hair density and thickness, and those figures become the baseline.

The doctor orders tests after the examination, based on specific signs:

• thyroid function with dry skin, dull hair or palpitations;
• sex hormones, DHEA-S and free testosterone with signs of androgen excess;
• prolactin with cycle changes or nipple discharge;
• blood counts and iron studies, because deficiencies can look much the same.

The doctor decides which tests you actually need. With an atypical picture, a scalp biopsy is done. Patients are seen by Professor Yuliya Ovcharenko and Professor Inessa Serbina.

Treatment: who is responsible for what

A disease is treated where it is, so hormonal hair loss is often managed by several doctors. A trichologist does not treat endocrine diseases, and if you need another doctor, we will tell you plainly.

• Endocrinologist: hypothyroidism, hyperthyroidism, hypoparathyroidism, excess prolactin, Cushing's syndrome, adrenal disease.
• Gynecologist: polycystic ovaries, cycle problems, choice of contraception, the decision on hormone replacement in menopause.
• Trichologist: identifies the type of hair loss, treats the hair and scalp, and follows the recovery.

What we do

With telogen shedding the key is removing the trigger; as supporting methods the doctor may use scalp mesotherapy or plasma therapy (see Injection options in the therapy of hair pathology). If androgenetic alopecia turns up, it needs separate long-term treatment, described on the Androgenetic alopecia page. Anti-androgen medicines are used only when indicated, because they are dangerous to a male fetus. For scalp care there are esthetic trichology procedures, and trichopigmentation and hair replacement systems can add visual density.

What not to do on your own

• Do not stop thyroid medicines, corticosteroids, contraceptives, hormone replacement or aromatase inhibitors because of hair loss. Talk to the doctor who prescribed them.
• Do not start testosterone, DHEA, anti-androgens or contraceptives for the sake of your hair. In people with androgenetic alopecia, androgens, DHEA and androgenic progestins can actually trigger shedding.

What to expect

The outlook depends on what is found. Shedding after childbirth or after stopping contraceptives usually settles on its own and hair gradually recovers. If the cause is a thyroid disease or another hormonal disorder, an endocrinologist or gynecologist treats it, and a trichologist follows the state of your hair.

It is different when a hormonal event has only made androgenetic alopecia visible. It will not go away by itself even with perfect test results, although treatment can slow it down. Later in life, age-related thinning may join it (see Involutional hair loss).

If postpartum shedding does not ease, or shedding goes on for months after a medicine was stopped, come back for another visit. At follow-up appointments we compare trichoscopy and phototrichogram data in the same area.

We see patients by appointment in Kharkiv, 17 Danylevskoho St. For fees, see the consultations price list and the clinical trichology price list.

Related pages: Hair loss in women, Androgenetic alopecia, Age-related hair thinning, Trichoscopy.