Losing Your Hair Over PCOS? Here’s My 5 Step Plan To Grow It Back
By Clare Goodwin
Last updated: September 3, 2020
Has PCOS made your hair fall out? PCOS hair loss is one of the most distressing symptoms, and is something that many of my patients suffer from.
I met Lisa* last week. She was diagnosed with PCOS 5 years ago and has been battling her weight and some hirsutism since then. She could manage that though. Then it got personal: PCOS started taking her hair.
Her once luscious ponytail was now merely a few strands and she was starting to get bald patches on her temples. Every shower ended in heartbreak, with the tray lined with her long brown strands. “I’ve always been ‘Lisa with great hair,’ and now I’m going bald. I could deal with the weight and the few chin hairs because my hair made me feel feminine. And now I don’t even have that.”
I’ve had hair-loss, but not like Lisa did. No, mine was more of a particularly bad blonding experience, which ended in my hair self-layering. That was a case of “shouldn’t have been tempted by the cheap Groupon voucher alopecia”. Entirely self inflicted. Lisa has Androgenic Alopecia.
What is Androgenic Alopecia?
It’s the kind of hair loss where it’s falling out at the roots. This is a really demoralising symptom of PCOS for many women, and I have huge sympathy for anyone going through it. It’s caused by the same thing that causes men get a receding hairline, androgen hormones. In women, the hair usually thins all over. But I’ve also seen it cause widening of the middle part, thinning at the temples, and thinning behind the front hairline.
This article will provide an in-depth look at the cause of PCOS hair loss, but if you just want to just to get to the ‘doing’ then download my 5 Step Plan to Grow Back those Luscious Locks. It doesn’t include any ‘miracle’ shampoos or quick fixes! It’s a 5 Step Plan to treat the root cause of hair loss. As a result, you’ll actually fix any other symptoms at the same time: acne, weight gain, those chin hairs and non existent periods.
How does PCOS cause hair loss?
Testosterone is broken down to Dihydrotestosterone (DHT) within the hair follicle’s oil glands. DHT binds to receptor sites in the hair follicle (kind of like a lock and key mechanism) and shrinks the hair follicle, killing it off in the process. Some women may have more sensitive receptors, or are more efficient in producing DHT. This makes them susceptible to hair loss.
Spironolactone is the drug often prescribed for PCOS hair loss. It fits into this receptor site (like a key) and stops testosterone getting in there. However, whilst doing this it also causes a lot of damage. It disrupts ovulation, estrogen metabolism, and adrenal function, so it’s most likely causing more harm than good. I will go into more detail on Spiro in future posts. For now, remember that Spiro is the (not particularly effective) quick fix that may be doing you more harm than good.
Excess testosterone and other androgens, such as DHEA-S and Androstenedione, also causes inflammation. Our hair follicles are sensitive little creatures, especially to something called oxidative stress. Oxidative stress is when there are too many free radicals and not enough anti-oxidants. It’s caused by inflammation.
Is It PCOS hair loss or is it your thyroid?
Your thyroid is a gland that sits at the base of your neck and it controls how fast and slow your metabolism is. If your thyroid isn’t producing enough hormone, then you have an underactive thyroid, also known as Hypothyroidism. Up to a quarter of women with PCOS have hypothyroidism. Hypothyroidism causes increased androgens (like PCOS) which, as I discussed above, causes your hair to fall out.
I’ve written an entire article about PCOS and Hypothyroidism, which I’d recommend reading if you’ve experienced any of the following symptoms:
- Weight gain, even with a low calorie diet.
- Feeling tired all the time, even after a good sleep.
- Depression or lack of motivation.
- Dry skin and hair.
- Thinning outer third of the eyebrow.
- High cholesterol.
- Cold hands and feet (or cold all over).
- Morning headaches.
- Mental sluggishness.
You don’t have to have all of these symptoms, in fact your hair loss might be the only one. As an example, apart from weight gain, my only symptom was that I was constantly cold. As I explained in my article about the thyroid and PCOS, thyroid blood tests are rarely done. Even if they are, they may not be accurate. Your thyroid hormone levels may appear ‘normal’ even when they’re not.
Lisa is a prime example of the issues surrounding the association between the thyroid and PCOS. When she was diagnosed with PCOS, she wasn’t also given a thyroid test. When her hair started falling out she went back to her doctor and asked if there was anything they could do. Her doctor ran a TSH blood test and it came back very low, at 0.6, so no further tests were done. However, when I started working with Lisa I had a full thyroid panel run. This found that she did actually have hypothyroidism.
How can I fix my PCOS hair loss (Androgenic Alopecia)?
When she came to me, Lisa’s first question was, ‘What should I be eating to make this go away?’. I told her that the answer depends on what’s causing the PCOS hair loss in the first place. More accurately, what’s causing excess androgens.
Not all PCOS is the same and the cause of excess androgens differs between everyone. Asking what diet is best is kind of like asking what type of fuel you should put in your car. It depends on the make and model; getting it wrong can bring you to a grinding halt. Like all PCOS symptoms, the key to fixing PCOS hair loss is treating the root cause of high androgens. This could be insulin resistance, high stress hormones, poor gut health, the pill, thyroid issues, or a combination of several of them.
The best thing you can do is find out what’s causing your high androgens, then treat this root cause. If you haven’t read my article:What’s Causing Your PCOS, and Why You Need To Know, then do that now. It will answer a lot of your questions.
Here are some tips that I think everyone with PCOS hair loss can benefit from:
1. Remove inflammatory foods
Studies have shown that those of us with PCOS have higher levels of inflammation than ‘normal’ women. Research has also suggested that inflammation may cause an increase in androgens and insulin resistance.
Food can cause inflammation in two ways:
- By being indigestible, either due to poor gut health or genetic predisposition. Examples include grains, such as gluten, and dairy.
- By being processed in a way that makes it inflammatory. Examples include processed soy, high fructose corn syrup, and seed oils (e.g. corn, canola, sunflower, etc).
On seed oils…
By that, I mean oils made from a seed plant: canola, soybean, sunflower, rice bran, etc. These ‘heart healthy’ oils that you thought were safe are actually part of what might be contributing to your PCOS. All of these oils contain high amounts of the type of fat that causes inflammation: Omega 6 fats. These are all found in seed oils. Conversely, Omega 3 fats, which are found in fatty fish and olive oil, reduce inflammation and therefore PCOS. This is where we should be getting most of the fat in our diets from.
Omega 6 Fats compete with Omega 3 Fats for enzymes. It’s therefore the ratio of Omega 3 to Omega 6 that’s really important. Studies have shown that a large Omega 6: Omega 3 ratio is associated with all inflammatory diseases, including insulin resistance, Type 2 diabetes, and obesity. Regarding PCOS specifically, studies have shown that higher Omega 6 in the blood is correlated to higher testosterone levels.
You should be aiming for a 1:1 ratio of Omega 3 to Omega 6. This is no small task, considering that most of you will currently be consuming a 10:1 ratio. It may even be as high as 25:1. The best way to achieve this 1:1 ratio is by removing all seed oils from your diet and increasing the amount of fatty fish you are eating.
2. Treat Insulin Resistance (if you have it)
The most common cause of high androgens in PCOS is insulin resistance. Insulin resistance is the precursor to Type 2 Diabetes, so it’s something that you want to get under control. The most important thing you can do is remove SUGAR from your diet. This is comes in many forms:
- Cane sugar.
- High fructose corn syrup (in manufactured products and sodas).
- Dried fruit, such as dates. This also includes ‘healthy’ treats made from them, like bliss balls.
- ‘Natural’ sugars, such as maple syrup, agave nectar, and brown rice syrup.
- Even no/low calorie artificial sweeteners, such as stevia and diet/zero sodas. Research shows that these likely still stimulate the insulin response.
As a rule of thumb, if it tastes sweet then don’t eat it, no matter the source. A good treat to have instead is some 90% cocoa chocolate. It has minimal sugar and lots of great antioxidants from the cocoa.
If you’re searching online forums for PCOS, you’ll probably be reading a lot about PCOS and low carb diets. Low carb and ketogenic (super low carb) diets can be really effective for reducing androgens in PCOS, but only if you have insulin resistance. Even then, they don’t work for everyone.
Excess androgens and PCOS can be caused by many factors, including too much stress, poor gut health, thyroid conditions, micronutrient deficiencies, and the pill. If you’re suffering from stress or insulin resistance, then reducing carbs will actually put more stress on your adrenal glands, making them produce more stress hormones and androgens.
If you’re thinking of trying a low carb diet then make sure that you find out whether you’re insulin resistant first. You can do this by reading my Insulin Resistance and PCOS article. You can also get your doctor to test your blood sugar, even if it was normal in the past.
3. It’s Not All About Diet
Although your diet is important, look at other aspects of your life that might be causing inflammation, excess androgens, and PCOS hair loss. The most common ones that I see are:
- High stress hormones.
- Too much medium-high intensity exercise.
- Poor gut health.
- Environmental toxins (such as BPA from plastics)
I can only imagine how heartbreaking PCOS hair loss is and why you would want to try everything to get it back. However, I hope you can now see what’s causing it to fall out and how there’s no scientific way that a shampoo can address excess androgens or inflammation. I’m afraid that you may be washing your money down the plughole with these.