Hair Loss and Hormonal Imbalance

Introduction to Hair Loss

High progesterone levels during the luteal phase of the menstrual cycle can trigger hair loss in susceptible individuals, particularly in conditions like PCOS, which affects 4-6% of women in the general population 1, 2
Hair loss can be caused by various factors, including nutritional deficiencies, hormonal imbalances, and certain medical conditions, requiring a comprehensive approach for effective management 3, 4, 5

For PCOS-related hair loss, the American College of Obstetricians and Gynecologists recommends addressing the underlying condition, which may include a weight loss program, consideration of metformin for insulin resistance, and monitoring of hormonal parameters including progesterone levels 2
A 5% reduction in weight can improve symptoms of PCOS-related hair loss, as suggested by the American College of Obstetricians and Gynecologists 2
Implementing lifestyle modifications, such as a weight loss program, is recommended as part of the initial assessment and treatment approach for female pattern hair loss (FPHL) in patients with PCOS, as suggested by the American Academy of Family Physicians 6

Topical minoxidil 5% and oral finasteride 1mg daily are recommended as first-line treatments for hair regrowth and preventing further hair loss by the American Academy of Dermatology 4, 7, 8
The combination of minoxidil and topical finasteride produces higher hair density increases (+81 hairs/cm² after 6 months) and 79% of patients achieved significant visible improvement versus 41% with minoxidil alone, as recommended by the American Academy of Dermatology 4
Platelet-rich plasma (PRP) therapy is recommended as a series of 3-5 sessions at monthly intervals, using manually prepared double-spin PRP injected at a dose of 5-7 mL (0.05-0.1 mL/cm²) per session, as recommended by the Periodontology society 4
Intralesional corticosteroids, such as triamcinolone acetonide 5-10 mg/mL, administered through monthly injections, are a treatment option for limited patchy hair loss, with 62% achieving full regrowth with <5 patches, as suggested by the British Journal of Dermatology 9
Contact immunotherapy is more effective than other treatments for severe Alopecia Areata, with variable efficacy of other treatments reported, according to the British Journal of Dermatology guidelines 10

Nutritional support, such as addressing deficiencies in iron, zinc, and vitamin D, can be beneficial for hair loss management, as suggested by the British Journal of Dermatology and the American Journal of Clinical Dermatology 9, 11
Using sulfate-free shampoos and conditioners, and choosing hydrating formulas with ingredients like natural oils, hydrolyzed proteins, and ceramides can help fragile hair, as suggested by the British Journal of Dermatology 12
Reducing thermal damage by limiting the use of heat styling tools, using thermal protectants, and air-drying when possible can help prevent further hair damage, as suggested by the British Journal of Dermatology 12

The American College of Clinical Dermatology recommends assessing thyroid function through tests such as TSH, Free T4, and considering thyroid antibodies if initial tests suggest thyroid dysfunction, as part of the initial evaluation for hair loss 13
The Obesity Reviews guideline suggests that vitamin D levels below 75 nmol/L may contribute to hair loss, and recommends targeting 25-hydroxyvitamin D levels of 75 nmol/L or greater 5
The American Journal of Clinical Dermatology recommends checking serum/plasma zinc levels, as deficiency is associated with hair loss and treatment resistance, and also checking copper levels as they compete for absorption 5
The American Journal of Clinical Dermatology suggests checking Vitamin B12 and Folate levels, including both RBC folate and serum B12 11
Baseline photos should be taken before starting treatment, with evaluation at 3 months for initial response, critical evaluation at 6 months, and comprehensive assessment at 12 months to determine continuation, as reported by the Journal of Clinical Oncology and the American Academy of Dermatology 3, 4

Women who are pregnant or breastfeeding should avoid minoxidil and finasteride, and it is not recommended for individuals under 18 years of age, with caution in patients with scalp conditions that may increase absorption, as recommended by the American Academy of Dermatology and the Journal of Urology 4, 7
Finasteride is contraindicated in pregnancy due to known teratogenicity, and women of childbearing potential must use reliable contraception while taking finasteride, as recommended by the Journal of Urology 7
Potential side effects of finasteride include sexual dysfunction and endocrine effects, as reported by the Journal of Clinical Oncology 3
The National Comprehensive Cancer Network recommends considering the effect of minoxidil on PSA levels, which could mask prostate cancer detection, with PSA levels typically decreasing by 40-60% after 12 months of treatment 14
Finasteride lowers PSA levels by 50% after 12 months, which is important for prostate cancer screening, as noted by the American College of Clinical Oncology and the American Urological Association 3

The British Association of Dermatologists suggests addressing psychological distress associated with hair loss and considering quality of life measures in treatment decisions, and providing resources for patient support organizations 10
Psychological support is essential, as emphasized by the British Association of Dermatologists 10