Hormones are essential to the good functioning of our body, and some of them play an important role in healthy hair growth. However, when they are insufficient, excessive or imbalanced (or we are overly sensitive to them), they can also lead to hormonal hair loss.
Androgenetic alopecia is the best-known hormonal hair loss condition, affecting 85% of men [1] and 55% of women [2] at some point in life. It is caused by a genetically increased sensitivity to dihydrotestosterone (DHT). However, other hormones can also cause hair loss. This article will tell you all you need to know about the most common forms of hormonal alopecia, including:
Hormones are substances secreted by specific glands and tissues in our body, which act as chemical messengers meant to organise, control and regulate our bodily functions [3]. They are often produced by the endocrine glands and play an important role in processes such as growth and development, metabolism, sexual and reproductive function and mood regulation [4].
Some of our hormone levels, their balance in our bodies, and our sensitivity to them can also influence hair growth. Here are the main hormones that, under specific circumstances, can play a role in hair loss [7]:
There are 3 main ways that hormones can negatively impact your hair growth and play a part in your alopecia [7]:
Several common hair loss conditions can be traced back to hormonal activity. Here are some of the most common.
Commonly known as male pattern baldness or female pattern baldness, this type of alopecia is the leading cause of hair loss worldwide. More than 85% of men [1] and over half of women [2] experience it during their lifetime.
Androgens play a significant role in the development of androgenetic alopecia. An enzyme called 5-alpha reductase converts some of your testosterone into DHT, a male hormone which plays a role in your sexual and reproductive function. However, DHT can also bind to specific androgen receptors in your hair follicles, making them shrink and causing hair miniaturisation that can advance to baldness if left untreated [5].
The higher your hair follicle sensitivity to DHT, the more likely this hormone is to bind to them. In fact, this type of alopecia is patterned because the follicles on your frontal area and crown are more sensitive to DHT than those on the back and sides of your head.
Symptoms of androgenetic alopecia: Male pattern baldness normally begins with a receding hairline and temple hair loss, then progresses to a bald spot on the crown if left untreated [5]. Female pattern baldness typically spares the frontal area, causing diffuse thinning and a widening of the midline parting [6].
Cortisol is a hormone that regulates your body’s stress response. Higher levels of cortisol are secreted when you’re undergoing physically or mentally demanding times (such as illness, surgery, mental health problems, bereavement, or unemployment).
You may have noticed that stress and anxiety can cause hair loss. This is because they trigger a condition called telogen effluvium. Excessive cortisol levels interfere with hair follicle function, disrupting your hair growth cycle [7][8][9].
Telogen effluvium normally sets in around 2-3 months after a stressful event and resolves itself in around 95% of patients within 3-4 months of stressor cessation [9][10]. However, rarely, this condition can become chronic and last for years [11].
Symptoms of telogen effluvium: excessive hair shedding (above 150-200 hairs per day [12]), diffuse hair loss (up to 30-50% of your hair [13] but without causing visible bald spots), in some cases a tingling or burning sensation on the scalp (also known as trichodynia).
Research shows that over 68% of women who have recently given birth experience postpartum hair loss [14]. This phenomenon is completely natural and no reason for concern.
During pregnancy, a woman’s body experiences a surge of female hormones (including oestrogen and progesterone) which stimulate hair production and keep your tresses in the growth phase for longer. About 4 months after birth, as your hormone levels start to return to normal, a larger proportion of your hair than usual enters an overdue resting/shedding stage, eventually falling out.
Moreover, stress caused by the birth itself and the exhaustion from caring for a newborn can raise your cortisol levels, also contributing to your hair loss.
The good news is that postpartum hair loss requires no treatment and typically resolves itself within 4-6 months of onset [15].
Symptoms of postpartum hair loss: diffuse hair loss all over your scalp, hair that falls out in clumps when brushing or during a shower but leaves no bald spots.
During perimenopause, women’s hormonal balance starts to shift. They start to produce lower amounts of oestrogen, so the proportion of male-to-female hormones increases. This often results in menopausal hair loss, consisting of hair thinning, as well as the onset of female pattern baldness, which affects over 52% of postmenopausal women [16].
Perimenopausal hair loss can start as early as age 35-45 and if left untreated, it can advance after menopause sets in. However, hair loss medications and hormone replacement therapy may help reduce alopecia. Shampoos for menopausal hair loss may also help keep your hair healthy and beautiful.
Symptoms of menopausal hair loss: diffuse hair thinning on the scalp, often accompanied by a widening of the midline parting or a Christmas tree pattern around the parting (signs of developing female pattern baldness).
Throughout life, our adrenal glands produce some hormones called dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S). They are precursors of male and female hormones, which means your body can convert them into androgens or oestrogens. Moreover, they are believed to play a role in promoting skin and hair health.
DHEA and DHEA-S levels peak in early childhood (around 6-8 years of age) and decrease steadily after puberty [30]. Around the age of 50, this decline suddenly becomes more abrupt due to changes to your adrenal glands [31]. This phenomenon is called adrenopause [31]. By age 80, you only produce around 20% of the DHEA and DHEA-S levels of young adulthood (women seem to experience this reduction more rapidly and acutely than men) [32].
Adequate levels of these adrenal hormones promote a healthy hair growth process. Deficiencies have been linked to hair thinning, especially in women. That is because the decline in DHEA and DHEA-S occurring in adrenopause often overlaps with menopause, which can lead to even lower oestrogen levels and more pronounced resulting hair thinning.
Finally, research shows an antagonistic relationship between DHEA and cortisol. This means that one rises as the other decreases. The steep reduction in DHEA and DHEA-s during andropause can lead to higher cortisol levels, which can induce telogen effluvium.
Symptoms of adrenopause-induced hair loss: diffuse or patterned hair thinning, changes in hair texture or increased hair breakage
Alopecia is a very common symptom of thyroid disorders. 50% of people with hyperthyroidism and 33% of those with hypothyroidism experience it [17]. Thyroid hair loss can happen through several mechanisms, from disruptions to your hair growth cycle, to reduced blood flow to the scalp or reduced scalp oil production that can cause dry, brittle hair that breaks off easily.
Treating your thyroid disorder will often curb the hair loss, and, in some patients, it can even lead to hair regrowth. However, some will only experience partial hair growth or none at all [18]. That is why, whenever possible, it is best to diagnose and treat thyroid conditions before alopecia sets in.
Symptoms of thyroid hair loss: diffuse hair loss (often with more pronounced thinning on the top of the head and the crown), sometimes slower hair growth, changes to hair texture (it can become either coarser or finer), dry hair that feels like straw or premature greying. Some patients with an underactive thyroid may also experience partial eyebrow hair loss [19].
Hormonal hair loss can be difficult to tell apart from other types of alopecia. These specific characteristics can help you tell if your hair thinning might have a hormonal cause.
If you are experiencing this kind of hair loss, you will either see diffuse hair loss all over your scalp or the typical signs of androgenetic alopecia discussed above. It will not normally manifest with small, smooth, bald patches on your scalp (save for the classic bald spot on your crown).
Potential non-hormonal hair loss causes: If you experience patchy hair loss, you may have alopecia areata or a common scalp problem (such as scalp psoriasis or ringworm).
None of the common types of hormonal hair loss presented in this article normally manifests with scalp inflammation. This means that if you experience redness, itching, a rash, or feel your scalp is tender in one spot, the cause is likely not hormonal.
Potential non-hormonal hair loss causes: if your scalp is red, tender, itchy and/or shows pustules, rashes, plaques or flaking, you may have a hair follicle infection (e.g. scalp folliculitis), or a yeast infection on the scalp (e.g. seborrheic dermatitis). Scarring alopecia will also often cause redness, burning and itching in the affected area.
Whether it is caused by hormonal imbalances that occur with age, stress or a health condition, hormonal hair loss is sometimes also associated with additional physical and/or psychological symptoms. Depending on the type of hormonal problem you may be experiencing, these may include:
The exception from this rule is male pattern baldness, which is not typically accompanied by any other physical symptoms.
If you regularly experience any of the symptoms above (or other notable ones) alongside hair loss, it may be worth seeing your GP for a checkup.
Potential non-hormonal hair loss causes: If diffuse alopecia is your only noticeable symptom, you may be experiencing medication-induced hair loss or a mild nutritional deficiency.
The reversibility of your hormonal hair loss generally depends on the type and stage of alopecia you are experiencing:
Yes, hormonal hair loss can sometimes progress if left untreated. The main kind of alopecia that will worsen over time is male/female pattern baldness. While in some patients, it will eventually stop advancing after a certain point (usually after a large bald spot has developed on their crown), in others, it can progress to almost complete hair loss. However, other forms of hormonal hair loss can also advance if unaddressed. Thyroid and menopausal alopecia are good examples. That is why it is important to see a trichologist if you notice your hair is falling out.
The Ludwig scale that measures female pattern baldness progression
The Norwood scale that measures male pattern baldness progression
Hormone-induced telogen effluvium can result in the sudden loss of as much as 30%-50% of your hair, but it will be diffuse hair thinning that does not normally progress to baldness [20].
Some forms of hormonal hair loss (e.g. androgenetic alopecia) cannot be fully prevented because they have a genetic component. However, you can reduce your risk of developing a form of hormonal alopecia by doing the following.
It is a good idea to get regular blood tests to monitor your hormone levels, especially if you have a history of hormonal imbalances or thyroid problems or if you are perimenopausal/postmenopausal. Identifying and treating hormonal dysfunctions early on can not only keep your hair full, but it can also prevent other health problems.
Unfortunately, you may be unable to get regular preventative hormonal hair loss tests on the NHS unless you have potentially concerning symptoms (such as alopecia, fatigue, weight loss, dizziness, or sexual dysfunction). However, the best hair clinics offer this paid service upon request.
While some stressful events cannot be avoided, you can develop healthy relaxation routines that can prevent stress from building up. Daily meditation sessions, exercise, sufficient sleep, regular walks in nature and setting time aside for self-care and being with your loved ones can make a significant difference. Attending therapy sessions may also help for maintenance or to guide you through difficult times.
Eating a healthy diet that’s rich in nutrients and vitamins for hair growth can keep your tresses beautiful and also help keep your hormones balanced.
Smoking can cause hair loss, as nicotine can reduce blood flow to the scalp. It can also accentuate the symptoms of androgenetic alopecia [21]. So cutting back on smoking or quitting entirely is excellent for your hair and overall health alike.
If you suspect you may have thyroid problems, don’t hesitate to get them diagnosed and treated, even if they don’t bother you much at this time. Thyroid disease can not only cause hair loss (which can sometimes be irreversible even after treatment). It can also cause numerous health issues, such as heart and blood pressure problems, fatigue, metabolism problems and mental health problems [22].
If you are a perimenopausal or postmenopausal woman, discuss the opportunity of hormone replacement therapy with your gynaecologist or endocrinologist. They will normally order blood tests to determine your hormone levels and recommend treatment to compensate for natural hormonal imbalances that occur in this stage of life.
This will not only be beneficial for your hair, but it can help ease other symptoms of menopause and increase your overall quality of life.
Sometimes, treating your hormonal hair loss is as simple as getting your thyroid condition under control or getting hormone replacement therapy during menopause, as per your doctor’s recommendations. However, some conditions require specific hair loss treatment. Here are some of the most effective options.
If you are experiencing androgenetic alopecia, a permanent hair transplant is as close as you can get to a cure for baldness. This safe and simple outpatient surgery involves harvesting healthy, less DHT-sensitive hair follicles from the back of your head and implanting them in your thinning areas. The best hair transplant clinics in the UK have a 97-100% success rate for this procedure.
This medication can help treat most types of hormonal hair loss, as it works by improving blood flow to your hair follicles [23]. Minoxidil allows your follicles to receive extra oxygen and nutrients, which help them grow thicker and fuller hair.
Finasteride is the world’s most prescribed medication for male pattern baldness, and it works by lowering your DHT levels. It is very effective for men [24].
Premenopausal women can’t use Finasteride, as it can cause birth defects and hormonal imbalances. It can, however, be prescribed off-label to postmenopausal women with female pattern baldness, with promising results [25].
PRP contains an abundance of growth factors that can stimulate your follicles for hair growth and help repair any damage they have sustained [26]. PRP hair treatments are performed by harvesting a small quantity of blood from the patient, separating the platelet-rich plasma and injecting it in your balding areas. It works well to help treat all types of hormonal hair loss.
This form of low-level laser therapy for hair growth can also be used to help treat most types of alopecia. Red or infrared light is absorbed into your scalp, increasing blood flow to your follicles and optimising the activity of your cell mitochondria [27].
This treatment is typically used by women who are experiencing polycystic ovary syndrome or undergoing menopause. Spironolactone can curb hair loss by reducing the production of androgens and there is evidence it can improve female pattern baldness [28].
If you suspect you may be experiencing hormonal hair loss, we are here to help. Book a consultation today with one of our experienced trichologists. They will perform a thorough examination of your hair and scalp, get a detailed account of your medical history and order all the necessary hair loss blood tests.
Based on the results, we will provide an accurate diagnosis and recommend the most effective hair loss solutions for your specific condition, hair needs, preferences and lifestyle. The sooner you start treatment, the easier it will be to restore your full, healthy, beautiful hair.
Find out more about hormonal hair loss conditions by reading the answers to these frequently asked questions.
Women experience certain kinds of hormonal hair loss more than men. For example, they are 500% more likely to develop thyroid conditions that can cause hair loss [29]. They can also experience postpartum, perimenopausal and postmenopausal hair loss and are more likely to develop telogen effluvium. However, men are significantly more likely to develop androgenetic alopecia, which is the leading cause of hair loss worldwide.
High testosterone itself does not necessarily cause hair loss. What matters more is the amount of testosterone that gets converted into DHT and, most importantly, your sensitivity to this male hormone. That’s because it is DHT, not testosterone, that binds to your hair follicles, causing androgenetic alopecia.
People who have a genetically higher sensitivity to DHT and whose bodies produce more of this hormone are more likely to develop pattern baldness.
No, Finasteride does not lower your testosterone levels. In fact, the opposite is true. Finasteride works by inhibiting the activity of an enzyme called 5-alpha reductase, which converts some of your testosterone into DHT. That means you will be left with higher levels of testosterone than before treatment started. However, you should know that many features often associated with high levels of testosterone in men (e.g. thick face and body hair, a deep voice or enlarged muscle mass) are in fact caused by DHT. That is because it is a stronger androgen than testosterone.
Yes, female hair transplants are as safe and effective against androgenetic alopecia as those performed in men. In fact, more and more women are choosing to have their hair surgically restored, as operative techniques have improved and the procedure has become more affordable.
Hair loss blood tests typically measure the levels of your thyroid hormones, as well as your male and female hormones. Besides hormones, they usually also screen for mineral and vitamin deficiencies that cause hair loss (such as iron, vitamin B, and vitamin D.). A complete blood count is also performed and blood sugar levels are measured to rule out other systemic illnesses that might make your hair fall out.
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