| Women with PCOS are more than twice as likely to experience hair thinning compared to women without PCOS of the same age, and the cause runs deeper than stress or diet alone. |
PCOS Causes Hair Loss Due to Excess Androgens
PCOS-related hair loss, clinically called female pattern hair loss (FPHL) or androgenic alopecia, is driven primarily by excess androgens – particularly dihydrotestosterone (DHT). In PCOS, elevated androgens shrink hair follicles and shorten the growth phase of the hair cycle, leading to progressively finer, thinner hair, especially across the crown and top of the scalp.1,2
Elevated insulin also plays a direct role: high insulin levels stimulate the ovaries to produce more testosterone, which then converts to DHT within the hair follicle. This means that hair loss in PCOS is both an androgen problem and, often, an insulin resistance problem – and addressing only one without the other typically produces disappointing results.3
What the Evidence Shows Helps
1. Addressing Insulin Resistance
Since elevated insulin drives androgen production, improving insulin sensitivity is foundational when PCOS causes hair loss. The 2023 International Evidence-Based Guideline for PCOS recommends lifestyle intervention – including dietary change and regular physical activity – as the first-line treatment for metabolic features of PCOS, including those that affect androgen levels.4
In naturopathic practice, this often includes a low-glycemic/load diet, resistance training, and targeted supplementation, such as myo-inositol, which has evidence supporting improved insulin sensitivity in PCOS.5
2. Anti-Androgen Strategies for When PCOS Causes Hair Loss
The 2023 International PCOS Guidelines note that anti-androgen medications (such as spironolactone) may be considered when other treatments are ineffective or contraindicated, though they are not the first recommendation.4 Prescribing of these agents in Ontario falls outside the scope of a naturopathic doctor in Ontario.
Natural options with some evidence for anti-androgenic activity include saw palmetto, which may inhibit 5-alpha reductase (the enzyme that converts testosterone to DHT), though larger, well-powered RCTs in PCOS specifically are still needed.6
3. Topical Minoxidil When PCOS Causes Hair Loss
Minoxidil applied to the scalp has established evidence for female pattern hair loss and works by shortening the resting (telogen) phase and extending the growth (anagen) phase of the hair follicle. It does not address the underlying hormonal driver in PCOS, but can support regrowth as part of a comprehensive plan – a 2023 review of FPHL in PCOS patients concluded that combination approaches (hormonal + topical) outperform either intervention alone.3
Many of my patients are afraid to start Minoxidil treatment because they know that it is not addressing the root cause of their hair loss, and that as soon as they stop using it, hair loss will resume. If we address the hormone imbalance that is causing PCOS-related hair loss, then once people discontinue Minoxidil, the hair loss doesn’t resume.
4. Targeted Nutritional Support If PCOS Causes Hair Loss
Iron deficiency is common in women and can significantly worsen hair loss. Always assess ferritin (not just hemoglobin) as part of a complete hair loss workup. Zinc, biotin deficiency, and low vitamin D have also been associated with hair loss, though supplementation should be based on demonstrated deficiency rather than routine use. 6
5. Stress and Cortisol
Chronic stress may elevate cortisol, which can disrupt the hair cycle directly causing Telogen effluvium. If cortisol is high, it will increase blood sugar and insulin, amplifying androgen production (DHEAs, DHT, testosterone) in a subset of women with PCOS. Stress management – including sleep optimization, nervous system regulation, and appropriate adaptogenic support – is an underutilized component of a comprehensive hair loss plan.
| Clinical note: Hair loss workup in PCOS should include total and free testosterone, dihydrotestosterone, DHEAs, SHBG, ferritin, thyroid panel (TSH, free T3, free T4, reverse T3, anti-TPO, anti-thyroglobulin), prolactin, and fasting insulin. Hair loss from thyroid dysfunction and iron deficiency must be ruled out before attributing loss exclusively to PCOS androgens or stress. |
What to Realistically Expect When PCOS Causes Hair Loss
Hair regrowth is slow. Even with effective treatment, patients often need to wait 6 to 12 months before seeing meaningful changes. Setting clear expectations around timelines and tracking progress with baseline photos can help you stay committed to your hair loss protocol.
| Disclaimer: This post is for educational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for diagnosis and individualized treatment. Naturopathic doctors in Ontario practice under the College of Naturopaths of Ontario. |
| PUBMED REFERENCES Related to When PCOS Causes Hair Loss |
| 1. Carmina E, et al. Female pattern hair loss and androgen excess: a report from the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab. 2019;104(7):2875–2891. PMID: 30785992 |
| 2. Klein DA, et al. A practical approach to the management of hair loss in patients with PCOS. J Eur Acad Dermatol Venereol. 2023. doi:10.1111/jdv.18842 |
| 3. Khare S, et al. Efficacy of SKS Hair Booster Serum in the treatment of FPHL in PCOS patients. Cureus. 2023. PMC10561348 |
| 4. Teede HJ, et al. Recommendations from the 2023 International Evidence-Based Guideline for Assessment and Management of PCOS. Hum Reprod. 2023;38(1):3–19. PMID: 37580314 |
| 5. Fitz V, et al. Inositol for PCOS: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-Based PCOS Guidelines. J Clin Endocrinol Metab. 2024;109(6):1630–1650. |
| 6. Dinh QQ, Sinclair R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007;2(2):189–199. PMC2684510 |
