When I booked an appointment with a dermatologist last year in a bid to sort out my hormonal acne once and for all, I didn't realise I'd come away knowing a hell of a lot more about my body than I did when I walked in.
In one hour, I discovered that my acne was likely a result of my Polycystic Ovary Syndrome (PCOS), a condition I share with approximately 1 in 5 women in the UK. According to Dr. Prudence Knight, an online doctor at Push Doctor, PCOS is thought to be caused by incorrect hormone levels. Aside from absent or irregular periods and a difficulty becoming pregnant due to absent or infrequent ovulation, physical symptoms can include acne and weight gain, as well as excess hair growth, typically on the face and also on the chest, buttocks and back, to name a few. In contrast, thinning hair on the scalp is also an issue, as my dermatologist pointed out. Surprisingly, it was a symptom my GP failed to disclose when I was diagnosed, even though I'd made countless visits about the problem before.
This made sense and it didn't. It explained the depleting areas on my temples and around my hairline - the reason why I hate wearing my hair up out of fear of exposing the bald patches. But one thing I didn't understand was that the condition causes excess hair growth in places, so how is it possible that it can cause hair loss on the scalp?
"In PCOS, androgen (AKA male hormone) levels are most often towards the higher range of normal and are sometimes raised," explains Glenn Lyons, Clinical Director of Philip Kingsley Trichological Clinic. "These hormones, particularly testosterone, are also the main catalyst and influence of androgenetic alopecia - female pattern hair loss," he adds, something Philip Kingsley trichologist, Jane Martins, expands on. "The hair follicle therefore miniaturises and starts to produce a finer hair, making the individual more conscious of their parting perhaps being wider," she says. "The pattern of the hair thinning involves the top and centre frontal hairline," continues Lyons. "Contrary to perceptions the loss is always gradual. This causes the usual concerns of seeing more scalp and complaints that partings are wider."
Although widespread, PCOS remains undiagnosed in many women in the UK
It's also important to note that although widespread, PCOS remains undiagnosed in many women in the UK, according to Net Doctor, but hair loss is a common indicator. "It is now established and recognised by hormone specialists that female pattern hair loss (FPHL) alone is now a major criteria for suspecting the presence of PCOS particularly in younger menstruating women," says Lyons, but he continues, "the presence of polycystic ovaries only really adversely affects scalp hair if there is an hereditary predisposition to hair thinning, otherwise PCOS on its own does not cause hair loss. Interestingly, a study published in the European Journal of Endocrinology in 2004 proved that there is a significant higher incidence of PCOS in women suffering with female pattern hair loss compared to those without hair loss. In the study 67% of women confirmed suffering with PCOS had FPHL."
So if your hair is thinning as a result of PCOS, what can you do about it?
You might have heard of using Spironolactone to treat hormonal acne. The female-only oral pill, usually advised to be taken daily, is an off-label treatment. It is usually used to treat low blood pressure, but the tiny white pill also has anti-androgen effects, and at certain doses, it effectively blocks male hormones and subsequently reduces both unwanted hair and hair thinning, according to consultant dermatologist and author of The Skincare Bible, Dr. Anjali Mahto.
"Spironolactone is a potassium-sparing diuretic that is licensed in the UK for treatment of blood pressure often in older patients with heart problems," she explains. “Women with PCOS tend to have two distinct types of hair problems. They often suffer with excess facial or body hair but also may notice shedding of scalp hair, often exhibiting as thinning at the crown and temples. At a certain dose, off-label, Spironolactone can potentially help improve scalp hair growth. However, in this context it should only be prescribed by a consultant dermatologist with experience in its use. This is because it is an unlicensed treatment.”
It's also important to note that Spironolactone is a diuretic or 'water tablet', which mean's it's likely to increase the passing of urine. Other side effects may include fatigue and breast tenderness to name a few, so always consult an experienced specialist, such as a dermatologist or GP before use. If Spironolactone isn't for you, Martins also suggests visiting your GP to discuss other oral anti-androgens such as Dianette.
"Despite the substantial amount of products available and advertised in retail outlets, they are mostly ineffective in controlling the hair follicles' sensitivity to circulating androgens," says Lyons, but there are a select number of topical treatments that can help.
"Hair follicles are only 3-4mm below the surface of the scalp and for many years at the Philip Kingsley clinic we have been successfully treating female pattern hair loss with the daily application of an anti-androgen solution. At least 90% undertaking this treatment have noticeable increased hair density (hairs per square centimetre) during the first 12-14 months. Thereafter, density is maintained with continued application."
"Minoxidil is a vasodilator which helps to stimulate growth, and is a well know ingredient used to help with this issue," explains Martins. In oral form, it causes hypertrichosis - excess hair growth - but if you have excess facial and body hair already, taking it might not be the best option. Although, an observational study by the International Journal of Dermatology found that low-dose oral Minoxidil (0.25mg), combined with Spironolactone (25mg) resulted in a reduction in hair loss in women.
Topical Minodixil, which you can now buy over the counter, comes in lotion and foam form at different strengths and can be concentrated to areas of thinning. "The percentage prescribed usually depends on the extent of the hair thinning," explains Martins, as it varies from person to person. Always consult a pharmacist, GP or trichologist before use.
According to Sally-Ann Tarver, Trichologist at The Cotswold Trichology Centre, phototherapy is also an option for those experiencing hair thinning as a result of PCOS. She recommends the Theradome LH80 PRO Laser Helmet, £749, which is a portable device that can be used at home. "Laser phototherapy has a similar action to Minoxidil and stimulates circulation to the hair follicles but in addition it improves hair quality and structure," she explains. "In my opinion, the results are better than with Minoxidil. Phototherapy is easier and there are no side effects. It doesn't have to be performed every day, so patients tend to stick with it and their hair improves over time." According to The Consulting Room, sessions in clinic can start from £45.
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