“The hair loss AND the [facial] hair growth are the worst parts of PCOS for me.” “They make me feel less feminine,” her voice trailed off as she averted her eyes.

Have you ever felt this way?

Unrealistic beauty standards and societal pressures aside, what she brought up is something I think a lot of people with PCOS experience: a sense that this condition diminishes the outward expression of their womanhood.

There’s a lot there to unpack. More there than we have time for in a single blog post, but I hope at the very least having read the words above, you know you’re not alone if you’ve ever felt this way. There’s no shame in feeling this way. I hope you have a safe place (a therapist, good friends, a support group, something) to explore those emotions.

In the meantime, you and I are going to explore the answers to some of the most commonly asked questions about hair loss and facial hair growth. We’ll also talk about conventional treatments and some natural/ lifestyle-based interventions to consider.

PCOS and Hirsutism

What is hirsutism?

Hirsutism is excess facial and body hair growth. Because facial hair growth varies from person to person and there are ethnic differences, I recommend speaking to a dermatologist, gynecologist, or reproductive endocrinologist to determine the severity of the hair growth you’re experiencing. Using the Ferriman-Hallwey Hirsutism Score, they can objectively classify the level of hirsutism you have.

What causes hirsutism in PCOS?

In PCOS, high androgen levels are the major culprit, but there are other things that can be at play as well. Individual sensitivity to the effects of androgens also plays a role. So even if you have “normal” androgen levels, your hair follicles might be more sensitive than someone else’s hair follicles, resulting in more facial hair growth.

What are other causes of excess body and facial hair growth besides PCOS?

Before I answer that question, I do want to say that qualifying and quantifying “excess” hair growth can be difficult for most of us to do objectively.

I think most women have a false idea of how much hair is “normal.” We grow up with hairless dolls and see waxed, lasered, and shaven celebrities in magazines, on TV, and on social media. Many of us think any hair at all is too much. And that’s just not true. It’s perfectly normal to have body and facial hair. Please keep that in mind.

If you’re like, “Yeah, I know Kendra, but what I have is too much.” then go speak to your healthcare team. They can help you assess it objectively and if necessary, uncover underlying reasons for the hair growth.

Here are a few causes of hirsutism besides PCOS:

• Certain medications and supplements

• Non-classical congenital adrenal hyperplasia

• Ovarian or adrenal tumors

• Acromegaly

• Cushing syndrome

Can PCOS related hirsutism be reversed?

With the right treatment and consistent longterm use of that treatment, PCOS related hair growth can be improved.

What are the treatment options for hirsutism?

Speak with your healthcare team to discuss the best form of treatment for you. Some options include:

Medications:

• birth control pills

• anti-androgens like spironolactone

Cosmetic:

• laser hair removal

• waxing

• threading

• shaving

I’ll share some of my nutrition and lifestyle-based recommendations at the end of this article.

PCOS and Hair Loss

What is PCOS related hair loss?

Often called androgenic alopecia (a term that should be avoided), typically the type of hair thinning seen in people with PCOS is female pattern hair loss (FPHL) which is different than male pattern hair loss. In FPHL, the hairline usually remains intact while the middle part and center become thinner, but rarely results in complete hairlessness.

What causes hair loss in PCOS?

Hair loss in PCOS, like hirsutism, is mainly due to elevated androgen levels. But, just like in hirsutism, there are other contributing factors like individual differences in androgen sensitivity and inflammation. And even if you have PCOS, you can also have other conditions that could be behind the hair loss you’re experiencing.

What are other causes of hair loss besides PCOS?

A few causes of hair loss besides PCOS are:

• thyroid conditions

• inadequate calorie intake

• vitamin and mineral deficiencies

• postpartum hormonal changes

• inflammatory conditions

Can PCOS related hair loss be reversed?

With the right treatment and consistent, longterm use of that treatment, PCOS related hair loss can be improved.

What are the treatment options for PCOS related hair loss?

Speak with your healthcare team to discuss the best form of treatment for you. Some options include:

Medications:

• minoxidil (Rogaine)

• antiandrogens like spironolactone

Cosmetic:

• hair transplant

• wig and weaves

• hair cuts, styles, and products that give the appearance of thicker hair

What are some natural remedies for PCOS hair loss and facial/ body hair growth?

Before trying any nutrition or lifestyle-based adjunct treatments for PCOS hair loss and hair growth, make sure to speak to your doctor to rule out other conditions that could be behind your symptoms.

1) Improve insulin sensitivity

Insulin resistance is one of the underlying drivers of so many PCOS symptoms. By improving your insulin sensitivity, you can improve many of your PCOS symptoms including high androgen levels.

That doesn’t mean you need to go keto, low-carb, or no sugar. Following the plate method, getting enough sleep, adding in simple supplements like inositol, managing your stress, and including enjoyable movement (huge fan of yoga, duh!) into your day can improve insulin resistance without dieting and deprivation.

2) Use supplements and herbs wisely

Herbs and supplements can be powerful allies on anyone’s reproductive wellbeing journey but more is not better. They should be used judiciously and they should be targeted to your specific concerns whenever possible. Your best bet is to work with a knowledgeable registered dietitian or functional medicine provider. Some of my favorite herbs/ teas and supplements to use with my clients include:

• spearmint tea- has androgen lowering properties.

• holy basil- an androgen excess safe adaptogen.

• inositol- insulin sensitizer.

• a prenatal or multivitamin- covers nutritional bases without megadosing.

• green tea- has anti-inflammatory and anti-androgenic properties.

3) Ensure you’re eating enough micro and macronutrients

I can’t tell you how many times people have come to me with low energy levels and hair loss. They’re convinced it’s because they need a new supplement or medication. And upon further digging, I discover they’re under-eating. I get it. Everyone says people with PCOS need to focus on weight loss. And we all know weight loss is as simple as eat less and exercise more, right? Wrong!

Bodies come in different shapes and sizes for a million and one reasons. Simplistic, disproven calories in vs calories out equations have no place in PCOS nutrition and care. You need adequate calories.

Undereating will not help you reach your goals and from what I’ve seen, it only worsens symptoms and creates new problems. When we don’t eat enough, our bodies prioritize the essentials. And guess what, friend? Thick flowing hair is not essential.

Please, make sure you’re eating enough. If you’re experiencing super strong cravings, feel like you have no energy, are preoccupied with food, and feel out of control around food, you might not be eating enough.

4) Drive down inflammation

Inflammation affects androgens conversion. Inflammation can lead to our bodies opting for the more potent pathway. There’s also a link between inflammation and hair loss. Anything you can do to counter inflammation is going to support optimal hormonal and overall wellbeing which will support symptom improvement.

Eating plenty of colorful foods, including herbs and spices in your meals and snacks, managing stress, and getting enough sleep can help to put a damper on inflammation.

5) Avoid hairstyles that cause excess pulling and damage

FPHL leads to smaller hair follicles, resulting in hair strands that are weaker and easier to pull out. To protect the hair on your head, be gentle. A dermatologist, trichologist, and hairstylist can give you some pointers.

Take-aways

Notice, I didn’t include any hair supplements or biotin. They just don’t work. And if you’re already taking a multivitamin or prenatal vitamin, you’re probably getting the nutrients you find in crazy high megadoses in those hair supplements. Save yourself some money and time.

No matter if you choose to go the natural remedies route, conventional medicine route, or opt for a combo approach, remember consistency and commitment are key. It can take six months to a year to see significant changes. And even after that, you’ll likely need to continue to do what you’re doing or the symptoms could return. Don’t quit!

References

https://www.nhs.uk/conditions/hirsutism/

https://www.mayoclinic.org/diseases-conditions/hirsutism/symptoms-causes/syc-20354935

https://www.ncbi.nlm.nih.gov/books/NBK470417/

https://www.aad.org/public/diseases/hair-loss/types/female-pattern

https://pubmed.ncbi.nlm.nih.gov/30785992/

https://jmrh.mums.ac.ir/article_9368_1c2b06ff4bf01e9a4fd46b3f07e797a8.pdf