From the Guidelines
A medical workup for PCOS (Polycystic Ovary Syndrome) and hair loss should prioritize comprehensive blood tests, including hormone tests and imaging studies, to accurately diagnose biochemical hyperandrogenism and guide treatment decisions, as recommended by the most recent guidelines 1.
Key Components of the Medical Workup
- Hormone tests: testosterone, DHEAS, androstenedione, LH, FSH, estradiol, prolactin, and thyroid function tests (TSH, free T4) to assess hormonal imbalances and hyperandrogenism
- Additional tests: fasting glucose, insulin levels, lipid panel, and vitamin D levels to evaluate metabolic and nutritional factors contributing to hair loss
- Transvaginal ultrasound to evaluate ovarian appearance for polycystic features, which is a key diagnostic criterion for PCOS
- Ferritin, zinc, and vitamin B12 levels to check for deficiencies that may contribute to hair thinning
Treatment Options
- Lifestyle modifications to address hormonal imbalances and insulin resistance
- Hormonal contraceptives like Yaz or Yasmin to regulate periods and reduce androgens
- Spironolactone (50-200mg daily) to block androgen effects on hair follicles
- Metformin (500-2000mg daily) if insulin resistance is present
- Minoxidil 5% solution applied twice daily to stimulate hair regrowth These treatments aim to address the hormonal imbalances of PCOS that lead to excess androgens, which cause hair thinning on the scalp while increasing unwanted hair growth elsewhere on the body, as supported by recent guidelines 1 and expert opinions 1.
Considerations for Hair Loss
- Mechanical removal of hair (e.g., plucking, shaving, waxing), electrolysis, and laser vaporization may be used to manage hirsutism, but concomitant medical management is usually necessary to reduce androgen levels 1
- The combination of an antiandrogen and an ovarian suppression agent may be an effective treatment approach for hirsutism, although the best oral contraceptive pill or antiandrogen agent is not known 1
From the Research
Medical Workup for PCOS and Hair Loss
- The medical workup for Polycystic Ovary Syndrome (PCOS) and hair loss typically involves a combination of physical examination, medical history, and laboratory tests to diagnose and manage the condition 2.
- Laboratory tests may include measurements of hormone levels, such as testosterone and androstenedione, as well as assessments of insulin resistance and glucose metabolism 3, 4.
- Treatment options for PCOS and hair loss may include medications such as metformin, spironolactone, and anti-androgens, as well as lifestyle modifications like weight loss and exercise 3, 4, 5, 6.
- The choice of treatment depends on the individual patient's symptoms, medical history, and other factors, and may involve a combination of medications and lifestyle changes 4, 5.
Treatment Options for PCOS and Hair Loss
- Metformin has been shown to be effective in improving hirsutism and other symptoms of PCOS, particularly in patients with insulin resistance 3, 4.
- Spironolactone, an anti-androgen, has been shown to be effective in reducing hirsutism and improving other symptoms of PCOS, particularly in patients who are unable to tolerate or do not respond to metformin 3, 6.
- Other anti-androgens, such as finasteride and flutamide, may also be effective in reducing hirsutism and improving other symptoms of PCOS 5.
- Combination therapy with metformin and an anti-androgen may be more effective than either medication alone in improving symptoms of PCOS 5.
Side Effects and Safety Considerations
- Metformin and spironolactone are generally well-tolerated, but may cause side effects such as gastrointestinal upset, menstrual irregularity, and mild nausea 3, 6.
- Anti-androgens may cause side effects such as acne, hirsutism, and voice deepening, particularly at high doses 5.
- The safety and efficacy of these medications in patients with PCOS and hair loss should be carefully monitored and individualized to minimize side effects and optimize treatment outcomes 4, 5.