From the Guidelines
Alopecia in Polycystic Ovary Syndrome (PCOS) is primarily caused by excess androgens, particularly testosterone and dihydrotestosterone (DHT), which bind to receptors in hair follicles, leading to androgenic alopecia or female pattern hair loss. The pathogenesis of PCOS involves hyperandrogenism, which is present in 75% of PCOS cases, and is a well-established contributor to the development of PCOS 1. In women with PCOS, the ovaries and sometimes the adrenal glands produce higher levels of androgens than normal, causing an imbalance in the hormonal environment. This imbalance leads to the shrinkage of hair follicles, shortening the growth phase of hair, and resulting in progressively thinner, shorter, and less pigmented hair. The excess androgens can also cause increased hair growth (hirsutism) in androgen-sensitive areas like the face, chest, and back.
Some key points to consider in the diagnosis and management of alopecia in PCOS include:
- Hyperandrogenism is a key diagnostic criterion for PCOS, and can be detected clinically through assessment of hirsutism, acne, or androgenic alopecia, or via biochemical testing of circulating androgen concentrations 1.
- The measurement of androgens, such as testosterone and androstenedione, can be useful in diagnosing biochemical hyperandrogenism in women with PCOS 1.
- Treatment approaches for alopecia in PCOS focus on addressing the underlying hormonal imbalance, and may include anti-androgen medications, hormonal contraceptives, and topical minoxidil to stimulate hair growth.
- Managing other aspects of PCOS, such as weight loss, insulin-sensitizing medications, and dietary changes, can also help improve the hormonal environment and reduce hair loss over time.
It is essential to note that the diagnosis and management of PCOS and associated alopecia require a comprehensive approach, taking into account the individual patient's symptoms, medical history, and laboratory results. As stated in the 2023 International PCOS Guidelines, informed by the systematic review and diagnostic meta-analysis 1, the most accurate androgen measurement for detecting biochemical hyperandrogenism among women with PCOS is crucial for guiding treatment decisions.
From the Research
Causes of Alopecia in PCOS
The cause of alopecia in Polycystic Ovary Syndrome (PCOS) is complex and multifactorial. Some of the key factors include:
- Hormonal imbalance: PCOS is characterized by hyperandrogenism, which can lead to androgenetic alopecia 2, 3
- Genetic predisposition: Androgenetic alopecia is known to have a genetic component, and PCOS may also have a genetic link 4
- Insulin resistance: Some studies suggest that insulin resistance, which is common in PCOS, may contribute to the development of androgenetic alopecia 3
Pathogenesis of Androgenetic Alopecia
Androgenetic alopecia is characterized by the miniaturization of hair follicles, leading to a decrease in hair growth and an increase in hair shedding 4, 2. This process is androgen-dependent and requires the presence of sufficient circulating androgens.
Diagnosis and Management of Alopecia in PCOS
The diagnosis of alopecia in PCOS is typically made clinically, with the help of trichoscopy and scalp biopsy if necessary 2, 5. Management of alopecia in PCOS may involve the use of topical minoxidil, oral anti-androgens, and other treatments aimed at reducing androgen levels and promoting hair growth 2, 5, 6.
Relationship between PCOS and Androgenetic Alopecia
Some studies suggest that men with early androgenetic alopecia may be at risk of developing metabolic syndrome, insulin resistance, and cardiovascular disease, similar to women with PCOS 3. This highlights the importance of considering the broader health implications of androgenetic alopecia in PCOS patients.