Can cream-based progesterone (natural progesterone) cause hair shedding?

Cream-Based Progesterone and Hair Shedding

Yes, cream-based progesterone can cause hair shedding in some individuals, particularly when used alone without estrogen. This effect is supported by clinical guidelines that note progestogen-only regimens may worsen certain conditions in some patients 1.

Mechanism and Evidence

Progesterone's relationship with hair loss can be explained through several mechanisms:

• Androgenic Effects: Some progesterone formulations, particularly synthetic progestins derived from testosterone, have androgenic potential when used alone 1.

• Hormonal Balance: Progesterone can influence the hormonal balance that affects hair growth cycles. When used without estrogen (which typically has protective effects on hair), progesterone may disrupt this balance.

• Absorption and Systemic Effects: Topical progesterone creams produce significant systemic absorption. Research shows that OTC progesterone creams can achieve blood levels comparable to oral progesterone formulations 2, meaning they can have systemic effects beyond local application.

Clinical Observations

The relationship between progesterone and hair is supported by several observations:

• Guidelines from the Journal of the American Academy of Dermatology note that "progestogen-only regimens may worsen [conditions] in some cases" and recommend discontinuation if symptoms worsen 1.

• Progestin-only contraceptive pills, injections, intrauterine devices, or subcutaneous implants may worsen acne 1, suggesting they can have similar androgenic effects that could impact hair follicles.

• In contrast, combined oral contraceptives (containing both estrogen and progestin) yield net anti-androgenic properties 1, which often improve hair retention.

Individual Variation

The effect of progesterone on hair shedding varies significantly between individuals:

• Some people experience no hair-related side effects
• Others may notice increased shedding within weeks to months of starting treatment
• The formulation matters - natural progesterone may have milder side effects than synthetic progestins 3

Recommendations for Management

If you're experiencing hair shedding with progesterone cream:

1. Document the timeline - Note when the shedding began relative to starting the cream

2. Consider formulation changes:

   • Micronized natural progesterone may have fewer side effects than synthetic progestins 3
   • Transdermal application methods may provide more stable hormone levels

3. Consult with a healthcare provider about:

   • Adjusting dosage
   • Adding estrogen if appropriate (which often counteracts progesterone's potential androgenic effects)
   • Exploring alternative treatments

Important Considerations

• Hair shedding may be temporary as your body adjusts to the hormonal changes
• Individual genetic predisposition to androgenic alopecia may make some people more susceptible
• Other factors like stress, nutritional deficiencies, or underlying medical conditions could contribute to hair shedding

While research specifically examining the relationship between topical progesterone and hair shedding is limited, the hormonal mechanisms and clinical observations support that this is a real phenomenon that should be addressed if it occurs.