Can Diane-35 Cause Hair Loss?
Yes, Diane-35 (cyproterone acetate and ethinylestradiol) can cause hair loss as a side-effect, as documented in the FDA drug label which lists "loss of scalp hair" among the reported adverse reactions in users of oral contraceptives. 1
Understanding Diane-35 and Its Effects on Hair
Diane-35 contains two active ingredients:
- Ethinylestradiol (35 μg) - a synthetic estrogen
- Cyproterone acetate (2 mg) - an anti-androgen
Paradoxical Effects on Hair
Diane-35 has a complex relationship with hair growth/loss:
Therapeutic use for androgenetic alopecia: Diane-35 is actually used to treat female pattern hair loss (androgenetic alopecia) in women. Multiple studies have shown it can decrease hair loss and improve hair density when used for this purpose 2, 3
Potential adverse effect: Despite its therapeutic use for certain types of hair loss, the FDA drug label clearly lists "loss of scalp hair" as a potential adverse reaction 1
Mechanisms of Hair Loss with Diane-35
The hair loss associated with Diane-35 may occur through several mechanisms:
Telogen effluvium: Hormonal changes from starting or stopping hormonal medications can trigger telogen effluvium, a temporary diffuse hair shedding that typically begins 1-3 months after starting the medication 4
Drug-induced hair loss: Similar to other medications, Diane-35 can directly affect the hair growth cycle 1
Individual sensitivity: Some individuals may be particularly sensitive to the hormonal changes induced by Diane-35 4
Risk Factors for Hair Loss with Diane-35
Certain factors may increase the risk of experiencing hair loss while taking Diane-35:
Low iron stores: Research has shown that women with serum ferritin levels below 40 μg/L respond less favorably to treatment with cyproterone acetate and ethinylestradiol, and may experience more hair-related side effects 5
Pre-existing hair conditions: Those with pre-existing hair loss conditions may notice changes more readily 4
Management of Diane-35-Associated Hair Loss
If hair loss occurs while taking Diane-35, consider the following approaches:
Continue treatment with monitoring: In many cases, hair loss is temporary and resolves after 3-6 months as the body adjusts to the medication 4
Check iron status: Ensure adequate serum ferritin levels (>40 μg/L) to optimize response to treatment 5
Consider alternative treatments: If hair loss persists or is severe, discuss alternative contraceptive or treatment options with your healthcare provider 4
Topical treatments: For persistent hair loss, topical treatments like minoxidil might be considered as adjunctive therapy 4
Important Considerations
Timing matters: Hair loss may occur when starting or stopping Diane-35 due to hormonal fluctuations 4
Paradoxical effect: While Diane-35 can cause hair loss as a side effect in some women, it is actually prescribed to treat female pattern hair loss in others, showing effectiveness in reducing hair loss and improving hair density over 6-9 months of treatment 2, 6
Individual response: Response to Diane-35 varies significantly between individuals 3
Duration of treatment: When used for treating androgenetic alopecia in women, improvement is typically seen after 6-12 months of continuous treatment 2, 7