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Hair, Hair, Everywhere
03/22/2022

Except on my head!

Female Pattern Hair Loss (FPHL) has long been associated with menopause. Researchers have investigated the role of hormones and hair loss; while there is lots of complexity as to why women loose scalp hair at a faster rate after menopause, there is a strong link to the drop in estrogen and progesterone that occurs around menopause.

There are lots of different hormone receptors in scalp hair follicles. Let’s group those hormones into two main categories – Estrogens and Androgens. Androgens are a group of hormones that can get labeled as “male” hormones, but that’s just because men have more of these hormones compared to women. Both men and women have all the hormones, but in different amounts.

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Estrogens (and progesterone) have been shown to protect women’s scalp hair follicles. Androgens have been shown to weaken the hair follicles - resulting in hair loss. While estrogens levels decline after menopause, androgens decline at a much slower rate. This means that the androgens have more of an impact on the hair follicles than they used to.

Thus, estrogen and progesterone preserve and protect our scalp hair follicles, and androgens (particularly testosterone and DHT) weaken and reduce the growth of scalp hair follicles!

So where do these Androgens come from, where are they made in the body?

The ovaries make a little bit of testosterone but not much. Most androgen hormones start as either Androstenedione or as DHEA(S) in the adrenal glands and the hair follicles. These two hormones are converted to testosterone and another hormone called Dihydrotestosterone (DHT). These are more powerful androgens, especially DHT. Testosterone and DHT will inhibit growth of the hair follicle and reduce the hair’s attachment inside the follicle.

There are many things that influence the amounts of Androgens made by the body, but when someone has a lot of these factors then androgen levels will be higher than average. This can contribute to more hair loss.

Estrogen blockers: Medications which stop the conversion of testosterone to estrogen e.g. (tamoxifen) can result in an imbalance between estrogen and androgens.
Supplies of fat tissue: Increases insulin resistance and exacerbates the impact of metabolic changes that come with menopause.

Sugar: A diet high in sugar will increase production of insulin which can increase androgen production.

Insulin resistance and Diabetes: Insulin increases androgens made by the ovaries AND it reduces the hormone that will bind to these hormones and inactivate them.

Steroids: Long term use of steroid medications can increase production of androgens e.g. danazol.

Genetics: Some families have patterns of hair loss more than others.

Metabolism: Metabolism changes post menopause, this can increase androgen production.

Stress: Stress stimulates the adrenal glands to make cortisol and adrenaline. At the same time, androgens also increase.

A woman who has a number of these contributing factors will very likely have an increased chance that hair will start to fall out faster than it grows after menopause.

There is research which shows that both estrogen and progesterone work to strengthen the hair follicle and to promote hair growth. However, if someone has higher than usual androgens, estrogen and progesterone can only help so much. The reasons for hair loss are complicated, it is not just about changing hormones. We know food choices and lifestyle play a big role too. If hair loss continues, it’s a good idea to check in with your doctor to make sure there isn’t another factor affecting you.

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