PCOS Hair Loss:
Treatments That Actually Work

Written by Kathleen Morrison
Medically Reviewed by Andrea Sleeth WHNP-BC, MSCP

Key takeaways

• PCOS-related hair loss happens when excess androgens (male hormones) shrink hair follicles, causing thinning—but it's treatable.
• Early signs include a widening part line, finer strands that won't hold styles, and more hair in your brush or shower drain than usual, causing distress.
• Medical treatments like Spironolactone, hormonal birth control, and Minoxidil can significantly reduce shedding and promote regrowth when used consistently.
• Lifestyle changes, including a low-glycemic diet, regular exercise, quality sleep, stress management, and certain vitamins and minerals, can help support hormone balance alongside medical treatment.

If you've noticed your ponytail feeling thinner, more hair in the shower drain, or a widening part that just won't quit—you're definitely not imagining things, especially if you have PCOS.

So, can polycystic ovary syndrome (PCOS) cause hair loss? And how?

Hair loss is one of the most frustrating symptoms of PCOS, and it affects way more people than you might think.

Here's what's happening: PCOS triggers excess androgens (those are the "male hormones" like testosterone) that basically tell your hair follicles to shrink.

Over time, your hair gets finer, shorter, and eventually some follicles just... stop producing visible hair altogether.

It's known as androgenetic alopecia, and while it sounds scary, the good news is that it's absolutely treatable.

So if you're feeling frustrated, take a breath. Your hair loss doesn't have to define your PCOS journey, and there are real solutions that work.

What causes hair loss from polycystic ovary syndrome (PCOS)?

PCOS-related hair loss is a type of androgenetic alopecia that happens when hormonal imbalances start messing with your hair growth cycle.

It's also known as female pattern baldness and is unlike other types of hair loss. There's a specific hair loss pattern that healthcare providers can actually recognize to diagnose PCOS-related hairfall.

Androgen, DHT, and the works

Think of your hair follicles like tiny gardens. In PCOS, excess androgens act like weeds, choking out the healthy growth you want to see.

The male hormones, particularly testosterone and DHT, gradually shrink the follicles. And, while testosterone gets most of the blame, its metabolite dihydrotestosterone (DHT) is actually up to five times more potent at triggering hair loss and thinning hair.

An enzyme called 5-alpha reductase leads to the conversion of testosterone to DHT right in your hair follicles.

With PCOS, you often have increased 5-alpha reductase activity. It's basically creating a localized DHT factory on your scalp.

Each strand gets thinner and shorter than the one before it, and eventually, some follicles just throw in the towel and stop producing visible hair altogether.

The insulin resistance connection

About 70% of people with PCOS have insulin resistance, and this is (yet) another cause of hair loss.

When your cells don't respond properly to insulin, your pancreas produces more to compensate. High insulin levels then stimulate your ovaries to crank out extra androgens—hello, vicious cycle.

Insulin resistance also lowers sex hormone-binding globulin (SHBG), a protein that normally keeps androgens inactive while they circulate.

Less SHBG = more free testosterone and DHT available to damage follicles.

Plus, insulin resistance promotes inflammation throughout your body, including your scalp, which further compromises follicle health.

PCOS-related androgenetic alopecia vs androgenic alopecia

You might see these terms used interchangeably, but there's a subtle difference worth knowing.

Androgenic alopecia is the umbrella term for hormone-related hair loss, such as female pattern baldness and male pattern baldness. It is caused by androgens like DHT.

Androgenic alopecia can happen to anyone, regardless of whether they have PCOS. It's basically your follicles being sensitive to (even) normal androgen levels.

PCOS-related androgenetic alopecia, on the other hand, happens because your body is actually producing too many androgens. So while the end result looks similar (thinning at the crown, widening part line), the underlying cause is different.

With PCOS, you're dealing with a hormonal imbalance that's driving the hair loss—not just follicle sensitivity.

Why does this matter? Because treatment approaches can differ for androgenic alopecia and androgenetic alopecia.

If you have PCOS, addressing the root hormonal imbalance often gives you better results than just treating the hair loss itself.

Prescription treatment options for hair loss from PCOS

Medical interventions offer the most direct approach to turning things around by addressing the underlying hormonal imbalances.

Working with healthcare providers who actually understand PCOS ensures you get treatments tailored to your specific situation.

The most effective treatments target multiple aspects of PCOS at once. Rather than just focusing on hair regrowth, these medications can also help regulate cycles, reduce acne, and improve metabolic health.

1. Hormonal birth control and Spironolactone

Combining birth control pills with Spironolactone creates a powerful one-two punch against PCOS hair loss:

Birth control pills containing ethinyl estradiol and low-androgen progestins (like drospirenone or norgestimate) suppress ovarian androgen production while increasing SHBG levels to bind up free testosterone.

Spironolactone—originally a blood pressure medication—blocks androgen receptors in hair follicles.

Doses between 50–200mg daily can significantly help reduce hair loss within 3–6 months. This prescription anti-androgen also helps with acne and excess body hair.

However, there are several side effects you may experience, including dehydration, headaches, decreased libido, dizziness, and vaginal spotting. It's helpful to know what to expect.

*Wisp treatment options are available only after consultation with a licensed medical professional. You should consult with your healthcare provider before starting a new supplement or treatment regimen. Individual results may vary.

2. Topical Minoxidil for regrowth

Topical Minoxidil remains the only FDA-approved topical treatment for female pattern hair loss.

Available in 2% and 5% formulations, this over-the-counter preparation works by prolonging the growth phase and increasing blood flow to follicles.

The 5% foam tends to cause less scalp irritation than the liquid solution while delivering better results.

Applied directly to thinning areas twice daily, Minoxidil can increase hair density by 10–30% over six months.

Heads up: initial shedding during the first 2–3 weeks is normal and actually indicates the medication is working. New hair growth typically shows up as fine, colorless hairs that gradually thicken and darken with continued use.

3. Oral Minoxidil for hormone-related hair loss

If topical products aren’t your thing, Oral Minoxidil might be worth a conversation. This once-daily prescription option has been trusted by dermatology providers for decades. It is now commonly used off-label in low doses to support hair regrowth tied to hormonal shifts.

Oral Minoxidil works from the inside out by helping keep hair in its growth phase longer and improving blood flow to hair follicles.

It’s often prescribed for hair thinning linked to PCOS, menopause, postpartum changes, and other hormone-related causes. Many people like the simplicity of a daily pill, especially if they’ve struggled to stick with topical treatments in the past.

Because it’s a prescription medication, Oral Minoxidil should always be taken with guidance from a licensed provider who can help tailor dosing and monitor how you’re doing.

4. Other prescription treatments for hair loss in women

Beyond Spironolactone, other medications may help manage PCOS hair loss:

• Finasteride: It blocks 5-alpha reductase, stopping testosterone from converting to DHT. While highly effective, it's usually only suitable for post-menopausal women or patients who have had a hysterectomy due to the risk of birth defects. Reliable contraception is a must.

• Metformin: While not directly anti-androgenic, it improves insulin sensitivity and can indirectly reduce androgen levels. For those with insulin resistance, adding metformin to other treatments often enhances results while improving metabolic health.

Fair warning: patience is required here. Hair grows slowly. It typically takes 3–4 months to see the best treatment results, including reduced shedding. In fact, it may take 6–12 months for visible regrowth.

Tracking progress with photos helps you and your provider figure out if adjustments are needed.

Lifestyle strategies that can help support hair health

Natural approaches, including diet and exercise, may complement medical treatments by supporting overall hormonal balance and follicle health.

While they might not reverse established hair loss on their own, these strategies can help slow progression and make prescription treatments work even better.

Eating for hormone balance

A low-glycemic, anti-inflammatory diet forms the foundation of natural PCOS management:

Focus on whole foods rich in omega-3 fatty acids.

Salmon, walnuts, and flaxseeds can help reduce inflammation and support hormone production.

Additionally,

• Aim for 25–30 grams of fiber daily from vegetables, legumes, and whole grains to help eliminate excess hormones.
• Limit refined carbs and added sugars to help stabilize insulin levels
• Include protein with every meal to slow glucose absorption and keep energy steady.
  

Supplements that may help support hair health

Strategic nutrition can address deficiencies common in PCOS that may contribute to hair concerns:

• Inositol (particularly myo-inositol and D-chiro-inositol in a 40:1 ratio) has been shown to help improve insulin sensitivity and may help reduce testosterone levels
• Iron deficiency is common in many women with PCOS and can directly impact hair growth
• Vitamin D deficiency affects follicle cycling and is worth testing for
• Zinc may help block testosterone conversion to DHT
  

Movement and stress management

Regular exercise improves insulin sensitivity more effectively than diet alone.

Aim for 150 minutes of moderate activity weekly, combining cardio with strength training. Resistance exercises are particularly helpful since increasing muscle mass helps regulate blood sugar and hormone levels.

Stress management matters too. Cortisol can worsen insulin resistance and is one of the main causes of additional shedding. Meditation, yoga, or deep breathing for just 10–15 minutes daily can help improve hormone balance.

And don't underestimate sleep (ideally 7–9 hours nightly), which allows your body to regulate hormones and repair tissues properly.

How to spot PCOS hair loss early

Catching the early signs of PCOS hair loss can make treatment way more effective.

The sooner you notice what's going on, the better your chances of keeping the hair you have and encouraging regrowth.

Here's what to watch for:

The "Christmas tree" pattern:

PCOS hair loss creates a widening part line that gradually spreads toward the front of your head, forming a triangular shape. This is different from the circular patches of baldness in the hairline you'd see with alopecia areata.

Changes in texture:

Strands become finer and more fragile, breaking easily when brushing or styling. Hair that was once coarse might feel silky and limp.

Styles won't hold:

Curls falling flat? Updos slipping out? That's because miniaturized follicles produce weaker hair shafts.

Excessive shedding:

Everyone loses 50–100 hairs daily—that's normal. With PCOS, this number can double or triple. You'll find more strands on your pillow, clogging the shower drain, and tangled in your hairbrush.

The key difference between normal shedding and PCOS hair loss? Normal shedding gets replaced by new growth at the same rate.

PCOS disrupts this balance. Either new hairs grow back thinner and shorter, or follicles enter extended hibernation mode, leading to further progression of hair loss.

Take charge of your hair health

Managing PCOS hair loss is about understanding what's happening in your body and taking a comprehensive approach. The combination of excess androgens, insulin resistance, and inflammation creates a challenging environment for hair follicles. Even menopause plays a role.

But with the right interventions, most people see significant improvement.

The bottom line: PCOS hair loss is treatable. With the right support and tools, you can manage this symptom while improving your overall health. Your hair doesn't have to define your PCOS journey. And you don't have to figure this out alone.

Ready to explore your options? Take the Symptoms Quiz to find the right PCOS treatment plan, or check out Wisp's PCOS support options to get started with same-day prescriptions and free delivery.

*Wisp does not offer oral finasteride or topical Minoxidil as part of the treatment. Our practice offers Oral Minoxidil only, which is prescribed off-label. Availability and treatment options may change, and all off-label use is discussed with patients as part of informed consent.

This blog post is for informational and educational purposes only and should not be taken as professional advice. Always consult with a qualified professional before making any decisions based on the information provided here.