9 Things to Know About Female Hair Loss

Female hair lossStruggling with hair loss? There’s no one-size-fits-all treatment because there’s no one-size-fits-all cause.

To find your hair loss solution, you need to think through nine different factors.

Blame your birth control

Contraceptive drugs such as levonorgestrel cause hair loss because they have a high androgen index, which means they are more similar to testosterone than they are to progesterone.

The American Hair Loss Association (AHLA) warns about the risk of hair loss from hormonal birth control. In 2010, they stated:

“It is imperative for all women especially for those who have a history of hair loss in their family to be made aware of the potentially devastating effects of birth control pills on normal hair growth.”

Have you been taking a testosterone-like type of birth control? Read the ingredients.

Progestins with a high androgen index include medroxyprogesterone acetate, levonorgestrel, norgestrel, and etonogestrel. They cause hair loss by shrinking (or miniaturizing) hair follicles, which is a slow process. You could be on the birth control for many months—or even years—before you start to notice hair loss. Progestins with a high androgen index can also cause acne.

Progestins with a low androgen index include drospirenone, norgestimate, and cyproterone. They do not cause hair loss when you take them, but they can cause hair loss when you stop them because they cause a rebound surge in androgens and androgen sensitivity.

Hair loss is a symptom of hormonal birth control

For more information about hair-loss causing types of birth control, read 4 causes of androgen excess.

Ovulate to make estrogen and progesterone

Your hair loves estrogen and progesterone, and the only way to make those hormones is to ovulate and have a natural cycle. Making your own estrogen and progesterone for hair is another reason to stop hormonal birth control, but take care: Stopping birth control can temporarily worsen hair loss. Why? Because pill-withdrawal can trigger temporary hair loss.

Rule out PCOS

The high androgens (male hormones) of PCOS can cause hair loss, acne, and hirsutism (facial hair). If you think you might have PCOS, speak to your doctor about having a blood test.

👉 Tip: PCOS cannot be diagnosed (or ruled out) by ultrasound.

Check your thyroid

Thyroid disease is another common cause of hair loss. If you have symptoms of thyroid disease, or if you have a family history of thyroid disease, check with your doctor for a blood test.

Consider iron

No matter what the cause of hair loss (birth control, PCOS, thyroid), you’ll need adequate iron to recover it. On a blood test, your “serum ferritin” should be at least 50 ng/mL. If it’s lower than that, consider supplementing 25 mg of a gentle iron such as iron bisglycinate.

Reduce inflammation

Inflammation hyper-sensitizes hair follicles to androgens (male hormones), which is why chronic inflammation can cause androgen hypersensitivity or androgenetic alopecia. If you have gut problems or a food sensitivity such as wheat or dairy, then addressing that underlying problem could help your hair.

Eat more carbs

Any kind of dieting, including low-calorie and low carb, can cause hair loss. Read Have you lost your period to a low-carb or keto diet?

Take zinc

Zinc is good for hair because it promotes ovulation, reduces inflammation, and blocks androgens. Zinc also directly stimulates hair growth. Common causes of zinc deficiency include a vegetarian diet and hormonal birth control. Read Why zinc is my favorite prescription for healthy periods.

Play the long game

Even with the best treatment, you won’t see any results for at least two months. Why? Because of the lag time with hair and its telogen phase. The telogen phase is like a “hair waiting room.” Once hair gets pushed into the telogen phase by birth control or nutrient deficiency or any other factor, it is destined to fall two to four months later–no matter what you do.

In other words, if you have a lot of hair in the telogen phase now, your hair will keep falling for a couple more months even after you start the correct treatment. But then it should start to settle down.

Stay calm, be patient, and stick with your treatment.

314 thoughts on “9 Things to Know About Female Hair Loss”

  1. My endocrinologist won’t treat me!! My testosterone is 188i have hirsutism and androgenic alopecia, 18lb weight gain. I have been struggling for almost a year with no help!! I have asked for a dht blocker, but still no script!!! He wants to get to the root cause?? I think it’s just hormones I’m 58.!!!

  2. Hi there, I’ve been suffering from (or have noticed) hair loss over the past 10 months or so. I went off the pill in December 2019, back on around Jan, and off since September. I was also on methylphenidate daily for ADHD but have recently stopped that too.

    Waiting another month before doing hormone bloods but my recent thyroid results: TSH 2.3 mIU/L, free T3 4.3 pmol/L, free T4 14.6 pmol/L, Thyroid Peroxidase Ab 292 IU/mL, Thyroglobulin Ab 31.5 IU/mL.

    I have always had elevated antibodies but the hair loss is semi recent- maybe accelerated or presenting since high stress and BCP switch earlier in the year. Doctors say I can’t pin it on thyroid- sure, but I’d like to understand how the elevated antibodies are interfering. I’m fatigued, underweight and have also lost five kilos this year without changing my diet. My ferritin was 37 & vitamin D 55 so I’m getting those back up.

  3. I think more and more stress shedding is going to be relevant. I know personally with Covid-19 affecting home-life as well as finances STRESS has been unavoidable. Also I have small kids at home and now in school from home and it continues to be a point of stress. I have started up taking the postpartum hair loss vitamin i took after my youngest (although I am not considered postpartum) to make sure I’m giving all the vitamins my hair needs hoping that it minimizes the fall (I take the Baby Blues ones https://babyblues.care/) . I hear more and more from other Mom’s right now suffering in the same way. Stress shedding is affecting a lot of people right now.

  4. After pregnancy I experienced pretty sever hair shedding and hair loss and ended up crying in my obgyn’s office. I was already feeling really vulnerable about my appearance. My doctor suggested I go the supplement route to encourage the hair to go into the growth phase after shedding so many nutrients after having the baby. I ended up getting recommended a postpartum hair vitamin from Baby Blues (www.babyblues.care) to help with the hair shedding and new growth and it was actually really effective. Has biotin, collagen, b12, folate, vitamin a etc. I definitely recommend to women trying a supplement. Especially with so much processed food out there and stress levels go up and we tend to eat badly.

  5. Hi Lara,

    After being on Loestrin for many years, I noticed my hair thinning and found out it causes AGA and telogen effluvium. The doctors convinced me to go on yaz but I had a shed with that as well. Now I know another shed awaits me when I get off of it and my hair will be nonexistent. What do I do? I’m scared!


  6. I totally agree with the points mentioned behind hair fall problem in woman. I really appreciate this information, well written article.

  7. In your book, you advised trying 0.1% melatonin in topical form for hair loss, along with other treatments and diet changes. I’ve been unable to find such a product. Could you please recommend one (I’m sure that info will benefit more than just me)?

    Thank you for your work!

  8. Hi Lara,
    I’m 36, never been pregnant, never been on HBC, technically normal BMI but on the lower end. I’m inclined to believe the significant front scalp hair loss I’ve had in the last month correlates with a very high stress traumatic situation from March – June and the general lower volume and breakage of my hair over the last 2 years is due to stress and unstable diet (restriction, vegetarian and heavy on carbs/sugar).

    I guess I always hear diet and stress listed as potential causes of a number of health issues but I’m unsure just how significant they are so have started to panic that maybe there is something more (pcos/perimenopause?).

    My periods have always been light and irregular but the past 6 months I bleed for one day and it’s light. I chart my temps and experience a dip along with cervical fluid but my temps are only very marginally higher in my luteal phase and cycles on the longer side so I think I’m ovulating but perhaps struggling to do so?

    I was worried about the hair loss being high testosterone and the light periods being early perimenopause.

    AMH – 4.57
    LH – 8
    FSH – 5
    Estradiol – 57
    TSH- 2.1
    Testosterone total – 39
    SHBG – 78
    Free Testosterone – 3.8
    Albumin – 4.9
    DHEA – 170

    In your experience would these numbers correlate to hair loss or perimenopause ? I had bloodwork on Day 8, I don’t know if that makes this panel completely worthless?

    Any thoughts would be greatly appreciated. I’m so distressed about losing my hair

  9. This is a very well written article. I will surely bookmark it and come back to read more of your useful information.

  10. I have hair loss. High night time cortisol, DHEA low in range, have Chronic fatigue and weight gain. I’ve just started taking 7 Keto DHEA and am waiting for a delivery of 20:1 Bio identical Progesterone/Estrogen cream. What are your thoughts please. I’m 67 and have had a total hysterectomy.

  11. Hello Dr. Lara, my question is: I take the amino acid L- cystin 220mg daily (I only know the German name) to prevent getting bald for now. Do you know if it has any side effects if you use it long term?
    An answer would be highly appreciated.
    Yours sincerely,

  12. Hello Lara,

    I’m wondering, can high prolactin cause hair loss? I’m a 26 year old female and have been going through drastic hair loss the past three months. Resulting in all over thinning, particularly on the crown.

    I was diagnosed with PCOS (post pill) three years ago but I had managed to regulate my periods up until 6 months ago. I was under a lot of stress and my diet/health/hormones took a serious whack. I had chronic PMS and pain which I have learnt could be down to high estrogen.

    I’ve recently had blood tests that show all normal hormone levels, except prolactin which was 780 mU/L. I’m now having regular periods, thanks to good diet, exercise and I believe maca root.

    I don’t understand why the hair loss is happening or what the cause is. What would be the best next step to take?

    Your posts are so informative and I definitely want to take a natural approach to healing but I’m scared the hair loss will continue if I don’t know where it’s comimg from.

    Any advice would be greatly appreciated, thank you.

  13. Hi Lara, I have your book, it’s my health bible and I read it all the time. I’m here because my hair is falling out and I can’t figure out which reason to attribute it to. It fell out once before thanks to the Pill, but I have been pill free for many years and my hair recovered.
    I’ve gone back 3-5 months since the onset, and it ties in with my relationship breakdown and moving house, both very stressful things. I also lost some weight around this time. Around 3 months ago my period became irregular and I’m no longer certain I ovulate. I also have Hashimotos and my ferritin and vitamin d are quite low. I have been supplementing with iron, vit d, selenium, and I take a hair vitamin containing zinc and magnesium. My question is, how can I figure out which of the above is my ‘smoking gun’? Or is it likely that they are all related, and it’s a chicken and egg scenario? I still feel quite stressed (even more so because I’m back here with scary thinning hair again) so was considering Ashwaghanda to help with that and my thyroid function – is it ok to take given my autoimmunity? (I am gluten free and healed my gut a few years ago, however some recent trips overseas did give me tummy bugs – could they be responsible for firing up my hashimotos?). My TSH, T3, T4 are currently good. Any advice/insight would be appreciated so so much.

  14. This article has been incredibly helpful. I have been on the birth control Yaz/Beyaz since my mid 20s (in my mid 30s now), with the exception of about 2 years when I had my son. I recently decided to go off the pill and have been through my first cycle, which was regular and on time and no more or less difficult than it was when I was on the pill. However, the big problem I am facing is that my hair is falling out at an alarming rate. It is terrifying me to think that if this continues I might go bald. My primary physician ran blood work to check TSH which came back at 2 and he sent me home saying it should slow down in another couple of months. At this rate, I don’t think I have another couple of months worth of hair to lose! I am trying to figure out if there are natural ways to combat the hair loss as my body adjusts to coming off the pill. Everything I’ve read is geared towards hair loss when you first go ON the pill. Would you have any suggestions to this rapidly balding me?

  15. Hi, I struggled with hair loss too during and after the pill. While it still isn’t back to the thick mane it once was, it is much better thanks to getting off the pill and taking Dragon Hair and Nails. This stuff helped me a lot with hair shedding. I’m sure there are other supplements on the market with similar blends.

  16. Hi Dr. Briden,
    I’m 26 years old and I’m having some hormone issues I think.

    I eat a very clean diet, lots of veggies and pasture raised meats, plenty of healthy fats and lower carbs, mostly consisting of sweet potatoes, little to no added sugars, and no processed foods.

    In early 2016 I felt like I was having some slight hair thinning at my right temple, it persisted for a few months, but eventually either filled back in or I stopped noticing. At the end of 2017 i started noticing it again in the same spot, fast forward to today and my hair is thinning all over, mostly on the top and temples from what I can see. I got some bloodwork done in January of 2018 and my results were as follows: TSH 0.96, T3 Free 2.08, Free T4 1.01, and Ferritin 32.6.

    My doctor put me on 10 mg of Iron 2x daily, 400 mg of Magnesium glycenate daily, a few brazil nuts daily for selenium, Omega 3, 1,000 IUD of D3, and I recently added 15 mg of zinc daily. I also take a multi vitamin, and B12(methyl).

    The last couple of years have been very stressful for me, I’ve struggled with anxiety and depression due to chronic back pain from an accident almost two years ago, making it hard to be nearly as active as I used to be, and my parents and I have not been on speaking terms for almost a year now.

    My Doctor told me she thinks my hair loss could be stress related, causing my T4 to T3 conversion to be low. She said the supplements and stress management are really her only tools she can give me. A month ago I decided to get off of my birth control pill that I had been on for 8 years. I was mainly on Lo Loestrin 24 and Lo Loestrin Fe during those 8 years, but there was a brief period during during 2015 to 2017 where I was on Norgestimate and Ethinyl Estradiol, and Trisprintec.

    I’ve been seeing a therapist for the last couple of months, and I’ve thought that I was learning to manage my stress and be a little more present and mindful, but my hair loss just seems to be increasing. I feel tired and bloated a lot, and sometimes feel like I just hold a little too much weight in my lower stomach.

    I’m devastated about my hair, and I feel like I’m caught in a vicious cycle. If I was certain this was just stress I feel like I could keep calm.

    I don’t have a lot of money to run a bunch of tests, but I guess I was hoping to get a second opinion to see if more tests are even necessary, or if this is really all about stress management.

    Would very much appreciate any input you could offer.


    • Jessica, do hope that Dr. Briden will share some insight into your condition, but meanwhile I wanted to say that I really empathize with how devastating this situation can be. (I’m in the same boat.) I hope that you can experience restored health, and find calm as you wait for the right answers.

  17. I’m curious if you ever recommend biotin supplements for hair loss? I know it is rare to have a biotin deficiency, but, as biotin is so often touted as helpful for hair re-growth, I wonder if there’s any validity to the claim.

    Also, is there a great risk in using a progeste cream even if low progesterone has not yet been verified by blood test?

  18. Aloha Dr. Briden,

    I’m a 26 y/o female whose been experiencing hair loss for about 2 years. I was just diagnosed with androgenetic alopecia. However, I’m just not ready to accept this diagnosis as there is NO history of AGA in my family and my doc has ruled out PCOS I have a vast history with medications, specifically for acne, and I can’t help to think that I’m reaping the effects of such use.

    Medication history:

    – was on antibiotics for about 5 years (13 y/0 -18 y/o) for acne
    – did 2 rounds of Isotretinoin (Accutane) in college (22 y/o -23 y/o)
    – was on birth control on and off for about 2 years
    – recently just started taking Microgestin (birth control) about 5 months ago ( first time using birth control in about 4 years)
    – diagnosed with hypothyroidsm about 12 years ago and have been on levothyroxine since.
    – Topical Retin-a use for probably about 6 years
    – Used topical Tazorac for about 1.5 years

    The question begs: have I completely ruined my gut microbiota?

    I am now only taking levothryoxine and Microgestin, and using nothing topically. Acne is definitely under control.

    Also,I had labs checked about 5 months ago:

    – ferritin was 11 ng/ml and I’ve been able to get it up to 23 ng/ml (within 5 months)
    – TSH 3.67 uIU/ml
    – T4 1.3 ng/dl
    – T3 108 ng/dl

    Have you ever heard of increased dosage/prolonged use of levothyroxine causing hair loss? 2 years ago my doc increased my dosage from 75 MCG – 100 MCG event though I wasn’t complaining of any side effects.

    I appreciate any insight and advice you may be able to give with the hopes for clarity and direction, not only for myself but for all else who read your blog. Thank you for shinning light on such a sensitive and weary subject!

    Mahalo nui loa!

    • I’m obviously not Dr Briden (or a Dr), but:

      -birth control can cause hair loss, while on it, switching it, or stopping it
      -thyroid meds can cause hair loss
      -your Ferritin is quite low
      -your TSH would be considered on the higher end by functional medicine standards (typically anything over 2.5)
      -some of the acne meds you used to be on can cause hair loss

      So, yes, I would say that you have a lot of other possible causes

  19. Thank you Lara for your informative posts.
    Too often we are in a gynecologist office for a total of 10 minutes, and get no answers. The most frightening thing is, the Dr. Is so uninformed about hormones!
    It seems they complete their med school and go on a mental vacation. Thank you!!

  20. Hi Dr Briden,

    What about hair loss due to LOW testosterone? I am 37 and my testosterone is BELOW 8 ng/mL. My chief complaint had been hair loss and zero libido since coming off the pill 3 years ago. My periods started up right away and have been regular, and my ferritin (80s), d3 (50s) and thyroid (inc antibodies and a TSH that fluctuates between 1 and 2), etc, etc all look great by functional ranges.

    Other than natural age related reasons, what are some causes of below-normal testosterone in a younger woman with regular periods? I am extremely reluctant to take any extraneous testosterone, but there isn’t much information on what a woman should do if she has below the normal range of testosterone. I feel so stuck and thought that coming off birth control would be the right thing, but I am just so frustrated that my body still feels broken and that I haven’t stopped losing hair 3 years later 🙁

  21. Hi I found your website following an article you wrote in the press in 2015 about the pill and hair loss. Your articles on here appear to refer to Androgenic Alopecia. My daughter has had Alopecia Areata since she was 14. We have been told by specialists that this is not hormone related in any way. She started taking the birth control pill (Levonorgestrel) 3 years ago. Over the last 18 months her Alopecia has worsened considerably but still follows the pattern of areata ie around the sides of her scalp. Her GP and specialists say the pill is not a factor. I would very much welcome your comments.

    • Of course, alopecia areata is a different situation. It’s not hormonal but is instead autoimmune. BUT. Hormones can worsen autoimmunity. In fact, hormonal birth control has been linked to a higher risk of autoimmune disease. She’ll want to look at natural treatment for autoimmune disease and perhaps long-term considering avoiding hormonal birth control as part of that strategy.

      • Thank you for your advice which I will pass onto my daughter and we will investigate natural remedies for her alopecia.

  22. Hi, why did I get gray hair after each childbirth? I’ve got 4 children and my mother also had premature gray hair, but not my maternal grandmother. In fact, her hair had hardly any gray. My babies were difficult sleepers and I did lose a lot of sleep for years ( I’m 41). If there’s anything I can do to reverse it naturally, that’d be much appreciated. Thanks!!

    • I seem to remember reading somewhere that going gray prematurely could result from thyroid dysfunction. My grandma was hyperthyroid and she went gray in her 30s. She decided to be a red head and is still rocking the gray hair in her 80s 🙂

  23. Hi Laura,
    I have been “trying” to avoid the BCP for a long time,I’m 46, because I get horrible side effects. Recently I was hospitalized for blood loss from a burst fibroid and HAVE to be on a pill so I can stop my periods as I am crazy anemic. I plan on taking the pills till I can get a partial hysterectomy. I am on a Progesterone Mini Pill so that estrogen won’t feed the fibroid. My question for you is I had been using Emerita Pro-gest cream prior to this with unsure results, though I know it helped my PMS and it didn’t hurt me. Should I continue the Pro-gest while I’m on the synthetic progesterone? Will it help balance out the side effects? Especially hair loss!
    Thank you,

    • Another idea is to talk to your doctor about natural progesterone capsules (Prometrium) which can work very well for perimenopausal heavy bleeding. I discuss in my book Period Repair Manual and you can also read Professor Prior’s recommendations for natural progesterone for heavy periods here: Managing Menorrhagia Without Surgery

  24. Hello,
    I try to send you a question but sorry for my English, I’m french and my English is very bad.
    I bought your book because in french, I didn’t found the answer to my problems.
    When I stopped birth control jasmine, I have lossed a lot of hair, I waited 5 mounths but no improvment and my doctor sayed to me that I have androgenetic alopecia, so I go back on the pill. But I’m loosing my hair again. and now I’m loosing my eyebrows and eyelashes.
    So I try to stop the pill definitively thanks to your book : I ‘m stopping gradually by cutting pill. You suggest to treat PCOS (when I stopped the BC my periods were regular, I don’t have acne and I made ultrasound it was negative but pcos cannot be well diagnosed)
    I made a blood test when I stopped the BC the third day of period : the results seemed normal (progesterone : 0.40 ng/mL, oestradiol : 37.6 pg/mL, prolactine : 10 ng/mL, testosterone : 0.330 ng/mL, FSH 5.7 UI/L , L.H : 3.8 UI/L) and the cortisol is a little high : 28,1 ug/dl
    I’m quitting sugar and taking magnesium. I would like to add natural anti androgen and I wanted to take DIM maybe, but I don’t know how choose.

    thank you for your help

  25. I’m experiencing excessive shedding the week around ovulation and the week of/after my period. My cycle is only 1+ day but is regular (every 28 days). I am taking 100mg oral micronized progesterone, zinc, copper, saw palmetto and fish oil. I suspect low estrogen and bad perimenopause. My labs (saliva and blood) all check out though: sex and thyroid hormones all in range, good Vit D and ferritin. I can’t take birth control because it gives me bad side effects (depression from testosterone suppression). Any thoughts of what is going on or what I can do? I’ve been dealing with this for 2+ years and don’t have much hair left. Other side effects I have during low estrogen time include: cold sensitivity, fatigue and depression.
    Thanks to anyone who takes the time to reply!

  26. I have gone this route for a year……………. hair loss worst than ever. Nothing, Nothing is helping. Severe depression. LIfe isn’t worth living. I have tried all advice. So angry no one in the medical community cares about this issue. It stops womens lives. We hide, draw back from all life. I died long ago. This is just a nothing person.

    • Monica – so very sorry for your current state of depression due to hair loss, I too have hair loss and have tried/read so much information my head is full. I agree that there are few answers from the medical community, and it is so, so frustrating – but sites like Lara’s have helped me become better informed of women’s hormones. For me, the depression and hair loss go hand in hand and I believe derive from the same cause – imbalanced hormones. I started seeing a hormone specialist and have started a very small dose of progesterone cream – I have learned over the years that I am very very sensitive to any kind of change in hormones so I am extremely cautious with all supplements/medications recommendations. Thankfully, the progesterone has helped with my depression, and because of this I find myself better able to cope psychologically with my hair loss.

      Although hair loss remedies are in their infancy, there are several ways to alleviate the depression (counselling/Cognitive Behavioural Therapy, exercise/food, meditation) that can help women better cope with the depressed feelings about hair loss. Blessings and hugs to you!

    • I feel your pain Monica. I have been struggling with hair loss for over two years and my depression just seems to get worse and worse. It can be such an isolating journey of trying to figure out how to treat it, and my experiences with doctors, endocrinologists, and dermatologists have been so disappointing. My hair loss isn’t even that extreme compared to many cases I’ve seen, but it feels extreme to me and I wish I could just get back to my old self. I would never have described myself as vain or image-obsessed, but this has truly cut to the core of my entire being in ways I never could have imagined. It just depletes your confidence. Exercise helps me cope, and committing to nutrition and wellness – maybe they won’t help my hair situation, but will be good for me in the long run and maybe that health reawakening is the silver line to this whole struggle.

      Dr. Lara, I wonder if you might consider a blog post follow up about patients that have overcome pill-induced hair loss and what their journeys involved. Like a call for stories, similar to what you recently did with the veganism post. I know it would be so helpful to hear about success stories and have a little hope that things will ultimately improve for the rest of us!

  27. Lara – thank you so much for writing this article. I’ve read so many different stories about Mirena and it’s really hard to unpick everything. Yours is the first thing I’ve read that actually makes sense and is informative. Hoping you can help.

    I’ve read that hair loss is a cause for concern with a lot of women who have Mirena. I wonder if you could let me know what causes it please? I have researched it and I see that the Mirena contains Levonorgestrel. Is this what might cause hair loss in some women? My current pill contains 150mcg Levonorgestrel/day, and Mirena contains just 20mcg Levonorgestrel/day reducing to 10mcg over the course of time. This is obviously much less so I wonder if I might be spared the hair loss side effect as I’ve tolerated my pill well up until now with no real adverse side effects.

    I guess I am just wondering if it’s the Levonorgestrel that is the cause of the hair loss some women report, or if the cessation of the Estrogen in the combined pill that might be the cause? (I’m having to stop taking the combined pill due to having Hypertrigliceridemia which is adversely impacted upon by Estrogen).

    (ps. I tried the implant a few years ago and tolerated that well too – no adverse side effects apart from major weight gain which, in the end, resulted in me having it removed and going back on the pill).

    Many thanks for any advice and thanks for such a brilliant site/article.

    • Hi Susan, even Mirena’s small dose of levonorgestrel seems to be enough to cause hair loss in some women. BUT, if your situation was stopping the pill to change to Mirena, then the most likely cause of hair loss was stopping the pill. (it would typically occur 2-3 months after stopping). Your hair should recover especially if you can manage to ovulate on mirena and make progesterone. (Not all women can ovulate on Mirena.) You can track your temperatures to know if you’re ovulating. You could also talk to your doctor about natural or micronized progesterone as treatment for hair.

      • Hi Lara
        Thank you so much for replying. I am due to switch from pill to Mirena in December. Just a lot of ‘what ifs’ at the moment. I have stopped my pill before when on Implanon (for 2 years) and without contraception whatsoever (for 1 year). I can’t say I remember noticing any hair loss during this time, so I am hopeful that the switch will have minimal effects on my hair/weight.

        I am 42 so have everything crossed that I might start ovulating again … I can only hope!

        Do you recommend anything natural that I could take during the switch/afterwards? Zinc maybe?

        Thank you again for replying.

  28. Hi Dr. Briden, I know you have mentioned many times that there is a 3 month delay when it comes to determining the cause for hair loss. I have noticed over the past year that my hair loss subsides a day or two following ovulation. I have regular cycles and monitor my temp shift each month so I am confident I still ovulate (I am 41). I have paid careful attention over the past year and, without fail, the amount of hair I lose in the shower etc decreases significantly 2 to 3 days after I have progesterone on board and picks right back up again on day 2 of my cycle. I am just curious to know if you have seen this before and, if so, what you think it could potentially signify. I am 2 years into dealing with hair loss and cannot determine cause, although I have to think it is hormone related given the difference during LP. (15 mos off Spiro; 10+ mos of increased calories, gentle carbs, etc, thyroid could be playing a role subclinically but hoped increasing nutrition would fix this) Thank you Dr Briden! Your book and blog have been invaluable to me and I’m looking forward to reading your new book.

  29. Hi Laura!
    I’m so thankful to have found your posts, I started hormonal birth control pills (containing levonorgestrel) just over a month ago. 2/3 weeks into taking the pills my hair has started shedding more than it ever has and there it is thinner visibly. I’m only 18 so this has shocked me. I’ve stopped taking the pill and will not use any other hormonal birth control now, however I am wondering if it will shed for a couple more months while my hormones go back to normal? I am going to take some supplements for my hair and I understand that it could take months, but I want to know when the shedding will stop as it is not fun.

    • You can probably expect shedding until at least 3 months after you last took the levonorgestrel. After that, your recovery will depend on whether you get your periods back and start making progesterone (which is great for hair).

  30. Hi Lara,
    What do you recommend for daily iron and protein intake? I haven’t been able to get my ferritin up past 55, even with 3 months of supplementation and eating a lot more fish, eggs, nuts, and leafy greens than I used to. Suffering bad hair loss and breakage, all tests come back normal though and no one will treat me so diet seems to be my only recourse. Thanks for any suggestions!

      • Yes, I do! I try to eat red meat twice a week (like flank steak or bison burger), and maybe chicken once a week, and salmon twice a week. Right now I think I am probably getting about 40-50g protein a day when I factor in eggs, almond milk/butter, nuts etc. And I eat spinach every day as well. I think that should be enough as long as I stay consistent? I just want my hair to stop coming out every time I run my fingers through my hair….

        • With my own patients, I look at other common reasons for low iron: 1) gluten, 2) dairy, 3) low stomach acid, and 4) heavy periods. Do any of those apply? (as in, do you eat gluten or cow’s dairy that could be impairing iron?).

          • I cut out gluten and dairy about 4 months ago and have stuck with it pretty faithfully – I’ve maybe had pizza twice, pasta twice too, ice cream a few times. I don’t really have heavy periods (probably two days of regular flow, followed by two days of light flow or just trickly spotting). How do I test for low stomach acid? Are there other symptoms for this? Thanks!

          • Just thinking about it a bit more. A ferritin of 55 is reasonable. I know some doctors aim for 80 or 100, but I’ve never found that to be necessary. Which supplement were you taking?

          • And I do have acne (mainly subclinical acne on my forehead, and occasional hormonal acne on chin) since stopping bcp 2 years ago. No real problems with bloating or constipation etc….

          • Hi Lara,
            I think it was this one: https://www.thorne.com/products/dp/iron-bisglycinate . 25 mg in the morning after food. Yes, it seems like my ferritin just won’t budge – it’s still 56 even after eating way more animal products that I used to. I just don’t know how to get back my hair health – it looks and feels brittle, lusterless, all around unhealthy….but no amount of nutrition seems to be making a difference :/

          • Thanks Lara, this has been such an endless game of detective so I appreciate any insight you might have. I’ve had my thyroid checked a few times and according to two different endocrinologists I’m fine….they said the tsh fluctuations over the past 2 years are normal.

            July 2016 – 2.85
            October 2016 – 2.51
            March 2017 – 4.72
            May 2017 – 1.670
            August 2017 – 3.45
            October 2017 – 2.37

            Free t4 is also pretty normal I think?

            Free T4 (same dates as above)

            For additional comparison, my tsh was 1.820 in March 2014 – a time when I was feeling all around healthy and happy (and wasn’t yet dealing with hair loss or post-pill syndrome….also wasn’t on the pill at that time…)

          • I never asked this specifically, but I don’t think I have them. I checked back on my lab results and this is what I have from about 8 months ago.

            Thyroglobulin Antibody 0.0-0.9

            My result: <1.0 (listed in the normal range)

            My gut says it's a combination of factors – miniaturization while on the pill, telogen effluvium of going off the pill, then the sebum productions and scalp oil has shrunk my hair even further….I don't look or feel like myself anymore.

            I did some hormone testing a year ago and had the following results, not sure if they would mean anything to you?

            DHEA – 118
            Testosterone 11.4 ug/24hr
            5a-androstanediol 42.6
            5b-androstanediol 149.2
            androsterone – 3216.

            I seem to get MORE acne when I take supplements or any kind of vitamins, which is why I have tried to stick with diet choices only, instead of adding things like DIM. Vitex made me breakout pretty badly. Now I'm only taking magnesium and zinc since my body seems less reactive to those.

            I just wish there was something I could do. Thanks for raising the alarm and education women about these horrible drugs – they have had such a negative effect on my life and self-esteem. I would never wish this on anyone!

  31. I’ve been off birth control, spironolactone, and sugar over 2 months. I started having extreme dandruff about 9 months ago. It mostly went away for for the last 6 months and has recently come back with a vengeance. Could this be related to going off the medicines? My face has gotten much more oily, so why is my scalp so dry?

  32. Hi Dr. Briden,

    I have lost about half my head of hair since quitting Ortho Lo in December 2015. In addition to the depression and mood swings and horrendous fatigue, I’ve been dealing with unrelenting scalp sebum. I was able to more or less control the post-pill acne by cutting out all dairy gluten alcohol sugar and caffeine (still doing that, only minor subclinical acne on my forehead now), but my hair still churns out sebum. I had never experienced something like this before. Now I have a waxy greasy patch on the back of my head that refuses to go away, and a bald spot right on the crown as well. Most derms have just said telogen ellfuvium, but the amount of thinning and the duration of the hair loss with no recovery points to anodgrenetic alopecia in my opinion. I’ve pretty much given up hope on getting my original hair back, and just want to get rid of this sebum overgrowth on my scalp. It is so unsightly and has really affected my self-confidence, libido, and overall sense of wellbeing and health. I started an even stricter anti-inflammatory elimination diet one month ago in the hopes of finally curbing the sebum (no dairy gluten sugar alcohol caffeine corn vegetable oils or nightshades) and have been eating lots of thyroid supporting foods as well, in case that’s part of the problem. My docs say no, but my TSH has jumped back and forth for 2 years with a low range of 1.5 and a high of 4.72 about 8 months ago. 3.5 most recently.

    Any thoughts? My periods are pretty normal – 29-35 days little to no discomfort and regular amount of bleeding.

  33. Hi doctor,

    I have normal levels of androgen, ovulate regularly but have AGA. What are the natural treatments you’d recommend to inhibit 5 alpha reductase since I ovulate regularly?

  34. Hi Dr Briden, what if hair loss is due to peri menopause? My iron levels are good. I do take B12 daily as well. Not sure about my zinc…. do you have an article written or book on the subject?

  35. Hi Dr Briden,
    I have recently been diagnosed with probbable AGA; I had noticed the minaturisation of some scalp hairs months earlier, and was expecting the diagnosis due to this and my other PCOS symptoms.
    I didn’t start to notice hair loss, however, until I was on a potent anti-androgen pill (Diane-35) and it continued as I switched to another, low-androgen index pill and then back to Diane.
    My question is: can sheer hormonal fluctuation caused by switching pills trigger AGA? As the pills I was on indicate the absence of androgens in my body, yet the miniaturisation must have progressed (and possibly started?) on the pill. Perhaps another explanation is that the miniaturisation process began before I started the pill, but because I had very thick hair it took me years to register it.

    Have you ever encountered miniaturisation of scalp hair follicles due to a low-androgen index or anti-androgen pill?

    Furthermore, have you seen cases where patients with scalp hair miniaturisation have stopped or reversed this process with natural remedies promoting hair-friendly hormones?

    Thank you and best wishes,

    • Very good question. I have had patients who experienced significant miniaturisation when coming off an anti-androgen pill like Diane. I don’t know exactly what’s going on but I suspect it’s because of a rebound androgen effect.

      Also, the problem with the pill (any pill) is that it robs the hair of the lovely effects of estrogen and progesterone.

      • If miniturization occurs due to Bcp or inflammation or any other issue, can it be reversed if the inflammation is stopped as outlined in your book? If so, does hair loss sometimes get worse before it gets better?

    • Hi Jane, my hair miniaturised on Diane 35. It also gradually fell out for a year. Once I came off it I experienced the dread shed which has continued ever since (going on 10 months). HOWEVER I do feel like my hair is healthier now, and I am confident that some of the thinning is going to reverse. No more synthetic hormones for me! Good luck x

      • Thanks Dr Briden! And thank you K! What confuses me the most is that Diane worked so well at clearing up my hormonal acne and slowing down the growth of body hair, yet seemed to exacerbate or even cause minituarisation of my scalp hairs– my hairs may have minutuarised anyway as I am hypersensitive to androgens but Diane certainly didn’t help. I can safely I’m never touching synthetic hormones again either!

        • Jane, Diane helped with my acne too and also made my hair less greasy. I don’t understand the science of it, but I believe Diane, Yaz, Brenda etc are WORSE for your body and for your hair because they are even less ‘natural’ than traditional pills. There are thousands of girls on the internet who have lost and had their hair miniaturise on Yaz and this is an anti-androgenic pill which is ‘good’ for hair. Bull!

          • Thats true I’ve read a lot of forums about women losing hair on Yaz, however most of my research indicates that it grew back once they went off it; I can’t seem to find the same success stories with Diane. I was on Diane for nearly 2.5 years and have definitely noticed a reduction in volume, Ive been off it for 8 months and it’s difficult to tell whether or not it has improved as I cut my hair short to make it look thicker.
            I am now addressing my PCOS symptoms at the root (my rebound acne is slowly but surely subsiding) and Im hopeful that I will regain my thick hair.
            I’m trying to focus on the positives of this experience– now, at 20, I know to avoid drugs and treat the cause of my acne naturally, but with this hair loss which I don’t remember having before the pill, sometimes it’s really difficult!
            Best of luck to you K, I’d be interested to know how you go with restoring your hair!

        • Jane I agree, I haven’t come across any success stories with hair recovery post Diane…Which is worrying. I was on it for almost two years. I’m 33 and worried that my hair is just going to miniaturise further. 3 years ago I had so much hair! I’ve got a lot of regret about my choices, but I just didn’t know what I know now. My skin cleared up at around 8-10 months post pill, so you should definitely be seeing some improvement. Let’s hope our hair follows suit. Best of luck 🙂

  36. Dr. Lara please.
    Would it make sense to apply progesterone to the scalp to help with hair loss? Instead of supplementing progesterone in other parts of the body, applying directly to the scalp could help with androgenetic alopecia?

  37. Dr. Lara,
    I was diagnosed with PCOS around the age of 19 because I was suffering amenorrhea after completing a 6 month stint on birth control (my first). After the diagnosis my doctor told me to go back on birth control as treatment and I’ve been on it ever since (with a short 1-2 year stint on quarterly progesterone pills). I am now 31 and have been wondering if being on the pill is doing me any good. I have suffered from back acne since I was a teen (before the PCOS diagnosis) and recently I have noticed hair thinning in my bang area. I’ve been on forms of Ortho Cyclen most of my years on BC, starting with Tri-Cyclen Lo, then upping to Tri-Cyclen when my withdrawal bleeds became less reliable and most recently did 3 months on Cyclen when my doctor suggested I try continuous BC for 3 months at a time to see if it would help me with regular hormonal headaches. After 3 months of the continuous BC was when I really noticed this change in my hair. My doctor ruled out thyroid and iron deficiency (39 at the time) and switched me back to Tri-Cyclen monthly. My doctors have always thought I should be on the pill to ensure I have regular withdrawal bleeds and haven’t ever suggested alternatives. At this point, reading your blog and other sources on the internet it seems as though BC isn’t doing much to help me, but I am also afraid of going off it because of all the possible hormonal side effects. I tested a bit high for glucose on a recent blood test and I know I need to work to change my diet and introduce more activity and exercise into my daily life. Do you think I should start with those lifestyle changes and then consider stopping BC once I get my health more on track or should I just stop it ASAP? I know there are so many factors that it is probably very difficult to give me any kind of answer, but I am so frustrated with doctors only advocating the pill and I’m not sure what to think at this point. Thank you for your blog and the time and care you take in helping and informing people.

  38. Dra. Lara.

    My name is Bianca Walesko,Please, I am reading your book and I have a question. In the chapter 10 where you talk about hair loss, you mention that

    “If you are diagnosed with androgenic alopecia, then your situation is more complicated. There is no one treatment.”

    In that case if I do not have any of the other conditions listed as iron and zinc deficiency, PCOS, do not take contraceptive pills, have no disease, or thyroid problems. If I only have hair loss, only androgenetic alopecia, there is no chance that I will improve. Will I lose my hair gradually, no matter what I do? Is not treatment only for androgenetic alopecia if it is not stained with another condition?

    Please, Thank you so much.

  39. Hi Dr Briden,
    I’ve been dealing with hair loss for the past 2 years, ever since I tried to go off the bcp Desogen. I went back on immediately but the shedding never stopped and I was told that I now have androgenic alopecia, which is devastating. What I noticed though is that I’m now spotting mid-cycle (dark blood) when I used to never spot when I was on the pill before (prior to the hair loss). Can you think of any reasons why I’m now spotting almost every month? I want to fix my hair and I’m hesitating between adding Spiro or stopping the pill.


  40. Hi Laura,

    I have now been sick for two years, and going off birth control actually made me much sicker. I thought my hair loss was FROM it, but it thinned drastically AFTER and hasnt abated, two years later. I developed crohns disease and irregular periods, which have now regulated but the hair loss is still here. I ended up being diagnosed with osteoporosis at 32, and hyperpaprathyroidism. Are there NOT some circumstances where hormonal birth control can be HELPFUL- ie, for bone loss, hair loss from hormone imbalance, as well hormonal imbalance causing exacerbated crohns?? Can it not HELP hair loss sometimes??

  41. Hi Dr. Briden,
    I’m 29 years old and for almost two years, I’ve been getting male pattern baldness. By now, I absolutely cannot put my hair up and it’s almost visible to the casual observer. When I was 20, I took Triphasil 28 for four months and I lost half my hair thickness and never recovered, despite not touching any other hormonal birth control again. Now I’m going bald and I don’t know why.
    I’m waiting to get another blood test done, this one for hormones, but my other blood test, the one for hypothyroidism, came back normal, though low across the board, except for hemoglobin, which was too low, and B12, which was midway normal. I’ve been experiencing androgen excess symptoms for a long time. I can’t remember how long.
    Would any amount of cinnamon of 10 ml. or less harm my hair line? Desperate for relief from cramps, (In the past, I have been sent home from work because of how awful I looked/felt) I had taken 3 – 10 milligrams of cinnamon a day in the second half of my cycle. Is that a potential culprit? My periods have been getting lighter, even without cinnamon on a monthly basis, though by now, that could be from the stress of losing my hair.
    Would chasteberry, even if it turned out that I didn’t need it, harm my hair line?
    Would having long hair affect my hair line? I want to be absolutely sure before I cut it off out of desperation.
    Will my hair grow back if I fix the possible androgen excess solution? I’ve been reading articles that describe male pattern baldness as permanent and it’s so depressing.

  42. Praying you can help me: I have pregnenolone induced hair loss and weight gain. My hair is continuing to fall out and I am gaining 1/4 pound each month no matter what I do. My other hormones, estrogens, progesternone, all the thyroids have been checked repeatedly. Is there anything you can tell me? Thank you, Paula

  43. I started noticing hair loss in August 2016. It was a tiny area at the front of my head at my part. I changed my part up and hoped for the best. Things were worse by October 2016 so I had my Mirena IUD removed and began drinking liver detox tea and taking hair vitamins and taking 200 mg of magnesium each day. My hair had more thinning around the center part and especially in the front but I kept waiting for it to get better and the Mirena synthetic meds cleared out. This week was a disaster. I noticed extreme hair thinning and my scalp is an oily mess. I got my period back the first month after getting the iud out but my period is late this month and when it does come, it is preceded by three days of light rust colored discharge (signs of low progesterone I believe) I have no idea why my hair loss is worse. I also use hair growth shampoos and head massage to promote hair growth.

    Here is what I am doing now- I cup peppermint tea each day
    Low Inflammation diet ( no gluten, no dairy, no sugar)
    300 magnesium
    Women’s balance supplements with vitex

    My questions- is it normal 5 months after stopping Mirena to have more hair loss after a stable time? What else can I do to protect and keep what hair I have? How long does it take to have hair growth return?

  44. Hi Lara! I stopped the pill for about 3 months ago, and I didn´t have period yet. May I need to worry? And is it possible that I´m ovulating but not menstruating? Because it seems that I have ovulated 2 times during this period, but I´m not sure..

  45. Hello Lara ,I had the mirena iud for 9 months about 4 years ago and my hair hasn’t been the same since. I have many minituarized hairs and areas where my hair fell out and never grew back. It’s incredibly devastating to see my hair strands slowly miniaturizing and not knowing what to do about it. My question is, why would the androgens from the birth control still be affecting my hair 4 years later and is there anything I can do to salvage My remaining hair? I’m so tired of crying and worrying about what my hair is going to do next. FYI, there is no family history whatsoever on either side of genetic hair loss. Any input would be greatly appreciated.

    • I am in the same situation except I had Mirena for 3 years and got it out 5 months ago. I keep having my hair fall out and it does not seem to be growing back in from where it is thinned out. I am getting regular periods but they have two days before and after of brown spotting so I think my progesterone is still off. I take magnesium and vit D every day. Pre Mirena removal I was borderline I sulking resistent. Hoping to reverse that as well by being off Mirena.

      Does anyone know of it is normal for hair loss and miniaturization to get worse for a while after coming off hormones before or gets better? I did not expect it to be cured by now but I did not think it would be worse. Did anyone have this happen and then finally see a change in larger and healthier hair follicles and hair regrowth?

  46. Hi Dr. Briden,

    What are your honest thoughts on antidepressents? I have been struggling with mild depression for a few years, and it has intensified significantly since going off otc-lo about 16 months ago. I have been working to balance out hormones with the assistance of my naturopath, but I am still struggling with depression. I think it is less hormonal, and more of a situational depression and frustration with hair loss etc. and all the time money I’ve spent trying to get answers and restabilize my body the way I know it is.

    I am considering antidepressents to help with the emotional upheaval (I think I had depression even before the Pill woes, but it has worsened since then), and am interested to hear your thoughts on the interactions between antidepressents and hormones. Also, do you think my hair loss could worsen due to an antidepressent?

    I have been trying everything for over a year and am desperate for some help, but I am worried that a drug could compound the problems even further.

    Thank you for any insights. I don’t know if you also write about this in your book, I would love to learn about the interplay between neurotransmitter drugs and female hormones.

    • Great question. I do hope to write more about hormones and mood.

      First of all, I don’t think that SSRI antidepressants would worsen your hair loss or disrupt your periods. The SSRI side effects that worry me most are loss of libido and osteoporosis risk. Also, the drugs are essentially addictive and can be very hard to get off.

      And I’m convinced that natural treatments have the potential to be more helpful. Have you seen Dr Kelly Brogan’s book “A Mind of Your Own”? A bit controversial, but I think worth a read.

      And finally, just a reassurance that post-Pill hair loss does improve, but it can take a year or two. Has your naturopath thoroughly assessed your thyroid, including thyroid antibodies?

      • Thank you for the book rec! I will check it out. I want to do everything humanely possible to avoid antidepressants….

        and yes, I’ve had my thyroid antiobodies tested, no sign of anything autoimmune. I am also visiting an endocrinologist soon to do another test. For over a year my hair has been brittle and thinning and completely different in texture, which I attributed to the vitamin deficiencies of going off the pill. However, my B12 is back up, my iron is at 56, and I have been taking zinc and copper on top of that. Maybe I can regrow what I lost/thinned already, but I feel like the texture and feeling of health should have returned by now. What do you think??

  47. Hi Dr. Briden,

    I’ve been suffering from hair loss since stopping otc-lo 15 months ago-I’ve been using scalp treatments from a tricho, keeping low on dairy and sugar, and have been supplementing with iron zinc copper and thyroid support for almost 3 months. However, after three months of daily iron supplementation (I was very diligent with iron because I know how critical it is to hair growth), my serum ferritin only went up from 55 to 56. My naturopath has no idea why my ferritin wouldn’t move, and wants to focus on my thyroid. Now I am taking a half grain each morning. My trichologist said some women just don’t absorb iron as well, or just can’t get up into the 70s/80s for unknown reasons.

    Do you have any suggestions? I have had my blood drawn so many times in the past year I am starting to lose count (and hope) that my hair will regain its thickness, volume, and shine. It almost unbearable to touch, that’s how foreign the brittleness/thinness is for me.

    • The most common reason to not absorb iron is a problem with gluten. That said, a ferritin of 55 is good. I don’t often see it go higher than that in women, and I don’t aim for higher. Remember the time delay with hair loss. It might be that you are doing everything right, and you will only just now start to see the benefits (after 3 months).

      • Thanks so much Dr Briden. I was tested for gluten already since I’m dealing with depressing fatigue brain fog etc (but no stomachaches or bowel problems) and it came back negative. I might retest just to be sure.

        Could drinking caffeine also inhibit iron absorption? I drink a cup of cofffee or green tea every day but nothing excessive.

        Everything I read says serum ferritin or 70+ is needed for hair regrowth and strength. Is there anything else I can do, or just stick with a good diet and enough heme foods??

  48. Hi- 2 years ago I used bioidentical progesterone cream 15 mg for 5 weeks and noticed hairloss by the handfuls stopped the cream but 2 years later still have hairloss in fact it has gotten so bad I have had to resort to wearing a wig ( which I love) but would love to slow done my loss as I am a fitness instructor and wear a hat! I also believe after the progesterone I overdid it with vitamins and maybe vitamin a! For the past year have tried to stay away from all vitamin a food and supplements! So I’m taking a all food hair, skin, and nails, biotin, omega, turmeric, vitamin d, and recently started biosil! I have came to terms with my hairloss but can you suggest anything else I can do? What about inistol?? And does it need to be with choline?? Thank you I’m only 42 and feel there is no return! Also my testosterone tripled but has since when down to normal in the past year!

    • If you were only on progesterone for 5 weeks, and your hair loss started during that time, then it could not be due to the progesterone. Because there is always a 6-12 week time-delay with hair loss. So. What was happening with your health 1-2 months before you started the progesterone? Did you stop hormonal birth control? Heavy periods? That will give you a clue.

      You’re not low-carb or vegetarian, are you? Has your thyroid been checked?

  49. Hi Dr Briden,
    Thank you for your insightful posts; I am inspired to use solely non-hormonal methods of birth control from now on.
    I used Diane-35 for my acne for two and-a-half years, from the age of 17 to 19. However, during last year I switched to Norimin (norethisterone/ethinylestradiol) for no more than 3 months due to my concern of blood clot risks with Diane. After my acne returned, I switched back to Diane before coming off the pill altogether 3 months ago.
    A few months after stopping Norimin I noticed that my hair was less thick; the preceding months I had also experienced severe emotional stress. Since switching back to Diane, my hair did not improve and remains thinner than it was before I took any contraceptive pills, with some hairs thinner than others and some individual hair strands differing in thickness from one end to the other.
    I am wondering, is it likely that Norimin (with neither a high nor low androgen index) caused permanent hair loss after just three months? Or is it more likely to have been caused by the period of emotional stress, the hormonal shift in switching pills, or a nutrient deficiency due to being on the pill? I am now taking zinc and other vitamin supplements.
    Thank you,

  50. Hi, Lara!

    First of all, sorry about my English (I´m from Brazil and it may have some mistakes…)

    I´m here to thank you!! I´m 29, and I use pills for about 10 years. During this 10 years, I have tried to come off the pills 3 times, but I always gave up because of hair loss, acne and the high sensibility on my scalps.. it got inflamed, red, itchness…

    But this time, I bought your book, and I follow up all your advices. No dairy, gluten, sugar, alcohol, and vegetable oil. No stress. I suplied Mg, Zn, Fe. I´m 1 month with no sintetic hormones, and I feel good! My hair is ok, I don´t have acne, and most important: my scaps are normal! I probably have a food intolerance that any doctor have figured out.

    I no it´s early to celebrate, but before your book, I could not stay one week without the pills and my body was a disaster. Now I´m almost one month, and I feel so good!!! I´m ansious to menstruate, and to understand my cicles, finaly!

    I don´t even know you, but you are already an angel in my life!

    I have a doubt: If I eat in a healthy way, can I eat a food with dairy and gluten on occasion without deregulate my hormons? Wich frequency would not make a mess in my body?

    Thank you very much,

  51. Thank you for all your marvelous work. At age 65, I find many of your offerings very useful, even when they are directed towards younger women. My question: A recent test shows my serum ferritin at 18. I have had considerable hair loss in the past several years. I am supplementing cautiously with iron. Would I be seeking a ferritin level of at least 50, as you suggest?

  52. Based on my own personal experience, I would also recommend a B-complex and amino acid complex supplement (like Genesa total amino acid or Whole Foods Amino Essentials), there is alot information on hair loss and amino acids.
    and Nigella seed oil (aka Black seed oil). Most importantly, take care of your liver, meaning = do not eat poorly, or comsume things that may be taxing on your liver such as dairy, like cheese, and alcohol.

  53. I need help deciding what form of PCOS I have so that I can treat my hair loss from it properly.

    I have the period repair manual but I meet a few of the types in terms of criteria. My hair loss is male pattern meaning it started in the front and is spreading to the ears and towards th back part meaning soon I will have horseshoe hair. My hair has gone from mild to moderate loss in only one month. I only noticed any loss 2 months ago. Please help! This seeks to be a very aggressive type of hair loss.

    i was on Mirena iud for almost three years before I noticed the thinning. I had it taken out 11/1/16 of this year. On 11/4/16 I had blood tests done and was found to have the following results

    Cortisol 13.98 (normal range 8.7-22)
    Testosterone 4325 ( normal ranger 8-60)
    DHEA 75.2 (normal range 31-228
    FSH 5.6
    LH 9.6
    Estradiol 66 pg/ml
    Progesterone .04
    Glucose 93 (normal range 70-100)
    Glyco HGB 5.7 (normal less than 6)

    So I appears as though I have signs of PCOS AND insulin resistance but I suspect it was caused by the Mirena so do I have pill induced hair loss and PCOS or insulin resistant PCOS and hair loss?

    Also, I just got my period back on 11/18 so I am on the right track and I am doing a light lover cleanse with tea and salt baths but should my hair be getting worse with no sign of new growth? I do also have excess oily skin and extra facial hair all in the last two months.

    Help! Please!

    • Mirena definitely causes hair loss.
      The test for insulin resistance is “fasting insulin” or “glucose tolerance test with insulin”. If you do have insulin resistance, then the focus it to correct that.

  54. Hi Dr Briden, I just came across one of your comments in one of your hair loss blogs, and that was “pill-induced hair loss can take a couple of years to reverse.” I was just wondering why that can be the case?

    I’ve been dealing with hair loss for over a year after discontinuing ortho-tri-cyclen lo, which I thought was too long, but maybe not? (I’ve had all the tests you’ve suggested, multiple times, and everything is normal)

  55. Hi Dr Briden,

    I am so confused by minaturization! I’ve had hair loss for almost 3 years, which started after the birth of baby #3, going on otc-lo to “balance” my hormones, messing with my bc, and then discontinuing it for good in Aug 2015. My shedding had since normalized, but I have noticed minaturization, which has been confirmed via observation by 2 Derms. My questions:

    1. Both Derms say that birth control does not cause minaturization, but I know you’ve said otherwise. So to clarify, can birth control cause minaturization? Even low-androgenic pills (such as ortho-tri-cyclen lo)?

    2. Can you reverse minaturization if you cease birth control and start to regularly ovulate (and assuming no other underlying issues/deficiencies and/or that the hair follicles haven’t been to damaged)?

    3. Does a scalp biopsy only confirm that minaturization has occurred or is it able to differentiate between minaturization caused by hormones vs genetics?

    4. Are there other things (like chronic telegen effluvium or seborrheic dermititis) that can cause minaturization other than genetics?

    Thank you!

    • Birth control with high-androgen index cause miniaturization. Ortho-tri-cyclen is norgestimate, which has a low androgen index, so no, it should not cause miniaturization.

      Miniaturization cannot always be reversed. Depends how far it’s gone.

      Miniaturization is caused by androgens or androgen sensitivity, which can be due to chronic inflammation. I discuss androgen sensitivity in my Androgen Excess post.

  56. I’m 26 and my period has stopped due to stress and lower estrogen (I’ve been overseas for over a year now and prior to this missing a period when traveling was fairly normal for me) my doctor is not particularly concerned and said that they should return to normal when I go home (in a month). I don’t take birth control. I don’t have any abnormal hair growth on my face or anything like that, but I feel like my hair has thinned on my head. If I go home and my stress lowers and estrogen and progesterone levels return to normal, is it likely that the hair lost from this will regrow with time?

    • –that is, in this amount of time (about 1 year) of hormone imbalance/hair loss, assuming my hormones go back to normal when I get home (In a month), is it likely that the hair loss is permanent? (If it’s worth noting- In all other aspects I’m healthy..I have a diet high in fiber, veggies and fruits, not too many refined foods, and I’m at a healthy weight.) And I did have my thyroid tested and it’s fine.

      Any feedback is greatly appreciated–hair thinning is stressful and I know stress isn’t helping the problem! Ha. So I guess I’m just looking for some reassurance or at least a good idea of what to expect.

    • Yes, stress can cause hair loss and periods to stop. Was there anything else 3 months prior to the hair loss that could have contributed? antibiotics? fever? etc.

  57. Hi Dr Briden,

    Question: What is a typical total time range for post pill hair shedding (i.e. 6-12 months)?

    Background: I discontinued Ortho-Tri-Cyclen Lo in Aug 2015 and I feel like I’m still dealing with hair loss issues over a year later. My day-to-day shedding has mostly normalized, but my hair still seems to be thinning, especially at my hairline and temples. I did see one Derm specializing in hair loss who mentioned minaturization, so I’ve been following your thoughts on minaturization as a result of the pill and androgen resurgence after discontinuing the pill.

    I have also had my thyroid (including thyroid antibodies), ferritin, vitamin D, FSH, AMH, sex hormones (DHEA, estrogens, testosterone -free and direct-, SHBG) and ANA tested. All normal. I keep asking them (OB, Naturopath, Derm, Primary) to test my Progesterone, but everyone keeps telling me it’s an “unreliable” test. All these issues started after baby #3 in Jan 2014, a pregnancy during which I was given progesterone shots from week 16-36 to help with preterm labor, as #2 was early, so I can’t help but think it’s all related (and then I started bc after, messed with my bc, and then discontinued it for good in Aug 2015 – so lots of exacerbating hormonal triggers).

    • Hi Leah,

      I feel like our stories mirror one another on so many levels. The only difference is I haven’t had any children like you have, but I have experienced the exact same post-pill battle particularly with my hair……I’ve also been waiting it out for close to a year, and I honestly can’t tell if it’s getting worse or staying the same. Have you received any good information on miniaturization? I find so much conflicting information, I had one hair loss specialist tell me he could see some miniaturization but that I had nothing to worry about it probably wouldn’t be permanent. But I can’t get decisive information anywhere, I’ve seen three hair loss doctors two naturopaths my regular doctor a dermatologist……it’s been endless, but because my hair was incredibly thick to begin with, I can pass for having a “normal” head of hair. If you look at a side by side photo though, it’s obvious I’ve lost a good 50% or more. If you have any other avenues worth exploring, please share your thoughts! We are both fighting the same battle

      • Hi Sarah,

        The hair loss specialist and Derm both mentioned AGA and minaturization, but they both said it’s impossible to say if it will reverse, that only time will tell, and that makes sense to me. I suppose it depends on what is triggering the minaturization; if it was birth control and that trigger was removed, than reason says it should reverse if the damage to the hair follicle isn’t too great. If genetics are triggering it, then it’s a different story.

        Like you, I also used to have a ton of hair, so while I know I’ve lost about 40%, most people would think my hair density looks normal. The hair loss specialist also mentioned CTE (chronic telegen effluvium). He said the hallmarks of women who suffer from this usually start with an above average amount of hair, usually experience an obvious trigger and/or seem to be very sensitive to triggers, and then lose hair cyclically for a longer amount of time (the time range for cyclical hair loss was pretty broad, like 1-7 years). He said the good news is that density reaches a stable point and while they keep shedding, they also keep growing hair, so things remain stable, and that the condition usually randomly resolves itself. Once again, only time will tell.


        • Leah and Sarah, my situation is the same as yours except my hair loss started on the pill and has extended into post-pill shedding (I came off the nightmare drug 4 months ago). I gained a lot of strength from a Youtube video I watched about a girl who lost her hair on Ortho Tri, came off it, and then experienced hair loss for the next year. It was then another year after that until her hair started to grow back. 3 years later she could notice significant improvement, 5 years later her hair had fully recovered. That’s a scary timeline, however if I could know that I would be fully recovered in 5 years, I’d be pretty happy. Just wondering if you guys have been taking anything (supplements/herbs) for hair loss, or found any particular shampoos beneficial? Good luck and stay strong x

          • I think I watched the exact same video! It provided a small dose of comfort. I would be fine dealing with this if I just had the assurance it would eventually go back to normal. I have been taking a vitamin supplement from Phillip Kingsley’s three step trichology line. https://www.philipkingsley.com/ I can’t say I’ve noticed any difference, and I’ve been taken it with the other scalp and hair products for a full three months, which is how long hair follicles are supposed to lag. So hopefully I’ll notice some improvement soon.

            Sebum and oil production on my scalp is a big factor here, so I’ve been using an expensive anti-oil shampoo recommended to me by a trichologist. I think the website is in french. She said that the sebum was clogging my follicles and preventing growth, so this is supposed to help. It defintiely keeps my hair a bit cleaner, but haven’t really noticed a big difference there either.

            For me, it’s just been hard to figure out whether I’m actively losing hair, or if it’s just thinning and breaking to an extreme degree. I definitely shed more than usual and pull out hair easily (especially after washing my hair, if I run my fingers through my hair I always wind up with several hairs coming out), but the thinning is a big concern as well. My hair used to be almost annoyingly thick and poofy, but now it’s like peach fuzz wisps.

            If you are interested in chatting more via email, let me know!

          • Thanks for the links Sarah 🙂 I am also dealing with very oily scalp, which only helps to exaggerate the stringy, limp hair I have. My scalp is also always itchy. I now have wispy peach fuzz for hair where there was once bouncy life. You say you don’t know if you’re still shedding…do you feel it has eased since coming off the pill? I also remember the girl from the Youtube video (I found her old posts on hair loss blogs) saying she really couldn’t figure out whether it was stopping or getting worse or staying the same for a long time. Like over a year. And she still felt like it was miniaturising too. I think the fact that you aren’t losing masses of hair every day is a good sign that you’re heading in the right direction. I wish I had been pill-free for a year – imagine how healthy your body is! Let me know your email address if you’d like to chat more. I’d love someone else to complain to other than my (suffering) partner x

  58. Hi dr. Laura, what do you tell me about endometriosis? Can it cause hairloss? Does it have to do with low progesterone? What do you recommend in this case?

  59. Hi Lara, I’m just wondering if estrogen excess can cause hair loss? Reason being that I was on an anti-androgenic pill for over a year and experienced significant hair loss (no other issues – iron, thyroid, zinc fine). I have found hundreds of girls on forums who have also lost hair whilst on Yaz, Diane, Brenda etc. Not just the shed once they stop it, but a hair thinning the whole time taking it. I can’t find any information or evidence anywhere else to support this – except that it is happening. I stopped the pill 3 months ago and am praying that this nightmare can be reversed. Any advice or expertise you could offer would be amazing. Thank you.

  60. Dear Lara,

    I have had Mirena for almost three years. At first all I noticed ( or cared about) was crippling anxiety but I also did not want to get pregnant so I pushed through it. 2 years into it I could say that the anxiety finally seemed to be letting up. Now I notice the hair loss. Or rather, the thin area at the front of my head (where bangs would be) where I can now see my scalp. I don’t think my hair is falling out faster than it should but it sure isn’t growing back in very well. I am going to have my Mirena iud removed but I wonder 1- will my hair grow back? 2- what vitamins/supplements/herbs should I start taking to help my body detox from the Mirena and create its own hormones levels again and also promote hair regrowth?

    Thanks, Amy

  61. Thanks for sharing this piece of information. To know more about Female pattern hair loss or the real cause behind your hair loss, I suggest you to consult with the topmost dermatologists rather than surfing on the Internet. Since this will bring you come across various causes, symptoms and solutions, but not exactly the one you really need.

  62. Hi dr briden,

    I was interested reading your post about the resurgence of sebum after birth control, and how birth control put you back to pre-puberty levels of testosterone. Scary!

    I’ve been reading a lot about hair loss from DHT and increased androgens. I am experiencing hair loss, but have no reason to think it’s genetic or conmected to anything other than stopping birth control. However my questions are…..

    – how long does that sebum overdrive usually last?
    – if it is temporary, can the impact on DHT and subsequent miniaturization be permanent?


    • The post-Pill overdrive usually lasts about 6 months or more. And yes, hair can experience a similar post-pill androgen-sensitivity, which will last for longer (up to a year) because of the lag-time of the hair follicles. I wouldn’t expect permanent miniaturization after only one year.

      • Do you think the androgen sensitivity is causing both the thinning and the shedding? Or are those impacted by separate things?

        I see that you suggest cutting carbs, dairy and sugar. Are there any particular foods that are GOOD at cutting inflammation and preventing sebum overdrive? I am desperate for a solution, and sick of wearing my hair up in a bun every day to hide the oil.

        Thank you!

        • Hi Elizabeth, I am experiencing the same thing as you and am taking a low dose of Saw Palmetto each day. Too early to tell if it’s going to help, but it was recommended to me by a friend who was suffering hair loss. For reducing inflammation I am doing pure veggies juices, twice a day if I can. Also I am dairy, sugar, gluten and grain free (except for rice). Good luck x

  63. Dr. Lara, Over the last 2 years I’ve lost about 50% of my hair, diffuse all over. I’m 28. Blood tests for thyroid & androgens are all normal (I’ve seen 2 endocrinologists). Negative for celiac disease. No hairloss in my family. Over a year ago I did test with low ferritin (11ng/mL) but 3 months ago I tested at 73ng/mL. Low iron was the only issue any of my doctors could find.

    I started Apri BCP about 5 months ago because the doctors told me it would help with hairloss. My hairloss started before I tried it though. However, I will now consider getting off it because of this article. I’ll also start taking Zinc.

    I’m getting depressed, disillusioned & I don’t know what more I can do. I’m a healthy eater, I exercise, I sleep 8 hours daily. I do have a high stress job, but all 3 of the dermatologists I’ve seen reject the notion that my situation is work stress related.

    Thank you so much for any additional insights you have.

  64. Please help me Dr. Briden.I am suffering from increasingly severe depression and emotional distress related to my hair loss and am desperate for any kind of guidance or reassurance you might be able to provide. I went off Ortho Tri Cyclen in December 2015, and my body went into a kind of shock in February 2016…..horrible acne for the first time in my life, excessive oil production on my scalp and skin, and rapid hair thinning. I have done extensive blood work with both a naturopath and my regular doc, and there is no indication of an severe imbalance or deficiency. I’m healthy by all accounts, but I of course know that the discontinuation of birth control has wrecked havoc on my body.

    I have visited three different hair loss specialists and received different information from each. One said that he noticed miniaturized follicles, but it was not necessarily a genetic thing that would last forever. He told me to just wait it out. (It has now been 8 full months since the thinning began, and I’ve noticed the most minimal of improvement.) Another said it was just the excessive sebum clogging and killing the follicle. She prescribed me an anti-oil shampoo that I have been using for 2 months and that has been helping to at least keep my hair feel drier. The third gave me a version of Minoxidil and I also purchased an expensive low-level laser hair band that I’ve been using one month. It is supposed to restimulate the follicles. No improvements yet. I am also taking a host of vitamins and using some other hair strengthening products. My hair still feels thin, lifeless, and just all around lackluster and unhealthy. I’ve lost at least 25% across my head.

    I know it’s related to stopping birth control. However, at this point the initial shed should have stopped, as it has been a full 8 months. Could I still be in the telogen phase and it’s just taking awhile?

    Is follicular miniaturization permanent? Or temporary? Also, can the testosterone effect CAUSE a genetic change or shift? That question doesn’t really make sense, but I am just confused by the information out there…..there is no sign of hair loss in my family, but the thinning I am experiencing seems to be permanent. That is my biggest fear.

    Given the scalp oil that came on with a vengeance, I know testosterone to be the culprit. I am worried that that conversion to DHT triggered the hair loss, and I know this can be a permanent process.

    I am getting normal periods and my sex hormone levels are all normal according to the bloodwork.

    I feel like I am doing EVERYTHING in my power to address the root cause, but I’ve seen no improvement anywhere. I’m desperate to feel confident again in myself and have my normal, thick and vibrant hair back.

    • When did you start the minoxidil? Did the doctor explain that it often causes an initial shed? Has your doctor checked your thyroid, iron, and zinc? you’re not vegetarian, or low-carb, are you?
      Eight months is actually not very long in this process. As long as everything else is ok, and you’re having regular periods, it should start to improve.

      • Hi Dr. Briden. Thank you for your response (and for this incredible blog. I have shared it with dozens of female friends and family members, everyone needs to read this stuff and be better informed!)

        I have only been using the Minoxidil for about 2 weeks, and haven’t noticed any irritation or increased shedding (at least not yet). Would you recommend holding off on it? I am just concerned because everything I read says to be proactive with hairloss you are experiencing, and to treat immediately instead of waiting too long.

        I am awaiting to do yet another hormone test with a new naturopathic doctor, which will hopefully connect the dots a little bit more intelligently and give me more answers. My family doctor and former naturopathic tested thyroid, iron and zinc and didn’t see anything of concern. Just a “little low” on iron, and a little low on vitamin d so I’ve been supplementing.

        I’m not a vegetarian, although I have been eating less meat in recent years. And I’m not low carb either. My periods are regular, with maybe a few days of variance between each month. (30-34 days)

        The hair itself has become very dry lusterless and brittle, and my scalp very oily. By the end of the day the hair roots on my scalp feels like they’re coated in wax, while the ends are so brittle it feels like pieces of straw.

        What about the sebum on my scalp? Would that be related to the resurgence of testosterone in my system, which I think had been shut off by the Ortho Tri Cyclen? Can the effects of increased testosterone (even if the resurgence is temporary) cause long-term follicle damage?

        Thanks again for all that you do!

        • Yes, you were on the progestin norgestimate, which had suppressed androgens, and yes, now androgens are rebounding. That rebound usually peaks at about six months off the Pill and then starts to improve. And no, it shouldn’t cause long-term follicle damage. It depends on what degree of minaturisation you already had, say from a previous androgenic birth control. Were you always on Tri Cyclen, or did you use a different type before that? It’s interesting you say one — but not all?– doctors observed minaturisation.

          • Hi dr briden.

            I had been on yaz and another generic birth control on and off in the past, but never had any kind of reaction while on or going off it. Looking at photos, I think perhaps my hair was starting to thin a bit about a year after starting Ortho Tri but the main thinning and shed and texture change has been since going off. One doctor referred to miniaturized follicles, but said they were not genetically miniaturized and it was probably just a withdrawal effect of the pill, and possibly DHT testosterone impacting them in the resurgence of androgens in my body. I’m just afraid that’s a permanent assault on my hair. My hair is so so thin! The third hair loss Doctor I saw was more dismissive and said he didn’t see anything of concern (but that is because my hair was SO long and thick and fluffy to begin with that event after losing 25-30% of it in less than a year, it looks normal to the outside eye.)

          • I think one of my big questions, that I haven’t been able to find a great answer for, is whether miniaturization is a permanent process? It’s still somewhat unclear to me whether my hair follicles have miniaturized or I’m just shedding, but my instincts say it is more of an overall thin (more so than one giant shed.)

            Does it get better?

            Thank you for your input!

  65. I have been off Ortho tri cyclen for 9 months now. In March my body went into sebum overdrive, and I started to notice an overall thinning of my hair. I’ve been using a strong anti-oil shampoo for 2 months that helps curb the sebum production on my scalp, and hoped that would help regrow hair that was perhaps clogged from oil. For two months I have also been taking vitamin supplements and hair regrowth treatments from Phillip Kingsley trichologists. I have also started using a laser device for hair regrowth. Overall, I would estimate that my hair has shrunk by at least 20%.

    I have had my thyroid checked by a naturopathic and internist doctor. Everyone says I am healthy as an ox, but I feel emotionally unstable and my hair is not regrowing. It is brittle, falls out, thin, and lacks the usual shine and fullness that it had both before I was on any kind of birth control, and while I was on it. The shock to my system has been in the discontinuation of the Pill, but after 9 months nothing has gotten better. I am ovulating and my periods are happening within 30-34 days.

    Is follicular miniaturization brought on by BC a permanent reality? Is my body still stabilizing? I thought the anagen phase was only supposed to last 3-6 months. Can you recommend any other avenues I should pursue? I have already been experiencing violent mood swings post-pill, and the related hair loss is only exacerbating the issues further.

    Thank you!

    • Sarah,

      Just wanted to say that many elements in your story mirror my own. I’ve been trying to get back to some sort of “normal” for almost 3 years now, since the birth of baby #3. I was also on a similar birth control (Ortho Tri Cyclen Lo), which I went off of for good in Aug 2015. Almost a year later, I am finally starting to see a decent amount of regrowth. Like you, I have have extensive tests (in depth thyroid testing, multiple times, iron, vitamin D, autoimmune tests, sex hormone tests, etc). I believe my hair loss is a perfect storm of hormonal triggers (pregnancy and birth control), allergies (developed new allergies after baby #3 and began reacting to almost all the products I was using on my skin), and scalp issues.

      I wanted to write you specially about my scalp issues b/c maybe something similar is happening to you? I’ve always had an oiler scalp and fine hair (though I used to have tons of it). After baby #3 my scalp became so dry and itchy. I figured my allergies to shampoo + hormonal issues were the culprit. I kept rotating products (still haven’t found the perfect shampoo) and tried using really moisturizing shampoos. About 6 months after discontinuing birth control, my scalp went from painfully dry to more oily (which I was happy about). Still the itching though. I saw a hair loss specialist and he mentioned minaturization at my front hairline (where the itching was the worst), and seborrheic dermatitis, which was a surprise since I didn’t have any flakes and have never had scalp issues. After using a prescription shampoo, it was like a layer of my scalp was lifted and it could finally breathe. It’s still a battle keeping it under control, and treading that line of using products that are good for my scalp but don’t decimate my hair. Since then, I have noticed less shedding in the shower (30-60 hairs down to 15-20) and tons of new growth around my hairline. My Derm said sometimes the inflammation from scalp issues can impact hair growth and seborrheic dermititis doesn’t always present with large, greasy flakes. Some people might just have itching and/or inflammation, which the hair loss dr could see with his magnifying tool.

      Anyways, every hair loss situation is so different, so my ramblings may not be helpful to you, but I wish I had thought to specifically ask about scalp issues before suffering for almost 3 years.

        • I still haven’t found that perfect product(s), and all of the chemical sensitivities and allergies I developed after baby #3 don’t make it any easier. My Derm prescribed a 2% ketaconazol shampoo, which really helped in the beginning (but is drying and a bit irritating after continued use). I also rotate with Sachajuan scalp shampoo and Nioxin scalp recovery shampoo. I’m still searching for that perfect day-to-day product that thoroughly cleans my scalp, I’m not sensitive to, and that doesn’t dry out my hair. I do find that condition, wash, and condition seems to help with the dryness, and weekly hydrating masks.

          • Also, there are some recent studies that show anti-fungal shampoos help with hair loss. Fingers crossed that’s the case!

  66. Hi Dr. Briden,

    I love your blog, everything resonates with me and validates what I’ve always known to be true–the pill was bad for me when I was on it, and life has gotten worse for me since going off nine months ago. Dramatic acne, hair loss and thinning, erratic emotions and depression, and overall surge in oil production. I have been tested for everything, no indication of thyroid or any serious vitamin deficiencies. It’s all Pill related.

    I hope you provide some guidance. The oil explosion and accompanying hair loss began in February….I waited three months and was taking some Vitex and vitamin D pills to boost some nutrients. I have visited two hair loss doctors–one said that my hair had miniaturized and would probably regrow with time. Another prescribed a strong anti-oil shampoo that keeps my hair drier and feeling cleaner, so it looks less flat and stringy from the oil. I have also been using Phillip Kingsley products for hair regrowth, and taking Biotin. I have read that 6 months following the 3 month time of “trauma”–in this case, discontinuing the pill–and I have counted back from December when I first discontinued use. Six months and I am still seeing no improvements, even with the hair loss products and vitamin supplementation. I am getting desperate, and wondering if post-pill hair loss is a permanent irreversible reality. I have pretty regular periods and am ovulating, so have been receiving those natural hormones for the full 9 months since I went off the pill.

    I am desperate.
    – Is follicle miniaturization permanent?
    – What else can I be doing to regain my normal locks, and control the oil overproduction from within?
    – Time, patience, vitamins, healthy diet, exercise….nothing has corrected the hormonal imablance that seems brought on by Ortho Tri Cyc discontinuation. Can BCP permanently alter hormones/homeostasis?
    – I think testosterone is the problem here. I believe Ortho Tri shuts that off completely (as with other hormones), so the resurgence has caused the DHT thinning and an uncharacteristic oil surge. How can I get it back to normal levels? I have already seen a family physician, a naturopathic, two hair loss doctors, and a dermatologist. I don’t know what else I can do.

    Thank you for any guidance or support you can provide.

  67. Help! I came off all prescription meds (spiro & metformin) bc I wanted to treat Pcos naturally. Now my shedding has gone from bad to extremely worse. Whats even worse is my Dr. Won’t believe listen to me about the Pcos symptoms bc I don’t look like your typical pcoser. I’m tall and lean and have a monthly bleed. She encourages me to cleanse and strengthen my liver and says it will stop then. I’m feeling so hopeless Dr. Lara. My scalp is starting to show and I know in my heart of hearts it will take more than cleansing my liver to stop it.

    • Can I just add I follow a pretty clean paleo centric diet, take vit D, fish oil, ovasitol. But the shedding just keeps getting worse. Maybe I made a mistake and should go back on met and spiro?

    • Hair loss always worsens a few months after stopping spiro. Do you eat enough starch? You probably needs rice or potatoes every night for dinner.

      • I have seen a lot of posts and comments about hairloss increasing when stopping spiro but really haven’t seen much on things calming down or subsiding after being off of it. Are there any success stories?

  68. Dear Lara, For those of us likely in peri menopause (I’m 46), is regulating ovulation, which is presumably sputtering out so-to-speak, the only way to get hair loss under control??? My DHEAs has shown to be slightly elevated throughout the past couple of years, but I’m not sure if the high anxiety of losing hair has increased my DHEAs (which is what my dr. thought) or if the DHEAs is the root problem. Of course, like many others, my dr. prescribed spiro. While taking 150 mg my shedding was greatly reduced and lots of new growth, but going down to 125 and 100 mg, the shedding is back.

    I never would have thought I would have responded emotionally so strongly with all the anxiety, panic attacks, etc. I’ve always considered myself a pretty stable person!!

    One thing I’ve never had checked is SHBG. Is that a valuble piece of info?

  69. I’m so glad to have found your blog. I am 48 and began noticing my hair loss about 6 years ago. I was told in 2010 that I have Androgenetic Alopecia, and since then my hair loss comes and goes, although I can visibly see the miniaturization. I was on BCP from ages 16-35, had children at age 37 and 44, and 2 years ago at 46 I went back on the pill to “regulate” my hormones and try to stop intense night sweats that began when I was breastfeeding my second child. My dr. says it’s ok to stay on the pill until I’m 53 and basically “skip” menopause symptoms. I have deliberately searched out low-androgen pills to try and help with the hair loss — at first I took Lo-Loestrin, but after reading up on it I changed to Portia for the past 8 months or so, thought it was helping a bit with the hair but as the night sweats continued I asked for and just switched to Ovcon35 a week ago. My dr. told me to stay on the pill between cycles (taking 2 days off in between) because I was having very heavy periods and intense headaches during the placebo weeks. My hair was still thin on Portia but doing a lot better overall. However, I had dental surgery in early March of this year, with IV sedation, and about 3 weeks ago I noticed I have lost a ton of hair on one side of my head, I have a bald spot. Over the past few years I have had big sections of hair fall out and didn’t notice it was gone till I saw the regrowth. Anyway, I feel weird being on/staying on the pill at my age, but I don’t know what to do to stave off the hair loss and deal with the night sweats. Any advice is appreciated! Thank you so much.

  70. Thank you for your time and dedication to study the complexities of womanhood. I certainly am one of the complicated ones. I have Pcos and the thorn in my side is my hairloss. I just might be the hopeless case.

    I tested with the spectra cell and I won’t bore you with all my results. I just want an honest opinion on what you think could be the cause of my hairloss. 🙂 if I may, just post my irregular results?

    -T3 reverse – 23 (borderline)

    -Progesterone/estradiol ra. – 24 L (had my period 10 days after saliva test)

    Estrone am – <5.0
    Estradiol am – 1.1
    Estriol am – 2.4
    Progesterone am – 26

    Bilirubin – 1.8. (I think I'm having gallbladder issues)

    Deficient – Oleic acid

    Borderline deficient – Vit D3, Manganese, Fructose, cysteine, selenium, vit K2,

    Omega 6/3 ratio -5.5
    Arachidonic acid- 10.3
    Linoleic Acid – 32.1

    Cholesterol (total)- 263
    Ldl – 203
    Hdl- 51

    So there's the ugliness of me. I'm 43. Started having regular monthly periods, even to this day, at 36. Been steadily shedding for 3 years now.

    My pre diabetes report was all good. Hem A1c – 4.7 ( was taking 1000 mg a day of Metformin at time of testing)

    Testosterone was 17. I was taking 100 mg a day of spiro at the time.

    I hope this is not too much for a post. I appreciate all of your valuable knowledge on such complicated issues that I personally cannot wrap my head around.

    ** just for the record, my other pcos symptoms are – mild hirtiuism, oily skin, mild acne ( which is being artificially suppressed)

    I have scoured your websites and follow you on social media. You really encourage me with all your posts. So thank you!!

  71. Hi Lara,

    What are your thoughts on cyclical (monthly) hair loss with accompanying scalp itch? I seem to experience this most every month the week after my period and then things return back to normal.

  72. I have had 3 bouts of TE in the past due to pill withdrawal so I am used to the trigger symptoms and all of the tests to check and rule out…

    But I have been fine for about a year and I have randomly started with shedding over the last couple of days. the ONLY trigger I have changed and added into my regime is a high strength 10billion cfu probiotic.

    The reason I did this was to help rid me excess estrogen and the symptoms of pms. (Sore boobs, low moods, hormonal acne, bloated was, emotional etc…) I had tried everything else and turned to my gut for health.

    Since adding in the probiotic, all of my symptoms have gone and physically I feel better than ever, no sign of estrogen dominance and my hair has even been growing through with spikey regrowth, But right on cue, 12 weeks after into my probiotics I am shedding.. Every trigger without fail for me in the past has been 12 weeks, so this can be the only thing I can correlate it to, literally nothing else has changed except I restarted hairfinity (which I have used previously and been always fine with)

    Is this happeningbecause the probiotic has levelled out my estrogen and so my hair is having a little wobble?
    If so is this likely to be short lived given that it has fixed my imbalances and I am adding in goodness not withdrawing from synthetic hormones?

    Im in desperation to figure this out your help would be so grateful!

    • Hi Rach, with hair loss, you always have to count back the months. What was happening 2-4 months BEFORE you noticed the hair loss? medication? fever? dental work? stress? low-carb diet? etc.

      • Hi Lara

        Thank you for replying X
        As far back as 2-4 months nothing has changed, my diet has been the same except for a change of coffee. I’ve had a bit of stress but no more than i would consider normal.

        The biggest difference is that my hormones feel a million times better than they have in a long time. I no longer have any PMS or physical estrogen symptoms. that’s due to taking the probiotic but I know that they shouldn’t be something that would ’cause’ the loss…

        I was more thinking it’s because my hormones have changed as a result of taking them and I’m flushing out excess estrogen better now my gut is optimal… Feels like I am clutching at a straw though but I genuinely have no other trigger x

        • Oh right, sorry. I reread your comment and see that you started the probiotics 12 weeks ago (the right timing). I have trouble believing that a probiotic which has been beneficial could have triggered hair loss. With a patient in a similar situation, I would probably advise to just ride it out, and assume it’s a blip (from something).
          That said, I usually don’t give probiotics for months and months on end. I often do a course, and then have a break, and then maybe return to it. So you could try a break (but of course then you’ll have to wait months so see if that indeed affects your hair).

        • Hi, I noticed (after trying a million things) that the culprit for my hair loss was caffeine. You mentioned coffee. I was a big coffee drinker, with heavy shedding. I switched to decaf to get better sleep and my hair ‘magically’ stopped falling out.
          I have a theory that caffeine can lower progesterone levels. I was having 24 day cycles and bad p.m.s. (I’m still trying to sort that out) but I do think some women’s hormones are especially sensitive to caffeine.
          I’ve gone back to drinking more regular coffee (I work at a coffee shop!) and it causes hair fall immediately. So I’ve resigned myself to decaf- because my hair is more important.

  73. my hair has been falling out like crazy……my endocrinologist said I have insulinemia which is causing hair loss and dark hair stubs on legs……I’m on 500mgs. Metformin a day….and I’ve been taking Viviscal vitamins for about 2 months…do you think this will stop hair loss…I think I see new hair growing in also what do you think of spirolectone for me…..please I need help…just found this site and am so greatfull for it and any advice you can give me…thank you so much….Sandra

  74. Hi there… Thank you for this article. I used to have strong, thick hair, but now I’m left with thin hair that’s shedding more and more with every brush and wash. It is really scary! At first it didn’t bother me much, but recently, I was alarmed by the amount of hair-loss. This prompted me to do some research on the topic, and to get to the bottom of the problem. Yes, your article, and many others, confirmed my fears.

    I have been using the pill for the past 23 years… yeah, I know, that’s a long time! I stopped using it for about 2 months now, and I’m determined to start the slow process of recovery.

  75. Hi Lara,
    I posted a comment earlier but you may not have seen it. Back in August I started losing my hair rapidly. After looking at what happened 3 months before, I narrowed it down to a few things: coming off the pill (Ethinyl Estradiol/desogestrel), a thyroid imbalance from over-medication and a low carb paleo diet. Once my hair started falling, I immediately went back on the pill, i.e. 2 months later, but it didn’t make a difference. I’ve also fixed my diet to eat more carbs and my thyroid has been stable for the past 3-4 months. Yet my hair is still shedding and it’s now been 8 months since it started.

    I’m considering going off the pill for good after reading your blog and your book. The only thing is that I had bad acne the 1st time I went off about 6 years ago. The prospect of having thin hair and bad acne is not super appealing right now and I was wondering if you had any opinion about tapering off the pill. Some women do it over 6 months: 3/4 of the pill for 2 months, 1/2 pill for the next 2 months and 1/4 pill for the final 2 months and they report less instances of acne. I suspect the drop in estrogen may be what triggered my Telogen effluvium (that or the hyper thyroid episode) so I’m tempted to try it. Any thoughts on this weaning off strategy?

  76. Hair loss problem in women is very common and this article clearly states the reasons for it. Some of the reasons mentioned here are totally new to me as I never considered them as a reason for hair loss. Very well explained, thank you for sharing!

  77. Well very useful article to all people thanks for this great post, here get best ways and treatment for best hair replacement they will helps sure, really nice to seeing this post get useful information

  78. What you cause your hair to break and break and break and then finally fall out? I also have temples losing again breaking and falling sides and all over. I do have low ft3 one ovary removed high cortisol still menstrating and 47 years old it’s getting pretty bad and happened in the course of a year I’m pretty scared as to how and fix this Drs say I’m fine not on any meds and no history of hair issues or medical issues

  79. Thanks so much for your blog it’s been so helpful! I was on and off birth control from 14yrs old until I was 29 (I stopped because of hair loss that became noticeable). I’ve been off the pill for over two years now. I do not have PCOS and I have always ovulated like clockwork (except for two years I had an IUD about ten years ago). I cut out drinking milk a long time ago, and stopped dairy except for butter a few years ago as well. Occasionally I’ll have goat cheese or a treat, but it’s rare. I’ve been hoping and waiting for all my hair to come back to its full glory. It was SO thick up until my late 20s. My dad, who I inherited my once thick hair from, even in his late 60s, has crazy thick hair still.. I’ve supplemented with magnesium, zinc, probiotics, even some chinese herbs I was recommended–which did curb shedding. I know you probably can’t say too much about my specific situation, but goodness, I feel like I’ve cut out so much (gluten, diary, low sugar) and supplemented for so long. What recourse do I have, if any? I miss my hair 🙁

    • This may not matter but I have noticed that my period is significantly lighter than it once was. It’s more than spotting but the normal part is only one day, otherwise very light. I usually get by with just tissue unless I’m working out. Another thing is that until I was in my early to mid 20s I consumed a very very large amount of dairy and no longer have dairy, maybe I’m not getting the calcium and vitamin D and that’s part of the problem?

  80. Hi Lara

    Firstly thank you for you wonderful post – so informative.

    Just wondering if being very sick with gastro (bed ridden )whilst travelling overseas in third world country could cause massive sudden hair loss 2.5 months later .. I was terrible sick for two weeks, food just instantly went through me .. I was not absorbing anything ..

    Now I am losing a lot of hair everywhere all of a sudden, I am shedding like crazy – it’s terrifying ..
    I am seeing an intergranite doc and get full blood work done , just wondering if you thinking my gastro could have caused it ?

    If so what can I do whist I wait it out ?

    • That sounds like a pretty textbook reaction, timeline and all. Count yourself lucky cause it’ll probably be fine and grow right back.

  81. I would like to add something that really doesn’t have to do with internal body chemistry… Traction alopecia. That’s why your hairline might creep up and why your temples might become patchier. Be careful of wearing ponytails or other tight styles everyday (I used to wear really tight ponytails everyday for 5+ years in my teenage years and now I’ve ruined my hair follicles). I never knew about this condition and danger, be mindful. Switch up your styles, don’t wear them too tight and let your hair hang loose as often as possible. Traction alopecia is very common for women with afro textured hair (kinky coils) due to the styles these women often wear, but it can happen to anyone. I am caucasian with straight/wavy hair and I suffer the effects from traction alopecia because I simply didn’t know any better and I just got used to always pulling my hair back really tight and sleek everyday. Would be so helpful if you added that as a small note somewhere Lara 🙂

  82. Thank you very much! I’ve experienced awful hairloss due to the Mirena and am so happy to find good information on this online.

  83. I’ve been losing my hair since my first pregnancy in 2007 and had my second son in 2011. In between those times I have been on bcp. I’m currently still on bcp but now noticing my hair line getting wider and alot of thinning. I’m 26 and losing my hair and my mind!! Please help

    • Andrea, I’ve been there. I would look into going gluten free and possibly supplementing with a good multi, iron and vitamin D. Iron and Vit. D finally stopped my hair loss. Also you should probably go off the pill for good. That stuff is awful for hair. My husband and I use the ‘extraction’ method (aka pull-out) and it has worked for us for years.

  84. HI,
    I was recently diagnosed with low iron (25) and my ferritin was 38. My vitamin D was also low. My hair has been thinning out for years, but especially in the last few. I am 42 and have a four year old and don’t take hormonal birth control. (I took the pill in my twenties and stopped it went it started thinning my hair.) I had went to the dr recently because of fatigue and hair loss. I had been concerned about this for years and finally got the dr to test my ferritin and iron stores. My question is, do you think adding DIM would help or hurt hair loss? After about two months of taking iron, I can see that my hair is slowly starting to grow again and I don’t want to ruin that, but I read that DIM might help black chin hairs, weight and estrogen dominance symptoms. I am also still pretty fatigued at times. I’ve been taking a ground liver supplement, ferrous sulfate, vitamin D, B complex, chromium, evening primrose oil and B-12. I’m not eager to add more things in as it’s difficult to take everything as it is since it seems everything says not to take it with something else. I have some ionic magnesium and haven’t been taking it, but after reading your website, I am going to add it back in. Thank you in advance, J.

  85. Hi Lara,
    I’m 36 years old, 5’6 and 130 lbs with an under active thyroid since I was 25 and treated with a combination of T4 and T3. I started losing my hair profusely last August. I’m not sure exactly what caused it because within a span of a few months (March thru June), I went though a painful breakup, changed my diet to low carb paleo and lost 10 lbs in 2 months, my thyroid went hyper and I also went off birth control for 2 months. It was basically the perfect storm for Telogen effluvium. Since then, my endocrinologist has been trying to adjust my meds to bring my hyoid back to normal levels. I’ve been eating more carbs and taking vitamin D and iron since I was deficient. My thyroid levels were perfect in December and my hair loss was finally starting to go down. But all of a sudden, as I went on a trip to Europe, my hair started falling out like crazy again. My blood pressure was high and I was feeling slightly hyper. A month earlier I had started taking Ashwaganda in an effort to manage my stress better. Is it possible that this caused me to become hyper again and triggered a new round of Telogen effluvium? When I came back to the US, I got tested and while my numbers a little higher my doctor said it wouldn’t have caused me to feel these symptoms. He still lowered my Synthroid from 100 mcg to 88 mcg. I also stopped the Ashwaganda. It’s now 4 weeks later, I’m feeling better (but tired) and my hair is still falling a lot. I feel like things were getting better and now I’m back to square one. I’m losing a lot of the shorter hair that had been growing back which is very depressing. Is it possible to experience another round of TE?

  86. I wanted to share my success story so that it may give others hope. Four years ago, when I was 25, I decided to stop taking Yaz as I was having numerous heart palpitations and it was really concerning. I went off the pill, suddenly (didn’t even finish the pack) after having been on birth control for the previous 10 years. About a month later, after coming off the pill, I noticed that I was losing loads of hair in the shower and my hair part was starting to widen. It was drastic, and very, very devastating. I tried to stay off birth control for another month, but the shedding was so severe that it scared me back on birth control. The shedding NEVER stopped and never returned to normal. Months, and eventually years went by and I had accepted the fact that my hair would never be the same again. I didn’t feel comfortable going to have my hair cut or styled because it was visibly thin in the center of my part and would fall out so easily. This went on for years and I eventually ended up losing approximately 1/3 to 1/2 of my hair (I did have alot to begin with, fortunately). At age 29, my husband and I decided it was finally time for me to kick my birth control to the curb, in hopes of trying to conceive our very first child. I was absolutely terrified to stop, as I knew the havoc the first attempt had caused, but because we were so set on having children I knew it was the only choice. In the very beginning of May (2015) I stopped using birth control. Initially, my cycles were somewhat irregular, for the first few months, my cycles ranged from 32 days to 21 days but I was having periods. My hair was still falling out, but not necessarily any more than it had been. This went on again, for around 6.5 months. Constant shedding, hair looked terrible and felt terribly thin. All of a sudden, my cycles started to regulate, literally like clockwork and I had 3 cycles in a row, starting in November that were 25 days exactly. What do you know, at around the 7 month mark, my hair suddenly stopped shedding, literally like, not a single hair shedding when I would run my hands through my hair, and absolutely no more clogging of the shower drain. This has been my first month in over 4 years that I have experienced no shedding and I can even see a thickening of my hair all over. I thoroughly believe that not ovulating was harming my hair, and that once my hormones really regulated (noted by the regular- clockwork periods) my hair really improved. I mean REALLY improved! I just really wanted to share my experience, as I have been dealing with hair loss for 4 miserable years and NOTHING ever worked. Not Rogaine, not finasteride, not exercising, or eating well, changing birth control brands or using special shampoos ever worked. It turns out, all I needed all along, was to let my body create and balance it’s own hormones and to have patience. A lot of patience. Please know, that it does take a very long time to see a difference. Many websites will tell you that telogen effluvium only lasts a few weeks and that you should start seeing your hair improve after 2-3 months. That was not the case for me. My hair, literally did not improve, nor was shedding reduced for the entire 6.5 month period. Have patience!

    • Jenny that was so inspirational. Sometimes our struggles in life are there to teach us patience, and to never despair and give up. Thank you for sharing, and wish you the best xx

    • Hi Jenny, thanks for sharing your story. That is consistent with what I see with my patients. The only way to really fix hair is to ovulate regularly and make hormones.

      • Hi, I have a somewhat similar situation. Was on Yaz for about eighteen months. Six months in I went to my GP concerned about increased shedding, she laughed it off to paranoia. Another six months later and my derm prescribed 200 mg per day of spironolactone for mild acne. Massive hair loss. Thankfully I had a lot of hair to begin with but it is still so much thinner and my crown and part is very thin. It has really hurt my self esteem. I quit the spironolactone and Yaz about three months ago. The shedding has slowed but not much new growth. I have had regular periods for the last two cycles. Should I be worried that the loss is related to something else since I haven’t seen much progress? Thanks for any help you can offer, I’m so tired of worrying about this!

    • Thanks for sharing Jenny. It’s hard to find any positive stories re female hair loss online. I came off the pill 3 months ago so…bring on the 6.5 month mark!!

  87. I was diagnoses with Stein Lenenthal Syndrome when I was 17 I am now 58. I had male fomation hair line, excess weight & either no period or I bleed for 30 days. I was diagnoses by an Endocrinologist later as I am shore you are aware it came under the heading of PCOS. From 27 until 37 I was on the IVF I became pregnant once my son was born at 27 + 3 & died 16 hours after birth. After finishing with IVF I went to see another Endocrinologist who was majorly upset with my hormone levels they were off the scale high. He commenced me on Spironolactone to suppress my male hormones & decrees my male line hair growth. I had tryed to give it up after my first menopause only to find the hair came back & I started to have periods after 3 years not having them. I went back on Spironolactone & 6 months later my periods stopped. I have not been game to stop again. It is getting harder to maintain my weight but I will try magnesium & see if it helps.

    • Those probably weren’t real periods, but rather post-menopausal bleeding due to endometrial hyperplasia. So, in your case, at 58, and given the fact that your hormones are “off the scale”, it’s probably best to follow your doctor’s instructions about the spironolactone. It should be fine to take magnesium as well.

      Please also ask your doctor if you are insulin-resistant or pre-diabetic. If so, then please treat that by stopping all sugary foods, desserts, sweet drinks etc. See my Insulin Resistance post.

  88. Hi Dr. Briden,

    After being diagnosed with H Pylori, which I suspect has had me feeling horrible for a while now, I did my research on the connection between H Pylori and PCOS. Some journals support the fact that they’re possibly linked and that H pylori causes prolonged stress on the body, the kind that can throw off hormones. If this were my personal case, would it theoretically be possible to heal PCOS if the elevated levels I have were originally caused by the H Pylori. I know it’s a long shot, but this condition has stripped me of so much that I’m holding on to my last hope that I will get my hair, body, and health back after ridding myself of this bacteria. I’d love your professional opinion.

    Thank you!

  89. Thank you for responding so quickly in re: APD. I was “diagnosed” by my Derm and OB in Oct 2015. The diagnosis was based solely on my current/past symptoms, which are:
    -Minor leg rash that affects the whole of both legs. Starts 7-10 days before my period and resolves completely 1-2 days into my period. This started with my first period since discontinuing bcp (Aug 2015) and has continued since then.
    -Bump/rash that I developed on my bottom in the latter part of my progesterone shot therapy with pregnancy #3 (late 2013). I was given progesterone shots from week 16-36. Once I started the shots, my skin was radiant and my hair thick and shiny, but around week 25 or so, I started to get the aforementioned reaction after each shot.
    -Severe rash on my chest, abdomen, and upper thighs with pregnancy #1 in 2010. It was diagnosed as PUPs, but went away prior to birth w/ Clobetesol.
    -I had the same leg rash when I first went through puberty at 13. It eventually went away, I don’t remember when, and then I went on otc and otc-lo from 18-28

    The individual pieces didn’t make sense, but when we put together my history, my Drs thought that APD made the most sense.

    Also interesting to note:
    -I went off bcp the first time in 2008 and had a year+ of periods, all of which were normal (always had normal periods before bcp)
    -From 2010-2014, I had three kids. The longest stretch of periods I had was 9, all of which were normal
    -I weaned baby #3 in April 2014 and started bcp in June 2014. I might have had one period, and nothing unusual sticks out. I started bcp b/c of my massive hair shedding and night sweats and I wanted to “regulate” my period. Sigh.
    -I seemed to do ok on bcp from June 2014-Dec 2014. My hair was still shedding and I was having night sweats, but only during my placebo week. My Dr recommended going from one pill pack straight to another. BIG MISTAKE!! My body freaked out. I bled for a month, and from that period on, my scalp would intensely burn and itch until my placebo week, when everything would abruptly disappear. That, along with your blog posts and book, gave me the courage to stop bcp in July 2015. Since then, the leg rash and scalp itch start the week before my period, and then my hair sheds the week after my period. The other two weeks, all is normal. I thought that maybe it was just the post pill shed, but it started the month after discontinuing and has continued cyclically ever since, which makes me wonder if it’s related to APD. Regardless, I have been experiencing hair shedding since May of 2014.

    The last batch of tests I received was in July of 2015. Results were as follows:
    -T3 free, 2.7
    -TSH 1.54
    -T4 free, 1.0
    -FSH, 1.2
    -Ferritin, 55
    -Celiac: Tissue Transglutaminase AB/IGA <1, Immuglobulin A 93

    Is it normal to shed hair so cyclically each month? It sounds like it might be worth it to run the same batch of tests since I've been off bcp for a bit. Anything else, other than autoimmune markers, that I should get tested for? Thank you again and apologies for the wall of text!

    • Okay, that does sound like possible autoimmune progesterone dermatitis. You reacted to the shots, and you’ve been reacting ever since you started to make your own progesterone in August. As to whether that inflammatory reaction could be the cause of your monthly hair shedding, I’m not 100 percent sure. What does your dermatologist say?

      If you were my patient, I would be looking at autoimmune protocols such as gluten-free diet (despite negative celiac) and repairing intestinal flora. Especially if you test positive for other autoimmune markers. Do you have a local naturopathic doctor you could work with?

      • My Derm isn’t sure about the inflammatory reaction causing hair loss. She said it’s certainly possible – there just isn’t a ton of literature about APD and hair loss. My hair keeps growing back and my scalp is fine, so she ruled out a few of the main causes of hair loss. Her guess is that I’ve always been sensitive to progesterone, as evidenced by my reactions when it has spiked. She’s hoping that the further removed I get from the event (progesterone shots), the more my body will “settle down” and go into a remission of sorts.

        I don’t have a local naturopath, but that is on my list of next steps. It just seems like my options, if it is indeed APD, are limited b/c I don’t want to go back on bc or take any other meds to suppress ovulation and it isn’t bad enough to take more drastic measures. My OB recommended antihistamines. They kind of work for the leg rash, but not the scalp itch/hair loss.

        I have been reading a blog by a women with APD Anaphylaxis. She noticed that the only time she was fine was when she was pregnant. She wondered if it was b/c her body was constantly being exposed to progesterone, a desensitization of sorts. She experimented with using Pueraria Mirifica to raise her estrogen, which helped raise her progesterone to keep it constant (I think??) and that has worked for her. If true, interesting theory, though I have no inclination to begin experimenting with natural supplements w/out being under the care of a professional.

        Thank you again for your guidance, it’s so unbelievably helpful when navigating something “weird.”

        • There is no herb to raise progesterone and “keep it constant”. Progesterone will always rise and fall in an ovulatory cycle.

          The strategy is not to flatten progesterone, but to stabilise your immune system. In other words, to reduce autoimmunity as you would for any other kind of autoimmune disease.

          There are big immune changes during pregnancy which is why autoimmune diseases of all kinds often go into remission with pregnancy.

          • Hi Dr Briden,

            I just wanted to follow up in re: APD. My gp retested my ferritin, vitamin D, TSH, FSH, and also tested me for ANA antibodies per your suggestion (general screen, I believe, and specially for Lupus, RA, and Sjogren’s syndrome). All tests came back normal, but my gp mentioned something interesting that might be helpful to others. My ferritin level is in the mid-fifties, which is within the threshold of “normal.” However, my gp mentioned that new dermatological guidelines say that anything lower than 60 may impact hair loss, and a good minimum level is between 60-80. She recommended iron supplements to build up my iron store and after a month, suggested taking supplements only during the week of my period to see if that helps my post period hair shedding.

  90. Hi Dr Briden,

    I have recently been diagnosed as having Autoimmune Progesterone Dermatitis. My doctors think it was triggered by getting progesterone shots to prevent preterm labor during my 3rd pregnancy. The main manifestation is a rash on my legs and general itchiness 7-10 days prior to my period that usually resolves shortly after starting my period. The rash and itchiness I can live with, but my scalp itchiness and hair thinning I cannot, and that is what I am most concerned about.

    Jan 2014: baby #3 born
    June 2014: started ortho-tri-cyclen lo to “regulate” hormones
    Dec 2014: Dr suggested I go from end of one bill pack straight to the next to skip my period since I was having intense night sweats. My body freaked out and I bled for over a month
    July 2015: discontinued bc. Reading your book gave me the knowledge and courage to give up birth control for good!

    My hair has been cyclically shedding since Jan 2014. I’ve had my vitamin, iron, t3, t4, fsh, and prolactin levels checked. I’ve also been tested for celiac. All came back normal.

    1. Anything else I should test (hair thinning, fatigue and low energy, though I have 3 kids 5 and under, night sweats right before period, anxiety right before period, low grade nausea most of the time, heavy bloating during period (new for me since stopping bc). I’m small (5’5″ 108lbs, so keeping my weight up is also a concern )
    2. Could the cyclical hair shedding be related to APD? I’ve been charting everything and I notice that my scalp gets itchy the week before my period and then I start shedding around the week after my period (which is my “fertile” time according to my period tracker). Then everything is totally normal the other 2 weeks.
    3. Anything natural I can do other than reduce inflammation by folowing your recommended diet (whigh I basically do)?

    Thank you!

    • Hi Leah,
      I’m a little bit confused about your situation. When were you diagnosed with Autoimmune Progesterone Dermatitis? Because you’ve only just come off the Pill four months ago. The Pill’s progestin is not progesterone, so you would not have had any natural progesterone in your system until your periods started up again in the last few months. Unless you had a few natural periods between when your baby was born (Jan 2014) and when you went on the Pill (June 2014). You could have made some progesterone then.

      Have you been tested for other inflammatory, autoimmune markers such as ANA and thyroid antibodies? Were your celiac (gluten) antibodies zero or “high normal”?

  91. Hi Dr. Briden,

    I’m a 24 year old diagnosed with PCOS back in April. Hair loss and slightly irregular periods were my only symptoms. My hair loss had dramatically picked up back from April to June, but in the following months had basically slowed to a normal hair pull. When I visited a hair specialist, she said i had androgenic alopecia and that I would need to start rogaine or I would lose all my hair. At that point, I had experienced thinning, but my hair wasn’t completely thinned out. My gynecologist insisted on starting me on Lo Loestrin and that it would help with my hair in the process. I took the pill for 2 months, but I noticed that I had dramatic thinning in my hair line in those two months. Is it possible that I just experienced loss in this area and that it’ll begin to grow back in? I’m adopting a high protein and low carb diet and getting off the pill since I know weight loss helps improve PCOS symptoms. As far as my bloodwork, the only high levels I have in my blood work (taken back in March) is slightly elevated DHEAS and an elevated prolactin. Also, my iron is normal and my ferritin is as well although it is at 32 and the hair specialist prefers it at 70 or higher. Vitamin D is also low at 26. Before getting on the pill, i was still having my period regularly every 35-40 days and was ovulating. If I am able to get back to regular periods, can I possibly have my hair fill in to at least a decent amount?

    • Hi Michelle, I’m wondering since you said your loss started in April and dropped off around June that it is related to vitamin D. I was taking 2,000 units a day and my levels were still too low (with hair loss)! I am now taking 10,000 units a day plus a multi-vitamin and my hair has FINALLY stopped falling out. It took a couple months, probably to build my Vit D levels up. I am hoping if I keep at it I’ll see some regrowth. Taking turmeric and pumpkin seed oil might help your hormones stabilize. Hope it helps.

      • Hi Sierra!

        Thanks for the response. I am currently taking the 50000 vit D2 prescribed by my doctor to get my levels up some more, but I worry about how much my hair has thinned. I thought the birth control would help, but I honestly feel like my hair is at half of what it was when I started the birth control. Is it even possible to have normal regrowth at this point? I am also trying NAC and sticking to a healthy diet to try to lose some extra pounds. I’ll feel better about the hair loss if I’m at least in better shape. Also, any info on H Pylori and it’s relation to PCOS? I was diagnosed last week and I’m currently treating it with antibiotics and my stomach and general nausea has reduced a ton. Thanks again!


        • Michelle, I think it is very possible. When you are done with your round of antibiotics you should take multiple probiotics to help establish healthy gut bacteria. Coconut oil is great too. It kills off bugs without harming you at all. Do what you can to get blood flow to your scalp. I’ve been doing (near) nightly scalp massages and have seen some re-growth. I also tip from the waist and brush my hair vigorously upside down to get the blood flowing. I’ve heard of people holding headstands too but that’s a bit extreme for me! 🙂 Dr. Lara has a lot of great info on here about treating PCOS naturally. B.C. really just screw everything up, for sure. I hope it helps! -Sierra

  92. Hello,

    I just had a question regarding follicle sensitivity to androgens. If you were on a high androgen index birth control pill for years and were sensitive to this pill, but did not notice it until later on (ie you didnt notice hair thinning or loss until years later), would coming off of the pill reverse the hair loss and any other side effect? Thanks in advance!

    • It’s tricky. Many women find that hair loss temporarily worsens when first coming off any Pill (even high androgen pills). But then it should improve as long as you make adequate amounts of estrogen and progesterone. It also depends on how much miniaturization has occurred. Miniaturization is not easily reversed.

  93. Hi, I was experiencing hair loss for years with normal hormone levels. At my last physical my iron and vitamin D levels were both in the single digits (really, really low). I had been taking vitamin D at 2,000 units for a long time but it wasn’t enough. I’m now taking iron and 10,000 units of vitamin D a day and my hair loss has finally stopped. I do have celiacs disease, and I believe that makes it very difficult to absorb nutrients from even a very healthy diet. Just a head’s up to other ladies.

  94. Hi Dr. Briden,

    I’m a 24 year old diagnosed with PCOS back in April. Hair loss and slightly irregular periods were my only symptoms. My hair loss had dramatically picked up back from April to June, but in the following months had basically slowed to a normal hair pull. When I visited a hair specialist, she said i had androgenic alopecia and that I would need to start rogaine or I would lose all my hair. At that point, I had experienced thinning, but my hair wasn’t completely thinned out. My gynecologist insisted on starting me on Lo Loestrin and that it would help with my hair in the process. I took the pill for 2 months, but I noticed that I had dramatic thinning in my hair line in those two months. Is it possible that I just experienced loss in this area and that it’ll begin to grow back in? I’m adopting a high protein and low carb diet and getting off the pill since I know weight loss helps improve PCOS symptoms. As far as my bloodwork, the only high levels I have in my blood work (taken back in March) is slightly elevated DHEAS and an elevated prolactin. Also, my iron is normal and my ferritin is as well although it is at 32 and the hair specialist prefers it at 70 or higher. Vitamin D is also low at 26. Before getting on the pill, i was still having my period regularly every 35-40 days and was ovulating. If I am able to get back to regular periods, can I possibly have my hair fill in to at least a decent amount?

  95. If you don’t respond to minoxidil, your doctor might prescribe antiandrogen medications, which may slow hair loss and even stimulate growth in some women. “They inhibit male hormones that can exacerbate hair loss,”

  96. Hi Lara,

    I am 34 years old, 5’8″, 145lbs and was on birth control pills for 13 years straight (Estrostep and for the past few years Apri). I got off the pill in May and my first 2 periods were 5 weeks apart. My last 4 periods have been 24 days apart. I do ovulate as I am trying to have kids and have been using the ovulation tests. My hair started to fall out in August and it doesnt seem like it is stopping. I had blood work done earlier this year with my annual physical and everything came back normal. I also have been on prenatals (Metagenics Wellness Essentials Pregnancy) since April of this year. I have no food sensitivities, eat healthy and exercise. Are thrre any supplements that I should take? Should I have blood work done?

    • When you say, everything came back normal at your annual, did the doctor test your iron and thyroid?
      So far, it sounds like typical post-pill hair loss. It will probably resolved itself (as long as your iron and thyroid are okay).

      • My RBC was 4.1 on a scale of 4.4-6.8, my MCV was 90.2 on a scale of 80-94 and my throid was 2.01 on a scale of .5-6 uiu/ml. Is it worth while to have a complete panel done now that I am off to the pill to make sure there is nothing else that could be causing the hair loss?

  97. Thank you so much for sharing the informative article. I have learned so much after reading it. I could see the slight hair loss and was confused about the factor causing it. The details provided by you will help me vividly.

  98. Think hair loss happens only to men? 30 million American women are have thinning hair, and it’s often a symptom of a serious illness.

  99. Hello Lara,
    I read all the posts and comments here. I took diane 35 for a few years, stopped 2 years ago and last year started again. About 4 months ago decided to stop, and in one month a terrible hair loss began. I already have little hair. You say it takes longer , but nothing specific happened before that.
    I got a very heavy period as soon as stopping the pill, but now it’s quite normal.
    I am taking all the supplements you suggested and nothing works.
    My weight is ok, i did some exams and they seemed ok too ( i live in china and health system here is complicated).
    I am desperate, can’t lose my hair anymore, and it’s shedding like crazy.

    • It’s probably too soon to have noticed an improvement in your hair. Didn’t you say it started falling 3 months ago? When did you start the supplements? It will take at least 3-4 months to see a change. Also, what was tested on your blood tests? Thyroid? Iron? Androgens?

      • I started losing hair last year. I was not on BCP but I had very heavy periods. Doc said iron normal..another doc said borderline low..13.7. Anyway went to doc. he put me on lo loestrin pill…hair kept coming out. Then tried another doc. he stated I was probably low estrogen without doing bloodwork put me on Loestrin. Hair stopped falling but then couple m onths later started again. I thought it was the pill that helped but now after reading so many things about it I want to stop this pill . How do you come off the pill? Im so scared my hair will go through another cycle and cant afford to lose anymore!! So stressful. I had the doc call me in spironolactone..just started it yesterday. I feel like Im treating myself because no one has answers. My thyroid normal. I went through IVF due to secondary infertility..i never produced enough progesterone and have wondered all along if this has anything to with it years later?? Would it hurt to take progesterone cream and stop the pill?

  100. Hi Lara, i am Gloria. Will turn 56 in a few days. I started to noticed slight receding hairline and mild hair loss in june 2015. I am pretty sure i will be reaching menopause in a few more months. Saw a dermatologist in sept 2015 and was diagnosed with alopecia. All blood work , hormone level, thyroid, zinc, iron, etc are normal. He recommended nizoral shampoo for my hair and to start minoxidil. I know minoxidil makes you loose more hair before you see any results in 2 to 6 months
    Have so much doubts about the recommended treatments. Have not start any of it yet. Please share your thoughts and advise.

    • That’s a very recent hair loss. It might just be something temporary. What was happening with your health in February or March of this year? Any fever? Antibiotics? Dental work? Stress? New medication or stopped a medication?

      • Had bronchitis towards end of Nov of 2014. Had a 5 day cause of antibiotic. Recur in a few months and had another 5 days of antibiotic. No fever during the occurrence. Nothing unusual or stressful that I can remember. The most relevance that I can think of in contributing to this hair thinning is the coming of menopause. No one that I know of in my family has it.. The frontal area is beginning to get noticeable, at least to me, especially under certain lighting. Have you known from your professional experience that it is temporary and may subside after menopause stabilizes? Does that make any sense?

  101. So confused. My testosterone is low (<3) free testosterone (0.2) also have reg. periods and I'm still struggling with all typical pcos symptoms like oily skin, hirtuism, and the most devastating, hair loss. Current meds – spiro 100mg. Met 1000 mg. Ovasitol, b12, omega 3, vit D. Would love to get off spiro, but scared to. My main worry is my hair and why I'm shedding. ~~ Thanks for all you do. It really gives us so much hope.

    • What were your androgen levels before you took spiro? Were other androgens tested: androstenedione and DHEA-S? or only testosterone?

    • It’s not a guarantee. A simple way to tell would be to track your basal body temperature. Temperature rises after ovulation because of progesterone.

  102. Hi Lara,

    I’ve read through most of your posts and your book, they were so helpful and gave me the nudge I needed to stop the bcp. I had 3 kids via c-section in 3.5 years (was on otc-lo for 10 years prior and got pregnant on 1st try with all 3). With my 3rd, my OB recommended progesterone shots to help with pre-term labor (have unicorn ate uterus and went into labor at 30 weeks with #2). After #3, I feel like my body has fallen apart. I developed all kinds of new food and product allergies and my hair has been shedding since April of 2014. I’ve had thyroid (inc the detailed scans), iron, d3, and celiac tests done…all normal. I went back on otc-lo back in June of 2014 to “balance my hormones.” After 6 months on bc, my scalp started to burn and itch, except for my placebo week. I discontinued bc in June 2015 and started ovulating right away. I do, however, get rashes on my legs, face, and scalp when I ovulate. My dermatologist thinks I have mild progesterone autoimmune dermatitis, brought on by bc, pregnancy, or the progesterone shots during pregnancy #3. If I’m mildly allergic to my own progesterone, and don’t want to go on synthetic hormones, which is what the Dr’s recommend, what are my options, if any? I can live with the itching, but I’d love to stop losing hair!

    • There’s a genetic tendency, certainly, but not everyone with the genetic tendency will actually experience hair loss. There is almost always another, aggravating factor… Such as nutrient deficiency, chronic inflammation, thyroid, androgens.

  103. I will give this a try. I have hashimotos. My TSH levels were at 2.8 last test and I’m on synthroid. My hair is falling out. I have had thyroid disease for 10 years without ever experiencing hair loss. It started when I stopped OrthoTC birth control (generic version). The hair loss worsens and I experience extremely sore breasts at least two weeks before and up until my monthly cycle. I got desperate after 7 months of hair loss and started taking the pill again. With the cancer history among women in my family (breast, uterine) and my loss of interest in sex, I decided to stop again. Within two months the hair loss started again. It has been one year exactly and even though it lessened a few months back (never stopped), it has started again. My doctor said there is no answer but I can go back on the pill! I take my synthroid, multi vit, complex b, biotin, and vit d. What else can I do?

    • To re-establish normal hair growth, you’ll need to make sure a few things are lined up: 1) optimal thyroid function (sometimes synthroid isn’t enough, and you might want extra blood tests for reverse T3 and thyroid antibodies), 2) good iron stores (ask for blood test for “serum ferritin”), and finally 3) a good level of progesterone each cycle (your breast pain suggests that you might have low progesterone).

  104. Hi.Am 35yrs old.I was diagnosed for PCO 3yrs back.I had regular period/34days.Last year i had irregularity 45dys long for 2cycles.I started vitex 1000mg per day then my period regulate to 28days.It’s 5mon since my period get regular.I have severe hair loss z past 5yrs/didnt know PCO back then.Have high LDH and triglyceride.Am over weight BMI=27.TTC for z past 7yrs with no success.Please help me to conceive&stop hair loss.

  105. Thanks for your reply! Do you think that taking too much vitex (or any other progesterone-like plant) would cause hair loss?

    • It’s only synthetic progestins such as levonorgestrel that cause hair loss. And there no herbs that are “progesterone-like”. Vitex stimulates ovulation so it stimulates production of your body’s own progesterone.

  106. Hi Lara,

    I’m just wondering if the bcp is not good for hair health due to the fact it prevents ovulation, then why was my hair and skin so much better on the bcp? I have been off the bcp for 2 years now and my hair is thinner than ever and my cystic acne is unrelently. I have given up dairy and been taking magnesium, zinc and fish oil. I also follow liver cleansing principles. I’m so frustrated. and fed up, I don’t know what else to do than go back on bcp or try accutane. What else is there?

    • Have you been diagnosed with PCOS? If so, you may also need natural androgen-lowering treatments such as sugar-free diet and Peony. PCOS could also be why hormonal birth control (depending on the type) improved your hair (because it reduced your androgens). Androgen-reduction by some pills is helpful of course, but it does not correct the underlying causes of PCOS. In that way, it traps women on hormonal birth control to control symptoms.

      As for acne, Yes, the pill masks acne. Synthetic estrogen (ethinylestradiol) strongly dries up skin oils, which the skin compensates for by making more oil. So when you do ever stop the pill again, the acne will be even worse than before (Pill-withdrawal acne).

      I know it’s not easy. I guess my best advice would be to try to get a full diagnosis of what’s going on… For example, determine: What Type of PCOS. And then treat that.

      Also, if you haven’t already, please see my Acne post.

      • Hi Lara,

        thanks for your response. I have had a firm diagnoses that I do not have PCOS. I ovulate regularly, and my bloods are all low normal. I do however, have Iinsulin Resistance. I am working on correcting this with diet. do you think IR could be exasperating my acne and hair.

  107. Hi Lara,
    Thanks for this post. What are your thoughts on Chromium, specifically GTF? Also, I wanted to know what specific dosage of Magnesium Glycinate you suggest for supplement.

    Thanks so much.

  108. Hi Laura
    My name is Natalie and I started having hairloss due to the anti depressant Lexapro. I began seeing a naturopath who prescribed me with iron after looking at my blood work. Everything was going well and my hair all began to grow back until I got sick and was put on anti biotics. All the new hair growth started falling out. I was devasted.My naturopath has since put me on magnesium aswell as the iron to support my nervous system. Do you have any idea why any drug that is not a natural supplement is doing this to my hair ? Thank you

    • Natalie- I don’t know about lexapro but the antibiotics for sure probably messed up your gut. If your gut is messed up you don’t properly absorb nutrients. Even though I ate healthy I was anemic and vitamin D deficient from overuse of antibiotics. Taking coconut oil and probiotics (and avoiding aggravating foods) had really helped me.

      • Thank you for your reply sierraschwartz!
        I was on Lexapro for 6 months and ended it once my hairloss was so servere that it also took my under arm hairs! Every since the Lexapro however I can not take ANY drugs that are not natural, because if I do my hair instantly begins to shed. I have asked my naturopath whether this side effect could be from my liver not being able to process chemicals?? Would you have any ideas?
        I have been having a probiotic drink every day for my stomach and my vitamin d levels showed up ok on my blood work. Should I supplement vit d anyway?
        Thanks so much for advice and input 🙂

        • Natalie, I’m not a doctor but it sounds like you had an adverse reaction. It seems promising that your hair did grow back before starting the antibiotics. Maybe there is a binder or something in the manufacturing of the two pills that you have an allergy too. It seems like conventional medicine advises lower levels of vitamin D than natural health practioners. If you are concerned about your liver, I’ve heard good things about milk thistle. No problem 🙂 we are all just trying to find good health, right?

  109. Hi Lara,

    I have read all your blog posts on pcos ,hairfall and menstrual problems. I should say they are very informational, information on which we can rely upon.

    I have had severe hair loss in the last year. Somewhere around october 2013, i had lost a little hair on my hairline and got a couple of pimples. My dermatologist thought it was something to do with hormones and put me on flutamide for a month. Within in a month, my face cleared and i also saw regrowth of some really short hair on my hairline. This did make my hairline look a little better. After this, i discontinued flutamide. I missed my following period and after another month, i got back acne, this time huge and cystic and also lost most of the hair i had regained and more. I was then diagnosed with pcos and my gynecologist put me on yasmin and spiro for a year. During this time, my hair thinned out terribly in the crown but got back hair on my hairline. I discontinued yasmin in jan 2015 and now have severe shedding and my scalp gets extremely oily even if i wash my hair on alternate days. My periods after stopping Yasmin are around 35-40 days apart. My ferritin level in jan was 10 and vitamin D was 3. Both extremely low. I have now been taking supplements for both.

    Is it possible that taking flutamide caused my pcos? Before taking flutamide, i had small acne and they were not cystic. After taking yasmin, i have lost a lot of hair in my temples and crown area. Will this hair grow back after stopping yasmin? Could this be because of low ferritin and vitamin d? Also, ive always had an oily scalp and sebum plugs. Could this also cause hair loss or thinning? What could be done to regrow hair in my temples? Im just 24 and do not want to lose my hair so soon!!

    • I don’t think flutamide would have caused PCOS. Were you having regular natural periods before October 2013? You weren’t on a different Pill back then?

      • I was having regular natural periods but they were 35-40 days apart. I was not on any birth control pill. I was on isotretinoin for acne during my teens.

        I have a feeling that my super oily scalp is whats causing my hair loss. Is it possible that these sebum plugs are causing hair loss/thinning?

  110. Hi Lara,

    I was hoping you could help. I am 24 and Almost 2 years ago I decided to come off birth control after being on it for 4 years and with that discovered I wasn’t having a period. 6 months later my hair started thinning and it’s been an uphill battle ever since. I was told by all doctors to just go back on the pill which I didn’t want to do so I took it upon myself to research and changed my diet and started taking a ton of supplements. I feel like I have PCOS as I would get my period before the pill but it was sometimes irregular. My blood work indicated normal testosterone but low estrogen. My skin has gotten worse since stopping the pill as well but my hair is in bad shape. Finally after a year and a half with no period I got one back this past December and have had one each month so far. I saw a hair specialist who told me to go back on the pill to manage the hair I still have and maybe make it a little better. I feel so conflicted as I’ve worked so hard to get a natural period but i feel like I have to choose that or my hair which is dry and thin and no where how it used to be so I am miserable. I also cannot lose my stomach fat and just feel unhappy. I take many supplements and don’t know what to do at this point.

    • Hi Lexi,
      The best way to help your hair is to get your period back (so you make estrogen and progesterone). The best way to get your period back is to figure out why you’re not getting it. In Chapter 7 of my book, I explain all the different possible reasons: sugar, thyroid, stress, post-pill, low-carb diet, soy, zinc deficiency, and more.

    • Hi Lexi,

      I’m in a similar situation to you. Although, my hair thinned out when I was on the pill as it was high androgenic. I stopped the pill two years ago now and started to ovulate immediately for about a year, then it stopped my period just went away. so frustrating. I have had all the blood tests you can think of for hormones, I had to push my doctor to give some of them to me. Finally I had an abnormal result for fasting insulin, it was too high. It took a while to get there but knowing what was wrong i.e. Insulin Resistance was the first step in the puzzle. Now I could treat the underlying issue. I have since started following a diary free (for my acne) insulin resistance diet and within a month my period has returned. It was absent for 5 months and 1 month into my own diet changes it has come back. I’m ecstatic.

      You need to find the underlying issue for you. I know it’s not easy and it took me ages but I finally found it and it has been such a relief. Push the doctors to do more blood tests.

      I agree with Lara that the birth control pill is never a good idea for hair growth. I will never go on the bcp ever again. Ovulating is so important to our overall health as woman.

      I supplement magnesium, zinc and chronium. Plus i take a probiotic.

      I’ve also started daily head massages to encourage hair growth. Have a look at perfecthairhealth.com a fellow called Rob regrew his hair by following a daily massage routine. He also recommends dietary changes and a few lifestyle changes like not washing your hair. I’m not doing that. I need to wash my hair and I’m just following my own healthy diet but I believe the head massage alone plus the correction of your own underlying hormonal issue will work. I have been talking to him and he is very genuine, I’m looking forward to giving this a go 🙂

  111. Hi Lara,

    I commented about a year ago on your post about the four causes of PCOS, and whether my diffuse hair loss was caused by type 3 from overuse of antibiotics.

    After a rough year of worsening hair loss and two derms diagnosing me with telogen effluvium (TE), I am trying my hardest to believe them but it’s hard. One has also suggested diffuse hair loss due to iron deficiency (maybe causing chronic TE?). All Thyroid and other hormones test normal. Ferritin was 16 at it’s lowest and now after a year plus I am up to 46 and still working on it as the loss has intensified. I understand this can be a waiting game as hair takes a long time to grow, and after a TE episode one is playing catch up for at least 2-3 years. I have no AGA pattern and loss has been equally diffuse across my entire head. I am also very oily (always have been), but no major acne, but likely seb derm. I have not been on birth control since 2006 and my cycles are like clockwork, though on the 5 day side with cramps.

    Anyway, my question to you is about gelatin–do you think as a supplement there is a role to play in supporting hair growth? Or even in regulating sebum production? When I look at my diet I likely don’t get much even though I do eat meat. I picked up some great lakes brand collagen hydrolysate and was wondering if you had any thoughts on this supplement.

    Thanks again so much!


  112. There is promising new research available at Rob’s http://www.perfecthairhealth.com I am going to try out the all-natural technique which promises 90% regrowth within 10 months. There are dietary recommendations but the heart of it is an aggressive scalp massage twice daily.

  113. Hi Lara,

    Just wondering if I can expect my hair to grow back after experiencing substantial hair loss from PCOS. I have lost a ton of hair and am very stressed out about it but am hoping it will return now that I am ovulating again. Any insight would be appreciated!

    Thank you!

    • Hi Julia Just wondering what you did to start ovulating again? I haven’t had a Period for 4 months and am desperate to get things working again. Thanks Heaps.

    • Hi Lara what are your thoughts on metformin? I have insulin Resistant pcos and am Taking Magnesium glycinate 1g daily but wondering if metformin would help too to get ovulation started. I haven’t had a Period for 4 months. My hair is already so thin i couldn’t lose anymore.

      • I think metformin can be helpful. Many of my patients take it together with the magnesium and other supplements. The only concern is that it can deplete vitamin B12, so ask your doctor to check that.

  114. Dr Lara,
    I’m not sure where to get some sound advice and treatment. I am 46 years old. I am in good health and rarely get sick. But I experience a range of uncomfortable symptoms that seem unrelated, but maybe they are ? I have mild heart palpitations, strange surges in my abdomen that feel like an adrenalin rush which I notice more at night; mild anxiety not related to any kind of external stimuli; significant irritability; poor sleep; frequent headaches; acne around the bridge of my nose and chin; hair loss and worst of all, zero libido. This has been worsening over 3 or 4 years. I have taken various types of pill since I was 18. I am fed up with these symtoms and am very unhappy with how I feel. I recently came off the pill before I have my hormones tested. I have had other blood tests which was all normal except ‘sticky platelets’ whatever that means. So not anaemic and no thyroid issues. I don’t think the GP has a plan except HRT. I don’t know where else I can go for an alternative opinion and treatment. Suggestions?

    • Hello Sharon,
      I am 48 years old and suffer much of the same symptoms since January. I’ve been to the ER twice and many specialists. My gynecologist has been testing hormones, thyroid, etc and has come back that I’m estrogen dominant and needed natural progesterone. I have been using it, cycling it with my period, and I feel so much better! Additionally, I take supplements–magnesium, selenium, zinc, vit. D, fish oil, vitamin E and primrose oil. I’m not losing hair and my heart palpitations feel better. I hope helps!

  115. Hi Lara

    I came off the pill almost 12 months ago after being on it for about 15 years and since then have noticed a gradual thinning of my hair all over and most noticeably at my temples. It’s getting very sparse at the temples like male pattern balding, to the point I feel i can no longer tie my hair up as it’s getting very noticeable. Im so worried this isn’t going to stop!! I am trying to conceive and have had all my bloods checked, thyroid, PCOS, iron studies, testosterone etc and nothing is out of the ordinary. I have been diagnosed with adenomyosis recently and im wondering if this could be affecting it? I’m really at a loss what to do and find it extremely stressful! I’ve just started zinc and Chinese herbs to help with inflammation. Any help you could give would be very much appreciated!! Thanks! Eliza

    • Hi Eliza,
      Are you ovulating regularly? The best thing for your hair is to make some progesterone (after ovulation, and then during pregnancy).

      • Hi Lara! Thanks for replying. Am seeing a fertility specialist and her investigations have shown I am definitely ovulating. Since coming off the pill my adenomyosis symptoms are gradually affecting me more and more and hair loss is just not ceasing!! Do you think excess oestrigen could be the cause? Thanks so much, Eliza

  116. I have been experiencing severe hair loss from PCOS ever since I went off the pill 10 months ago. I just started getting my period/ovulating about 2 months ago. Do you think my hair will eventually grow back? Thanks!

  117. Hi Lara

    I have cystic acne on my chin area, hair thinning all over my head but more noticeable at the front centre part. Acne on my head too. I have been suffering from all these things since being on Levongestral for 2 years during which time I ran this pill together preventing periods. I stopped taking this pill 15 months ago and have had consistent 28 day cycle periods for 12 months following, however, the last 3 months my periods have stopped completely. The acne is terrible and my hair doesn’t seem to be shedding but is definitely not thickening up. I am over weight at 130 kilos. I know my weight must be having an impact. I have seen a oriental medicine prac who has told me my hormone levels are low (even though they sit in the normal ranges) she say’s I am exhibiting symptoms of PCOS without actually having PCOS. My thyroid test was ‘normal’ at 2.0 I have started taking a herbal formula prescribed by the oriental medicine pract for my acne but I would really like to get to the underlying issue – but neither my doc or the oriental medicine prac seem to know what that is. Can you help?

    • When you say you don’t actually have PCOS, do you mean a normal ultrasound? Ultrasound cannot be used to diagnose PCOS. Your periods have stopped so your doctor should order blood tests including: FSH, LH, testosterone, SHBG, androstenedione, and most importantly: glucose tolerance test (with insulin) or fasting insulin.

  118. Hi Lara, Up until having children, I was on the pill since my early 20s. Ever since having my last child now 6 I have had dramatic hair loss. I already have baby fine hair, so continued loss after breast feeding was very noticeable. I looked was like a two year old just starting to grow hair. It thins all over, but particularly on my left and sides/temples. I think they called it androgenic alopecia. I also noticed small, very fine, white hairs on my jaw and and above my lips. My doctor put me on Yaz for two years thinking I had skinny PCOS, but I always have regular periods, fell pregnant straight away with kids. I also started Rogain. My doctor revised the diagnosis and felt I didn’t have it. My hair thickened immediately on YAZ. Jan 2014 I stopped YAZ as my mother had had advanced and aggressive breast cancer, so the plan was always to stop YAZ after two years. I continued Rogain and commenced Spironolactone 25mg a day for six months. When the shedding continued I spoke about increasing it. I have been taking 75 mg for six months. The shedding has continued and if it continues at this rate I will need to wear a wig (I am still in my 30s and very active with team sports, so I imagine my life would change dramatically). They are concerned with continuing me on the pill and said I should never take HRT (my Mum did take HRT). I would be grateful for any suggestions. Thank you.

    • I’m not a fan of Spironolactone (as I discuss in Spironolactone: The ‘Safe Drug’ for Hormonal Hair Loss?). It can inhibit ovulation which is not good when you need to ovulate in order to make the two best hormones for hair: estrogen and progesterone.

      In your case, your hair loss is so severe that there must be a missing part to the story. Have you been assessed for thyroid and/or gluten sensitivity? Both of those cause severe hair loss.

      • Hi Lara, Thank you very much for your reply.
        Yes, I was tested for everything and my thyroid was fine. After breastfeeding years ago, I wasn’t taking supplements and was under stress due to my Mother’s illness, so some of my vitamin levels were low, but they all have improved and are within the normal levels. I do have the coeliac gene, but I do not have coeliacs disease. I know when I ovulate and this always happens at the normal time each month. My father has very fine hair. My mother always had thick luscious hair before chemo and taking the drug femara, which made her hair very fine and thin. From memory of my last results I think my SHBG levels were high, but I guess this is due to the Spironolactone. I have always eaten lots of salmon, tuna, eggs, chickpeas, humus, broccoli, carrots zucchini, capsicums, nuts (almonds/brazil nuts), lentils, avocados, blue berries/raspberries. I make my own breakfast, which I would have a few days each week of spirulina, LSA, Chia seeds, berries, nuts, Maca powder. The other days I have eggs and salmon or occasionally bacon or grain toast with salmon. I limit red meat to a couple/three times a week and I like bread but I don’t over indulge. I love chocolate and I do eat a lot of dark chocolate (high % of cocoa) and this is my biggest indulgence. I drink one or two glasses of alcohol a week. I have tried absolutely everything and try to remain positive, but it is so disheartening when the only way I can retain normal hair is through some hormonal drug, such as the pill.
        Thank you

  119. Hi Lara,
    Thank you so much for you post! I have post pill amenorrhea since I went off Yaz Sept 2014. I started experiencing extreme amounts of hair loss since January 2015. I am not sure if these incidences are related, but my best guess is that they are. I had my hormone levels tested and my estrogen levels are low (26 pg/mL) and my ferritin levels are also low. I am only 29 so I am not going through menopause. I have started taking iron supplements 3 weeks ago but I have not seen much of an improvement in my hair loss. I am pretty thin and since I went off the pill I have been trying to gain weight but still struggling with amenorrhea. I am not sure what else to do. Any suggestions would be appreciated!

    • That timing (three months after you stopped the Pill) is the typical “time delay” that I discuss in the post. Your hair should improve on its own as long as you get your periods back, and as long as you have no other underlying conditions (such as thyroid, iron deficiency, or PCOS).

      Your low estrogen is not a concern. It will go up dramatically as soon as you move towards ovulation and a period.

      Sounds like you did need iron, and it will help, but not for at least three months (maybe longer). Remember the time delay with hair.

    • Jennifer- I have to take iron too. I also take a multi for hair growth. I’ve also been eating relatively low carb, high protein and high fat (also gluten free and very little grain). I also try to eat a lot of pumpkin seeds (zinz!). SInce starting the regime my hair loss has stopped. I hope it helps. I know hair loss is so traumatic, especially for a young woman.

  120. Dear Dr. Briden,

    With PCOS hair loss, can it be a combination of more than 1 type of PCOS (ex. inflammation and IR) so the hair loss will look differently? I have high androgens, with diffused hair loss only (not temples). Is that still considered androgenic alopecia?

    With your patients, do they often experience a burning sensation in localized areas of their scalp? Sometimes I have a white bulb attached to it, others do not have it.

    I realize you are not a Derm doc. But any knowledge you can share about your patient’s experiences will help tremendously. I’ve been to a derm doc, they were so condescending and a waste of my time and money…

    Thank you.

    • Most definitely, it can be a combination of more than one type of PCOS. Insulin resistance and inflammation is a common combination. Yes, androgenic alopecia can present as diffuse hair loss. One of my readers asked about the burning sensation in my other hair loss post. I’m certain it’s from inflammation. Best treatment is the anti-inflammatory diet and supplements that I discuss in my book (for example, dairy-free diet and zinc supplement and repair intestinal permeability).

  121. Hi, Lara. I got myself on Reclipsen as a last ditch resort two years ago to regrow my hair. Prior to being on the pill, my period was pretty much regular. If my cycle has always been regular, does that mean my hairloss is due to something else other than hormonal? I was on Yasmin in college for less than a year to help with acne and haven’t been on the pill until two years ago yet I was still losing hair. I started Rogaine six years ago and decided this past month to stop it. I am waiting anxiously to see what effects it will have on me. I started Propecia two years ago because without my hair, I wouldn’t let any man near me so there was no way I’d get pregnant. A year ago, I cut out gluten and started a low glycemic diet. Sometimes I think the diet is helping me because my hair strands appear thicker, but the thinning areas are still there. I don’t know what else to do, but pray and pray. Yes, I’m otherwise healthy, but hairloss has essentially crippled me, it’s so debilitating. Do you think stopping the pill will help me? Also my hairloss pattern is overall diffuse on the crown and towards the back as well as at my sides. I lost my hairline as well. I don’t remember when it all started, but I remember sitting at the dinner table one night, running my fingers through my hair as I often do, and having a wad of hair come out with my fingers. I don’t care what doctors say, hairloss in women is a reflection that something is not quite right and I refuse to give up the fight. Any suggestion, feedback will be greatly appreciated.

  122. Thank-you Lara. It makes sense to correct the underlying issue (I’m just not sure mine has been corrected yet as I have the unexplained/mystery type of PCOS!), so I was looking for a miracle cure in the meantime:)

  123. Hi Lara, my hair started shedding 3 weeks ago, approximately 3 weeks after stopping Yaz and discontinuing birth control. According to your article this seems way too fast to be the cause, in October I changed from Estelle to Yaz. Does this mean the cause for me was changing birth control bills? In the past I have stopped taking Estelle for up to 6 months with no hair loss, if anything my hair looked better after stopping Estelle.Thanks, Sally

  124. Hi Lara, I was wondering if there are any supplements you would recommend for protecting against thinning hair/hair loss? eg diatomaceous earth, or high dose silica, or biotin? I have PCOS, have only recently started ovulating after having a baby over 2 years ago, and although I have been following your advice for a year my hair continues to thin dramatically. thanks in advance!

    • Claire- I’ve found spearmint to be very effective at blocking androgens that cause hairloss. I take it as a supplement or drink the tea. Just make sure you also take iron because spearmint can block iron absorption.

    • Hi Claire, I have not found there to be any one supplement that works for hair loss. I wish there were, and then I would certainly share it with you all.

      It’s always about correcting the underlying issue. The important thing is that your periods are back. Given the time delay (explained in the post), you hair should start to improve within 6 months of re-establishing regular periods.

  125. I have been following and recommending your blog since my hair loss started in July of 2014. I turned 45 in August and have NO history of hair issues and both sides of my family have full heads of beautiful hair. My hair was destroyed after coming off Loestrin. There is no way to describe how I feel about having been told a drug was safe and not knowing I was ingesting something for almost 4 years that was killing my hair. I have thyroid disease but it’s being treated and there was no fluctuation when I went off the pill. My hormone tests came back normal. No high male hormones that would cause hair loss. I haven’t lost all my hair but its a real mess. It’s lost more than half it’s density and yes there is a lot of miniaturization.
    Most doctors have wanted me on Rogaine but I have stuck to everything you have said. I found a Trichologist to work with who works more naturally. I am using a natural form of Rogaine (no drugs) Tricho 7 by Philip Kingsley- I have been getting my ferritin levels up, taking Magnesium glycinate, Biotin, Selenium, Zinc,Vitamin D3,Gelatin protein caps,Vitex etc
    I have been having a period every 25 or 30 days. I had one irregular period (possibly due to sleep cycle change with work) but now I am terrified that I am going to enter peri menopause and there will be no hope to get my hair back. It seems like you are saying that if you lose your hair and your body is going in to menopause or peri menopause you just will never get your hair back. Is that correct? If Loestrin caused my hair loss ( I was also on Propranolol for headaches which I stopped at the end of August when I found out it caused hair loss) is there no hope?

    Doctors continued to tell me it was totally safe to be on the pill until I reached menopause – but if I had waited until then and Loestrin destroyed my hair it sounds like the hair loss would have been permanent, if it isn’t already. You should be aware that doctors are telling women it’s ok to be on the pill this late in life. I went off because I was getting married and I knew my problems with my periods (painful cramping) would be back when I went off the pill. My libido was non existent and that isn’t good for my first, and one and only marriage. I am very worried that it’s impossible to get my hair back because of Loestrin and or because of the changing hormones at my age. I would really like to know what your opinion on this is! Thank you in advance.

    • I am interested to see what everyone has to say about this issue as well because I am dealing with miniturization from BC too. No other known medical issues and I got my periods back right away but I am now 1 yr post BC and my hair is worse than ever. Very thin on top. Following male pattern baldness patterns but by all accounts the meds should be out of my system and my hormones (since I get my period each month) should be regulated by now as well and yet my hair gets worse every 2 weeks. I will be in a wig soon. I have tried everything (laser comb, hair loss vitamins, shampoos, spearmint tea, topical natural rogaine, )and no luck. Nothing has even slowed the loss. Any ideas on how to help?

        • Wow. That is great to know your hair is growing back! Did it continue to thin and look worse up until the 14th month mark? All I know is that my thin patches continue to spread every month and I am afraid they will not stop. They look worse and worse every week. Did yours continue to get worse until suddenly it began to get better?

          • Yeah it did. To be honest it is still thin and I can still see a lot of scalp. But the shed is reducing now and if I search for them I can see new little hairs. My advice to you would be not to mess around with too many vitamins or rogaine etc. Every time I tried something aggressive it made my situation worse. Time (and regular periods) seems to be key. Slowest and longest 14 months of my life and it’s still not not over!

  126. Hi, Lara. Can you please tell me which Probiotic or what strains you find helpful for people who have taken heavy antibiotics for recurrent vaginal and ear infections and for people with PCOS. Is LSV3 good?

    • Ava- I’ve had similiar problems. I take a spoonful of virgin coconut oil every morning. You can also apply on the infection for instant relief. Coconut oil is a miraclulous super food IMO. 🙂

  127. What are your thoughts on recovering your hair after years of thinning? I have a mother without hair and a sister who is also thinning at a young age — definitely genetic. I do suffer from autoimmune thyroid but have managed to turn to Traditional Chinese Medicine, diet, and stress management and avoided having to use synthetic hormones. I also have Celiac. I am doing a lot of what your blog suggests while seeing a TCM doc and taking raw herbs. Is there any chance that my hair can recover? I’ve been following this protocol for the last year or so. Just wondering if it’s unrealistic to hope for a full head of hair.
    Thanks! Adriana

      • You should be able to keep the hair that you have, and maybe even improve things. Of the things you mentioned, the most important thing is celiac disease. You really must strictly avoid gluten (even tiny amounts of gluten). Also, don’t be afraid to take thyroid hormone (if your blood test says that you need it). It can really help with hair.

  128. Hi Lara this gentle carbohydrates stuff I’d love to know more sounds like me…anxious, thin hair loss, anxious even in sleep, gluten intolerant, used to be low carb as that’s what seemed healthy for very one….now I am eating gf bread and lots pumpkin and sweet potato but notice some say night shade veggies not great? Why is this? How much woud u suggest each meal and what types of gentle carbs? Thanks

    • I explain all about it in my Gentle Carb post (just click the link). Most women need at least 150 grams per day of whole food starch such as potato, sweet potato, and rice. Those are better options than GF bread, but ok to have GF bread sometimes, or even a sourdough spelt bread (if you’re not actually gluten-sensitive).

  129. Dr. Lara,
    I’ve had massive hair loss for the last 4 months. Over half my hair. I’m 34 yrs old and was on Loestrin for 30 days. I noticed the loss immediately and stopped it. My bloodwork resulted in Hashimoto but my thyroid still is fine. It hadn’t been destroyed yet. My DHEA-S levels are about 550 and the range should be under 266. Im taking Vitamin B complex, Biotin, Omega 3’s, vitamin D, Remag and Relyte (magnesium and minerals by Dr Carolyn Dean). What are some natural ways to lower my DHEA’s and thyroid peroxidase? I’m really desperate to get this under control.

    • The drug in Loestrin is norethindrone, which is actually one of the least androgenic progestins. Also, that was too fast (less than a month) to notice hair loss. In your case, I would say that your hair loss is from something else (something that happened 2-6 months prior). Maybe illness? or a flare-up of your autoimmune thyroid problem? Or heavy period blood loss (iron loss).

      • Thanks for your response. In all my research, Loestrin is the highest androgenic pill on the market so I’m a bit confused. And I have no idea if there was a relation- it just seemed coincidental with the sudden hairloss?

        No illness during that time. Could the really high DHEA-S just occur without an illness or the Hashimoto? And, is there a way to lower that naturally? I really don’t want to start on any medications.

        • Hi Misty, I’ve looked into a bit more. You’re right. Norethindrone is still fairly androgenic — although less androgenic than the widely prescribed levonorgestrel. There a nice summary here.

          High DHEAS is usually the result of chronic inflammation (I discuss that in my Types of PCOS post). That goes hand in hand with the autoimmune inflammation. Best strategy: reduce inflammation by avoiding inflammatory foods such as wheat, dairy etc. I go into quite a bit of detail about inflammation in my book.

  130. Dr. Lara, I’ve learned so much from both blogs on hair loss. Thanks so much! have a question- what are your thoughts on strength training? I really enjoy working out with weights and do it about 5 times a week. Do you think it may spike androgens too much and contribute to thinning?

    • No, I don’t think that exercise spikes androgens. What really matters is body fat. As long as you have enough body fat to ovulate and have regular periods, then exercise is fine.

  131. In your experience, how high do androgens have to be before you’re considered to have an androgen problem and not just a sensitivity to androgens? My doc says I’m sensitive but my testosterone levels have been as high as 75ng/dl, she said testosterone tests are useless unless the results are really high. Would also like to know more about hyperandrogenism with ovulatory cycles.

    • I look for all androgens (testosterone, DHEAS, and androstenedione) to at least be in the normal range. You should also test SHBG (sex hormone binding globulin) to know your “free androgen index” or FAI. (free androgens can be high even if testosterone is in range).

      Great question about ovulatory cycles with high androgens. In my experience, it’s mostly to do with inflammation and environmental toxins stimulating the adrenal glands to make androgens. That’s the Type 3 PCOS that I describe in my 4 Types of PCOS post. Solution is to reduce inflammation and help your body to eliminate toxins.


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