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[Hurdity]

Hi everyone

There has been a lot of discussion, posts and threads about hair-loss as well as some technical information.

I put this together in September but never posted it as I thought the topic had been covered but as it is still very current, and some of the information that has been posted is very specialised and difficult to understand by the lay-person, I've dug it out. I hope at least some of this information is accessible and broadly understandable even to the non-specialist?

It's a collection of statements and articles about hair-loss in women and the role of hormones and menopause – at our current state of knowledge - EACH WITH A SEPARATE LINK!  By no means comprehensive and while I read them back in Sept I haven't read them recently nor do I have time to at the moment.

I have separated out the articles so you can pick and choose which ones you read. In no particular order - some  are about hormones and their effects, some about treatments for hair loss. Nothing will tell you about your own hair loss but I hope they are interesting and that it's helpful to have some of these in the same place.

Warning - LONG POST!

BMS Tools for clinicians – testosterone replacement in menopause

https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

“Testosterone is an important female hormone. Healthy young women produce approximately 100 – 400 mcg per day. This represents three to four times the amount of estrogen produced by the ovaries. Approximately half of endogenous testosterone and precursors are derived from the ovaries e.g. androstenedione and half from the adrenal glands e.g. dehydroepiandrosterone. Some of the effects are direct and some due to peripheral conversion to estrogen by aromatase. Testosterone levels naturally decline throughout a woman's lifespan. Loss of testosterone is particularly profound after iatrogenic i.e. surgical and medical menopause and premature ovarian insufficiency when testosterone production decreases by more than 50%.”

“After the menopause, estrogen levels fall to undetectable levels. Consequently, the small amount of remaining testosterone may predispose to androgenic symptoms, especially acne, increased facial hair growth and male pattern baldness. Personal genetics are key to the susceptibility to these problems.”


Women's Health Concern - Menopausal Hair Loss (More than “a bad hair day”)

https://www.womens-health-concern.org/help-and-advice/factsheets/menopausal-hair-loss/


Menopause Matters Effect of progestogens as part of HRT:

https://www.menopausematters.co.uk/perimeno.php

“Progestogens which can be used cyclically are of 3 main types:

1.   Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
2.   Less testosterone related - Medroxyprogesterone acetate(MPA).
3.   Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).
Side effects are often experienced during the progestogen phase of treatment and can be reduced by using a product containing a different type or route of progestogen.”

Testosterone derived progestogens on average may have more androgenic affects (such as hair loss on head and hair growth on face) than other types.

SOME SCIENTIFIC STUDIES

Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study
(British Journal of Dermatology)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380548/

Abstract

Background
Androgens are thought to have an adverse effect on female scalp hair growth. However, our clinical experience of androgen replacement therapy in women with androgen deficiency, in which hair loss was seldom reported, led us to question this concept.

Objectives
To evaluate the effect of subcutaneous testosterone therapy on scalp hair growth in female patients.

Methods
A total of 285 women, treated for a minimum of 1 year with subcutaneous testosterone implants for symptoms of androgen deficiency, were asked to complete a survey that included questions on scalp and facial hair. Age, body mass index (BMI) and serum testosterone levels were examined.

Results
Out of the 285 patients, 76 (27%) reported hair thinning prior to treatment; 48 of these patients (63%) reported hair regrowth on testosterone therapy (responders). Nonresponders (i.e. no reported hair regrowth on therapy) had significantly higher BMIs than responders (P = 0•05). Baseline serum testosterone levels were significantly lower in women reporting hair loss prior to therapy than in those who did not (P = 0•0001). There was no significant difference in serum testosterone levels, measured 4 weeks after testosterone implantation, between responders and nonresponders. No patient in this cohort reported scalp hair loss on testosterone therapy. A total of 262 women (92%) reported some increase in facial hair growth.

Conclusions
Subcutaneous testosterone therapy was found to have a beneficial effect on scalp hair growth in female patients treated for symptoms of androgen deficiency. We propose this is due to an anabolic effect of testosterone on hair growth. The fact that no subject complained of hair loss as a result of treatment casts doubt on the presumed role of testosterone in driving female scalp hair loss. These results need to be confirmed by formal measurements of hair growth.

Other Body Changes Affecting Sexuality
Hair changes

North American Menopause Society

http://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/other-body-changes-affecting-sexuality

“The shift in the balance between androgen and estrogen levels can also lead to excessive hair growth (hirsutism) in areas of the body where hair follicles are especially sensitive to androgen, such as the chin, upper lip, and cheeks. Many midlife women report the sudden growth of single, thick (often dark) hairs on their chin, while others may notice downy peach fuzz–like hair on their face.

The menopause-related shift in the testosterone-estrogen balance can also produce the opposite effect—hair loss. About 50% of women observe some degree of hair loss or thinning before age 50. Although hair loss may worsen with natural menopause, improvement has been seen in women who experience surgical menopause as testosterone levels plummet after the ovaries are removed. Aging itself also contributes to hair loss in women. Hair loss with aging has a genetic component as well, so your parents' experience with hair loss can sometimes give a sense of what you might expect.

The effects of postmenopausal hormone therapy on hair density are uncertain: some women report more hair loss, while others report less.”

Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness

(British Journal of Dermatology 2011)
https://www.ncbi.nlm.nih.gov/pubmed/22171680

Hair loss is an important symptom of the menopause Re: Non-hormonal treatments for menopausal symptoms

BMJ 2017
https://www.bmj.com/content/359/bmj.j5101/rr-4

Extract
“Being the commonest cause of hair loss in women, FPHL is a non-scarring alopecia which typically presents with progressive hair thinning at the vertex of the scalp, with sparing of the frontal hairline. Although FPHL can occur at any time after puberty, it most commonly begins at, or soon after, menopause (1). The significant psychological distress associated with hair loss is well-recognised. Symptoms of depression, anxiety, low self-esteem, and obsessional behaviour have been commonly associated with FPHL (2).

The exact role of hormones in the aetiology of FPHL is not fully understood. Although the role of androgens and genetic susceptibility is recognised in male-pattern hair loss, it is less well understood in FPHL. What is known, is that the majority of women with FPHL have neither clinical nor biochemical features of hyperandrogenism (3).”

Treatments for female pattern hair loss

A Cochrane review (2016) of treatments
https://www.cochrane.org/CD007628/SKIN_treatments-female-pattern-hair-loss

NICE Info:

Scenario: Management of a woman with androgenetic alopecia (Revised 2016)

https://cks.nice.org.uk/alopecia-androgenetic-female#!scenario

Hormonal therapy in female pattern hair loss

Int Journal of Womens Dermatology (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419033/

Scientific paper looking at the effect of hormones and treatments ( in US)

Enjoy and feel free to add other papers and articles to this list

Hurdity x

[Wrensong]

Thank you Hurdity - this is comprehensive & very interesting & must have taken an age to collate.  I imagine many members will find having this all together in one place very helpful - I've already bookmarked it  . 

Especially reassuring was the study you linked to in the Dermatology journal in which androgen deficient women were treated with Testosterone from which this is an extract:-

No subject reported scalp hair loss on testosterone treatment, casting doubt over the presumed role of testosterone in causing hair loss.

Makes me a little less afraid of trialling T later! 

A fab effort on your part again 
Wx

[Lanzalover]

Thanks Hurdity

Lanzalover x

[Tc]

Thank you for taking the time to do this hurdity. X

[Wilks]

Wow, what a great collection, Hurdity!
That's really thoughtful of you x

[Alicess]

Thank you, Hurdity 🌷

[Penelope]

https://www.hairclub.com/blog/hashimotos-disease-and-hair-loss-what-you-should-know/


Hope this helps with hair loss also!xxxxx

[Anaise]

Or you could just stop taking Estrodrial instead. No further hairloss.

[Sammiejane]

hi ladies

everybody keeps saying low estrogen causes hairloss but this isn't the case for everyone x

when we were children before reaching period days we had very little in the way of hormones similar to that post menopause and you don't see children with thinning hair !

it's more likely to be balance of hormones or unopposed estradiol as that hormone is surging and the other are still low !

some women loose hair throughout there pregnancy due to raised hormones levels and others loose hair after giving birth to be honest my hair was so thick is didn't notice either way but it's funny how i've only supplemented with estradiol and have been shedding hair ! since i've stopped it's reduced not fully stopped but only been 11 days x

it seems lots of women had no issues with the pill yet hrt they do ! maybe bio identicals don't suit everyone and some do better on testosterone derived progestin i was fine on levonorgestrel

just a thought

[Penelope]

sammiejane you are right and very insightful.
Hair loss is hormones and very much connected with thyroid.BUT when a women finally gets around to asking for thyroid test they come back normal and are dismissed.
Thyroid should be diagnosed on family history and or symptoms alone 85% of patients have normal blood tests but they suffer terribly with all the symptoms that are expressed on this forum.when ever I hear my hair is dry and brittle or my hair is falling out I know it's thyroid.

The pill works fabulously for those with thyroid and they come off and get very ill and the doctor puts them on HRT.It will never work as well to make them better because the contraceptive pill is twice the strength of HRT.
Women have got to advocate for them selves.Research and go with there gut feeling.
It you ever got all these symptoms you have after the birth of your child or in the middle of your life and it is now horrendous since menopause hit.Thats a huge red flag that it has been your thyroid all this time.
I among millions of others have been misdiagnosed for 25 years.

[Hurdity]

Hi

I've just read this on Dr Newsons website and thought some of you may find it interesting

https://www.menopausedoctor.co.uk/menopause/menopause-and-hair-loss-by-consultant-dermatologist-dr-sajjad-rajpar

Just adding Bobidy's helpful post here too!

Hurdity x

[Tc]

My hair started falling out at 51,.  A year after  my wife died from  her two year fight against cancer. My  Hair was coming out in  handfuls and matted  on my  pillow. .I was  Still having periods. No peri symptoms at the time. 

.since then it seems to go in cycles  falls out a lot. Stops falling out for a,few weeks  but doesnt grow either then falls again. . Bit of a  Bald patch at crown but no other big bald patches ..just very thin hair.. I've lost more than half my hair volume.

I had my ovaries removed 18 months ago but my hair loss started way before. ...when, as I said,  I went through a period of extreme stress so just wanted to say. That it maybe isnt  always hormone related or just hormone related alone. .   

 Xxx

 

[jaycee]

TC You might have seen my various posts on my hair loss, i have all tests,and all come back normal, been seeing a dermatologist who said it isn't female pattern hairloss, as it isn't the right pattern for thayt
He said it is Telogen Effluvium, and will grow back,
The Derm, said he thinks mine  is stress related, so yesterday had a scalp biopsy, which will take 2- 3 weeks for results
I have a very itchy scalp sometimes, and using Dermovate lotion, which helps
When i first noticed the itching scalp, also had a very itchy back too, which felt spotty, more like a rash, but didn't think to go to the Drs with it,wish i had my hair might not have got as bad as it is now
I have never had spots in my life, so i reckon it probably IS stress  related, and i have been under a lot of stress in the last 2 years, but more so the last year
The biopsy wasn't really painful, but i bled a lot and i have 3 stitches in it
I asked for a thyroid test as i also put a stone and a half on, which is unheard of for me,
My normal weigh is at tops 8st.5lbs,i am now 9st 6lbs, from 8st.but thryroid came back normal

[jaycee]

Penelope, how did you eventually discover it was your thyroid after 25 years, ?
I have had a few thyroid tests over the years for various reasons,
The last time because i was feeling very tired and put a lot of weight on [for me] all of a sudden, well over a few months,and sudden hair loss, it might have been thinning a bit but i didn't notice if so, except slightly at one side,then suddenly had almost bald patches

[Sammiejane]

HRT caused my weight gain i was 8st 3 now 9st 5 in a year since being on hrt