How to Treat Androgenic Alopecia in Females

Androgenic alopecia is the most common cause of hair loss, affecting over 30 million women and people assigned female at birth in the United States.

About 1/3 of all women will experience this pattern of hair loss in their lifetime - and yet it is still poorly diagnosed and mostly untreated.

This type of hair loss and thinning goes by a few different names - androgenetic alopecia, female pattern hair loss, and female pattern baldness - but all of these describe the same root cause of hair loss and thinning - hormones.

Because androgenic alopecia is so common, conventional doctors often diagnose this type of hair loss and thinning by visual inspection alone, which means they just look at your hair and scalp for the common pattern or groups of symptoms that describe it.

For instance, androgenic alopecia usually starts to appear near your center part. In the middle and later stages, you may also lose hair on either side of your part and toward the front of your scalp. 

Androgenic alopecia doesn’t tend to result in patchy hair loss or bald spots, but rather slow, diffuse hair loss that eventually makes your scalp visible through thinning hair. Your hair follicles, also known as the root of your hair strands, become smaller over time, resulting in finer, shorter, and less pigmented hairs.

If this sounds familiar, or if you’ve been told you have androgenic alopecia by a healthcare professional, you may have also been told that there’s not much you can do about it.

Maybe you were told it’s genetic and you just have to live with it. Or maybe you were told to try a medication like spironolactone, finasteride, or minoxidill to see if it will help. 

Or maybe you’ve been trying fancy shampoos, taking generalized hair-growth supplements, or scouring the internet for anything you can find to save your hair.

If so, you’re not as alone as you feel, I promise you that. And there are better, more precise steps you can take.

What if I told you that you could actually assess your body’s hormones - using advanced Functional testing - and then treat the cause of androgenic alopecia at the root - literally and figuratively?

Sounds pretty good, doesn’t it?

Well, that’s what I’m going to show you how to do - but first we need to understand which hormones are causing androgenic alopecia in the first place, and why they’re being so unfair to your hair!

You might have already guessed that androgen hormones are a part of this story - and you’d be right! Androgens are a family of hormones including DHEA, testosterone, and the downstream metabolites of both, including the all-important 5-alpha-DHT or Dihydrotestosterone. 

When androgens become too high relative to other hormones, it results in androgenic alopecia. 5-alpha DHT is especially problematic because it’s much, MUCH more androgenic than other hormones like testosterone.

Not only does an abundance of DHT cause hair loss on the scalp, but it can also cause hirsutism, a symptom where excessive hair grows on the face, particularly around the jawline or upper lip. It can also cause increased acne and even result in irregular or absent menstrual cycles.

Because androgens are made by the body throughout the post-puberty lifespan, androgenic alopecia can start as early as your late teens.

But in females, it’s much more common to start seeing hair thinning after menopause, because while androgens may stay at similar levels, estrogen and progesterone begin to decline.

So, even if your levels of 5-alpha DHT may not be too high overall, they can become relatively too high when estrogen and progesterone start to drop during peri-menopause and menopause. And this relative rise in androgens shrinks the hair follicle, shortening the hair growth cycle and resulting in hair that’s more wispy, short, and gray or see-through.

This might surprise you, but you can test these hormone levels! And you should, because there’s no point in treating androgenic alopecia if that’s not what’s causing your hair loss and thinning, right?

My preferred way to test for the root cause of female pattern hair loss is the Dried Urine Test for Comprehensive Hormones, otherwise known as the DUTCH test.

The reason I recommend it is because the DUTCH doesn’t just test testosterone, but rather it shows us the entire hormonal cascade beginning with DHEA and ending with 5-alpha DHT. Specifically, it shows us your body’s 5-alpha reductase activity, which is the enzyme that makes DHT.

The DUTCH test can tell us how likely it is that DHT is the culprit for your hair loss, because it shows us how much DHT you’re making relative to your other hormones - because the test also gives us levels for all three estrogens (yep, there are three) and progesterone metabolites! They don’t call it comprehensive for nothing!

There are a few things that tend to increase production of DHT by this 5-alpha reductase pathway.

First on the list is insulin resistance.

Insulin resistance happens when your cells don’t respond normally to insulin, the hormone in charge of your blood sugar. 

This means that your blood sugar stays high over longer periods of time, which results in problems like type 2 diabetes, fat gain especially around your midsection, high blood pressure, cholesterol problems and cardiovascular disease.

This group of problems is often called metabolic syndrome, and it is associated with a high-carbohydrate diet that includes a lot of processed foods and sugars, an inactive, sedentary lifestyle, and behaviors like drinking too much alcohol and smoking.

Another condition associated with elevated 5-alpha reductase activity is PCOS or polycystic ovarian syndrome.

PCOS is almost always linked with insulin resistance, and can be caused by chronic stress and adrenal issues, chronic inflammation, and even as a result of previous birth control pill use.

Androgenic alopecia is a very common symptom of PCOS, and both can be treated by decreasing 5-alpha reductase activity.

So, if your DUTCH test reveals relatively high DHT or 5-alpha reductase activity, improving insulin sensitivity is always the first step. The Mediterranean diet, which is full of colorful fruits and veggies, lean protein, and healthy fats, has been shown to be very effective at correcting insulin resistance. 

Giving up ultra-processed foods, soft drinks and other sweetened beverages, and exercising 3-4 times per week are also great insulin-sensitizing strategies with solid research behind them.

But there are other Functional Medicine strategies you can use to slow down production of DHT, and shift your body’s preference away from the 5-alpha reductase pathway. However, before I share specifics, you should know that for men and people assigned male at birth, high DHT can cause prostate problems as well as male pattern hair loss.

For this reason, many of the high-quality nutraceutical products designed to downshift the 5-alpha reductase pathways are marketed as prostate support - but I don’t want that to throw you off! The very same ingredients help resolve androgenic alopecia in females, too.

So when you see me recommending a product called something like “Super Mega Prostate Health,” don’t be confused - we’re using it to stop hair loss, not shrink the prostate that you don’t have, ok?

And to make it easy for you, I’ve compiled a free user guide for my favorite Functional Medicine treatment strategies for androgenic alopecia that you can download - click HERE to grab a copy for yourself.

Alright, let’s talk about some natural, plant-derived compounds that help lower DHT.

Saw Palmetto berry extract has been studied for it’s ability to inhibit the 5-alpha reductase pathway, specifically the fatty acids and phytosterols found in this little palm plant.

It’s really common to see Saw Palmetto listed as an ingredient in hair-growth formulations, but it’s not always the correct part of the plant, which makes it less than helpful.

You want to make sure the product you choose is standardized for those fatty acids and sterols that are the active ingredients - not just some random berry juice. As a bonus, Saw Palmetto extract is anti-inflammatory!

Reishi mushroom has also been shown to inhibit 5-alpha reductase, and it has many other health benefits. In a research study exploring the anti-androgenic effects of 20 species of medicinal mushrooms, reishi mushrooms had the strongest action in inhibiting DHT production.

Green tea and spearmint tea have both been shown to have anti-androgen effects. The ECGC or epigallocatechins in green tea also prevent cancer and improve insulin sensitivity, so it’s a double-whammy. And spearmint tea has been used in Middle Eastern regions as a remedy for hirsutism - a common symptom of too much DHT in women.

Other plant-based compounds that have anti-androgen effects include black cohosh, nettle root, Pygeum africanum, licorice, Vitex, and white peony. 

One quick reminder - these strategies will only help solve your hair loss and thinning if the root cause is androgenic. There are MANY MANY causes of hair loss and thinning in women, and often those root causes are layered...more often than not, there are multiple causes in play at the same time.

For a more in-depth look into the “why” behind hair loss and thinning for ladies, check out my Hair Loss Deep Dive tutorial - you can sign up HERE.

And like I mentioned earlier, I’ve compiled a FREE user guide that details how to put my recommended anti-androgenic strategies to work. The guide has details on dosing, tips about changes you can expect, and even a 20% discount on my preferred practitioner-grade products! Be sure to check it out!