Does the Birth Control Pill Cause Hair Loss?

The business of shitting on the pill for page clicks

Hair loss and the birth control pill was a big topic this week. A young woman shared dramatic photos of her hair loss that she reported was diagnosed as alopecia areata due to stopping the birth control pill.

Alopecia an autoimmune condition of the hair follicles and it can be devastating with profound hair loss, but the cause is unknown.

I am all for people sharing their experiences online. What I am not in support of is media (ahem Buzzfeed) running with the story and not doing due diligence. Lots of people want information about the pill, so why not take this as an opportunity to educate? I mean, apart from that fact it would take some effort and shitting on the pill is apparently profitable.

I read several articles on alopecia areata and spoke with a dermatologist and not one source considered the birth control pill as probably cause. As alopecia areata affects women and men equally, if there were a hormonal predisposition, or the birth control pill were a factor, we should see this condition affecting more women than men. 

The Buzzfeed article, which I am not linking to, claims the birth control pill can negatively affect the immune system leading you, the reader, to falsely conclude that it causes alopecia areata. The proof? Buzzfeed linked to a poorly written review “article” in Lincare Quarterly, which is literally an anti-contraception, forced birth medical journal. No really, it’s the journal of the Catholic Medical Association and it apparently exists to get lies about abortion and contraception published so they can later be quoted as evidence, eroding facts and creating doubt. This “article”, like everything in Lincare Quarterly, is best described as used toilet paper, but the cheap stuff.

Furthermore, the medical expert cited by Buzzfeed is a naturopath who apparently sells supplements and recommends seed cycling, which might possibly be medical therapy in Middle Earth, but it is not medical therapy here on Real Earth. Seed cycling is so indescribably biologically ridiculous that it is medically illiterate. Naturopaths are not experts in hormones, but apparently they are experts in selling supplements.

Even then, the naturopath told Buzzfeed that it was “important to acknowledge that there is not a lot of literature when it comes to hair loss after the discontinuation of birth control” (there actually is literature, but hang on). But of course her “own clinical experience along with the experience of other providers tells me that hair loss after stopping birth control can be quite common.” So she doesn’t know the literature, but is fine with anecdotes? It’s worth pointing out that the business model of many naturopaths is likely negatively impacted by the pill. To sell you supplements to fix problems supposedly caused by the pill, you need to be convinced that the pill has caused damage. 

(In case you are wondering, I get paid the same amount whether I prescribe the pill or talk with someone about natural planning or arrange surgical sterilization. I get paid the same whether I prescribe the pill for acne, prescribe antibiotics, or recommend over the counter benzoyl peroxide).

Seriously though, you have to love the I acknowledge that I have zero proof to back up what I am saying, but I’m going to say it anyway and the absolute lack of pushback from the reporter. 

But facts have no place when there is the potential to incite panic over the pill.

Sigh.  

So let’s get to the question. Does the birth control pill cause hair loss?

We know that hormones affect hair growth and loss. Androgens, hormones like testosterone, can cause hair loss, and estrogen can support hair growth. Estrogen can also counteract the effect of testosterone. 

To answer the question about the birth control pill and hair loss you need to look at the various types of hair loss. There are a variety of different diagnoses to consider, so let’s consider how some of them may be related to the birth control pill. 

Alopecia areata or AA, the hair loss that prompted the Buzzfeed article, is an autoimmune condition and the exact cause is unknown. One review article suggests there are 4 cases in the literature of possible pill related AA, but unlike the folks at Buzzfeed, the medical experts writing the article were clear to state that this might also be coincidence. Look, autoimmune conditions are tricky things. Some get worse with estrogen, some can improve, and for others it’s neutral.

Is it plausible the pill plays a role in AA for a few people? Sure. Is it likely a significant or even a minor cause of AA? No. Is it worthy of an article misinforming people about a false link between the pill and AA? Certainly not. 

Telogen effluvium or TE is the most common cause of drug-induced hair loss. Hair goes through a cycle of being active and growing (anagen) and then through a rest phase called telogen. Hair falls out during telogen, the hair follicle rests, and then it wakes up, and hair starts to grow again. Medications or even stress can trigger TE, which is when more hairs than typical go into telogen. Basically, all the hair loss that you might expect over several months happens at once, and so obviously it looks dramatic (typically we lose 50-100 hairs a day). When TE is severe, people can lose up to 50% of their hair. It is awful when it happens, but it grows back. It also has nothing to do with the hormones being made in a lab, as the Buzzfeed article suggested.

Drugs can trigger TE by causing more hair follicles to enter telogen at once, basically hitting the snooze button for more than typical. As we see TE less with modern pills which have much lower doses of estrogen than the pills we used to use, and as estrogen triggers anagen or hair growth, when the estrogen is taken away more hair may be biologically ready to enter telogen. So it’s not likely due to a “hormonal shock”, and more due to the fact that a growth stimulant (estrogen) has been removed and so the follicles are now free to enter telogen. As TE doesn’t happen when a progestin only method is stopped, that is further evidence for the fact that it’s due to withdrawal of the growth-promoting effect of the estrogen.

Currently, TE due to the pill is not common. It can happen, but perspective is needed.

Going back to the Buzzfeed article, I wonder if the original diagnosis was TE…

…went to a dermatologist who stated that she was experiencing hair loss from hormonal shock, but hers was the worst case she had seen. So, after blood tests and a biopsy…

but because the hair loss was so severe, a biopsy was done (appropriately so), and a different diagnosis, meaning AA, was made. I can see TE being described as “hormonal shock”, although I wouldn’t use that analogy. Nothing is damaged, it’s simply more hair follicles going to sleep because estrogen has been stopped. But there is no data to support AA being caused by “hormonal shock.”

OB/GYNs are familiar TE, not because it’s common after the pill, but it because it definitely happens after delivery. This is how we know it has nothing to do with the withdrawal of “synthetic” hormones. Interestingly, no one writes scary headlines warning people not to get pregnant because of TE. And I would be remiss if I did not point out that the estrogen-containing pill can be used to treat postpartum TE…as the estrogen stimulates anagen or hair growth.

Androgenic alopecia, or AGA, is hair loss related to increased androgens (hormones like testosterone). This is a condition that most commonly occurs with polycystic ovarian syndrome or PCOS. Hair loss from PCOS is actually treated with the estrogen-containing birth control pill as the pill reduces the levels of androgens.

It’s true that some of the progestins in hormonal contraception can act like androgens on hair follicles, and so the pill is also a theoretical cause of AGA. However, there is no compelling data showing a link with hair loss due to AGA with the modern versions of the estrogen-containing pill, possibly due to different progestins being more commonly used or in lower doses and/or the fact that the estrogen counteracts some of the effect of the progestin. Might some people be more sensitive to the effect of progestins? It’s possible. AS there is a biologically plausible link between hair loss due to AGA and the pill, stopping the pill or switching to one with a different progestin might be considered. However, if you have androgenic alopecia (AGA), your doctor may well recommend the estrogen-containing birth control pill and they can do this based on solid evidence.  

Progestin only methods, like some IUDs, the implant and the shot, can cause hair loss due to androgenic alopecia, possibly due to the dose and/or because there is no counteracting estrogen. The risk varies by the method used. For example with the Mirena IUD the risk is 0.33%, but with the implants and the shot the risk may be as high as 1-10%, depending on the study. 

Frontal fibrosing alopecia (FFA), is a cause of permanent hair loss. It is a condition that affects the hair follicles at the hairline in the front and the temples. The estrogen-containing birth control pill appears to be protective and may lower the risk of FFA. 

There are a variety of other medications and medical conditions that can cause hair loss, such as low iron and thyroid disorders. As the pill reduces iron deficiency, it would protect against this as a cause of hair loss. The pill doesn’t affect thyroid disorders. 

So, what does this all mean?

Stopping the pill can cause hair loss due to TE, which remember, isn’t common and is temporary, but this condition can be very distressing. This isn’t due to a build up of toxic “synthetic” hormones, the likely mechanism is withdrawal of the estrogen and thus its effect on hair growth. This explains why the incidence is lower with pills that have a lower dose of estrogen and why this form of hair loss is not see with hormonal contraception that doesn’t have estrogen. TE can also occur postpartum and the pill can even be used as a treatment when that happens.

The estrogen-containing pill can also protect against androgenic alopecia, frontal fibrosing alopecia, and hair loss due to low ferritin.

And there is no good evidence to support the pill as a cause of alopecia areata. Might it be the cause for a few people? Sure, but really anything could be.

People need to be educated about the pill so they can make an informed choice. It is disheartening to continually see disinformation about the pill dressed up as information and offered as empowerment. Never mind how depressing it is to see how many people gleefully posted on Instagram as “proof” the pill is harmful. 

When people warn about a link between hair loss and the pill, as we see with TE, and they don’t warn about postpartum hair loss due to TE that tells me that as long as your body is in servitude to the patriarchy, complications are meaningless. When the media and anti-pill advocates ignore facts about the pill and hair loss, that tells me they are invested in pill panics. And when a literal forced birth “journal” is used as medical evidence in an article that is supposed to help women? That’s fucked up.

But hey, that’s wellness right? Wrapping up misinformation and patriarchy with a pink bow and calling it feminist empowerment.

Until the next pill panic…

References

Williams NM, Randolph M, Estarabadi AR et al. Hormonal Contraceptives and Dermatology. American Journal of Clinical Dermatology. 2021:22:69–80

Gilhar A, Etzioni A, Paus R. Alopecia Areata. NEJM 2012;366:1515-25.

Peterson H, Clifton J, Miller D, et al. Hair loss with use of the levonorgestrel intrauterine device. Contraception 2007;76:306-309. 

Benagiano G, Benagiano M, Bianchi P, et al. Contraception in autoimmune diseases. Best Practice & Research Clinical Obstetrics and Gynaecology 60 (2019) 111e123

Alopecia areata NIH https://www.niams.nih.gov/health-topics/alopecia-areata#:~:text=Causes%20of%20Alopecia%20Areata,genetic)%20factors%20play%20a%20role.