Female Hair Loss in a 51-Year-Old Patient with PCOS and Hormonal Triggers
Hair loss in women can be both emotionally and physically distressing, especially when it has been ongoing for many years. At Reena Jogi, MD – Hair & Skin Dermatology in Katy and Houston, Texas, we specialize in helping patients navigate the complexities of hair loss, which often involves multiple contributing factors such as genetics, hormones, stress, and medications.
Patient Case Overview
A 51-year-old female presented to our clinic for evaluation of progressive hair thinning. She reported experiencing diffuse hair loss since the age of 21, with noticeable shedding over the years. Her history is significant for polycystic ovary syndrome (PCOS), a condition that often influences hormonal balance and contributes to androgen-related hair loss.
Over the past year, she had been using both oral and topical minoxidil with good improvement. However, after starting hormone replacement therapy (HRT) in January, she experienced worsening hair shedding. Although she discontinued HRT in March, the increased shedding persisted, prompting her to seek further evaluation.
She had also been taking Viviscal, a hair growth supplement, and was open to switching to Nutrafol for added support.
Examination Findings
On exam, the patient displayed diffuse hair thinning across the mid-frontal scalp, with a positive hair-pull test, confirming telogen effluvium (TE). Given her long-standing history, she also had evidence of androgenetic alopecia (female pattern hair loss).
Diagnosis
Androgenetic Alopecia (Female Pattern Hair Loss) – Chronic, genetically driven thinning.
Telogen Effluvium (Stress- and Hormone-Triggered Shedding) – Recent onset related to hormonal changes after HRT.
Underlying PCOS – Likely contributing to androgen sensitivity and patterned loss.
Treatment Plan
We reviewed treatment options in detail, including both medical and procedural therapies:
Oral Medications: Continue oral minoxidil, add dutasteride to reduce androgen-related shedding.
Nutraceuticals: Alternate Nutrafol and Viviscal for hair support.
Procedures: Consider AlmaTED ultrasound-based therapy and platelet-rich plasma (PRP) injections to stimulate hair growth.
Lifestyle & Diet: Counseling provided regarding the role of nutrition and stress in ongoing shedding.
Future Hormonal Evaluation: Encouraged follow-up with gynecology and endocrinology for continued PCOS and hormonal assessment.
The patient elected to begin dutasteride, continue oral minoxidil, and alternate hair supplements, with potential plans for AlmaTED.
Discussion
This case highlights how female hair loss is often multifactorial—a combination of genetics, hormones, and external triggers. In women with PCOS, hair loss can be particularly challenging to manage. Additionally, hormonal therapies such as HRT can trigger telogen effluvium, leading to worsening shedding even when patients are on proven hair regrowth therapies.
At Reena Jogi, MD, we take a comprehensive approach to hair loss treatment in women, combining evidence-based medical therapies with advanced in-office procedures to achieve the best outcomes.
Conclusion
Female hair loss requires a personalized treatment strategy. This case demonstrates the importance of identifying hormonal triggers, addressing androgen sensitivity, and combining therapies such as oral minoxidil, dutasteride, and nutraceutical support with procedural treatments like AlmaTED and PRP.
If you are experiencing female hair thinning or PCOS-related hair loss in Katy or Houston, Texas, we invite you to schedule a consultation with Dr. Reena Jogi to explore your treatment options.
