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Q:  Over the couple of years after starting OrthoTriCyclen, I noticed that I started losing a lot of hair (losing hair in the shower and even after combing my hair AFTER getting out of the shower!) I just recently switched to Apri a couple of months ago and I still continue to lose a lot of hair. Is it possible that oral contraceptives can cause androgenic alopecia since there's the presence of androgens in these combination contraceptives?? If I started taking an oral contraceptive with low or no androgenic potential, would this perhaps decrease my hair loss?

A: Your question is one of concern to many women with alopecia: What is the effect of oral contraceptives on hair?
Unfortunately, there are few scientific studies on female alopecia so I must rely on my own experience treating many women with this condition over the past 20 years. Some birth control pills contain a progestin with androgenic (testosterone-like) activity. The most androgenic progestin is levonorgestrel found in Alesse, Triphasyl, Nordette, LoOvral, LevLite, Trilevlen, Levlin, etc. No one has proven that this is worse for alopecia than the others, but it may make sense for women with acne, increased hair or alopecia not to use these OCs. However I have seen women with these conditions use them without problems so if you are on one and it agrees with you, there is no reason to switch. OCs containing desogestrel and norgestimate are not androgenic at all so these may be preferable.

Many OCs lower levels of free testosterone which is thought to be why they help acne. They may also help alopecia though by themselves, OCs are usually not adequate treatment for female hair loss.

Remember that most women use OCs at one or another time in their lives so most women with any medical condition, including alopecia, will have been on OCs. I do not think non-androgenic OCs cause of worsen alopecia. As for the slightly androgenic ones, we do not know for sure.

If alopecia progresses on the pill, it is reasonable to consider adding other treatment.
Because estrogen makes hair stay on the head longer, this hormone in the pill may help alopecia. When the pill is stopped, a few women may have shedding because of the drop in estrogen levels. For this reason, stopping the pill is not a good way to deal with androgenic alopecia. Of course, this is not a reason not to stop OCs if there is a medical or other reason for doing so.

Hope this is helpful.

Geoffrey Redmond, MD

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