Can stopping high androgen birth control reverse or stop androgenic alopecia?

This is a great question and one that I have managed many, many times. I always tell patients of my own that if they are looking for a simple answer, there unfortunately is not one. This question is very involved. The birth control is never the only cause. There are dozens of genes that are doing their thing here as well. There is not a yes or no answers here - only chances of certain things happening. I would encourage you to review this question in detail with a dermatologist so that he or she can best advise in your specific situation. There are just so many factors here. Let’s look at some scenarios together. 1) First, it’s possible that Loestrin does have a minor role for some. It’s not a definite link but rather a possibility. Some patients who stop Loestrin develop a telogen effluvium just like many women do after stopping birth control. The hair starts to look worse. This now accelerates the underlying androgenetic alopecia. The telogen effluvium eventually slows down and some hair regrows but 6-7 months later the hair density is worse than before going off the Loestrin. This is probably the most likely scenario. What the patient does not realize is that she has actually slowed down the loss in the long run but lost more in the short run. In other words, had she stayed on Loestrin the hair would have been thinner in 5 years down the road than if she stopped. 2) The second possibility is that shedding occurs after stopping Loestrin and over time their is regrowth back to a level above the density before stopping. This is not common but certainly it is a possibility. In this scenario, the hair density does not return back to “normal” but rather improves a bit from what it was while on Loestrin. 3) The third scenario is one where the patient switches from a high androgen birth control pill immediately to a low androgenicity birth control pill. This scenario does not involve actually stopping a birth control pill. This can slow down the rate of loss considerably for many patients. It does not return back to “normal” density like age 15 but does slow or stabilize loss for many. I often explain to patients that instead of moving forward at a rate of losing 3 % of density per year. the rate drops to 1% or 0.5 % - or sometimes zero.

These are the scenarios involved in this question but do keep in mind they are not the only options for the patient. Not at all. A full history and examination and blood tests are needed. If there is a history of underlying PCOS or late onset congenital adrenal hyperplasia, recommendations could be different. If there is a component of low iron, stress, seborrheic dermatitis, thyroid disease, hair breakage from heat or dyeing, the recommendations will be a bit different. But in these scenarios, the advice for many women could be to switch the oral contraceptive and start treatment of the thinning with treatments such as topical or oral minoxidil and/or oral antiandrogens like spironolactone. Low level laser may also be an option.

I thank you for this excellent question. Be sure to review this with a dermatologist. Focus on the long run and not the short term as patients who undertake these changes do get increased shedding in the short term that is frightening. There may be shedding when any oral contraceptive is stopped. There may be shedding when minoxidil is started. There may be shedding when spironolactone is started. Take lots of pictures for you and your doctor to review.