I have to stop taking my birth control. I have to stop taking it, like, yesterday. I know it immediately and I hate that it’s true.
I’ve been on Loestrin (and more recently, Watson’s generic Microgestin) since around the time I turned 21—over four years now. It’s the only birth-control pill I’ve ever taken and it’s never given me much trouble. In fact, I quite like it. My period is light and infrequent, no cramps, no weight gain, no pregnancy, no problem.
Except maybe I’ve been shedding a bit more hair than I used to. A loose strand across my forearm in the morning, later one at my desk. The drain clogs in the shower every few days, and the clump of tangled brown hair is springy between my fingers. Alone, this is not much cause for concern. On average, humans lose between 50-150 scalp hairs each day. For me, it’s nothing so noticeable. I’m certainly not going bald, and I can’t seem to remember my ponytail ever being much thicker than it is now. The forums and message boards all cite “waking up to loose strands on your pillow” as a real indicator of significant hair loss. And so far, I’ve found none there. It has been gradual, anyway. Hard to pinpoint when the shed started. I’d never dyed my hair before this year, and I’d like to think it was the shock of bleach and toner on a virgin scalp.
The thing is, I have a family history of premature androgenetic alopecia, or diffuse hair loss, which means that I have a genetic propensity toward the same fate myself. And what I’ve recently discovered is that, of the many birth-control pills on the market, my pill, Loestrin, is among the most androgenic available. Androgen, in its more potent form DHT (dihydrotestosterone), is the hormone responsible for the reductive thinning, or miniaturization, of scalp hair follicles. Pumping my bloodstream with a birth-control pill containing high levels of this hormone, then, would be very foolish to continue, considering my genetic predisposition.
So, just a week into a new pack of Microgestin, I stop taking them altogether. I schedule an appointment with my OB-GYN, tell her why I’ve ceased taking the pill mid-month, ask her to please find me a different pill, anything else, whatever contains low or no androgen. Apparently, my doctor was unaware of this unfavorable side effect (though she was quick to inform me that the birth control shot Depo-Provera is widely known to cause hair loss). She’ll have to do a little research into this, she explains. She’ll call me back with options in a few days.
Yet, all over the Internet, there are forums and message boards filled with sob stories from young women who’ve lost sometimes more than 50 percent of their hair after taking Loestrin in particular. For women, whose hair, across all cultures, associated with sexuality and feminine beauty, a thinning scalp can be highly traumatic. Many describe feelings of low self-worth, shame, and depression. “[It] takes up about 98 percent of my thoughts every day! I am crazy self-conscious,” writes a woman named Sarah at the website WomensHairLossProject.com. Others lament a once-heavy ponytail reduced to the diameter of a Sharpie marker; they fear a windy day will blow askew a carefully brushed bob (shorter hair looks fuller, less weight on the ends) and reveal a too-visible scalp.
It’s not just the hypochondriacal Internet affirming my hunch. While working on this article, I spoke with several female friends about my experience on the pill, wondering what they take and whether they’ve experienced unwanted side effects themselves.
“I didn’t even notice my hair was thinning until my mother pointed it out to me,” said Veronica, a 26-year-old book editor in Manhattan, who was on Lo-Loestrin (a triphasic chemical cousin to monophasic Loestrin, with lower estrogen levels and a norethindrone progestin rather than norethindrone acetate) for eight months in 2012. “When I looked closer I could see she was right. I used to have thick brown hair and bangs, now you can visibly see my scalp and I don’t wear my hair up very often because I’m afraid more of my hair will fall out.” While Veronica can’t prove the pill caused her hair loss—she stopped taking it because she felt it was “controlling [her] and [her] emotions”—she agrees that the timing does make sense.
To be clear: There have been no double-blind or controlled studies that conclusively confirm this hair-loss hypothesis. Besides, nearly all birth-control pills (plus other medications like beta-blockers, NSAIDs, and certain antifungals) list hair loss as a possible side effect among many others: blood clots, depression, unwanted hair growth on the arms and face.
“I think that there’s a link there, but again, that’s based only on my experience,” says Dr. Geoffrey Redmond, an endocrinologist specializing in female hormone problems at the Hormone Center of New York, and the author of the book It’s Your Hormones, who has treated over 10,000 women in his 25-plus years of practice.
“The pill has two types of hormones in it, or most of them do: a form of estrogen, which is good for hair, and a progestin, which is a modified form of progesterone. And those vary in their androgenic activity,” he says. “The two situations which might give rise to hair loss over the pill are, first of all, if someone is on an androgenic progestin, of which the norethindrone in Loestrin is one of them, and norgestrel, which is in a variety of other pills, that’s another one—that’s the one that’s most androgenic.”
The second situation is estrogen—it makes hair grow better, which is why most women notice their hair gets fuller during pregnancy; and a drop in estrogen, as in after giving birth, will trigger shedding. In a way, stopping a birth-control pill is a little bit like giving birth, hormonally, in that the estrogen levels drop, and it’s fairly common for women to notice hair loss from stopping the pill. But it’s not from having been on the pill, it’s from stopping it.”
Another situation Redmond says is important to be aware of is that sometimes a woman with a tendency toward hair loss can be on a “hair friendly” birth-control pill, one high in estrogen, and only upon quitting the pill, losing the benefits of its estrogen, and going through a shed, will she realize she has a problem with alopecia.
All right, so we know that Loestrin and its ilk are, as Redmond terms it, “hair-unfriendly pills.” So what does he recommend? The ones that are non-androgenic are the family that include Yaz and Yasmin—though there are safety issues with those in terms of blood clots. And those that contain desogestrel, such as Desogen, Mircette, and Apri (the latter of which was what my OB-GYN followed up with and prescribed to me). And also those that contain norgestimate, which include Ortho-Cyclen and Tri-Cyclen. (A controversial pill called Diane-35 is known to be particularly good for hair and acne, though it’s not approved in the United States and has been banned in France after a spate of fatal blood clots.)
“Stopping the pill itself may make [hair loss] worse, at least temporarily,” says Redmond, explaining that telogen effluvium, or the period of hair loss post-pill, usually begins anywhere from a few weeks to three months after discontinuing use of the BCP. The shed itself can last several months.
“Usually going on one of the [hair-friendly pills] is the best thing to do in that regard,” he advises, adding that going on a testosterone blocker, like spironolactone, can be additionally beneficial for those who have experienced hormonal hair loss.
Rachel, a recent college graduate with PCOS who experienced significant hair loss after taking Microgestin, was prescribed spironolactone by her OB-GYN. “Since I started taking it at the same time I changed my birth control to the NuvaRing, I’m not entirely sure what benefits come from which medication,” she says. “However, with the two working together I’ve definitely had much less shedding and positive hair growth.”
Hair loss can occur in women of all ages, and according to Dr. Redmond “it’s a combination of genetic susceptibility plus hormonal events that bring out that susceptibility.” But there are typically two peaks for hair loss: mid-twenties to mid-thirties, and then mid-forties onward, when a lot of women are in peri-menopause.
“Every human being gets androgenetic alopecia; it’s an aging process,” explains Dr. Paul McAndrews, a hair transplant and corrective surgery expert in Los Angeles, and a clinical instructor of dermatology at the USC School of Medicine. “Tooth decay is an aging process, too. A dentist doesn’t stop tooth decay; toothpaste does. I don’t stop hair loss, I fill in cavities just like a dentist.”
Just as you’d go to the dentist to drill and fill a molar cavity, McAndrews sees male and female patients, ranging from teens to octogenarians who are curious about their candidacy for hair restoration surgery. Not everyone is a match. For starters, you need to have enough donor hair (usually coming from the back of the head, near the nape of the neck) to use for follicular implantation in the sparse spots up above or in front—anywhere from 700 to upward of 2,000 grafts. Also, the patient needs to be realistic about her expectations for results. “It’s a supply and demand thing,” says McAndrews. “I lose sleep worrying if I can keep up with someone’s goal.” Young men in their twenties and thirties, and women, tend to arrive at his office hoping to restore their 18-year-old fullness, which is just not realistic. McAndrews agreed that the androgenic hormone pill would be problematic for those with a genetic propensity for ADA. He said it would be wise to stop taking it, lest it turn on my “genetic light switch.”
For those who have experienced significant hair loss and are prepared to undergo the type of restorative surgery McAndrews specializes in, expect to pay top dollar: 2,000 transplanted grafts can run you close to $20,000, that’s about $10 per hair follicle! But the procedure, unlike scam solutions marketed online—miracle tonics, pricey at-home laser therapy combs—absolutely works.
I hope the charismatic McAndrews and I never have reason to meet. I hope that switching from Microgestin to Apri abates any further excess shedding, and that my “genetic light switch” hasn’t been turned on to advance the thinning process prematurely. There are so many birth-control pills available today, it’s easy to forget that the pill does much more than merely prevent unintended pregnancy. “People think, ‘Well, they all work the same for birth control, so what difference does it make?’ But it does make a difference,” says Redmond, the endocrinologist. Finding the correct combination of hormones for your body and your unique genetic background is crucial, the sooner, the better.