The relationship between hormone replacement therapy (HRT) and hair loss in women is nuanced and frequently misunderstood — both by patients who fear HRT will worsen their hair loss and by those who hope it will reverse it. The reality depends significantly on the specific type of HRT and the individual patient.
Oestrogen has a protective effect on hair follicles — it extends the anagen phase and partially counteracts the effects of androgens on follicle miniaturisation. Women who enter menopause and lose oestrogen production often experience diffuse hair thinning as a result of this change in the hormonal environment. Combined HRT that includes oestrogen can help maintain the oestrogen-protective effect on follicles and may reduce menopausal hair shedding.
The progestogen component of combined HRT is the variable that most affects hair outcomes. Some synthetic progestogens — particularly those with androgenic activity, such as norethisterone and older formulations — can exacerbate androgenetic hair loss by binding to androgen receptors in susceptible follicles. Progestogens with anti-androgenic or neutral androgenic profiles — such as micronised progesterone, dydrogesterone, or dienogest — are preferable for women with hair loss concerns.
Women who are experiencing post-menopausal hair loss and considering HRT should discuss hair loss as a specific consideration with their prescribing physician, so that the choice of progestogen is made with this in mind. Consulting a dermatologist or trichologist with expertise in female hair loss in parallel with the HRT discussion provides the most complete approach.
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