HRT hair loss, don't know what to do next!

[Pinkseashells]

Sorry this is long but hoping someone can help! Started peri about 5 years ago at 47, had night sweats, immense rage but for the first time since i was a teenager my hair was amazing, thick and long and healthy which i attributed to a new diet and increased protein consumption. Went on HRT in May 2022 as rages were out of hand and sleep was awful. Had been a year without a period at that point so doc thought full menopause. The HRT helped other symptoms but i had very heavy bleeding which was unmanageable even when dose changed (started on 50mg evorel patch and 200mg of utrogestan tablet 14 days monthly, which doc reduced to 25mg of oestrogel to try and manage bleeding and same dose of utrogestan).
However HRT completely ruined my hair. It started as shedding which i didnt take much notice of as still had a lot of hair, but then got so thin and straggly. By March 23 others were noticing including my hairdresser that it was shedding really badly, and looks like Tef E when i have researched. Also after reading hormone repair manual i wonder if the new hair growth i had in peri could have been due to oestrogen dominance and not protein as i had thought.
Read threads on here of others experiencing hair loss on HRT and came off it as was terrified. Its not shedding as badly as it was now but still lose more than i used to when washing hair and it is thin around temples and any new growth is like candy floss and all fluffy and thin, and now poor sleep and rage back and i dont know what to do. Terrified to go back on HRT and lose more hair and wondered if anyone has had similar experience and if they retried HRT and/or managed to reverse hair thinning. Am trying rosemary oil, georgiemane and collagen but cant see a huge difference yet and wonder if that was the last hurrah for my hair. I have also read others say that oestrogen helps hair growth so wonder was it the progesterone that was causing and was my dose too high once my oestrogen dose was changed? Thanks for reading and any advice!

@MrsPelligrinoPetrichor ive just started rosemary oil last week so hoping that helps.
@LuckyCharmz no havent had anything like that, have had covid but before all this started

@heartbroken40 thats interesting to know, maybe I should it try it! I have had good results with the topical, but it can make my scalp dry and a bit itchy at times which I don't like.

Offering some solidarity. My hair was shedding quite bad last year for about 3 months. It’s thinner overall & my parting is a bit wider. I can only think it’s hrt that’s caused it, I have 75mg patch & Mirena. I’ve tried collagen, biotin, scalp oiling etc & it’s not really improved. Ive bought the saw palmetto supplement but have now read you can’t take it with HRT. My ferritin has consistently been good every time I’ve had it checked, it was 84 in October. So it’s not that. My GP is not interested, said as I was bereaved in June it’ll be the stress from that & I have Telogen effluvium. All this without seeing me. I think I may have to go down the same route as @heartbroken40 so it’s reassuring to know I can buy minoxidil tablets.

Sorry you are having it too @Offredismysister, i know there are worse problems to have but its so horrible isnt it.😔I have done some research on TE today as am sure it is that and it does say it usually rectifies itself within 6-9 months and that minoxidil is the only treatment even if you go to a specialist, so im not going to waste money on a private consultation as i think @heartbroken40 and @nottaotter are saying what they would anyway. So i am also going to try that. Fingers crossed for us.x

@nottaotter I absolutely hate topical stuff on my scalp/hair. That's why I moved straight to oral minoxidil. I read all of Dr Donovan's posts, did my research and ordered.

To the OP: true TE actually stops by itself in 6-9 months as you said, but it often unmasks AGA especially in older ladies (40+).

The only thing is Oxford online pharmacy only sells the pills to men so you need to ask your partner to order for you (I will complain to them about it at some point but my partner ordered quite a few boxes for me so I'm fine for a few years now but when the time comes to reorder at the end of 2026 I hope they allow women to buy it too- very sexist)

@heartbroken40 i wouldnt usually take any meds im not prescribed but i have researched and am going to get them as all of the clinics mention them as potential (and only) treatments. And i took prescribed HRT not even thinking this would be a result! Can i just ask do you take both medications at the same time daily, and have you had any side effects like extra hair growth anywhere else? Very grateful to you as you have clearly had same and come out of the other side and i was feeling very down about it.x

I take the oral minoxidil in the morning (I normally have low blood pressure but it hasn't affected it) and finasteride in the evening. I perhaps have a bit more extra peach fuzz on my face but I dermaplane/thread regularly. I definitely don't have super thick hair on my face or anything.

Some people do get hair loss from HRT (any hormonal change can cause hair loss) that's one of the reasons why I'm reluctant to even try

Good luck and let us know how you get on

Thanks so much @heartbroken40 i definitely will!
Yes i hadnt read anywhere about hair loss and it is played down a lot IMO on many of the main HRT advice platforms, i thought i was imagining it at first and would have come off it sooner. Ive dug deeper and as you say any hormonal change can cause it. For anyone reading this who is on the fence with HRT or thinks it might be causing hair shedding helpful advice i have found since is to ease in gently if you take HRT as the shock of hormonal change can cause TE. Im not going back on it though. DH and my family and work colleagues have been great and agree to let me know if im stroppy and tell me to take 5!

I keep reading that something like 50% of women over 40 have thinning hair. But I don’t see this reflected in everyday life. Do update this thread @Pinkseashells if you go ahead & have good results. I’m seeing a different hairdresser tomorrow to look at options. My current one is a friend & is too nice.

@Offredismysister i will definitely update with how i get on. And good luck with hairdresser today x

Was just coming on here to say that. I got my ferritin up to 126 and no more hair loss. It was 35 initially and caused me to lose a lot of hair.

Another thing I did OP was use mens regaine foam (5% minoxidil) and apply it once a night to scalp. It's great but once you start you do have to sue continuously to maintain results. There is a women's regaine but lower percentage and more expensive so I was told to use men's version.

Both of the above suggested by a private dermatologist as I had really bad hair loss and shedding due to stopping breastfeeding and starting a new medication. Was so bad I didn't wear my hair down for 2 years because it was too thin. A year into siring the regaine and iron tablets (210mg ferrous fumerate and Hugh strength vit c to help absorb) and my hair is about 6 months from being back to normal again.

@Plumtop11 have only just seen your message, thank you so much! So glad for you that yours is almost back to normal, thats amazing! I decided in the end to see a consultant dermatologist privately and get a proper diagnosis and saw her today. She has confirmed it is androgenetic alopecia (not the Tef E i had self diagnosed) and as i thought it has been brought on by HRT which she confirmed fairly commonly causes hair loss, particularly the progesterone, and particularly if you are predisposed to hair thinning genetically (lots of bald men in my family it doesn't have to be women) and have had hormonal issues previously (i had suffered PCOS in my 30’s and that can be an indicator of hormonal sensitivity). She was very reassuring and confident my hair can be recovered. She suggested i don't stress myself out further with a potential shed episode with minoxidil as a first option (even though it is pretty much guaranteed to work) as i have a few big family/social events in next month or two and don't want to lose more hair, so am going to try a topical finasteride (trying that before oral as moods can be a side effect of oral and was one of reasons i went on HRT) and 100mg oral Spironolactone and seeing how that goes, but I can add minoxidil if i don't see a big improvement (she also said Regaine 5% if i do decide to use it).
I am on an iron supplement now so hoping with all of that i get some improvement in 6 months but if not will try the Regaine. She did say i don’t have a lot of miniaturisation of follicles and no scarring so she is very confident it will go back to baseline. So i feel much more hopeful and less scared, and will come back and report on results!

Thank you for starting this thread OP.

I had an awful lot of shedding two years ago. I think it was peri and stress (family related). I took iron tabs and Biotin. I went to the GP who did blood tests and said there was nothing wrong. I was convinced I had alopecia too. The amount of shedding in the shower scared me.. my parting was very wide and my hairline was receding. I had always had really thick hair and to hear hairdressers calling one another over to exclaim at my hair was so distressing.

It took twelve months but it did come back. I’m more careful with it now. I wash it twice a week at most and try not to use too much heat on it. I stopped putting it into a ponytail when I was doing housework/going to bed. Overall I’m more careful with it.

Please continue to update this thread if you remember. I hope your treatment works. It sounds frivolous to stress about hair but it’s our biggest accessory.

@Christmasnutcracker its so frightening isnt it. I looked everywhere for answers so hopefully others who do the same will find this thread and know that it can be fixed. I am the same as you i am very careful now when brushing it and washing it, and the dermatologist said to avoid blow drying it and using heat wherever possible as a general rule. Its definitely a huge thing for a woman, i feel so much better now i know what it is and am hoping by this time next year it is back to normal.

Just seen your update OP.
Can I ask which private healthcare provider you used?

Hi @Offredismysister I researched hair clinics in my area then worked out it was a consultant dermatologist i needed (and not a trichologist as they can just be hairdressers with a diploma and not the Dr’s i thought they were). Once i found a few (around 6) i read their websites and googled reviews and picked one with some of the best ones. I contacted to make an appt through her clinic website. I was really reassured when i saw her as she has treated it successfully in lots of cases. Ive just started the treatment so will update on progress! So my advice is research consultant derms in your area. It wasnt cheap but i am just looking at it that going private for my hair is worth it.😊

Glad you got the answers.
i also lost hair on HRT - wasn’t ferritin or iron. I now take an SSRI for mood, and my hair is slowly returning to usual growth.

Thanks @Pinkseashells
I have looked at the major providers near here, spire, Nuffield, bupa but none of the dermatologists mention hair loss.
I’ll keep looking.

Are you near London? There are a few on Harley Street with their own practices, and the majority have really good reviews. I didnt look up providers, just searched ‘consultant dermatologists near me’ maybe try that?x

@Twoshoesnewshoes What is an SSRI as i could do with something for my moods still?! So glad yours is growing back!😊

SSRI is essentially an anti depressant/anti anxiety medication. I take citalopram which has been great.

Thank you, i dont know if it would work for me as im not anxious or sad, its more angry moods i have had with menopause but im aware of it now and managing it better so people around me aren't suffering from them!x

Ah no I’m midlands. I saw a hairdresser who said she could see new growth & that my crown was normal as she has lots of clients with a similar split. She suggested a few options.

Could I ask why you were prescribed spironolactone please?
I would like this prescribed for oily skin which is causing awful spots. I have tried most other things. I want to get my skin under control before I start HRT. The doctors seem reluctant to prescribe.

@Offredismysister yes i think its very common, ive gone the medication route as i have had shedding for so long and its got so thin and straggly. The DHT which the HRT triggered can only be reversed with prescribed medication and i dont want it to get worse. She said regaine is highly effective but i am trying to avoid the dread shed if i can!