PCOS Acne, Excess Hair and Hair Loss: Causes and Treatment Options

Acne, unwanted hair and thinning hair are some of the most distressing PCOS symptoms, and often the most visible. They have a shared cause and several treatment options.

The common cause: androgens

All of these symptoms come from higher androgen levels (hormones like testosterone) or higher sensitivity to them. In PCOS, the ovaries tend to make more androgens, and insulin resistance can push levels higher still.

Androgens affect skin and hair follicles in different ways depending on where they are:

• Skin: more oil production, leading to acne and oily skin
• Face and body hair: fine, light hair turns coarse and dark (hirsutism), often on the chin, upper lip, chest, stomach and back
• Scalp hair: follicles shrink over time, causing thinning at the crown or along the part line

Acne

PCOS acne often appears along the jawline, chin and neck, can be deep and tender, and tends to continue past the teenage years.

Options to discuss with your doctor or dermatologist:

• Topical treatments such as retinoids, benzoyl peroxide or azelaic acid
• Combined birth control pills, which lower androgen activity
• Spironolactone, an anti-androgen medicine, sometimes added to the pill
• Oral antibiotics or isotretinoin for more severe acne, prescribed and monitored by a specialist

Excess hair (hirsutism)

Hirsutism affects many people with PCOS and can have a big emotional impact. It deserves proper treatment, not just a quick mention.

• Hair removal: shaving, waxing, threading and depilatory creams work immediately. Laser or electrolysis reduce regrowth over time
• Combined birth control pills are often the first medical step
• Anti-androgens (such as spironolactone) may be added if there’s not enough improvement after about six months. They must be used with effective contraception, because they can affect a developing baby
• Eflornithine cream slows facial hair growth for some people

Thinning scalp hair

PCOS-related hair loss usually looks like female-pattern thinning: a widening part or thinner hair at the crown, without bald patches.

• Topical minoxidil is the most widely used treatment
• Anti-androgen medicines may help some people
• Ask your doctor to check iron, thyroid function and vitamin levels, since these can also cause shedding

Be patient and measure fairly

Skin and hair treatments take time. Most need three to six months before you can judge them, and hair growth treatments often longer. That’s long enough to forget what things looked like at the start.

Two things help:

1. Take consistent photos every month in the same light and position
2. Log symptoms like acne flare-ups and hair shedding regularly. Ovra shows how often each symptom appears and which phase of your cycle it clusters in, so you can see whether a treatment is working

It’s not about hygiene or willpower

PCOS acne isn’t caused by poor skincare, and excess hair isn’t something you could have prevented. These are hormonal symptoms with real treatments. If they’re affecting your confidence or mood, tell your doctor. That’s a valid reason to treat them.

Sources

• 2023 International Evidence-based Guideline for the Assessment and Management of PCOS (Teede et al., J Clin Endocrinol Metab, 2023)
• ACOG, Polycystic ovary syndrome (PCOS) FAQ

This article is general education, not medical advice. Check with your doctor before making medical decisions.