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As your prolactin levels go higher than what is deemed normal, a condition called hyperprolactinemia sets in. This creates a hormonal imbalance that gradually causes hair thinning. Prolactin does not cause hair fall, but it does disrupt your hair growth cycle. It can happen owing to stress or even due to the medical side effects of thyroid disorders and PCOS. While this condition predominantly affects women, it can have an indirect effect on men as well. High levels of prolactin can also boost dihydrotestosterone (DHT) production, which is a key cause of male pattern baldness.
Now, let’s understand what prolactin actually is. The most common association with the word "prolactin" is breastfeeding, and that is correct. Prolactin is a hormone, located in your pituitary gland, that produces milk after childbirth. However, prolactin also interacts with other hormones, mainly estrogen, progesterone and testosterone. When prolactin levels increase, a condition called hyperprolactinemia sets in and disrupts your hair growth cycle.
What is hyperprolactinemia, and how is prolactin involved?
Hyperprolactinemia takes place when an abnormally high amount of prolactin enters the body. It is a condition that impacts less than 1% of the general population, with women more prone to this condition.
For some, the condition can be temporary, with causes often linked with stress, pregnancy or certain types of medication. In others, hyperprolactinemia can be a chronic condition which needs proper consultation from a specialist.
The most common medical cause is a prolactinoma. Here, a tumour sets in the pituitary gland and overproduces prolactin. The word ‘tumour’ may have rung a few alarm bells; in reality, a prolactinoma is not cancerous and certainly not life-threatening. However, it still needs to be diagnosed and managed. After all, it can impact your reproductive health, bone density, vision, and most certainly, your hair.
How does high prolactin cause hair loss?
Well, the honest answer is no, it doesn’t. At least not directly. High levels of prolactin interfere with your hormonal system, which keeps your hair cycle on track. It is known as the hypothalamic-pituitary-gonadal axis, and when prolactin levels are elevated, the axis is thrown off balance.
Your ovulation may stop. Your estrogen levels could drop. Your androgen balance could shift, making your hair follicles too sensitive to hair fall. In women, you would see diffuse thinning of the scalp or increased daily hair fall. While men would experience fatigue, reduced sex drive and gradual thinning as testosterone production is suppressed.
So, even though prolactin doesn’t cause hair loss, it is connected to your hormones.
How does prolactin disrupt your hair growth cycle?
Your hair growth cycle undergoes four key phases:
- The anagen phase – Where your hair actively grows
- The catagen phase – Where your hair is preparing to test
- The telogen phase – Where your hair actively rests
- The exogen phase – Where your hair begins to fall
Your hair thrives and feels nourished during the anagen phase. Ideally, the phase should last between two and seven years. But when your prolactin levels are high, your hormones are thrown out of balance, which can push your hair follicles into rest. As a result, your hair begins to fall out.
At the same time, increased levels of prolactin in your system can make your hair follicles more sensitive. Thus, making you more prone to telogen shedding. Plus, if hair thinning runs in your family, elevated prolactin can only further expedite the process. You are likely to see its impact on your hairline and crown.
It is for this reason that any hair fall due to an imbalance of prolactin is gradual, almost invisible, until it becomes undeniable.
What causes prolactin to rise?
The most important step is understanding the causes of a prolactin imbalance and how to address it. There are mainly three causes for excessive prolactin:
Physiological causes
More common than the other two, physiological causes are driven by the brain and nervous system, which respond to everyday physical and emotional demands. You would face temporary prolactin fluctuations in any of these activities:
- Pregnancy
- Breastfeeding
- Intense physical exercise
- Stress
- Sleep
These are natural, short-term fluctuations that can easily be resolved on their own.
Medical causes
Medical causes are the most common reason for elevated prolactin levels of them all. The diseases are:
- Pituitary adenomas (prolactinomas)
- Hypothyroidism
- Polycystic ovary syndrome (PCOS)
- Chronic kidney disease.
Your body’s ability to regulate prolactin diminishes in any of these conditions.
Medication-induced causes
Often overlooked, but medication-induced causes are more common than you think. Your prolactin levels can increase as a side effect of any of these medications:
- Antidepressants
- Antipsychotics
- Certain blood pressure medications
- Oral contraceptives
So, if your hair falls begins after starting a new medication, maybe this is a connection worth discussing with your doctor.
What are the prolactin hormone imbalance symptoms?
It is not easy to notice all the symptoms of a prolactin hormone imbalance. However, there are signs you can look out for. In women, the most common symptoms are:
- Irregular or absent periods
- Milky discharge from the breasts outside of pregnancy or breastfeeding
- Difficulty conceiving
- Reduced libido
- Vaginal dryness
- Gradual hair thinning
- Headaches
- Vision problems (in case of a large pituitary tumour)
In men, the signs show up as:
- Erectile dysfunction
- Reduced facial hair
- Fatigue
- Headaches
- Vision problems (in case of a large pituitary tumour)
- Reduced sex drive and
- In some cases, breast enlargement
As the hair thinning is gradual, it is often dismissed or blamed on stress-related activities. In reality, these are signs your hormonal system needs a proper clinical evaluation, and you need to consult a doctor immediately.
Why is elevated prolactin more severe for men?
Women are more prone to elevated prolactin; however, a higher level of prolactin can be quite severe for men. After all, a woman’s body is designed to experience prolactin imbalance through pregnancy, breastfeeding, menstruation, while there is no natural biological reason for a spike in men. What it tells us is that there is a larger underlying issue that needs to be addressed.
It also makes diagnosis challenging, as the symptoms are similar to those of other issues. Symptoms like low libido, erectile dysfunction, fatigue and reduced muscle mass are easily dismissed or attributed to other age-related causes. This, unfortunately, delays the diagnosis, and by this time, prolactin levels have shot up.
Typically, for men, excessive prolactin will suppress testosterone in the body. It can cause fertility problems, mood disturbances, and at times, even the loss of bone density.
How is prolactin imbalance diagnosed?
If your doctor suspects you may be suffering from a prolactin imbalance, they are likely to conduct blood tests to measure your serum prolactin levels. To get accurate results, it is best to take blood samples in the morning, as prolactin fluctuates naturally throughout the day. To help build a fuller picture, additional tests are conducted for:
- Thyroid function (TSH)
- Estrogen or testosterone levels
- LH/FSH levels
If the findings show high prolactin levels, you may be advised to undergo an MRI of the pituitary gland to check for signs of a prolactinoma. You could also be asked to take a vision test if a larger tumour is suspected to be present. That is why it is important to get a proper diagnosis because just treating your hair without addressing the root cause doesn’t really resolve your condition.
What are the treatments for prolactin imbalance?
When it comes to prolactin imbalance treatments, there is no single approach. This is because the treatment depends on the cause of the high prolactin levels.
Prolactinomas
For those with prolactinomas, treatment usually consists of medication. The most prescribed medications are dopamine agonists like cabergoline and bromocriptine. These medications need to be taken for a long time but have been shown to significantly reduce prolactin levels and, at times, even shrink the tumour. There are side effects like nausea or dizziness, but they ease off when doses are adjusted.
However, when the medication has not been able to manage prolactin levels or reduce the tumour, surgery is advised. Radiation therapy can also be considered, but only after medication and surgery have proven to be insufficient.
Hypothyroidism
If the treatment is for hypothyroidism-related high prolactin, then replacement of thyroid hormone is usually enough to get prolactin back to its normal levels.
PCOS
When it comes to PCOS, treatment is a bit more layered. Usually, prolactin imbalance due to PCOS is related to insulin resistance and androgen excess. So, addressing lifestyle factors and using insulin sensitisers can stabilise the hormonal imbalance, while supporting PCOS and your hair loss.
Medication
This is also the easiest treatment for high levels of prolactin, as it requires you to switch to an alternate drug, which is clinically appropriate for you. Of course, you should only change prescriptions after consulting your doctor.
How does your lifestyle impact your prolactin imbalance recovery process?
Prolactin can be managed medically, but your lifestyle also plays a significant role in your recovery. Take a look at some of the ways your lifestyle affects your prolactin:
- Being chronically stressed will raise your cortisol
- Being sleep deprived will also raise your cortisol
- Poor gut health limits how your body absorbs nutrients
- Nutritional deficiencies will deprive your hair of nutrients
These lifestyle shifts are not optional but extremely necessary for your recovery.
How long does recovery take after treatment for a prolactin imbalance?
Honestly, the only valid answer is time. When your prolactin levels are stable, it will take nearly two to three months to notice a drop in shedding. You are likely to see any signs of visible growth only after the four to six-month mark. Any meaningful improvement in hair density can take anywhere from six to twelve months.
It is important to remember that hair follicles require time to re-enter the anagen phase. It is a biological process; it cannot be rushed. All you can do is create the best possible conditions internally and give it the patience it needs.
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Your body is always communicating with you, showing you signs that it is under stress. So, when you suffer a prolactin imbalance, one of the first places it gradually reaches is your hair. It’s easy to miss, until it is impossible to ignore. Yet, with most conditions, time and the right treatment can make all the difference.
Frequently Asked Questions
Is stress solely responsible for elevated prolactin levels?
No, stress is not solely responsible for a rise in your prolactin levels. Your prolactin levels can also increase due to medical causes like pituitary adenomas, hypothyroidism, polycystic ovary syndrome (PCOS) and chronic kidney disorders and medication-induced causes owing to side effects of antidepressants, antipsychotics, certain blood pressure medications and oral contraceptives.
Does high prolactin always cause hair loss?
No, it is not the case for everyone. It is more likely to take place when prolactin interferes with other hormones.
Is prolactin hair loss reversible?
Yes, especially when it is identified early and immediately treated. After all, the longer the imbalance, the longer it takes to recover.
Do men also experience prolactin-linked hair loss?
Yes, though it is not really that common. When there is a high level of prolactin, testosterone is suppressed, which can lead to hair thinning.
Does your diet affect prolactin levels?
When you go on extreme diets, you restrict calorie intake which disrupts the hormonal balance and prolactin regulation. So follow a balanced diet that supports metabolic and gut health.
References:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3408995/
- https://www.tandfonline.com/doi/full/10.4161/derm.19472#d1e88
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1606541/
- https://www.ncbi.nlm.nih.gov/books/NBK537331/#:~:text=Epidemiology,appear%20earlier%20than%20in%20men.
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