Is HRT the Fix for Menopause Hair Loss?

If you’re in perimenopause or menopause and noticing your formerly thick ponytail is starting to feel puny or your part seems to be widening, it’s understandable to feel frustrated. Just know you’re not the only one Googling vitamins for menopause hair loss.

About 50 percent of women experience the most common type of hair loss, called female-pattern hair loss (FPHL), at some point in their lives. ¹ The condition often surfaces or gets worse during perimenopause due to fluctuations in hormones like estrogen and progesterone. ²

One potential solution for hair loss is hormone replacement therapy (HRT). While not specifically approved as a hair loss treatment in menopause, certain types of HRT may stop hair thinning in its tracks and even spur regrowth. While it doesn’t cause hair regrowth for everyone, for some women, HRT gets to the root of the problem.

Here’s what experts know (and are still figuring out) about how HRT might help with hair loss.

About the Expert

Michele Green, M.D., is a cosmetic dermatologist who treats hair loss.

How HRT Can Help With Hair Regrowth

Since shifting hormones appear to be a major factor in female pattern hair loss (FPHL) in perimenopause and menopause, HRT may stimulate hair regrowth.

To understand how HRT might prevent menopause hair loss, it helps to break down the hair growth cycle. At any given point, every hair follicle on your scalp is in one of three stages:

• Growth phase (anagen), a period of active growth during which strands of hair sprout from follicles and go on to reach their full length and volume.
• Transition phase: (catagen), a transition period when hair stops growing.
• Resting phase (telogen), when hairs aren’t growing or being shed.
• Shedding phase (exogen), when hairs fall out.

During menopause, shifts in estrogen, progesterone, and androgens (such as testosterone) appear to disrupt this hair growth cycle, contributing to FPHL. ^{3 4} Research has shown that women who’ve reached menopause have a reduced proportion of hairs in the growth phase and an increased proportion in the resting phase. ⁵

FPHL is characterized by the gradual shrinking (aka miniaturization) of hair follicles, which then produce fewer, finer hairs with shortened growth phases. ⁶ Women in menopause with FPHL may notice:

• Overall loss in hair density
• Changes in hair texture
• Thinning and loss around the crown and/or the temples

“By increasing estrogen and progesterone levels, HRT can keep hairs in the resting stage and prevent them from entering the shedding stage,” says cosmetic dermatologist Michele Green, M.D. “HRT can also reduce hair follicle shrinkage and increase hair thickness and density, and may promote new hair growth, depending on the patient’s response to the medications.”

A second type of hair loss, telogen effluvium (TE), can also occur in midlife. TE is characterized by rapid hair shedding when hairs prematurely move from the anagen phase to the telogen phase and fall out early. TE usually occurs two to four months after a disruptive life event, such as childbirth, traumatic injuries, or emotional stress. When the stressful event is over, hair regrowth begins.

Green says HRT is typically effective only for FPHL, because of the association with hormonal imbalances. TE is unlikely to respond to HRT because it’s not a hormonally related form of hair loss.

Does estrogen help hair growth?

Since estrogen is believed to promote growth by keeping hairs in the growth phase for longer and preventing follicle shrinkage, HRT regimens containing estrogen may promote hair growth.

Estrogen levels fluctuate wildly during perimenopause before decreasing as menopause nears. These drops in estrogen are associated with more hairs in shorter growth phases, which can trigger or exacerbate hair loss, Green says.

Declining estrogen levels in menopause might also cause blood vessels to shrink, restricting the blood supply to hair follicles and interfering with the flow of nutrients and oxygen. ⁷

HRT that contains estrogen—which means most HRT regimens prescribed for menopause symptoms—helps replenish diminished levels of the hormone.

If you’ve ever been pregnant, you may already be familiar with how hair can change during periods of known hormonal upheaval. During pregnancy, when estrogen levels soar, many women have lustrous, fast-growing locks. ⁸

Does progesterone help hair growth?

HRT regimens that include progesterone can help minimize hair loss by preventing hair follicle miniaturization.

During this process, hair follicles shrink and produce shorter, finer hairs (vellus hairs) rather than strong, full-length strands (terminal hairs). With FPHL, some portion of scalp follicles miniaturize enough to stop producing hair altogether. ⁹ Experts used to think miniaturization occurred gradually, over the course of multiple hair growth cycles. But most now believe that the process happens within a single growth cycle, which can last for two to eight years. ¹⁰

Among many other functions, progesterone prevents testosterone from being converted into DHT, a more potent version of the hormone that binds aggressively to receptors and is associated with follicle miniaturization, says Green. Since progesterone drops during menopause, HRT that contains progesterone may prevent this from happening.

Does testosterone help with hair growth?

There’s some evidence that for women who are androgen-deficient, testosterone therapy may help with hair growth. For the most part, however, testosterone and other androgens are thought to work against scalp hair growth. ¹¹

Testosterone levels fall during menopause, but more gradually than estrogen and progesterone. That means testosterone rises proportionally to the other two hormones. Elevated androgens like testosterone have been linked to FPHL. For example, in one study, postmenopausal women with hair loss had higher levels of testosterone and DHT (and lower levels of estrogen) compared to those without hair loss. ¹²

Additionally, HRT with testosterone, which might be prescribed for low sexual desire related to menopause, can have a negative impact on hair growth. “Testosterone can increase the risk of hair thinning and hair loss when elevated,” Green says. “In the body, testosterone can be converted into DHT, an androgen hormone that is associated with hair follicle miniaturization.”

Most women with FPHL have normal androgen levels. ¹³ So, although high levels of androgens like testosterone might be one possible cause of FPHL, the condition doesn’t seem to be entirely androgen-dependent. What’s more, women with androgen deficiency can develop FPHL. For these women, HRT regimens that include testosterone may promote hair growth. ¹⁴

How fast can HRT help with hair loss?

One small study from 2023 suggests estrogen-only HRT might improve hair density and strand strength within six months. ¹⁵ However, therapeutic responses vary, and experts can’t reliably predict if HRT will stimulate hair regrowth in menopause.

One factor in how quickly—and how well—HRT might help with hair loss is whether or not thinning and shedding were issues before menopause.

“It is hard to say exactly why some women respond better to HRT than others,” says Green. “Some women may only experience hair loss as a result of menopause, in which case using HRT to increase estrogen and progesterone levels can greatly improve their hair. Other women may have preexisting hair loss that’s exacerbated by reduced hormone levels during menopause. These women would likely need additional medications or treatments [beyond HRT] to alleviate their hair loss.”

Which Is the Best HRT for Hair Loss?

For hair loss in menopause, doctors might prescribe estrogen-only HRT or estrogen-progesterone combination therapies.

HRT isn’t approved to treat hair loss alone, although your doctor may prescribe it off-label if you’re experiencing menopause symptoms that might coincide with hair loss, like hot flashes and night sweats, vaginal dryness, and recurrent UTIs.

Estrogen and estrogen-progesterone combination therapies are available as pills, creams, patches, injections, and more. “Research is limited as to which HRT delivery system is best for hair loss,” Green says. “Some women may use one system over another depending on their preference, tolerance, or medical history. When choosing an HRT system, it is best to consult with a board-certified OB-GYN.”

Other Medications for Menopause Hair Loss

• Topical minoxidil (the active ingredient in Rogaine) is the only FDA-approved treatment for FPHL. It encourages hairs into the growth phase, Green says. She notes that many dermatologists also prescribe oral minoxidil off-label to women in menopause for hair loss, which research suggests might be slightly more effective for FPHL than the topical version. ¹⁶
• Finasteride (Propecia) is an oral medication that’s FDA-approved for hair loss in men and commonly prescribed off-label to perimenopausal and menopausal women. Finasteride inhibits the conversion of testosterone into DHT to prevent follicle shrinkage. Dutasteride is a newer, more potent drug in the same class. Studies suggest that dutasteride is more likely than finasteride to cause hair regrowth. ¹⁷ These drugs aren’t prescribed to premenopausal women due to safety concerns, including an increased risk of birth defects in male fetuses if taken while pregnant. ¹⁸
• Spironolactone, an antihypertensive drug, prevents testosterone and DHT from binding securely to androgen receptors. It’s the antiandrogen drug most commonly prescribed off-label to women in menopause for hair loss, although there’s limited evidence of efficacy. ¹⁹
• Platelet-rich plasma (PRP) injections are a newer option for menopause hair loss. The treatment involves taking a sample of a patient’s blood and separating out PRP, which contains growth factors and proteins that support tissue regeneration, then injecting it into the scalp. Green says PRP injections can reduce shedding, increase hair thickness, and promote regrowth.

Other potentially helpful fixes for menopause hair loss beyond HRT include:

• Low-level light therapy
• Botox injections
• Microneedling
• Topical anti-androgen drugs.

Hair loss treatments are often combined to maximize results. Minoxidil, for example, is commonly prescribed alongside spironolactone or finasteride. ²⁰ If you’re considering these medications or HRT for hair regrowth, an OB-GYN or dermatologist can talk you through your options.

Mentioned in This Article:

Finasteride + Minoxidil

Manage hair loss and promote hair regrowth with a topical solution of both finasteride and minoxidil. This FDA-approved, two-in-one prescription supports healthier, fuller hair.

Learn More

Estradiol Patch

Estradiol patches can help alleviate symptoms of menopause, including hot flashes, vaginal dryness, and osteoporosis, by supplementing reduced estrogen levels.

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Progesterone

Prescription progesterone tablets help balance and regulate the body’s natural hormone levels to benefit women undergoing menopause or experiencing menstrual conditions.

Learn More

About the reviewer

Dr. Shelly Chvotzkin, D.O., F.A.C.O.O.G., is a physician board certified in obstetrics and gynecology. She is a member of the American College of Osteopathic Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the Menopause Society (formerly known as the North American Menopause Society or NAMS).