AboutPeter J. Panagotacos, <B>M.D.</B> Expertise I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified
in Dermatology and Hair Restoration Surgery.
Experience I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified
in Dermatology and Hair Restoration Surgery.
More information can be found at my website
www.hairdoc.com
Question Do you have to necessarily be dependent on Spironolactone in order to keep hair? I ask because I find it very curious that I had not had a problem with hair loss in the past, in fact, I had too much hair and then with the coincidence of the recent events that have happened I thought that my problem was due to stress in which in some form or another has triggered an elevation in cortisol and testosterone. Is it possible that my condition will improve to the point that I don't need medication anymore?
I have heard that when it comes to PCOS you have androgenic alopecia. I would think this is a chronic condition you've always had and it is a little difficult to reverse. But is it also possible to have PCOS or at least symptoms of PCOS (acne, excess hair, etc..) and just have a sudden elevation in testosterone, BUT not have AA?
One last question, are you familiar with effects of dexamethasone? I have had two dexamethasone suppression tests and noticed that I broke out more than usual a couple of days after stopping the medication. My doctor says no, but I am wondering if this is causing some other adverse reaction in my situation since my cortisol is already high.
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Followup To
Question -
I am experiencing hair loss. I have been told I have PCOS because a small cyst was discovered by a sonogram recently and I had every other symptom: excess hair, irregular menses and acne, all except hair loss. My other symptoms however, except for the acne, were never really severe. Acne went under remission after Accutane 10yrs ago, but then came back recently less severe. This along with a new symptom--hair loss. It happened after a prolonged event that had me severely stressed and I became an under eater when I began college (I am 23 yrs old). I reduced to eating small square sandwhiches and a bowl of cereal a day and quit eating meats. I also began having heart palpitations, depression and excessive sweating and anxiety recently.
I am being seen by and endocrinologist and told her my PCOS symptoms never caused me hair loss in the past and not all PCOS sufferers experience this problem, why now and why with the coincidence of the recent events? She was dubious at first and still thought it was the PCOS, but went along with some bloodwork to be sure, but not all testing is complete. So far, I am negative for any auto-immune disorders and my testosterone levels are high despite oral contraceptives given to me for the hair loss specifically about 2 months ago. My cortisol is 4x's the normal amounts and was proven with 2 cortisol blood draws and a 24 hr urine test. I am underway for a Cortisol DHEAS test to see where this cortisol is coming from. I am being given 2mgs of dexamethasone 4x's a day for 2 consecutive days and then have a cortisol DHEAS test on the third day. What is dexamethasone? I don't understand why my doctor is testing me with dexamethasone if my cortisol is already high? Doesn't this accelerate hair loss with added cortisol?
I have never had a scalp biopsy before, but based on what I have said, could there be a possibility that my problem is not the PCOS, but excess cortisol? If so, what type of hair loss is this, tellogen efflevium? My hair loss seems to have been a sudden onset, but has persisted for about 1 1/2yrs and hasn't slowed down. Same goes for my other symptoms, including the palpitations which are increasing. They are waking me up at night and then I feel shaky and anxious. All of this seems to have stemmed from the time I started school.
Answer -
Dexamethasone is a cortisone and is used for many different conditions. In PCOS there is an increase in Testosterone and as a result an increase in DHT. It is DHT which tells hairs to grow old and fall out. You may be experiencing premature androgenetic alopecia as a result of the high levels of DHT over the years. This is normally treated by blocking the site where DHT works by giving spironolactone. You should ask your endorinologist about this.
Answer I'm sorry but this question is too long and involved for me to help with. I have asked you to consult with your endocrinologist for those answers. I can not. Yours seems to be a complicated case which should be managed by your own private doctor who knows the problem in more detail than I.
