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It’s normal to worry about hair loss wherever it happens. You may be particularly concerned if you’ve noticed your pubic hair falling out.
Don’t worry. There could be several reasonable explanations for why your hair down there is falling out, from low T to stress. Your healthcare provider can help you pinpoint the specific cause and suggest treatment options, so it’s a good idea to set up an appointment. Until then, reading up on the possible causes of pubic hair loss may ease your worries. Let’s begin.
What causes loss of pubic hair?
A little hair loss now and then is normal, but if you’re noticing a large amount of pubic hair falling out, it could signify an underlying medical condition. Here are some possibilities:
Hair loss is a normal part of aging for both men and women. While we tend to worry about thinning hair on the top of our heads, age-related hair loss can affect any kind of body hair, including hair down there. Armpit and pubic hair can turn gray and thin, just like your scalp hair (Sinclair, 2005).
Hormones play a major role in hair growth, particularly androgens like testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA). During puberty, androgens cause new hairs to suddenly sprout in new places (Grymowicz, 2020). You may notice symptoms like pubic hair loss if you have a health condition that affects androgen production.
For example, if your adrenal glands decrease DHEA production, you may notice pubic hair thinning (Binder, 2009; Kinter, 2022). A condition called Addison’s disease affects the adrenal glands, causing a host of symptoms, including hair loss in the armpit and pubic areas (Munir, 2022).
Low testosterone levels (hypogonadism) can also slow hair growth in the armpits and pubic region. Low T affects about four in ten men age 45 and older. Symptoms may include reduced sex drive, low sperm count, and fewer erections (Sizar, 2022).
In women, declining estrogen levels may cause a loss of pubic hair (Grymowicz, 2020). Genitourinary syndrome of menopause (GSM) (previously known as vaginal atrophy) describes a range of symptoms that affect postmenopausal women. In addition to vaginal dryness and reduced lubrication, some women experience thinning and graying of their pubic hair (Angelou, 2020).
Alopecia: what is it, types, causes, treatment
Different types of alopecia can cause pubic hair thinning. Androgenetic alopecia is the most common type of alopecia in men and women. Also known as female or male pattern baldness, it’s characterized by elevated levels of dihydrotestosterone (DHT). Too much DHT causes hair follicles to shrink, leading to hair loss. Hair loss is often most noticeable on the scalp, but it can potentially affect hair in the pubic region (Qi, 2014).
Alopecia areata is an autoimmune condition that causes your body to attack hair follicles. As a result, your hair falls out, and you may notice bald spots or thinning hair. Alopecia areata affects both men and women equally. In some cases, alopecia areata primarily affects scalp hair, called alopecia totalis. In other cases, you may experience baldness all over, including in your pubic region. This is known as alopecia universalis (Qi, 2014; Spano, 2015).
Scarring alopecia, or cicatricial alopecia, includes a group of hair loss disorders such as lichen planopilaris (LPP), Graham-Little syndrome, and frontal fibrosing alopecia. Like alopecia areata, scarring alopecia is an autoimmune disorder that attacks your hair follicles. In addition to hair loss, it also causes scarring and can affect hair in the scalp, pubic, and armpit areas (Qi, 2014).
It isn’t just a myth—stress can literally make your hair fall out in what’s known as telogen effluvium. The word telogen refers to the affected stage of hair growth. Let us explain. Hair growth takes place in four stages: the growth (anagen) phase, followed by the transition (cataten) phase, then the resting (telogen) phase, and lastly exogen (shedding) phase (Grymowicz, 2020).
Telogen effluvium occurs when you suddenly lose a lot of hair, brought on by extreme stress or a traumatic event. A significant amount of your hair quickly shifts to the shedding (telogen) phase. As a result, you may experience sudden extreme hair loss in various regions a few months after the stressful event occurs. Telogen effluvium can affect anybody but is reported more often in women (Hughes, 2022).
Medications and other conditions
Some medications include hair loss as a side effect. For example, chemotherapy may cause hair loss all over (including pubic hair loss) within a few weeks of starting treatment (Qi, 2014; IQWiG, 2019).
Other conditions that may cause pubic hair loss include (Qi, 2014; Alsalhi, 2021; Porter, 2022; Grymowicz, 2020):
- Chronic cutaneous lupus erythematosus (CCLE)
- Klinefelter syndrome
- Hemochromatosis (iron overload)
- Thyroid dysfunction
How to treat pubic hair loss
Treating hair loss in the pubic region depends on the underlying cause. For those undergoing cancer treatment, normal hair growth may resume a few weeks after the chemotherapy is stopped (IQWiG, 2019).
Hair loss treatments like minoxidil (Rogaine) and finasteride (Propecia; see Important Safety Information) may be recommended for certain types of alopecia or stress-related hair loss (Qi, 2014; Grymowicz, 2020). While there is no cure for alopecia areata, anti-inflammatory medications can reduce inflammation and help stimulate new hair growth. Treatment may include corticosteroids or topical minoxidil (Qi, 2014).
If a hormonal insufficiency, such as DHEA deficiency, contributes to pubic hair loss, DHEA supplements may restore pubic hair growth (Binder, 2009). Testosterone replacement therapy—including gels, patches, and oral medications—may be prescribed to men with low T (Sizar, 2022). For women with GSM, hormone therapy and lifestyle changes like lubricants can improve symptoms (Angelou, 2020).
Hair shedding vs. hair loss: what’s the difference?
If you’re worried about pubic hair loss, set up an appointment with your healthcare provider. Hair loss can happen anywhere on the body, and your provider deals with these things every day, so don’t feel embarrassed to talk to them.
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- Angelou, K., Grigoriadis, T., Diakosavvas, M., et al. (2020). The genitourinary syndrome of menopause: An overview of the recent data. Cureus, 12(4), e7586. doi:10.7759/cureus.7586. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32399320/
- Binder, G., Weber, S., Ehrismann, M., et al. (2009). Effects of dehydroepiandrosterone therapy on pubic hair growth and psychological well-being in adolescent girls and young women with central adrenal insufficiency: a double-blind, randomized, placebo-controlled phase III trial. The Journal of Clinical Endocrinology and Metabolism, 94(4), 1182–1190. doi:10.1210/jc.2008-1982. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19126625/
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- Institute for Quality and Efficiency in Health Care (IQWiG). (2019). Hair loss in chemotherapy: Overview. Retrieved on Oct. 26, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK547552/
- Kinter, K. J. & Anekar, A. A. (2022). Biochemistry, dihydrotestosterone. StatPearls. Retrieved on Oct. 26, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK557634/
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- Porter, J. L. & Rawla, P. (2022). Hemochromatosis. StatPearls. Retrieved on Oct. 26, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK430862/
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- Sizar, O. & Schwartz, J. (2022). Hypogonadism. StatPearls. Retrieved Oct. 26, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK532933/
- Spano, F. & Donovan, J. C. (2015). Alopecia areata: Part 1: pathogenesis, diagnosis, and prognosis. Canadian Family Physician, 61(9), 751–755. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26371097/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.