What's Happening?

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Ready, Set, Almost GO!

Launching soon: Progress Your Hormones Community

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It’s so exciting. We are getting women from all over the world, joining our founders group for the Progress Your Hormones Community. This will be a Hormone Community for Women Navigating Perimenopause and Menopause.

If this sounds like something up your alley, join our founder’s group. And because we are creating this from the ground up, I would love your input on what kind of community would feel like your hormonal haven. -Dr valorie

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Become a member

Would you like to work with Dr. Davidson for HRT prescriptions? Apply to join our HRT Membership program. We only prescribe for members in Washington, California, Arizona, Utah, and Hawaii. By application only.

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Dr. Valorie and Dr. Maki have Gone Social:

• YouTube: Progress Your Health Podcast​​
• Instagram: @DrValorie​
• TikTok: @DrValorieD​
• Apple Itunes: Progress Your Health Podcast​
• Spotify: Progress Your Health Podcast​​

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Come join the conversation!

I do not have AI write my articles.

I am sure ChatGPT or AI could take my huge articles and whittle them down to beautifully condensed, perfectly worded paragraphs of info.

But I like to write. So if you like to read, let’s be friends.

- Xo DrValorie

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Hormones and Hair Health:

Part 2: Why Hair Thins in Menopause

Dr. Valorie Davidson

This article is part two of a three-part series about hair thinning and shedding.

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● Part 1: Perimenopause and hair thinning (newsletter #7)

● Part 2: Menopause and Hair Loss (newsletter #8, this one)

● Part 3: Lab Tests for Hair Loss (newsletter #9)

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Let's talk about hair and menopause. When estradiol levels drop, so can your hair.

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Last week's newsletter talked about perimenopause and hair loss. While there is overlap between hair loss in perimenopause and menopause, there is a distinction between the two. In perimenopause, there is a drop in progesterone, erratic estrogen spikes and valleys, and especially the stress from cortisol.

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But in menopause, it is really about the estrogen, which has declined to almost nothing, that has such an effect on hair shedding, lack of growth, and even the quality of the hair strand.

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Women in menopause will say, 'I'm not stressed, life is excellent, but my hair isn't.' Or, 'Life is great, the only thing that stresses me out is my hair!'

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But to really understand it, meet Kim, my menopausal hair avatar.

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Kim:

The loss and changes to your hair during menopause are related to your estrogen levels. While it may have started in perimenopause, the thinning, especially on the top of the head, can point directly to estrogen or a lack thereof in menopause.

Now, this article is not just about telling you to start taking estrogen HRT, and you will have mermaid locks. Which you would think, with salt water and sun damage, mermaids should have terrible hair. But I digress. I will discuss estrogen HRT for hair. However, if you don't want to take HRT, that's okay too. I'll cover other tips on supplementation and food.

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First, let's learn why your hair changes in menopause.

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Science and Fun Stuff:

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Why is my hair thin, falling out, and never grows in menopause?

If you examine our human bodies, the way our systems work, including the endocrine, cardiovascular, and metabolic systems, as well as the intricacies of our respiratory system, and how we grow and age, it seems like magic. I bet you were not even aware that you were breathing or that your heart was beating a few seconds ago (I am sure you do now). But calling how our bodies work science doesn't even give it justice, because our bodies are so fascinating.

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And our hair! It may seem simple, but hair growth is a complex and intricate process.

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And when estrogen drops in menopause, that entire complicated process of how your hair grows gets disrupted. So let's talk hair growth!

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The Place to Be! The growth or anagen phase is the place you want your hair to be for the majority of the time.

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Let me clarify this. Each follicle/hair strand can be in:

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• Anagen Phase: The growth phase, where the individual hair stand is growing. In non-menopausal women, this phase can last years (3 up to 7 years in some people).
• Catagen Phase: This is the transition phase, which lasts up to two weeks, during which the follicle detaches from the blood supply. And moves quickly into telogen.
• Telogen: This is kind of an inactive stage where hair is dormant and doesn't grow, but it doesn't fall out either (this can last up to 3 months).
• Exogen: This is the shedding phase, during which you are supposed to experience normal shedding (approximately 150 hairs per day). Except during menopause, when it feels like there is more shedding than growth.
• Kenogen: This is where the hair follicle is 'suspended.' It is not growing another strand of hair. It's like an empty parking lot. And in menopause, it's as if more cars are leaving than parking. Eventually, the parking lot has more spaces than cars/hair.
• Essentially, each strand has its own lifespan, going through anagen, catagen, telogen, and exogen phases. In 'normal' jargon, each hair strand will have growth, transition, dormancy, and then shed.

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Where do we want the hair stands to be?

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We want them in anagen for as long as possible. Unfortunately, when estrogen levels drop in menopause, that shifts the length of anagen (shortening it).

As I mentioned above, it is like a big parking lot where more cars are leaving the lot than are parking. Eventually, the parking lot is sparse with cars/hair.

That is because menopause extends the kenogen phase where the follicle is suspended and not even growing another hair strand out of it. This happens in menopause and also in chronic telogen effluvium (shedding and delayed growth).

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Starving Hair (will grow for air, food, and water):

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When estrogen levels drop in menopause, it can starve your hair.

Estrogen is a vasodilator to help keep blood flow and microcirculation to the tiny capillaries that deliver nutrients, hydration, and oxygen to your scalp and hair follicles.

When estrogen levels drop, our hair follicles no longer have access to the nutrients, oxygen, and hydration they once had. We all know what happens to living creatures deprived of air, food, and water (not to be morbid or anything).

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Pimp My Ride:

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Remember when you didn't wax your car and it would become dull and bland? But you put a layer of wax (I have waxed many cars in my youth), and it glowed, shone like new, and it would feel 'soft', even though it's a chunk of metal?

Lower levels of estrogen cause sebaceous gland activity to slow down. Sebum (hair's natural oil) is made of:

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• Triglycerides (moisture lock)
• Wax esters (protective barrier)
• Squalene (antioxidant)
• Free fatty acids (antimicrobial)

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Estrogen is like a gorgeous coating of wax for your hair strand, creating shine, softness, and flexibility.

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My Foundation is F-ed:

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Your hair follicle is deeply embedded in your scalp dermis. That is far below the superficial layer (epidermis). The dermis is like the foundation of a house and is made of collagen. And we all know, if the foundation of your home is cracked, crumbling, or falling apart, everything inside is going to suffer (not to mention your pocketbook).

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Estrogen promotes collagen synthesis. So, no estrogen means less collagen, which means your foundation is struggling.

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X estrogen = X collagen = Fragile, dry hair strands that fall out more easily.

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Why is the top of my head thinner, but the back is good?

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Often, women say that the hair at the back of their head is much healthier than the top. There are three reasons for this.

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1. DHT: Dihydrotestosterone is converted from our testosterone. During menopause, our testosterone levels will drop slightly, but we are still producing it from the DHEA made in the adrenal glands. DHEA can convert to testosterone and then to DHT. The follicles on top of the scalp are very sensitive to DHT. So, without estrogen and progesterone to buffer DHT, testosterone, and DHEA (androgens) will cause the follicles to shrink and even stop growing hair altogether.
2. We have significantly more blood flow and circulation at the back of our heads than at the crown. That is why I let my hair gal convince me to buy this scalp massager while I'm washing my hair. Remember, estrogen helps with vasodilation and circulation of the scalp—less estrogen, less blood flow to the crown of the hair.
3. The back of our heads (occipital region) has more sebum production in general. So more wax to pimp your ride.

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Now you know the WHY, are you ready for the DIY for your hair health?

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In the full paid version of this article,

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• The difference between static vs rhythmic HRT and how each affects hair
• How to feed your hair from the inside out
• The foods, supplements, and nutrients I recommend for feeding your hair

Want to see what happened next with Shannon?

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Inside the full version, I’ll walk you through her personalized HRT plan.
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It’s one thing to talk about hormone health—it’s another to see it in action.

Upgrade to the full newsletter here and get the rest of the story.

Simon Says:

Nourish yourself with something that brings you joy. Whether it’s collagen, bone broth, a slow walk, or a loud laugh—your hormones (and hair) will thank you.

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The Faces of PCOS: Classic, Common, and Concealed

Dr. Valorie Davidson

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For this article, I wanted to write about PCOS. So many women have, as I like to call it, 'Shades of PCOS'. It is important to note that not everyone is alike when it comes to PCOS. PCOS can be a struggle, and I have seen so many women confused about what PCOS is, and wondering if they even have it. I wanted to share some of my experience from being in clinical practice since 2004, including what I have learned about PCOS.

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PCOS is not a disease, but is considered a syndrome. From the name, polycystic ovarian syndrome, it is easy to assume there are multiple cysts on the ovaries. But there is much more to PCOS. I consider it more of a spectrum, as some women can have nearly all of the criteria of PCOS, and others just a few. In all cases, there are not a lot of conventional health treatments. Most of the time, women are offered birth control pills, regardless of where they are on the spectrum of PCOS. And/or offered medications that have a long list of side effects. Which do not help with the symptoms the woman is experiencing.

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Three Faces of PCOS:

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After working with hormones and women's hormonal health for over 20 years, I believe there are three types of PCOS (which I will go into depth about later in this article).

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• Classic
• Common
• Concealed

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What is PCOS?

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PCOS stands for polycystic ovarian syndrome. You might be thinking, 'Well, I guess that means there are multiple cysts on the ovaries.' But there is so much more to PCOS than ovarian cysts. In fact, there are many women diagnosed with PCOS who do not have cysts on their ovaries. As a general statement, in PCOS, there are hormonal imbalances that can cause a myriad of symptoms and conditions. Ranging from acne to period issues to easy weight gain to infertility and much more.

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In PCOS, there are elevated levels of androgens. The androgens in particular are testosterone and DHEA. There are many other hormones affected in the system, but know that one of the hallmarks of PCOS is the higher levels of testosterone and DHEA.

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PCOS can start in the teens, but it's usually missed at this point, as the symptoms are just blown off as teenage hormonal changes. And as I mentioned, some women may have a lot of PCOS symptoms and others just a few. Regardless, PCOS can significantly affect the quality of life as well as physical and mental health.

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Symptoms of PCOS:

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One of the hallmarks of PCOS is elevated levels of androgens, mainly Testosterone and DHEA. Now I am going to say this over and over. PCOS is like a spectrum; some women can have really high levels of androgens, some just a slightly elevated level that might not even be picked up on. But let's get on with the symptoms of PCOS.

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1. There can be multiple ovarian cysts: Just like the name states, in polycystic ovarian syndrome, there can be multiple cysts on the ovaries. Let me start by saying, it is normal and common to get small follicular cysts during our cycle. As the body gets ready for ovulation, the ovaries will produce multiple follicles in hopes of one of those follicles becoming the main fertile egg. After ovulation, the mature ovum/egg leaves the ovary to travel down the fallopian tube. There can be a few little follicles left on the ovary. This isn't usually felt or noticed and will regress and be metabolized in just a few days up to a month.
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   In PCOS, there can be actual cysts that stay on the ovaries almost indefinitely. I have to mention that while the name states polycystic, many women with PCOS do not have cysts in their ovaries. I will tell you more about this later when we go over the three common types of PCOS.
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   At day 14 in a 28-day cycle (who has a perfect 28-day cycle? But for explanation's sake), instead of ovulation, in PCOS, the egg will not leave the ovary. It becomes a cyst instead of a mature, fertile egg. This cyst is more complex and not a simple follicular cyst. The PCOS cyst will stay in or on the ovary. Over time, many cysts can accumulate in or on the ovary. This is where the common phrase, "string of pearls," is named. The multiple cysts in the ovaries can look like a strand of pearls on a pelvic transvaginal ultrasound.
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   These cysts have "minds" of their own and can secrete hormones out of balance for the system. Another key point here is that there is no ovulation. Instead, there is a cyst formation. This is why PCOS is one of the main causes of infertility. This also means there is little to no progesterone made in PCOS. In a 28-day cycle, on day 14, the egg leaves the ovary, and the corpus luteum starts secreting progesterone. If there is no ovulation, you will see very low to no levels of progesterone in PCOS.
2. Let's talk about the Period issues in PCOS or lack of: With PCOS, women can skip periods. Some women might miss a period or two in a year. Others can miss their period for up to six months or more. Because of the imbalance of estrogen and progesterone, and the elevated levels of DHEA and testosterone, there is often not a lot of endometrial lining that has accumulated to be shed during a period.
   Additionally, to complicate matters, because estrogen and progesterone are not secreted appropriately, there are no hormonal signals to shed the lining of the uterus. In other cases, over time, the uterus can continue to grow the uterine lining, making it quite thick. Another way of saying it is that with PCOS, there can be either a very thin endometrial lining or a very thickened lining that is not shedding. This is why a lot of women with PCOS will explain how painful and heavy their period is when it finally shows up.
   Often, my PCOS patients are horrified when I tell them I want to help balance their hormones so they get a monthly period. They exclaim that their periods are painful and heavy; they don't want that every month. Of course, the goal is to balance the hormones so the cycle is regulated and not painful or heavy.
3. Infertility: Some women who have PCOS can have reduced or no ovulation, impacting their fertility. This is always a big concern when a woman gets the diagnosis of PCOS. Trust me, there are options, and plenty of women can and do get pregnant with PCOS. But the possibility of infertility can be a worrisome aspect for women who have been diagnosed with PCOS.
4. Weight gain: Weight gain is one of the most complained-about and frustrating symptoms of PCOS. It is very easy to gain and very hard to lose weight. Women can have the best diets and exercise regimes and still notice that they are gaining weight. In PCOS, there is an imbalance of estrogen and progesterone to androgens (those being testosterone and DHEA). There is little to no progesterone. Progesterone helps to buffer the other hormones. Estrogen likes to "grow things", such as the uterine lining and waistline. There are other hormones out of balance, in particular insulin, that can cause excess weight gain.
5. Acne: Because of hormonal imbalances, acne is common in PCOS. Often, the acne is cystic. Anyone who has had a cystic pimple knows it can last for weeks before it goes away. Meaning it seems like there is a constant stream of cystic acne, especially located on the chin and jawline area. The neck and back are also common areas for cystic acne in PCOS. This is absolutely not due to hygiene or products but to the hormone imbalance in PCOS. Specifically, the elevated levels of testosterone and DHEA.
6. Hair loss: The higher levels of testosterone and DHEA without the buffering effect of progesterone can cause 'androgen-derived' hair loss. You will notice thinning and loss of hair in the temples, hairline, and the top of the head. Hair loss can be really stressful. It feels like you have no control when your hair is falling out, making you terrified of brushing or even washing it. Not to mention the effect PCOS has on the thyroid hormones, which can make hair loss even worse. Women with PCOS worry that with the rate at which they are losing hair, they won't have any left soon.
7. Hair growth: While the hair on the head can thin and fall out in PCOS, there can be hair growth elsewhere. You can see hair growth on the face, specifically the chin and upper lip. Some women with PCOS will have hair growth on the neck and under the chin. As well as hair growth on other areas of the body, such as the chest and belly. Now we are human, and humans grow hair. It is normal to have a few hairs on the face, around the areola, or on the lower tummy. But in PCOS, the hair growth, also called hirsutism, is to a higher degree. The hair is dark and coarse, and there is more of it on the body. Again, this is due to the elevated levels of testosterone and DHEA.
8. High Cholesterol: Women with PCOS can tend to have high cholesterol. In a typical cholesterol or lipid panel, there is total cholesterol, HDL (high-density lipoproteins), LDL (low-density lipoproteins), VLDL (very low-density lipoproteins), and triglycerides. In PCOS, it is mainly the triglycerides that are elevated.
9. High Blood Pressure: The renin and aldosterone system is not in balance. This can raise blood volume, which increases blood pressure. Also, because of the other hormone changes with estrogen, lack of progesterone, high androgen, and high insulin can raise the blood pressure. Not to mention, it's so easy to gain weight with PCOS, which alone can raise blood pressure.
10. Anxious: The mood is not mentioned enough with PCOS. In treating women/teens with PCOS, I have found pretty much 100% of the time, there is some level of anxiety. Estrogen and the androgens can be very stimulating, and progesterone is very relaxing. The lack or reduced levels of progesterone and high androgens in PCOS can contribute to anxiety.
11. Irritability: They don't call it "testy" for nothing. Elevated levels of testosterone and androgens can cause "testiness" or irritability. Women will comment that their patience levels are short. That their tolerance is gone. They are easily annoyed and become angry at minor things that do not warrant that level of irritation. Women describe that they will go from 0-60 for something they know is minor. And in the moment of being angry, they know it's not a big deal, but they are making it that way. It is their hormones that are creating this overreaction.

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Types of PCOS:

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These are the main types I have seen in treating patients with PCOS. As I mentioned before, PCOS is like a spectrum. There can be some women who have all the symptoms, while others have just a few. It is essential to be aware of this for effective treatment. Someone with many symptoms is going to have a completely different treatment plan than someone who has some of the symptoms.

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The three types I have observed in clinical practice are CLASSIC, COMMON, and CONCEALED.

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Classic PCOS:

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Honestly, this is not seen as often as you would think. A woman who has Classic-PCOS will see all of the symptoms. And bless her, because having Classic-PCOS is A LOT to deal with.

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• You will see dark facial hair and chronic cystic acne.
• Very thin hair, especially on the top of the head and temples.
• There is weight gain--it is super easy to gain weight, and what feels impossible to lose. I have had Classic types tell me that they can even gain weight in their feet.
• There is high blood pressure and high cholesterol.
• Not to mention high blood sugars and high insulin, leading to insulin resistance and possible diabetes, if not already diabetic.
• There is a lot of irritability all month long, plus anxiety.
• And even with the strongest will power, the Classic-PCOS women will have terrible carb cravings, especially for sugar.
• These women rarely get a period. They will miss multiple consecutive months. They might get maybe two periods a year.
• And because they are rarely ovulating, there can be infertility issues.
• These are the women who have many cysts in and on their ovaries. They have the 'Classic' string of pearls visualized on a transvaginal ultrasound.

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Common PCOS:

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This is the most "common" type of PCOS seen. The Common-types should be diagnosed fairly easily. But because they do not fall into the Classic presentation, they may get missed in diagnosis. These are the symptoms that a Common-type PCOS female will present with:

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• Easy weight gain in the middle, the stomach, the hips, and the thighs
• Thinning hair
• Irritable easily
• Some cystic acne on the chin and jaw area
• Trouble getting pregnant, but is usually successful with fertility options
• May get random cysts on or in the ovaries. But there is no string of pearls or multiple ovarian cysts
• May miss a period occasionally.
• Common-types are not regular in their periods.
• But they may get a period every month for five months, then miss two.
• Or have very long cycles up to 45 days.
• Or they may have a period every other month.

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Common types again are not regular, but they do not miss multiple months like the Classic Types PCOS.

Concealed:

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This type of PCOS often goes undetected. They are found going doctor to doctor, not feeling well, and never given an answer. This is because they have just a few of the symptoms but not enough to qualify for 'PCOS.' But they do have a hormone imbalance, and when you break it down, it is a type of PCOS. It seems to get worse when a Concealed Type hits perimenopause or late 30s to early 40s. The female hormones are changing, and the body cannot maintain.

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What you will see in the Concealed variety:

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• May have a child, so it looks like there are no fertility issues
• Really irritable--all the time, and way worse before their period
• Yes, they have regular periods, but the worst PMS
• Anxiety-it seems that they have a lot of low-grade anxiety all the time
• Hair is thin
• Slender until they hit mid to late 30s to early 40s. This is when they gain weight, especially in the stomach.
• No matter what they do, they cannot lose weight. Even with severe caloric restriction and lots of crazy exercise, there is no real change to the weight.
• Carbohydrate cravings, especially for sugar

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All these symptoms of the Concealed are blown off as genetics or lifestyle. I have had so many patients with Concealed PCOS say that their previous doctors thought they were lying about their lifestyle and exercise habits.

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In the second half of this article, I walk you through:

• The full hormone cascade behind PCOS—including DHEA, LH, testosterone, cortisol, insulin, thyroid, and more
• Real-world lab interpretation (not just “your labs are normal”)
• Why most women get missed or misdiagnosed
• And how to finally make sense of what your bloodwork is telling you

→ Subscribe to the full version of the newsletter to read the rest.
This article could change how you think about PCOS—and what to do next.

I washed my hair this morning, and I found myself getting a little nervous as I put more and more strands of hair on the shower door. Now, those of you who know me are rolling their eyes because I have a lot of hair.

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But after hitting menopause, I am starting to wonder, am I going to start to lose my hair?

Of course not, I have worked with menopausal women for over 20 years, with hormonal hair health being a big part of that.

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But everyone says, oh you hit menopause and you lose your hair.

Of course with age and time, our hair is going to change, we have to be okay with that.

But if your hair seems to be shedding like crazy, get your hormones checked, get your nutrients checked, check your stress.

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But is it funny, strange, or sad that I am even beginning to worry about hair? But is it? Hair for women is a part of our identity. We should not pass it off as a superficial issue, because it is a big deal. For women, hair loss is a huge issue. And there is so much information out there about take this and take that. I feel it does start with nutrition, protein, good healthy nutrients, then hormones and supplements, managing stress. Women that I have worked with that are concerned with their hair, I always test their hormones and DHT levels.

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But it is something we as women think about and even myself. And no one feels sorry for me, those of you that know me, I am not complaining. But I do understand these thoughts cross our minds sometimes, or a lot of the time.

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The other day I was looking at my temples. Do my temples look light? Do they?

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Then I began pouring over old pics to see if my temples looked like this 10 years ago. And my temples look no different. But why am I even creating worry out of nothing? And why are all these videos of ladies patting their temples with colored powder showing up on my social media?
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- DrValorie

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