Medication-induced hair loss is a common issue and often reversible. In recent years, metformin, a prescription drug for type 2 diabetes and polycystic ovary syndrome (PCOS), has come under the radar for potentially causing hair loss.
There have been a few reports of people losing hair after prolonged usage of metformin. However, there is little scientific evidence that links metformin and hair loss. This article explores the relation between metformin use and excessive hair fall. Scroll down to learn more.
In This Article
What Is Metformin?
Metformin helps control the sugar levels in your blood and increases the body’s response to insulin. It is available as a liquid, a tablet, and an extended-release (long-acting) tablet and should be taken orally (2).
Although metformin is well tolerated, it may cause a few side effects, like (2):
- Stomach pain
- Muscle pain
In rare cases, metformin may also cause chest pain. A few people reported hair loss as another possible side effect of metformin usage. Is that true? Let’s take a closer look.
Does Metformin Cause Hair Loss?
There is no scientific evidence to establish a direct link between metformin and hair loss. However, a few isolated reports of people experiencing hair loss while taking the drug have emerged in the past few years.
In one report, an individual with type 2 diabetes who took metformin and sitagliptin experienced excessive shedding of the scalp and eyebrow hair (4). In this case, hair loss may have been drug-induced, but there is no conclusive evidence to prove the same.
Another study found that metformin’s long-term use may reduce the levels of vitamin B12 and folate (5). The lack of these two vital nutrients may trigger hair loss (6).
If you are taking metformin and notice hair loss, it might be due to the lack of vitamin B12. Let’s take a closer look at this in the next section.
Metformin And Vitamin B12 Deficiency
Metformin can lead to reduced vitamin B12 absorption in the gastrointestinal tract. An average of 6% to 30% of patients who used metformin can develop vitamin B12 deficiency. The American Diabetes Association treatment guidelines recommend regular monitoring of vitamin B12 levels in people with diabetes who take metformin (7).
Vitamin B12 is necessary for DNA synthesis, neurological function, and red blood cell formation. A deficiency of this water-soluble vitamin can lead to numerous serious health issues, including hematologic and neurologic symptoms (8).
Vitamin B12 deficiency is also linked to hair loss (6). Low levels of the vitamin can lead to weaker hair follicles. It can also cause anemia, which is associated with hair thinning and hair loss. Premature graying is another possible symptom of vitamin B12 deficiency.
It is unclear whether metformin leads to hair loss or not, but diabetes patients using the drug may experience excessive hair fall for many reasons. We examine the several underlying reasons below.
Diabetes And Hair Loss
Studies have found a correlation between type 2 diabetes and the risk of hair loss (9). Diabetes can slow down hair growth and cause excessive hair loss. It is not rare for those with type 2 diabetes to lose eyebrow hair and body hair. The rate of hair regrowth is also slower.
People with diabetes are also more likely to develop alopecia areata universalis – a condition in which the immune system attacks the hair follicles, causing complete loss of body hair (10). The stress of living with a chronic medical condition like diabetes can also trigger hair fall and thinning hair.
Currently, there is no concrete proof to suggest that metformin can cause hair loss. Thus, it is also helpful to look at some other related causes of hair loss to identify the real problem.
Metformin does have many unpleasant side effects, but excessive hair fall and balding are not among these (2). If you are experiencing hair fall while taking the drug, you may want to consider several other related factors (11):
Family history can have a great impact on a person’s hair health. If you have a family history of alopecia and pattern baldness, you are more likely to develop it.
- Medications And Supplements
Prescription drugs and steroids for conditions like cancer, depression, heart problems, blood pressure issues, and arthritis may cause hair loss. If you are taking any other drug along with metformin, consult your doctor about drug interactions.
- Hormonal Changes
Pregnancy, childbirth, menopause, and thyroid problems involve hormonal changes that may cause severe hair fall. Discontinuing birth control pills may also cause hormonal imbalance and hair fall.
- Medical Conditions
If you have other medical conditions, your hair loss can be caused by several reasons other than metformin. Conditions like thyroid disease, autoimmune diseases that attack hair follicles like alopecia areata, and fungal infections like ringworm can lead to temporary or permanent hair loss. Trichotillomania, a hair-pulling disorder, and diseases like lichen planus and some types of lupus also cause excessive hair fall and balding.
- Stressful Events
Going through an extremely stressful event like the death of a loved one or a divorce can cause a general thinning of hair and excessive hair fall. People who have been through physical trauma may also experience hair loss. Stress-induced hair loss is usually temporary.
- Hairstyles And Hair Treatments
Individuals who love experimenting with their hairstyles may experience a type of hair fall called traction alopecia. Sometimes, permanent hair treatments may also cause hair to fall out. Often, hair loss due to these reasons is temporary. However, if the follicles are damaged, hair loss may be permanent.
Before assuming that taking metformin is causing your hair to fall, consider the above factors. But if you are certain that your hair loss is linked to metformin, here is what you can do to manage the situation.
How To Treat Metformin Hair Loss?
- Get A Complete Blood Test
Iron deficiency and hormonal imbalances can cause hair fall (12). To determine the exact reason or deficiencies, do a blood test and consult your doctor for advice.
- Follow A Healthy Diet And Take Supplements
A well-balanced nutritious diet is important for maintaining good hair health. Insufficient nutrition can cause a range of health issues, including hair fall and thinning hair (12). Consume lots of fresh fruits, vegetables, legumes, seeds, and nuts in your diet. Consult your doctor and ask them if you need any multivitamin supplements to meet your unique nutritional requirements.
- Consult A Trichologist
You may also consult a trichologist, an expert in hair health, for guidance and solution.
- Change Your Hairstyle
Losing hair can be distressing. Avoid styling your hair in a way that might pull the roots. Consult a good hairstylist and style your hair in a way that makes it look fuller.
If you are considering taking metformin for health reasons, here are a few things you need to keep in mind.
Things To Know Before Using Metformin
Apart from the previously discussed side effects, here are a few things to remember before you start taking metformin:
- Risk Of Lactic Acidosis
Metformin may rarely cause a serious health condition called lactic acidosis (2). It is a medical condition characterized by lactate buildup in the body, leading to low bloodstream pH. Lactic acidosis is often the result of an underlying chronic medical condition, medication, or poisoning. Consumption of alcohol increases your risk of developing lactic acidosis.
Before taking metformin, do inform your doctor if you have any allergies. A few medications and drug interactions may cause allergic reactions.
- Serious Medical Issues
If you are above the age of 65 or have medical conditions like kidney disease, heart disease, cancer, or liver disease, talk to your doctor about your health history. Also, tell them about your smoking and drinking habits, if any.
- Other Prescription Drugs And Supplements
If you take any prescription drugs to manage other health conditions, discuss this with your doctor before taking metformin. Some drugs can cause unpleasant reactions if taken together (2). Also, tell your doctor about any nutritional supplements like multivitamin pills or herbal remedies you may be taking.
Summing It Up
Metformin is a first-line drug prescribed for type 2 diabetes. Though there is no scientific proof that links metformin and hair loss, a few reports show people experiencing heavy hair loss after metformin use. Your hair loss can also be directly linked to type 2 diabetes and associated complications. If you have type 2 diabetes and take metformin, and have recently noticed hair loss, consult a doctor to find out the exact cause. Also, consume a nutritious diet and follow a healthy lifestyle to maintain your overall health.
- Metformin: Current knowledge
- Essential Medicines List (EML) 2017
- Loss of Eyebrows and Eyelashes During Concomitant Treatment with Sitagliptin and Metformin
- Adverse effect of metformin therapy on serum vitamin B12 and folate: short-term treatment causes disadvantages?
- The Role of Vitamins and Minerals in Hair Loss: A Review
- Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes
- Vitamin B12 Deficiency
- Association of type 2 diabetes with central-scalp hair loss in a large cohort study of African American women
- Simultaneous development of insulin dependent diabetes mellitus and alopecia areata universalis
- Alopecia areata
- Diet and hair loss: effects of nutrient deficiency and supplement use