Q. Will combined oral contraceptive pills help treat acne and female pattern hair loss?

Hello doctor,

I am a 38 year old female, and I am currently taking Tetracycline tablets 500 mg, twice a day for my adult acne. I have been taking them since last year. Previous to this, and sometimes still, I use Duac 10 mg or 50 mg topically. I used this on my back and face for about a year before the Tetracycline. I was put on Marvelon when I was 15 years old, for acne as a teenager. I was on it until I was 36 years old, with a couple of small breaks to be put on antibiotics because the acne came back. I resorted to the combined pill when I was 35, and I visited a dermatologist since my hairline was receding. They did a biopsy of my hair and told me I had female pattern baldness. When I came off Marvelon two years ago, I lost about three-fourth of my hair. It is traumatizing since I knew I might lose some but just did not realize how much. I was told by doctor after doctor, that it would grow back, and none of them would refer me to a dermatologist about it. I am still waiting to see one, my appointment is after two months. Some of my hair grew back, but it has since fallen out again. My hair and skin distress me all the time. From the research I have done, going on the pill so young and for so long, with female pattern baldness was one of the worst things I could have done, but of course, this was not known back then.

My dad had acne his whole life, and my sister has PCOS. My dad also has type 2 diabetes, so I am aware we may have issues in our family with excess androgens. There is hair loss on both sides in the family, male and female. My doctor and dermatologist will not prescribe Spironolactone. I am aware my options for my skin and hair are limited. I have had stomach issues since being on the antibiotics as well as candida in my mouth and vaginally. I take probiotics. I do not want to be on the antibiotics much longer if I am honest, my skin does not heal as well as it should while on them. I am wondering if I am not absorbing my nutrients well enough since my hair is still falling out. Could the Tetracycline be causing more hair loss? I have had my iron tested. My ferritin is about 50, and I take iron when I can since I know it needs to be about 80 for supporting my hair. The doctors here would not test for anything else since they deem my iron and thyroid to be at acceptable levels. I am considering going back on Marvelon again simply to have a break from the antibiotics, and other supplements I am taking and also because maybe it will have a good effect on my hair.

What would you recommend? Do you think going back on the combined pill will help my hair grow back or at least stop it from falling out further? Will it fall out again though when I come off of it? I am not in a relationship right now, but it is my hope to still meet someone and have a family. I know my skin was always really good on Marvelon, and my sex drive is not so much. I also wonder, will coming off Tetracycline mean that if I take it in future it would not work again or will take longer to work? Will it cause me problems with building up resistance? I read a lot about how people's acne comes back with a vengeance once they come off. I do not want to start with a treatment such as Minoxidil since there are side effects and it is a lifetime treatment, any gains I make will just fall out again should I decide to have a family. For this reason, I have not tried Accutane, but could not start this until I have seen the dermatologist anyway. I would be concerned with this anyway since I heard it can cause hair loss in itself. I have started derma rolling and use a laser on my hair too. I take silica and MSM for my hair but have not tried Biotin since it can cause acne. I am just very frustrated and sad about the lack of interest or help that is been offered here in my country. Hence, I am asking a question here. Any advice you may have would be really appreciated. Is Marvelon the best to go back? Are there others I could consider, which are also anti-androgen? What are the long term effects of something like Spironolactone? 

Hi doctor,

Thank you for your very comprehensive answer. It is a lot more helpful than any answer I have had from my own doctor. I have not looked into PRP so I am going to do this and when I talk to my dermatologist, I will consider the other options you mentioned too. I was given the test for PCOS so I know I do not have that. What will the other blood tests show? Is it worth having them anyway?