Choice of oral contraceptives is important for women with androgenetic hair loss

Androgenicity of 'combined' birth control pills  

First approved in 1960, there are now many different brands of oral contraceptives on the market. One common class of oral contraceptive pills are those which contain an estrogen component and a progestin component. These so called "combined OCPs" are the most popular of the birth control pills. Today, I'd like to highlight an important topic: the “androgenicity” of oral contraceptive pills or "OCPs"

The Estrogen Component. 

Significant attention has been given in recent years to making oral contraceptives safer by reducing the estrogen dose. Many modern OCPs contain 20-35 micrograms of estrogen (ethinyl estradiol) compared to 50 micrograms or higher in years past.

The Progestin Component.

What is sometimes forgotten in the discussion of OCPs is that the progestin component is important to consider as well, especially for women with androgenetic alopecia.  Some progestins are significantly more ‘androgenic’ than others.  

In general, all oral contraceptives are "anti-androgenic" to some degree as they function by reducing the production of androgens by the ovaries. But because the progestin that makes up the OCP differs, this translates into a scale of 'androgeneticity' for oral contraceptives with some being less androgenic than others.

The least 'androgenic' progestins often added to OCPs include norethindrone, norethindrone actetate, desogestrel, norgestimate and drosperisone.The most 'androgenic' progestins in OCPs have names like levonorgestrel and norgestrel. However, it’s not so simple as to say that the androgenic progestins are bad and the least androgenic are better: the combination of an estrogen with the progestin to make up the combined OCP alters the pill's overall androgenic potential. For example, even the levonorgestrel is an androgenic progestin, it has such a low amount of progestin in many OCPs, that the OCP might actually itself have a low androgenicity rating.  

My preferences for starting an OCP

Overall, one should always speak to their physician before starting or changing a birth control.  My preference for women with androgenetic alopecia who decide to start a birth control pill is to choose one with 1) low androgenic activity overall and 2) a progestin with low androgenic activity.  My advice may be slightly different if someone is already on a certain type OCP. The importance of the 'androgenicity' of the OCP does not carry the same relevance if the woman does not have androgenetic alopecia. 

Low androgenicity OCPs include : ortho tri-cyclen (contains norgestimate), ortho-cept or desogen (contains desogestrel), modicon (has norethindrone), ortho cyclen has (norgestimate), demulen (has ethynodiol diacetate), and ortho 777 (has norethindrone).

Other OCPs may also have low androgenicity and all women should speak to their physicians before starting or changing any oral contraceptive. Oral contraceptive use may not be appropriate for everyone.