PCOS Skin and Hair Symptoms: What’s Going On Inside Your Body (And What You Can Do About It)

Jodie Relf
Jul 28
5 min read

If you’re battling with stubborn breakouts, unwanted chin hairs, or noticing your ponytail feels thinner than it used to, it’s not in your head—and it’s not just “cosmetic.” These PCOS skin and hair symptoms are rooted in real, measurable hormonal imbalances happening in your body.

And when you understand why these changes happen, you can begin to feel more empowered and less at war with your reflection. Let’s walk through the science behind it all—simply, clearly, and compassionately.

Why Does PCOS Cause Skin and Hair Symptoms?

Polycystic Ovary Syndrome is a condition of hormonal dysregulation. Two main players often drive the visible changes in your skin and hair:

1. High Androgens (Testosterone and DHT)

One of the hallmarks of PCOS is hyperandrogenism, which means your ovaries (and sometimes adrenal glands) are producing more androgens than normal. These “male” hormones—particularly testosterone—play a crucial role in the skin and hair symptoms many women experience.

Here’s how it works:

In your skin and hair follicles, testosterone can be converted into a more potent hormone called dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase.
DHT binds to androgen receptors in the pilosebaceous units—these are the combined hair follicle and oil gland structures in your skin.
In some areas of the body (like the chin, upper lip, chest, stomach, and back), DHT stimulates these follicles to grow thicker, darker hairs—this is known as hirsutism.
At the same time, on your scalp, DHT has the opposite effect: it causes hair follicles to shrink (miniaturise), leading to shorter, finer hair growth and eventual hair thinning—a condition called androgenic alopecia.

In short: elevated androgens overstimulate hair in some areas, and weaken it in others.

2. Insulin Resistance and Its Hormonal Chain Reaction

The second key piece is insulin resistance. This is extremely common in PCOS and means your body’s cells aren’t responding well to insulin, the hormone that helps control blood sugar.

To compensate, your pancreas produces more insulin than normal. High insulin levels do a few things:

They stimulate the ovaries to produce more testosterone, increasing androgen levels further.
They reduce the production of sex hormone-binding globulin (SHBG), a protein that normally binds to excess testosterone in the blood. Less SHBG = more free testosterone available to act on tissues like skin and hair follicles.
Insulin also binds to insulin-like growth factor (IGF) receptors in the skin, especially in folds and creases, triggering overproduction of skin cells. This leads to acanthosis nigricans—dark, velvety patches of skin—and may also promote skin tags.

So while androgens are the main driver, insulin resistance is often the fuel that feeds the fire.

The Science in Simple Terms

Here’s a quick analogy: Think of your skin and hair like little hormone-sensing machines. In PCOS, they’re being flooded with “go” signals—more oil, more hair growth in places you don’t want it, and less where you do—all because the hormonal traffic lights are stuck on green.

That’s why a topical cream or facial alone won’t fully fix things. We have to address the hormonal traffic at its source.

Why This Isn’t Just “A Cosmetic Problem”

These visible symptoms affect how you feel in your body—and that’s deeply personal. Maybe you’re hiding acne under makeup, avoiding selfies because of facial hair, or feeling heartbroken watching your hair thin.

Please know this:

You are not being vain.
You are not alone.
And you are not at fault.

Your skin and hair are just messengers. They’re showing you what’s going on inside—and with the right tools, you can improve those signals.

What’s Coming Next in This Series

This is the first in a detailed series breaking down each of the major PCOS skin and hair symptoms, so you feel informed, supported, and empowered:

Part 2: Facial Hair & Hirsutism – What Helps (and What Doesn’t)
Part 3: PCOS Acne – Why It’s Stubborn and What Can Actually Work
Part 4: Dark Patches & Skin Tags – What They Mean for Your Metabolism
Part 5: Hair Thinning & Loss – Managing Androgenic Alopecia in PCOS

Each post will explain what’s happening in your body and offer practical, evidence-based steps you can take—no shame, no scare tactics, and no one-size-fits-all fixes.

What You Can Do Today

While personalised care is always best, here are a few foundational steps that support hormone balance and skin health:

Support blood sugar regulation with a balanced, fibre-rich diet (think: whole grains, lean protein, healthy fats, and lots of veg)
Move your body regularly—even a daily walk can improve insulin sensitivity
Be gentle with your skin—avoid aggressive scrubs or harsh ingredients

You Deserve More Than Just “Try Losing Weight"

So many women I work with have been told to just lose weight or go on the pill—and left feeling confused, ashamed, and unsupported. You deserve more.

By understanding your hormones, tuning into your symptoms, and building a support plan that works for you, you can absolutely feel better in your skin—and more confident in your own body.

References:

Patel S. et al. (2025). Cutaneous manifestations of polycystic ovary syndrome (PCOS). Annals of Medicine & Surgery, 87(5), 2804-2811. This review explains how PCOS hormones lead to skin and hair changes (acne, hirsutism, alopecia, acanthosis) and discusses treatment approaches journals.lww.comjournals.lww.comjournals.lww.comjournals.lww.comjournals.lww.com.
Mostafa M.H. et al. (2020). Prevalence of Cutaneous Disorders in Patients with PCOS. Open Journal of Obstetrics and Gynecology, 10(9), 1245-1258. Provides statistics on how common skin symptoms are in PCOS (e.g., ~72–82% have acne, hirsutism or alopecia; ~60–70% have hirsutism)scirp.org.
Carmina E. et al. (2021). Prevalence of acne vulgaris among women with PCOS: a meta-analysis. Gynecological Endocrinology, 37(5), 441-447. Summarizes that acne is more frequent in PCOS women (pooled prevalence ~42% in adults, higher in teens, and up to 76% in those with high androgen levels)pubmed.ncbi.nlm.nih.gov.
PCOS Treatment – Unwanted hair and hair loss. National Health Service (NHS), UK. (n.d.) – Patient guidance describing management of hirsutism and alopecia in PCOS, including the use of combined oral contraceptive pills, eflornithine cream, anti-androgens (spironolactone, finasteride, etc.), and minoxidil for scalp hair loss nhs.uknhs.uk.
Harborne L. et al. (2003). Metformin or oral contraceptive pills in the treatment of hirsutism in PCOS? Journal of Clinical Endocrinology & Metabolism, 88(9), 4116-4123. (Study noted in review) – Found that metformin was as effective as an OCP (Dianette) in reducing hirsutism, with added benefits on weight and insulin journals.lww.com.
Colonna L. et al. (2018). Effect of drospirenone-containing oral contraceptives on acne and hormone levels in PCOS. International Journal of Women’s Dermatology, 4(3), 139-143. (Referenced in review) – Showed that an EE/drospirenone pill significantly improved acne lesions and reduced androgen levels in PCOS journals.lww.com.
Yen H. et al. (2021). Metformin’s effect on acne in PCOS: A meta-analysis. Dermato-Endocrinology, 13(1), e1897774. Combined data from 51 studies – reported that adding metformin led to significantly better acne improvement in PCOS women journals.lww.com.
Gupta V. et al. (2017). Quality of life in women with PCOS with dermatological manifestations. Journal of Clinical and Diagnostic Research, 11(5), WC01-WC05. Highlighted that hirsutism, acne, and alopecia in PCOS are linked to higher anxiety, depression, and lower quality of life, emphasizing need for psychosocial support