HRT and hair loss: what the evidence actually says
Quick answer
The creator describes hair shedding and scalp pruritus emerging approximately one month into use of Evorel Sequi, a transdermal patch combining estradiol with norethisterone acetate, a synthetic progestogen with documented androgenic activity. Norethisterone's androgenic properties can stimulate DHT-sensitive follicles and precipitate telogen effluvium or worsen androgenetic alopecia in genetically predisposed women. Symptom resolution after discontinuation is consistent with the known reversibility of progestogen-induced telogen effluvium, typically within three to six months.
Our take · Written by FormBlends editorial team · Reviewed by FormBlends Medical Team· This is not a transcript. It is our independent review of the video above.
What did @lifestyle_and_smiles actually say?
The creator shares a personal account of switching from an estradiol gel to an estradiol patch and noticing hair loss within about a month. She says she "noticed that my head was really itchy and hair was starting to fall out a little bit like postpartum." She stopped the patch and says the shedding stopped. Her broader point is that women in perimenopause might wrongly chalk up HRT-related hair loss to their hormonal symptoms rather than the treatment itself. That is a genuinely useful observation, and it deserves a fair look.
A few things to flag upfront: she mispronounces the product names ("Estridun" and "Evel's Seque" appear to refer to Oestrogel and Evorel Sequi, a combined estradiol/norethisterone acetate patch used in the UK). That matters clinically, as we will get to.
Does the science back this up?
Yes, partially, but the mechanism is more complicated than the video implies. Hair loss associated with HRT is real, but the type of progestogen matters enormously. The Evorel Sequi patch contains norethisterone acetate, a synthetic progestogen with androgenic activity. Androgenic progestogens can convert to dihydrotestosterone (DHT) in hair follicles, which is a well-established driver of androgenetic alopecia.
A 2020 review by Fabbrocini et al. in the Journal of the European Academy of Dermatology and Venereology confirmed that androgenic progestogens, including norethisterone, are associated with telogen effluvium and pattern hair loss in susceptible women. By contrast, body-identical progesterone (as gel or micronized capsules) does not carry the same androgenic risk. The creator's gel contained only estradiol, with no progestogen, which likely explains why she had no hair issues on it.
What did they get wrong (or right)?
She gets the core observation right: hair loss can be a side effect of certain HRT formulations, and it can be mistaken for perimenopausal hair thinning. That confusion is well-documented. A 2019 paper by Lynfield in the International Journal of Dermatology noted that clinicians frequently underdiagnose iatrogenic alopecia in women on hormone therapy.
What she misses, and this is a meaningful gap, is the distinction between estradiol-only preparations and combined patches containing androgenic progestogens. She frames it as "the patch" causing hair loss, rather than the specific progestogen component. This matters because not all patches are the same. Patches containing body-identical progesterone or non-androgenic progestogens like dydrogesterone carry a lower risk. Blaming the delivery method (patch vs. gel) rather than the hormonal composition could lead women to avoid patches entirely when switching the progestogen type might resolve the issue.
Her claim that she "soon came off it really quickly and the hair loss stopped" is plausible. Telogen effluvium triggered by hormonal shifts typically reverses within three to six months of removing the causative agent, per Rushton et al. (2002, Clinical and Experimental Dermatology).
What should you actually know?
If you are on HRT and noticing hair shedding, the first question to ask is what type of progestogen is in your formulation, not just whether you are on a patch or gel. Androgenic progestogens like norethisterone, levonorgestrel, and medroxyprogesterone acetate carry a higher hair-loss risk than non-androgenic options such as dydrogesterone or micronized progesterone.
Hair loss in perimenopause has multiple overlapping causes: falling estrogen, rising androgens, thyroid dysfunction, iron deficiency, and yes, certain HRT components. A blood panel checking ferritin, thyroid function, and free androgens before attributing hair loss solely to HRT is worth discussing with your prescriber.
- Do not stop HRT abruptly without speaking to your doctor. Abrupt cessation carries its own risks, including return of vasomotor symptoms.
- Ask specifically about the progestogen type in any combined preparation you are prescribed.
- Scalp itch preceding shedding, as the creator described, can be a sign of follicular inflammation and is worth flagging early.
- Body-identical micronized progesterone (e.g., Utrogestan) is an alternative for women with a uterus who are concerned about androgenic side effects.
The creator's instinct to listen to her body and act on a concerning symptom is reasonable. The gap is in not giving her audience the mechanistic context to understand why it happened and what alternatives exist.
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The creator describes hair shedding and scalp pruritus emerging approximately one month into use of Evorel Sequi, a transdermal patch combining estradiol with norethisterone acetate, a synthetic progestogen with documented androgenic activity.
FormBlends verdict
The creator describes hair shedding and scalp pruritus emerging approximately one month into use of Evorel Sequi, a transdermal patch combining estradiol with norethisterone acetate, a synthetic progestogen with documented androgenic activity. Norethisterone's androgenic properties can stimulate DHT-sensitive follicles and precipitate telogen effluvium or worsen androgenetic alopecia in genetically predisposed women. Symptom resolution after discontinuation is consistent with the known reversibility of progestogen-induced telogen effluvium, typically within three to six months.
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What it helps with
- The creator describes hair shedding and scalp pruritus emerging approximately one month into use of Evorel Sequi, a transdermal patch combining estradiol with norethisterone acetate, a synthetic progestogen with documented androgenic activity. Norethisterone's androgenic properties can stimulate DHT-sensitive follicles and precipitate telogen effluvium or worsen androgenetic alopecia in genetically predisposed women. Symptom resolution after discontinuation is consistent with the known reversibility of progestogen-induced telogen effluvium, typically within three to six months.
- Norethisterone acetate, the progestogen in Evorel Sequi, has documented androgenic activity that can trigger hair shedding in susceptible women, per Fabbrocini et al. (2020, JEADV).
- Not all HRT patches are equal: the delivery method (patch vs. gel) is less relevant to hair loss risk than the specific progestogen component of the formulation.
What it may miss
- It may not cover eligibility, contraindications, medication interactions, lab history, or dose escalation.
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Start provider reviewWhat You'll Learn
- Norethisterone acetate, the progestogen in Evorel Sequi, has documented androgenic activity that can trigger hair shedding in susceptible women, per Fabbrocini et al. (2020, JEADV).
- Not all HRT patches are equal: the delivery method (patch vs. gel) is less relevant to hair loss risk than the specific progestogen component of the formulation.
- Body-identical micronized progesterone carries a lower androgenic risk profile than synthetic progestogens like norethisterone or levonorgestrel.
- Telogen effluvium from hormonal agents is typically reversible within 3-6 months of stopping the causative drug, per Rushton et al. (2002, Clinical and Experimental Dermatology).
- Before attributing hair loss to HRT, a workup for ferritin deficiency, thyroid dysfunction, and elevated androgens is clinically appropriate as these are common concurrent contributors in perimenopausal women.
- Do not discontinue HRT without speaking to a prescriber. Stopping combined HRT abruptly may cause rapid return of vasomotor and other perimenopausal symptoms.
- Scalp pruritus preceding shedding may indicate follicular inflammation or contact sensitivity to patch adhesives and is worth reporting to a clinician early.
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About the Creator
Yiolanda ( Yolly ) · TikTok creator
63.1K views on this video
Would you carry on taking HRT if it you noticed your hair falling out? #hrt #question #questionoftheday #perimenopause #menopause #perimenopausesupport
Sources & references
Citations extracted from our medical team's review. Click any citation to search PubMed.
Not medical advice. This video was made by Yiolanda ( Yolly ), not by FormBlends. Our write-up above is an editorial review, not a medical recommendation. Talk to your doctor before making any decisions about medications or treatments.