If you have primary biliary cholangitis (PBC), ursodiol may already be a part of your treatment plan. This medication is a first-line treatment for PBC, helping to protect your liver and slow the progression of liver damage.

But what if, while taking ursodiol, you start noticing more hair in your brush or shower drain? Could ursodiol be the reason behind unexpected hair loss — or might something else be contributing? Let’s explore the connection between ursodiol, PBC, and hair health.

Understanding Ursodiol and Its Role in PBC

Ursodiol (also known as ursodeoxycholic acid or UDCA) is a treatment for primary biliary cholangitis, a chronic autoimmune liver disease that damages the bile ducts. These small ducts help carry bile from the liver to the small intestine, where it aids in digesting fats. In PBC, the immune system mistakenly attacks the bile ducts. This causes bile to build up in the liver and can lead to inflammation and long-term liver damage.

Ursodiol — sold under brand names including Actigall, Reltone, Urso 250, and Urso Forte — works by reducing the amount of toxic bile acids in the liver. It replaces some of the more harmful bile acids with a gentler form, helping to protect liver cells. This can slow down the disease and may improve liver function, though it does not cure PBC.

Does Ursodiol Cause Hair Loss?

Many people who take ursodiol wonder if it can lead to hair loss. While hair loss is not a commonly reported side effect in most medical references, some people have shared that they noticed hair thinning or shedding after starting the medication.

The most common side effects of ursodiol include:

• Diarrhea
• Stomach pain
• Nausea
• Dizziness
• Back pain

Hair loss is not officially recognized as a side effect of ursodiol, but that doesn’t mean it never occurs. Some people living with PBC have described changes in their hair — including thinning or increased shedding — while taking ursodiol. However, scientific evidence directly linking ursodiol to hair loss is limited.

Could PBC Itself Cause Hair Loss?

Primary biliary cholangitis can indirectly contribute to hair loss in several ways.

Nutrient Deficiencies

PBC affects bile production, which is essential for digesting fats. When bile flow is reduced, the body may struggle to absorb fat-soluble vitamins — like A, D, E, and K — that are important for strong, healthy hair. A lack of these nutrients can weaken hair follicles, slow growth, and lead to more shedding.

Autoimmune Effects

Because PBC is an autoimmune condition, the immune system mistakenly attacks healthy tissues — in this case, the bile ducts in the liver. Many autoimmune diseases, such as lupus and thyroid disorders, are also linked to hair thinning or excessive shedding. The inflammation triggered by autoimmune activity can disrupt the normal hair growth cycle. If you have other autoimmune conditions, they may also be contributing to hair loss.

Chronic Inflammation and Stress

Long-term conditions like PBC can put the body under both physical and emotional stress. This type of stress may trigger a condition called telogen effluvium, where more hair than usual enters a resting phase and falls out. Chronic inflammation can also interfere with the body’s normal processes, further weakening hair strands and slowing regrowth.

Why Might Ursodiol Contribute to Hair Loss?

Although there’s no clear scientific proof that ursodiol causes hair loss, some health experts have proposed possible explanations for how it might play a role.

Changes in Nutrient Absorption

Because ursodiol affects bile acid levels, it could influence how the body absorbs certain vitamins and minerals important for hair health. If the body has trouble absorbing nutrients like iron, biotin, or fat-soluble vitamins (A, D, E, and K), hair follicles may become weaker. Over time, this can lead to increased shedding or thinning.

Medication Side Effects in Individuals

Everyone responds to medications differently — what causes a side effect in one person may not affect someone else. While hair loss isn’t widely reported as a side effect of ursodiol, some people may notice changes in their hair due to individual sensitivities, genetics, or interactions with other medications.

Other Factors That May Contribute to Hair Loss in PBC

In addition to ursodiol and PBC itself, other factors may contribute to hair loss:

• Age-related hair thinning — Hair naturally becomes thinner with age. This gradual change can sometimes be mistaken for a side effect of medication.
• Iron deficiency anemia — Common in people with chronic conditions, low iron levels can affect hair strength and lead to shedding.
• Thyroid issues — PBC is often linked to other autoimmune disorders, including hypothyroidism. An underactive thyroid can slow hair growth and cause thinning.
• Scalp conditions — Conditions like seborrheic dermatitis or fungal infections can irritate the scalp and lead to increased hair shedding.
• Chronic fatigue and stress — Living with a long-term illness like PBC can take a toll on both physical and emotional health, which may affect the hair growth cycle.
• Hormonal imbalances — Shifts in hormone levels, including estrogen or testosterone, can change how thick or fast hair grows.

What Does the Research Say?

At this time, no major research studies have confirmed a direct link between ursodiol and hair loss. However, some members of myPBCteam have shared that they noticed increased shedding while taking the medication.

If you think ursodiol might be affecting your hair, talk to your doctor. They can help look into other possible causes — like nutrient deficiencies, thyroid issues, or interactions with other medications — and guide you on next steps.

How To Manage and Prevent Hair Loss While on Ursodiol

If you’re taking ursodiol for PBC and are noticing hair loss, here are some steps that may help manage it.

Check for Vitamin Deficiencies

Have your doctor test for low levels of vitamins A, D, E, and K — as well as iron, biotin, and zinc. If you’re deficient, supplements or dietary changes may help restore balance and support healthy hair growth. Work with your healthcare provider to choose the safest and most effective approach.

Eat a Nutrient-Rich Diet

A balanced diet is essential for supporting hair growth. Include healthy fats (avocados, nuts, and fatty fish), lean proteins (such as eggs, poultry, and legumes), and plenty of colorful fruits and vegetables to give your body what it needs to build strong hair strands.

Use Gentle Hair Care

Harsh styling habits can make hair loss worse. Try to avoid frequent heat styling, chemical treatments, or tight hairstyles that can lead to breakage and thinning. Use mild shampoos and conditioners, and pat your hair dry instead of rubbing it.

Consider Alternative Medications

If hair loss becomes severe or affects your confidence, ask your doctor whether another medication may be an option. There may be alternatives for managing PBC that carry a lower chance of contributing to hair shedding.

Manage Stress

Chronic stress can interrupt the hair growth cycle. Finding ways to manage stress — such as yoga, meditation, breathing exercises, or hobbies you enjoy — can support both your emotional well-being and your hair health.

Ask About Topical Treatments

Some over-the-counter treatments, like minoxidil, may help promote hair regrowth. Before starting any topical product, talk to your doctor to make sure it’s safe to use with your current medications.

Talk to Your Healthcare Provider

If you’re noticing hair loss while taking ursodiol, it’s important to consider the bigger picture. PBC itself, nutrient absorption issues, and other medications could all be contributing factors. While there’s no strong scientific evidence that ursodiol directly causes hair loss, some people may be more sensitive to its effects.

If you’re concerned, talk to your doctor about possible next steps. They may recommend checking for nutrient deficiencies, adjusting your diet, or making changes to your hair care routine. Taking a proactive approach can help reduce shedding and support healthier hair over time.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with PBC.

Have you wondered about hair loss while taking ursodiol? Share your experience in the comments below, or start a conversation by posting on your Activities page.