Is There Any Association Between Clinical and Biochemical Hyperandrogenism in Women With Female Pattern Hair Loss?

Abstract

Background The exact association between clinical and biochemical hyperandrogenism (HA) is heterogeneous and cannot be ascertained, especially in normoandrogenic women. Objectives Evaluate any association between clinical phenotypes and biochemical parameters of HA in premenopausal women with female pattern hair loss (FPHL). Materials and methods A cross-sectional observational study on 362 women, who were assessed for general characteristics, the different FPHL severities by Sinclair's score, hirsutism by modified Ferriman-Gallwey (mFG) score. Evaluation for biochemical HA included total, calculated free and bioavailable testosterone (TT), free testosterone (FT), and bioavailable testosterone (BT), respectively, and dehydroepiandrosterone sulfate. The variables of clinical HA were FPHL, hirsutism, and acne. Results The enrolled young premenopausal women's age range was (14-47 years). Around 78% were overweight or obese women. Eighty-percent of women had a mild FPHL, with a median of three years, where 2/3 of women had a duration <3 years with no significant relationship to FPHL severity. About 73% of women had either a mild to moderate hirsutism, and around 16% had acne. The biochemical HA was confirmed in around 52% of women (n=188), who show high levels of calculated FT. The calculated BT is high in 78.5% of women (n=284). The means of HA's biochemical indicators were in their reference ranges or slightly above, with no specific change pattern with the corresponding FPHL severity. None of these parameters had a significant relationship with the severity of FPHL. The FPHL duration was not affected by any presumed variable of clinical or biochemical HA. Conclusions FPHL severity was associated with other clinical HA signs like hirsutism and acne, but not to HA's biochemical parameter. Other parameters, like sex hormone-binding globulin (SHBG), and BMI, had no significant relation to the FPHL severity.

A practical approach to the management of hair loss in patients with polycystic ovary syndrome

“…7 Studies assessing hair growth suggest that hormonal effects on hair growth may also be mediated by localized events in the peripheral tissues. 11,12 The impact of the local environment on hair loss is supported by the paradoxical presence of hair growth (hirsutism) in PCOS patients with FPHL. In specific anatomic locations, including the lateral face, upper lip, chin, inner thighs and chest, androgen activity results in the conversion of small, vellus hairs into dark, terminal hairs.…”

“…Though the exact role of androgen activity in FPHL requires further research, FPHL in PCOS patients is likely influenced by androgen excess as patients with PCOS demonstrate both elevated testosterone and reduced SHBG serum levels 7 . Studies assessing hair growth suggest that hormonal effects on hair growth may also be mediated by localized events in the peripheral tissues 11,12 . The impact of the local environment on hair loss is supported by the paradoxical presence of hair growth (hirsutism) in PCOS patients with FPHL.…”