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Blood Exam - Female Hair Loss

Female hair loss is many times more complicated than hair loss in men. The following are typical of what a blood exam would involve. Please note that the normal values can change depending on one's age.

Female Hormone Levels

Hormone to Test
 
Normal
Values
Signifiance 
CBC - complete blood count   To test for anemia, blood loss and certain vitamin deficiencies which can cause hair loss. 
Serum iron, serum ferritin, and total iron binding capacity (TIBC)   To test for anemia - a common cause of hair loss in women.
ANA   To test for Lupus - a common cause of hair loss in women.
Follicle Stimulating Hormone (FSH) 3-20 mIU/ml FSH is often used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS.  PCOS is commonly linked to hair loss in women.
Estradiol (E2) 25-75 pg/ml Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. Labelled the "female" hormone but also present in males it represents the major estrogen in humans. Estradiol has not only a critical impact on reproductive and sexual functioning, but also affects other organs including bone structure.

Women have half the amount of 5-a reductase compared to men, but have higher levels of the enzyme aromatase, especially at their frontal hairline. Aromatase is responsible for the formation of the female hormones estrone and estradiol. It also decreases the formation of DHT. Its presence in women may help to explain why the presentation of female hair loss is so different than in males, particularly with respect to the preservation of the frontal hairline. It may also explain why women have a poor response to the drug finasteride (Propecia), a medication widely used to treat hair loss in men that works by blocking the formation of DHT.

Levels on the lower end tend to be better for stimulating. Abnormally high levels may indicate existence of a functional cyst or diminished ovarian reserve.

Many believe that a drop in estradiol may also experience hair loss in women.

Estradiol (E2) 100+ pg/ml or 2x Day 3 There are no charts showing E2 levels during stimulation since there is a wide variation depending on how many follicles are being produced and their size. Most doctors will consider any increase in E2 a positive sign, but others use a formula of either 100 pg/ml after 4 days of stims, or a doubling in E2 from the level taken on cycle day 3.
Estradiol (E2) 200 + pg/ml The levels should be 200-600 per mature (18 mm) follicle. These levels are sometimes lower in overweight women.
Luteinizing Hormone (LH) < 7 mIU/ml A normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS. PCOS is commonly linked to hair loss in women.
Luteinizing Hormone (LH) > 20 mIU/ml The LH surge leads to ovulation within 48 hours.
Prolactin < 24 ng/ml Prolactin is the hormone that enables the breast to secrete milk. It is a test that your doctor might order when considering androgen excess in your body.  Increased prolactin levels can also interfere with ovulation.
Progesterone (P4) < 1.5 ng/ml Some suggest that when progesterone levels fall as a result of lack of ovulation, the body responds by increasing its production of the adrenal cortical steroid, androstenedione, an alternative precursor for the production of other adrenal cortical hormones. Androstenedione conveys some androgenic (male-like) properties, in this case, male pattern hair loss. When progesterone levels are raised by natural progesterone supplements, the androstenedione level will gradually fall, and your normal hair growth will eventually resume. Since hair growth is a slow process, it may take four to six months for the effects to become apparent. This can be corrected by using naturally compounded hormones.

An elevated level may indicate a lower pregnancy rate.

Progesterone (P4) > 15 ng/ml A progesterone test is done to confirm ovulation. When a follicle releases its egg, it becomes what is called a corpus luteum and produces progesterone. A level over 5 probably indicates some form of ovulation, but most doctors want to see a level over 10 on a natural cycle, and a level over 15 on a medicated cycle. There is no mid-luteal level that predicts pregnancy. Some say the test may be more accurate if done first thing in the morning after fasting.
Thyroid Stimulating Hormone (TSH) .4-4 uIU/ml Thyroid condition is commonly linked to hair loss in women. It is important to test both T3, T4 and TSH to rule out the possibility of thyroid condition.  Mid-range normal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have an effect on fertility.
Free Triiodothyronine (T3) 1.4-4.4 pg/ml Thyroid condition is commonly linked to hair loss in women. It is important to test both T3, T4 and TSH to rule out the possibility of thyroid condition. Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal levels of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function.
Free Thyroxine (T4) .8-2 ng/dl Thyroid condition is commonly linked to hair loss in women. It is important to test both T3, T4 and TSH to rule out the possibility of thyroid condition.  A low level may indicate a diseased thyroid gland or may indicate a non- functioning pituitary gland which is not stimulating the thyroid to produce T4. If the T4 is low and the TSH is normal, that is more likely to indicate a problem with the pituitary.
Total Testosterone 6-86 ng/dl Testosterone is a steroid hormone from the androgen group. It is primarily secreted in the testes of males and the ovaries of females although small amounts are secreted by the adrenal glands. It is the principal male sex hormone and an anabolic steroid. In both males and females, it plays key roles in health, well-being and can have significant impact on one's hair growth. Most would consider a level above 50 to be somewhat elevated.
Free Testosterone .7-3.6 pg/ml Free testosterone (T) is transported into the cytoplasm of target tissue cells, where it can bind to the androgen receptor, or can be reduced to 5α-dihydrotestosterone (DHT) by the cytoplasmic enzyme 5α-reductase. DHT binds to the same androgen receptor even more strongly than T, so that its androgenic potency is about 2.5 times that of T. The T-receptor or DHT-receptor complex undergoes a structural change that allows it to move into the cell nucleus and bind directly to specific nucleotide sequences of the chromosomal DNA. The areas of binding are called hormone response elements (HREs), and influence transcriptional activity of certain genes, producing the androgen effects. 
DHEA 350-4300 ng/ml DHEA is the precursor of androstenedione and testosterone. An elevated level of DHEA many signal excess androgens in the body.
Androstenedione .7-3.1 ng/ml Androstenedione can convert to testosterone in our bodies.
Sex Hormone Binding Globulin (SHBG) 18-114 nmol/l Increased androgen production often leads to lower SHBG.

A study published in the British Journal of Derm measured plasma sex-hormone binding globulin (SHBG) and testosterone levels in a pilot study of eight women aged 21-41 years who complained of diffuse hair loss; and subsequently in a larger group of fifteen patients of a similar age range. There was a significant reduction in SHBG levels in both groups of patients when compared to controls, but testosterone values were normal. 

VDRL   A screening test for syphilis. Syphillis can result in patch hair loss.

Other Tests

Scalp biopsy   A small section of scalp, usually 4 mm in diameter, is removed and examined under a microscope to help determine the cause of hair loss.
Hair pull   A doctor lightly pulls a small amount of hair (about 100 strands) to determine if there is excessive loss. If more that 3 hairs come out, then the patient is likely suffering from excess hair loss. Normal range is one to three hairs per pull.

 

17alpha-Estradiol Induces Aromatase Activity in Isolated Human Hair Follicles.

S. Niiyama, R. Hoffmann. Dept. of Dermatology, Philipp University, Marburg, Germany.

Women tend to develop AGA later and milder than men, but with the decline of serum estrogens during the menopause many women show an accelerated progression of AGA. Estrogens may play a protective role against the development of AGA, because pregnant women are in some way protected form androgenetic hair loss, but lose their hairs again postpartum. In Europe, topically applied estrogens such as 17▀-estadiole are used to treat androgenetic alopecia, both in women and men. The femal hormone 17▀- Estradiol can be used only in women, whereas the hormonally almost inactive isomer 17a-estradiol can be used in men as well. Although some clinical studies show considerable success of such an approach, the underlying pathways of 17a-estradiol-induced hair regrowth are unknown. It is likely not a receptor mediated hormon effect, since 17▀-Estradiol is an hormon and 17a-estradiol not. Recently it has been shown that hair follicles from women with AGA express more aromatase activity compared to male hair follices, and interestingly those women taking aromatase inhibitors tend to develop rapidly progressive AGA. These circumstantial lines of evidence indicate a role of aromatase during the pathogenesis of AGA. In order to unravel the pathways of 17a-estradiol-mediated effcets on the hair follicles, we measured aromatase activity in isolated intact human occipital hair follicles by incubating hair follicles with H3-1▀androstenedione with or without 17a-estradiol (1nM, 100nM, 1ÁM) for 24 or 48 hours. In comparison to the controls (female, 444fmol/mm3 = 100%), we noticed a concentration- and time-dependent increase of aromatase activity in 17a-estradiol-incubated female hair follicles (e.g. 24h: 1nM = + 18%, 100nM = + 25%, 1ÁM =+ 57%; 24h: 1nM = +18%, 48h: 1nM = +25%). Our ex vivo results suggest that under the influence of 17a-estradiol an increased conversion of testosterone to 17▀-estradiol and androstendione to estrone takes place. In theory this pathway may diminish the amount of intrafollicular testosterone available for conversion to DHT, and because DHT is the major mediator of AGA, this pathway may explain the beneficial effect of 17a-estradiol on the development and progression of AGA. Results suggest that SRY is a male-specific transcriptional stimulator for 5aRII in hDPCs.

Low sex-hormone binding globulin levels in young women with diffuse hair loss.

Miller JA, Darley Cr, Karkavitsas K, Kirby JD, Munro DD

Br J Dermatol. 1982 Mar;106(3):331-6.

We measured plasma sex-hormone binding globulin (SHBG) and testosterone levels in a pilot study of eight women aged 21-41 years who complained of diffuse hair loss; and subsequently in a larger group of fifteen patients of a similar age range.There was a significant reduction in SHBG levels in both groups of patients when compared to controls, but testosterone values were normal.
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