The Association Between Clinical and Biochemical Hyperandrogenism in Women With Female Pattern Hair Loss

Background: The exact association between clinical and biochemical hyperandrogenism (HA) is heterogeneous and cannot be ascertained, especially in normoandrogenic women. Aim: Evaluate any association between clinical HA phenotypes and biochemical parameters in premenopausal women with female pattern hair loss (FPHL). Methods: A cross-sectional observational study on 362 women with different degrees of FPHL, who were assessed for general characteristics, the degree of FPHL by Sinclair’s score, hirsutism by modified Ferriman-Gallwey (mFG) score. Evaluation for biochemical HA included total testosterone (TT), sex-hormone-binding globulin (SHBG), calculated free testosterone (FT), calculated bioavailable testosterone (BT), and dehydroepiandrosterone sulfate (DHEA-S). The variables of clinical HA which were used in this study are FPHL, hirsutism, and acne. We used the Free and Bioavailable Testosterone Calculator to calculate the FT and BT. Results: The enrolled young premenopausal women’s age range was (14-47 years). Around 78% of them were overweight or obese. Eighty-percent of women had a mild FPHL, with a median duration of three years where 2/3 of women had a duration < 3 years, and had no significant relationship to FPHL degree. 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 the enrolled women (n=284). The means of biochemical indicators for HA 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 to the severity of FPHL. The duration of FPHL was not affected by any presumed variable of clinical or biochemical HA. Conclusions: FPHL severity is associated with other clinical HA signs like hirsutism and acne, but not to HA’s biochemical parameter. Other parameters, like SHBG, HOMA-IR, and BMI, had no significant relation to the severity of FPHL. Clinical implications: FPHL severity does not correlate with the magnitude of hyperandrogenism. The assessment of women with FPHL is primarily clinical. The biochemical picture assists the diagnostic process.