I am an endocrinology intern from Brazil. The case is: Female, 30yrs. She presents with concern for losing hairs and low testosterone, sent by a dermatologist. Menses are normal, no changes in desire or muscle mass or body hair (only alopecia). Hormone profiles: thyroid functions normal , prolactin normal, DHEA normal, LH/FSH/estrogen in normal range. Testosterone = 12,2 (range 15-80) and repeated testosterone=6,9.
The questions: 1) what do I have to think about it (hypothesis)? 2) which are the tests that I have to ask in this case? 3) management? Thanks.A Rubin, Sao Paulo
First, I cannot offer specific advice in the absence of seeing a specific patient so all I can do is comment about alopecia in general. As you know, most causes of alopecia are not endocrine -- having said that, it clearly can occur as a result of low estrogen (without a concomitant decrease in testosterone) after the menopause. For postmenopausal hair loss estrogen therapy is somewhat effective. Testosterone measurements in laboratories are so poorly performed that I am never confident about any values, low or normal or high. About 25% of testosterone comes from the ovary, 25% from the adrenal, and 50% from peripheral conversion from inactive precursors. So have you considered any adrenal abnormality here? If there is no evidence of this either, I would not think that her hair loss is primarily endocrine. Robert W. Rebar, M.D.