Female Pattern Hair Loss Evaluation and Testing
Androgen levels do not need to be routinely checked in patients with FPHL. They should be checked in women with virilization, severe acne, hirsuitism, irregular menses or infertility. Women with severe bitemporal notching or loss of the frontal hair line should also be checked for hyperandrogenism. Free and total testosterone levels and DHEA-S are good initial screening tests. If any of these tests are significantly elevated, the patient can be referred to endocrinology for further workup.
Iron levels may also be important in women with FPHL, although this is controversial. Ferritin and the ratio of serum iron to total binding capacity (TIBC) can be checked. Even if the relationship of iron levels to FPHL is unproven, many women are iron deficient and feel better if their iron stores are replenished. One study suggests that serum ferritin greater than 40 is desirable, while another study recommends a serum ferritin greater than 70.