If alopecia androgenetica (AGA) is suspected.
Men with AGA
If the clinical findings are typical, no further laboratory diagnosis is required in men. 2nd-order laboratory parameters-depending on the results of the history, physical examination, etc.-for differential diagnostic workup
- Testosterone
- Androstenedione
- Dehydroepiandrosterone sulfate (DHEAS)
- Sex hormone binding globulin (SHBG).
- TSH (thyroid-stimulating hormone).
Other notes
- Men with alopecia androgenetica have a similar hormone pattern to women who have polycystic ovary syndrome (PCO syndrome), according to one study; following values compared to the control group.
- Testosterone (24.61 vs. 20.57 nmol/l; p = 0.04).
- DHEAS (3.63 vs. 2.64 µg/ml; p = 0.02).
- LH (7.78 vs. 4.56 mIU/ml; p ˂ 0.001).
- Prolactin (14.14 vs. 9.97 ng/ml; p = 0.01).
- Free androgen index (FAI; total testosterone to SHBG; 74.49 vs. 49.99; p ˂ 0.001).
- FSH (4.02 vs. 5.66 mIU/ml; p ˂ 0.001) and SHBG (35.07 vs. 46.41 nmol/l; p ˂ 0.001).
- LH/FSH quotient (2.34 vs. 0.89; p ˂ 0.001).
- Insulin: no differences
CONCLUSION: Men with alopecia androgenetica, like patients with PCO syndrome, may be at increased risk for such conditions as metabolic syndrome, insulin resistance, cardiovascular disease, and infertility. Women with AGA
If there is evidence of hormonal dysregulation (e.g., acne, hirsutism), gynecological-endocrinological examination/diagnosis is required. 2nd order laboratory parameters-depending on the results of the history, physical examination, etc.-for differential diagnostic workup
- LH (luteinizing hormone).
- FSH (follicle stimulating hormone)
- 17-beta estradiol
- Testosterone
- Sex hormone-binding globulin
- 17-alpha-hydroxyprogesterone
- Dehydroepiandrosterone sulfate (DHEAS)
If hypoestrogenemic effluvium (estrogen deficiency-related hair loss) is suspected.
Laboratory parameters 1st order – obligatory laboratory tests.
- FSH (to rule out climacterium praecox or POF syndrome/premature ovarian failure: cessation of ovarian function before age 40).
- Estradiol
- TSH (if pathological: TRH test useful).
- SHBG
If alopecia areata (circular hair loss)1st order laboratory parameters – obligatory laboratory tests are suspected.
- ANA – Auto-Ak (IgG) against cell nuclear antigens (due toexclusion of collagenoses, especially dermatomyositis and polymyositis).
- Lues serology – due toexclusion of syphilis.
- IgE – due toexclusion of an atopic disease (atopy).
- Mycological diagnostics – if microsporiasis (fungal skin disease) or tinea capitis (fungal disease) is suspected.
- Micronutrients (vital substances)
- Vitamin D3
- Vitamin B12 – due toexclusion of pernicious anemia.
- Zinc (see below “Further notes”).
- TPO-Ak – autoantibodies against thyroideaperoxidase (due toExclusion of Hashimoto’s thyroiditis).
Furthermore, the iron must always be examined as part of the laboratory diagnostics: For this purpose, a ferritin serum level examination. Ferritin is a transport or storage protein of the human body, which is able to store a large number of iron ions. The ferritin serum level is thus a reflection of the organism’s total iron storage. In order to rule out malnutrition of the hair roots, the concentrations of the following vitamins, trace elements or pollutants can also be determined:
- Biotin
- Iron – ferritin (see above)
- Copper
- Selenium
- Zinc
- Arsenic
- Lead
- Mercury
- Thallium
Other notes
- Patients with alopecia areata had decreased serum zinc levels (risk group) according to one study. These correlate inversely with resistance to therapy. The more severe the conditions of alopecia areata were, the lower the serum zinc levels were.The trace element was measured in serum after venous fasting blood was collected.
