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When Do You do Bloodwork in Women with Female Pattern Hair Loss?

This is a common situation where a woman comes into our office presenting with female pattern hair loss. It is often a question as to whether or not bloodwork is necessary to see if androgen excess is responsible for the hair loss.

A recent review article in the Journal of the American Academy of Dermatology 2021 looked at androgen-mediated skin disease and came up with an algorithm for when bloodwork or ovarian ultrasounds are necessary when investigating women with androgen mediated skin disorders.

The authors indicated if the woman presents with female pattern hair loss (FPHL) alone then no further bloodwork or investigation is required. However, if the woman has more than 1 androgen-mediated skin disorder (e.g. acne, FPHL, hirsutism) or has FPHL and menstrual irregularities or evidence of virilization, then bloodwork is recommended to rule out an underlying problem.

This algorithm clarifies the situations in which further investigation is necessary in the evaluation of FPHL.

Reference:

Androgens in women: Androgen-mediated skin disease and patient evaluation. Bienenfeld A, Azarchi S, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. J Am Acad Dermatol. 2019 Jun;80(6):1497-1506.