Adrenal androgenic female-pattern alopecia: sex hormones and the balding woman1
James M. Kasick, M.D.
Wilma F. Bergfeld, M.D.
Willard D. Steck, M.D.
Manjula K. Gupta, Ph.D.
Nineteen white women (age range, 18–37 years) with a distinct pattern of diffuse alopecia, characterized by retention of the frontotemporal hairline and progressive loss of central scalp hair, were evaluated. The serum adrenal androgen dehydroepiandrosterone-sulfate (DHEAS) ranged from 2.2 to 5.8 μg/ml (mean, 3.9 ± 1.1 μg/ml). The normal female range is 0.3 to 3.2 μg/ml (mean, 2.0 ± 0.7 μg/ml). All women had a normal total serum testosterone level. Of two women with elevated levels of serum prolactin, one had a pituitary adenoma as revealed by computed tomography. Apparently, DHEAS is hydrolyzed to dehydroepiandrosterone (DHEA) and subsequently converted to more potent androgens. In the hair follicle, DHEA will inhibit glucose-6-phosphate dehydrogenase, a key enzyme of the pentose cycle that is essential for the synthesis of nucleic acids. The disruption of the growth of scalp hair may be due to this increased adrenal production as well as to the peripheral metabolism of DHEAS.