Blood tests are used to identify whether the patient is suffering from true androgenic hair loss or female pattern hair loss. Female pattern hair loss presents with the same clinical features as androgenic alopecia, but there is not always evidence of elevated androgens in the serum. Blood tests do not measure the level of testosterone upregulated to DHT, so DHEA can be evaluated with testosterone.
Free / Total testosterone. Androgenic alopecia implies a dependence on increased expression of androgens, but female androgenic alopecia does not require an absolute elevation of androgens in the blood. The majority of women with androgenic alopecia have no clinical or biochemical evidence of elevated androgens. However, a subset of women with androgenic alopecia do, and women with concomitant symptoms of hirsutism (excess body and facial hair), adult acne, and irregular periods, should be screened for excess testosterone.
Dehydroepiandrosterone sulfate. This test is often done for women who show signs of having excess male hormones. Some of these signs are hair loss, excess facial and body hair growth, oily skin, acne, irregular periods, or problems becoming pregnant.
Sex Hormone-Binding Globulin (SHBG). Most testosterone is bound to sex hormone-binding globulin protein and is not active. If you have a low level of sex hormone-binding globulin, you may have a high level of free testosterone in your bloodstream. Low levels of SHBG are associated with obesity, stress and high levels of cortisol.
Ferritin / Serum Iron / TIBC. Iron deficiency contributes to hair loss and can be identified by two methods: serum ferritin or serum iron, and TIBC (total iron binding capacity). Low ferritin levels are diagnostic of an iron deficiency. However, low iron stores in patients with chronic disease may not be detected as ferritin is an acute phase reactant, and active inflammatory disorders and infections increases iron storage. The elevation in these situations give a false reading of normal or high iron stores. Iron deficiency is associated with low serum iron, and a relatively high TIBC, with a low percentage of saturation.
Vitamin D. Androgenic alopecia is associated with low levels of vitamin D and other fat-soluble vitamins. A higher level of vitamin D receptors are found in patients with low levels of vitamin D. Although vitamin D is commonly referred to as a ‘vitamin’ it is a biological response-modifying steroid hormone and now understood to be one of the most influential steroid hormones in the body. Vitamin D has emerged as the second most important nutrient (after iron) in healthy body functioning.
Cholesterol / Triglycerides. An abnormal lipid profile can contribute to hair loss. Cholesterol helps to repair and heal your body; you will produce more if there is a great deal of inflammation occurring in your body. So, any factor that would raise inflammation, can raise your cholesterol too. A high level of triglycerides can indicate poor sugar regulation, or the start of insulin resistance. Cholesterol is a precursor to testosterone and oestrogen, so high levels of cholesterol will increase levels of DHT.