Why I’m Losing Hair Despite Testing “Normal”

New Delhi: Despite having “normal” blood tests, hair loss is a common frustration for many women. Doctors say the answer may lie not in routine reports but in what’s happening inside the scalp.For female pattern baldness, patients are typically advised to undergo a battery of tests—nutrition checks such as testosterone, free androgen index, thyroid function, and vitamin levels. However, these often revert to normal, leaving both patients and clinicians without clear answers.A study published in the International Journal of Dermatology now provides an explanation. Researchers at Delhi’s Ram Manohar Lohia Hospital found that women with female pattern baldness had significantly elevated levels of a hormone marker called 3α-diol G, even though standard hormones such as testosterone remained within the normal range.Female pattern hair loss causes progressive thinning at the front and top of the scalp, affects a large number of women and often affects self-confidence. But routine investigations often fail to identify the cause.The study compared 44 women with hair loss and 30 women without hair loss. The study found that affected women’s levels of 3α-diol G, a marker of hormonal activity within hair follicles, nearly doubled, and that higher levels were associated with more severe hair thinning.Explaining the difference, Dr. Kabir Sardana, professor, Department of Dermatology, RML Hospital, said that female pattern hair loss (FPHL) is a hereditary, progressive thinning phenomenon that usually manifests as widening of the hair loss areas, while telogen effluvium (TE) is a temporary, rapid hair loss that is usually triggered by stress or illness. Although FPHL can cause permanent shrinkage of hair follicles, TE is usually self-limiting.He added: “We have always thought that female pattern hair loss is not caused by androgens, but this is not the case. It’s just that we don’t have the right tests in the right places. We already use off-label antiandrogens to suppress these hormones, but they must be used with caution, especially in women planning a pregnancy, because they can affect conception. “Unlike traditional tests, 3α-diol G reflects hormonal effects at the level of the skin, where hair loss begins. This helps explain why many women continue to lose hair even when their blood reports show normal results.The researchers also found that only a small proportion of patients showed abnormalities on routine hormone tests, pointing to the limitations of current diagnostic methods that rely on systematic measurements.Experts say the findings could shift the focus from hormone levels in the blood to hormone activity in the scalp, potentially improving diagnosis and treatment. However, larger studies are needed before this approach becomes part of routine care.In a nutshell, the study highlights a key message. Researchers say it’s not just the amount of the hormone in the blood that determines hair loss, but its action in the hair follicles.