Why hair loss despite ‘normal’ tests | India News

New Delhi: Hair loss despite “normal” blood work is a common frustration for many women. Doctors say the answer may not lie in routine reports — but in what’s happening inside the scalp.For female pattern alopecia, patients are usually advised a battery of tests – nutritional work such as testosterone, free androgen index, thyroid function and vitamin levels. Yet, these often return to normal, leaving both patients and physicians without clear answers.A study published in an international journal of dermatology now offers an explanation. Researchers at Delhi’s Ram Manohar Lohia Hospital found that women with female pattern hair loss had significantly higher levels of a hormone marker called 3α-diol G—even when standard hormones like testosterone were within normal ranges.Female pattern baldness, which gradually thins 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 to 30 with hair loss. It found that levels of 3α-diol G – a marker of hormonal activity in hair follicles – were almost twice as high in affected women, and higher levels were associated with more severe thinning.Explaining the difference, Dr Kabir Sardana, professor of dermatology at RML Hospital, said female pattern hair loss (FPHL) is a genetic, gradual thinning that often presents as a wide patch, whereas telogen effluvium (TE) is a temporary, rapid shedding usually due to stress or illness. While FPHL leads to permanent miniaturization of hair follicles, TE is usually self-limiting.He added, “We always believe that female pattern hair loss is not caused by androgens, but this is not true. It’s just that we’re not looking at the right place for the right test. We already offer off-label anti-androgen drugs that block these hormones, but they must be used with caution, especially in women who are planning to conceive because they can affect conception.”Unlike conventional tests, 3α-diol G reflects hormone action at the skin level—where hair loss actually begins. This helps explain why many women continue to experience hair loss even when blood reports appear normal.The researchers also found that only a small fraction of patients showed abnormalities in routine hormone tests, pointing to the limitations of current diagnostic methods that rely on systemic 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.Simply put, the study highlights a key message, researchers say, that it’s not just how much hormone is in the blood, but what it’s doing to the hair follicle that determines hair loss.