Evidence of Increased 3-Alpha-Androstanediol Glucuronide in Female Pattern Alopecia: A Cross-Sectional Observational...

The role of androgens in female pattern hair loss (FPHL) is disputed as patients usually have normal androgen levels. 3α-androstanediol glucuronide (3α-diol G) is a marker of peripheral hyperandrogenism, but has not been assessed in FPHL. We aimed to evaluate ovarian, adrenal, and peripheral (3α-diol G) androgens in Indian women with FPHL and correlate them with the clinical severity of FPHL.

A cross-sectional observational study was conducted at a tertiary care hospital in India, involving 44 women with trichoscopically confirmed FPHL and 30 age-matched healthy controls. Clinical severity was graded using the Ludwig and Sinclair scales. Serum total testosterone (tT), SHBG, free androgen index, AMH, DHEAS, LH, FSH, TSH, prolactin, and 3α-diol G were measured.

FPHL patients presented with Ludwig grade 1 (70%, n = 31) and Ludwig grade 2 (29.5%, n = 13). Serum 3α-diol G levels were significantly higher in FPHL (mean: 8.43 ± 4.44 nmol/L, range: 3.2-20.74 nmol/L) compared to controls (mean: 4.23 ± 1.39 nmol/L, range: 1.81-7.29 nmol/L; p < 0.001). Levels of other androgens and pre-androgens were not significantly different between the groups. Abnormal tT levels (6.8%, n = 3) and DHEAS (4.5%, n = 2) were seen in a minority of cases. There was a positive correlation of 3α-diol G with FPHL severity (Ludwig scale, Spearman's ρ = 0.37, p = 0.013), with receiver operating characteristics (ROC) analysis revealing a high diagnostic accuracy (AUROC 0.85; cut-off ≥ 5.242 nmol/L; 82% sensitivity, 73% specificity) as compared to other hormonal parameters.

Serum 3α-diol G is a promising biomarker of peripheral hyperandrogenism in FPHL and correlates with clinical severity and may help in monitoring antiandrogen therapy.