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Hair Loss/Postmenopause: DHEA level question

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QUESTION: Hi Dr. Panagotacos,

I had a complete hysterectomy at 42, both ovaries out, and was never put on estrogen therapy. I'm now 50 and have experienced diffuse hair loss of probably 50% of my volume. I also have temporal thinning that I can mask with hairstyle.

Blood work done six months ago gave these results: Estradiol 22 (to be expected), TSH 1.11, Ferritin 93, DHEA 476, and Vitamin D 31. Also, Total Testosterone 9 and my Free Testosterone 1.6. I've been told by a layperson that 476 seems high for DHEA at my age. Question: Does my DHEA level seem high? Should I be re-tested? Is this a red flag for hair loss?

I use Rogaine 5%, Nizoral shampoo every few days, take Vitamin D supplement, along with Calcium, etc.
I also just started using laser helmet. I'd consider Spironolactone, if a professional thinks it would be helpful. Question: Would Spironolactone work for someone in menopause, even without use of estrogen? I've always had oilier skin with adult acne that I keep at bay. I wonder if this means I'm more sensitive to androgens?

I understand that, as we age, hair thinning occurs. However, I'm concerned that because of my hysterectomy at an early age, my genetically predetermined hair loss pattern has been accelerated. I'd like to preserve what I can!

Thank you in advance for your answers/thoughts.

ANSWER: Hi Anne,
  A DHEA level of 476 seems to be twice what is should be.  
Female Ages 40 - 49: 32 - 240 ug/dL
Here is a good source of information:
http://www.nlm.nih.gov/medlineplus/ency/article/003717.htm
It may be that your condition is an inherited defect in the adrenal gland.

My advice is to consult with an endocrinologist and ask if you can be treated as if you had PCOS because your Androgen Receptor sites on your scalp hairs are super sensitive to any androgen stimulation. This may include a HRT or OCP with no androgen such as YAZ and spironolactone to block the androgen receptor sites.
  Your current therapies are all reasonable treatments to help ailing hairs, but I strongly suggest you get treated for the high DHEA to block further progression of your AGA - predetermined hair loss pattern .



---------- FOLLOW-UP ----------

QUESTION: Thank you so much for your prompt reply. Now that I have your answer things are starting to make sense. Before my hysterectomy (which was due to an enormous ovarian cyst), I had irregular periods my WHOLE life, I had a lot of trouble conceiving (only one pregnancy), and I struggled with oily skin/acne for decades.

Follow up questions for you:
The test I had done was for DHEA. The NIH link you provided discusses DHEA-Sulfate results. Should I assume that my DHEA-S number is just like my DHEA? Or, should I be retested for DHEA-Sulfate?

Also, the reference range for DHEA given on my lab report is listed as: 102 to 1185. So, my DHEA appeared to be well within the range. Why does the reference range allow for such a high number?

Finally, if I'm reluctant to use HRT due to family history of breast cancer/stroke, would Spironolactone (and/or some other DHT blocker) alone still be beneficial in my post-menopausal situation?

Thank you again, Dr. Panagotacos, for your answers and help. You provide an immensely useful service to us hair-loss sufferers.

ANSWER: Most of the DHEA is found in the blood as DHEAS. I believe the test measures both. In any case your levels are too high and need to be blocked.
If you can not take Yaz then consider spironolactone but see an endocrinologist to sort this out for you. The only test with that range would be a 24 hour urine collection with a reference range 100 to over 1000.
DHEA is by far the major product of the adrenal cortex, and over 99 percent of it is sulfated before secretion. it is usually measured as a blood test measuring the DHEAS

Here is another reference:
ttp://www.uptodate.com/contents/measurement-of-adrenal-androgens

---------- FOLLOW-UP ----------

QUESTION: Hi again, Dr. Panagatacos,

Since you have been so helpful already, I wonder if I might prevail upon you once again. I need some recommendations for excellent, experienced endocrinologists in your area or the West Coast...ones who you feel would be knowledgeable about what to do with my DHEA results and situation. I would be flying in from Hawaii.

And, to confirm, because my ovaries are gone it looks as if I am dealing with adrenal gland issues, correct? And, this is what is leading to excessive DHEA production.

Thank you, once again.

Answer
Hi,
  Yes, I believe you have an adrenal gland problem.

 On the West Coast I would suggest UCSF Endocrinology Department here in San Francisco "Endocrinology at UCSF Medical Center was ranked fourth in the nation .  You would have to go to Mayo Clinic or Johns Hopkins to get the number one or two ranked departments
http://www.ucsfhealth.org/clinics/endocrinology/

You may want to do a bit of research on your own as to where there may be an expert on adrenal gland issues such as yours. There may be one at UCLA that I do not know about.

 Finally I have to warn you that many experts in their field see problems with a narrow scope and you may find someone telling you " there may be a problem with your adrenal gland that causes hair loss but it will be too difficult to correct and you can always wear a wig".
 There are Dermatology Departments who have world class specialists in Androgenetic Alopecia and when you find your endocrinologist see if there is a "Hair Loss Clinic " in their Dermatology Dept such as Dr Elise Olson at Duke University, Dr Wilma Bergfeld at the Cleveland Clinic, Dr Leonard Sperling at the NIH,Dr Paradi Mirmirani at UC San Francisco.

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Peter J. Panagotacos, <B>M.D.</B>

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website www.hairdoc.com

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