On sensitive hair follicles, dihydrotestosterone binds to androgen receptors, and this hormone receptor complex activates genes that gradually convert large terminal hair follicles into miniaturized follicles. The miniaturized follicles grow a variety of hairs of varying length and thickness, and these hairs are characteristic of this disorder. In women with baldness, these fine hairs are more scattered but are most pronounced on the frontal and top scalp. Women usually retain a ring of hair along the hairline of the forehead. The fine hairs, sparse hair pattern and early onset support the diagnosis of this disorder. Severe patchy baldness in women Severe patchy baldness in women.
Most female patients with pattern baldness have normal menstruation and are able to have normal pregnancies. Unless the patient has signs and symptoms of hyperandrogenism such as hirsutism, severe folliculitis, masculine features, and breast leakage, a full hormone test is usually not necessary. Serum levels of total or free testosterone, dehydroepiandrosterone sulfate, and prolactin are measured to determine if androgen excess is present, and serum thyroxine, iron, and ferritin are measured to rule out other possible causes of female pattern baldness.