thin hair but want to take testosterone

[Karen]

Dear Dr. Redmond,

I'm 30 years old, and my hair started thinning when I was about 16. As my testosterone and DHEA levels are on the low end of the range, I thought I must be sensitive to what little testosterone I do have. On the other hand, I've always had far less body hair than average, and no underarm hair. Could one be oversensitive to testosterone on the head, and undersensitive to it on the rest of the body? I should also mention that when I was 26 I was diagnosed with a microadenoma (prolactinoma) and given cabergoline, and since I've been on this medication I finally started having mild underarm hair, with the existing body hair slightly increasing as well.

My second question is this: I've suffered from vulvar vestibulitis for the past 12 years, and have tried every available treatment except surgery. Recently I've heard about success with a topical compound of testosterone and estrogen, and am very eager to try it (I seem to fit the profile of hormone related VVS). According to articles I've read, in very low dosage this should not cause alopecia, especially in someone like me with little testosterone to begin with, but I'm still worried. How long in your experience does it take for low dosages of topical testosterone to start causing hair loss in women prone to it? And would it be possible to use a topical product that blocks testosterone on the scalp only, like men do?

Thank you very much in advance for your help!

[Geoffrey Redmond, MD, FACE]

Dear Dr. Redmond,

I'm 30 years old, and my hair started thinning when I was about 16. As my testosterone and DHEA levels are on the low end of the range, I thought I must be sensitive to what little testosterone I do have. On the other hand, I've always had far less body hair than average, and no underarm hair. Could one be oversensitive to testosterone on the head, and undersensitive to it on the rest of the body? I should also mention that when I was 26 I was diagnosed with a microadenoma (prolactinoma) and given cabergoline, and since I've been on this medication I finally started having mild underarm hair, with the existing body hair slightly increasing as well.

Prolactinomas (pituitary tumors that release the hormone prolactin) suppress the ovary so that it releases less estrogen and less testosterone. These changes can cause head hair loss with loss of pubic hair.

My second question is this: I've suffered from vulvar vestibulitis for the past 12 years, and have tried every available treatment except surgery. Recently I've heard about success with a topical compound of testosterone and estrogen, and am very eager to try it (I seem to fit the profile of hormone related VVS). According to articles I've read, in very low dosage this should not cause alopecia, especially in someone like me with little testosterone to begin with, but I'm still worried. How long in your experience does it take for low dosages of topical testosterone to start causing hair loss in women prone to it? And would it be possible to use a topical product that blocks testosterone on the scalp only, like men do?

Thank you very much in advance for your help!

Vulvo-vaginal vestibulitis is a condition in which the skin near the vagina is extremely sensitive to touch so that pain limits or prevents intercourse and even light touch may be painful. There are treatments for it but no single treatment that works for all women.

Estrogen cream is a reasonable treatment to try but applying testosterone to the vulva is a terrible idea but it is absorbed very rapidly and can cause hair loss, among other problems. I have seen many women whose alopecia was caused by applying testosterone to this area. I do not think it helps VVVS

[Karen]

Thank you very much for your reply! I've decided not to use testosterone as even if it did work, the risk would indeed outweigh the benefits.

I'd just like to clarify my first question, in order to try and understand what caused my hair loss to begin with (it can't be the prolactinoma, as that only developed in my mid twenties). During puberty the hair on my head started thinning, which would seem to indicate too much testosterone or oversensitivity to testosterone. On the other hand, I had almost no acne, very little body hair, and no underarm hair at all, which would indicate low testosterone or undersensitivity to testosterone.
Is it possible to be both oversensitive to testosterone on the head and undersensitive to it on the rest of the body?

Thank you again for your help.