Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

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Female androgenetic alopecia of male pattern (FAGA.M)-

 A variant of Female pattern baldness associated with Ovarian thecoma

 This type of hair loss is closely linked with hyperandrogenism or high levels of male sex hormones [testosterone] in women due to a specific type of ovarian tumour known as ovarian thecoma.

   Thecomas are rare androgen-secreting ovarian tumors, representing 0.5–1% of all ovarian tumors This type of tumours can occur at any age although more common in postmenopausal women. There are different variants for this tumour. However, Typical thecomas are almost always estrogenic or oestrogen hormone producing types; the luteinized forms are  excessandrogen producing variants and cause virilizing symptoms in about 10% of women affected.

 Thecomas are present in only 0.01–0.25% of all patients presenting with signs of excess androgen production or  clinical hyperandrogenism. Thecomas may present with a specific type of hair loss due to increased levels of circulating androgens[ male hormones produced by the tumour].

Female androgenetic alopecia or female pattern baldness is a common cause of hair loss, induced by androgens in genetically susceptible women, typically characterized by diffuse central hair thinning, maintaining the frontal hairline. However, there is another type of alopecia also described by Ludwig in 1977 , called female androgenetic alopecia of male pattern (FAGA.M).

Female androgenetic alopecia of male pattern (FAGA.M)

 It is clinically characterized by recession of the frontal and parietal hairlines, mimicking the pattern of androgenetic alopecia in men, and it is found in women with circulating androgens at high levels, particularly in ovarian thecomas.

Ovarian thecomas may present with secondary amenorrhoea or missed periods, infertility and symptoms of virilization such as deepening of voice, enlargement of clitoris etc . Hirsuitism or hair growth on body parts excessively may be an associated symptom. Acne also can be found in women having thecoma due to hyperandrogenism or excess male hormone production by the tumour cells.

Ovarian stromal cell tumors may secret large amounts of testosterone, which may produce rapidly progressing androgenic effects

Ovarian thecomas are commonly investigated with ultrasonography and the findings are non specific of an ovarian tumour. The characteristics may include an echogenic mass with distal acoustic attenuation, a well-defined hypoechoic mass, or an anechoic lesion with through-transmission. Secondary features of hyperestrogenism, such as endometrial thickening, also may be seen in thecomas which are oestogenic in nature. The differential diagnosis list may include ovarian neoplasms particularly fibroma and granulosa cell tumour.

Serum testosterone levels may be elevated markedly. All routine tests and tumour markers CA-125 ,ca19-9,AFP are checked for ruling out other types of ovarian malignancies.CT ,MRI scans of abdomen are also taken in some cases for ruling out other causes

Thecomas are mostly benign, however malignant varieties also have been reported in medical literature. Benign tumours follow a slowly progressive course, while malignant varieties are rapidly virilizing .

 Surgery is the best treatment of choice. Serum testosterone level  also declines after surgery.

References

1.      Nocito AL, Sarancone S, Bacchi C, Tellez T. Ovarian thecoma: clinicopathological analysis of 50 cases. Ann Diagn Pathol. 2008 Feb;12((1)):12 [Google Scholar] [Ref list]

2.      Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977 Sep;97((3)):247–54. https://pubmed.ncbi.nlm.nih.gov/921894/

3.     . McGee J, Fleming NA, Senterman M, Black AY. Virilizing luteinized thecoma of the ovary in a 15-year-old female: a case report. J Pediatr Adolesc Gynecol. 2009 Oct;22((5)):e107–10.

4.     https://radiopaedia.org/articles/ovarian-thecoma

5.     11. Loh KC, Lo JC, Zaloudek CJ, Fitzgerald PA. Occult virilizing ovarian tumours in postmenopausal women: problems in evaluation with reference to a case. Ann Acad Med Singapore. 1998;27:712–716. https://pubmed.ncbi.nlm.nih.gov/9919347/

6.     skin_academy_hair_skin_hormones_and_menopause_current_status_knowledge_on_the_management_of_hair_disorders_in_menopausal_women_293016