A normal total testosterone does not rule out androgen effects

Clinical hirsutism may signal androgen activity even when a routine total-testosterone assay is reported normal.

PCOS with clinical hyperandrogenismAndrogen-related signs may be present with normal ultrasound findings.
Altered SHBG and free androgen exposureTotal testosterone alone may miss differences in biologically available androgen.
Adrenal androgen contributionDHEAS or other adrenal markers matter in selected presentations.
Non-classic congenital adrenal hyperplasiaSelected patients need clinician-directed evaluation of androgen precursors.
Other dermatologic or endocrine causesAcne, stress-related shedding, thyroid or nutrient problems may coexist.

Scalp hair thinning has several competing causes

Female-pattern hair loss can coexist with hormonal changes, nutrient deficiency or other dermatologic disorders.

Female-pattern hair lossFollicular susceptibility can cause thinning independent of markedly elevated blood androgens.
Other dermatologic or endocrine causesAcne, stress-related shedding, thyroid or nutrient problems may coexist.
PCOS with clinical hyperandrogenismAndrogen-related signs may be present with normal ultrasound findings.
Altered SHBG and free androgen exposureTotal testosterone alone may miss differences in biologically available androgen.
Adrenal androgen contributionDHEAS or other adrenal markers matter in selected presentations.

PCOS assessment considers clinical hyperandrogenism, ovulatory pattern and ovarian morphology; one normal scan is not decisive.

PCOS with clinical hyperandrogenismAndrogen-related signs may be present with normal ultrasound findings.
Altered SHBG and free androgen exposureTotal testosterone alone may miss differences in biologically available androgen.
Other dermatologic or endocrine causesAcne, stress-related shedding, thyroid or nutrient problems may coexist.
Adrenal androgen contributionDHEAS or other adrenal markers matter in selected presentations.
Female-pattern hair lossFollicular susceptibility can cause thinning independent of markedly elevated blood androgens.

Rapidly progressive hirsutism or virilization calls for timely clinician assessment for uncommon causes.

Non-classic congenital adrenal hyperplasiaSelected patients need clinician-directed evaluation of androgen precursors.
Adrenal androgen contributionDHEAS or other adrenal markers matter in selected presentations.
PCOS with clinical hyperandrogenismAndrogen-related signs may be present with normal ultrasound findings.
Altered SHBG and free androgen exposureTotal testosterone alone may miss differences in biologically available androgen.
Other dermatologic or endocrine causesAcne, stress-related shedding, thyroid or nutrient problems may coexist.