Why am I experiencing weight gain, hair loss, and osteopenia at the age of 46?
Possible causes of symptoms in 3 mins

Q. What could be the causes of weight gain, hair loss, and osteopenia in a 46-year-old woman?

Answered by  
Dr. Shaikh Sadaf
and medically reviewed by   iCliniq medical review  team.


Professional Bio: Dr. Shaikh Sadaf is a Specialist in Diabetology and Endocrinology. She completed her MBBS from the University of Pune, MRCPI Internal Medicine from Ireland, MRCGP (Membership of the Royal College of G... 

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This is a premium question & answer published on Oct 02, 2023
Patient's Query

Hello doctor,

I am a 46-year-old female with regular cycles. At the age of 42, I was diagnosed with osteopenia, but doctors have been unable to determine the cause. There is no family history of osteopenia, anorexia, drug use, or autoimmune issues. However, I did experience a car accident that left me disabled, resulting in a stressful five years. Around nine months ago, I started noticing weight gain and hair loss, leading to extensive testing, including bloodwork and urine analysis. My cortisol level is within the range of 4 to 50 mcg/dL, with my measurement at 49.1 mcg/24h. Additionally, my SHBG level is elevated at 138 nmol/L, compared to the normal range of 17 to 124 nmol/L. Unfortunately, the testosterone levels were not provided in the description. After my first spine surgery five years ago, I unexpectedly suffered a fracture in the sacral region while walking. Initially, it was suspected to be a hardware issue, but further scans, such as CT and MRI, revealed the fracture without significant trauma. This prompted ordering a bone density exam, which led to the diagnosis of osteopenia, technically classified as osteoporosis due to the unexplained fracture. Subsequently, I underwent hip surgery four years ago and spinal surgery the year before. Although no medications have been prescribed specifically for osteopenia or osteoporosis, my doctor considers my bone health within normal limits. Currently, my medication includes the following:

  1. Ambien for sleep.

  2. An allergy medication.

  3. Hydrochlorothiazide for edema caused by nerve damage.

  4. Adderall for ADHD.

  5. I take Adderall once or twice daily at a dosage of 20 mg.

I need your valuable suggestions regarding my health. Please suggest. Thank you.

Answered by  Dr. Shaikh Sadaf


Welcome to icliniq.com.

I have read your query, and understand your concern.

Based on the information provided, it appears that you may be experiencing idiopathic premenopausal bone loss. This means that the underlying cause for your condition cannot be determined without further investigation. It is important to consider undergoing thorough assessments for gastrointestinal diseases such as celiac disease or malabsorptive gastrointestinal disorders, postoperative states, the number of children you have had, diabetes, alcoholism, bone marrow disorders, rheumatoid arthritis, other inflammatory conditions, hereditary hemochromatosis, hypogonadism assessment, history of eating disorders, renal disease, and liver disease assessment. I suggest you have a comprehensive assessment by a general internal medicine specialist who can evaluate the above-mentioned factors. Alternatively, you can continue with vitamin D and calcium replacement therapy as prescribed. However, I suggest you consult with a healthcare professional to ensure appropriate management of your condition. I hope this information helps you. Feel free to ask any further queries.


Patient's Query

Thank you for the reply doctor,

My GP is well aware of my issues and has referred me to the rheumatologist, hematologist, gastroenterologist, and OBGYN. The OBGYN internal scan showed that my ovaries and estrogen levels are fine. Now, I have been referred to an endocrinologist. Specifically, I was asking about the high cortisol, high SHBG, and low testosterone levels. My testosterone level is under 3 ng/dL. I was seeking an endocrinologist because these three values are the only ones out of range. I want to understand why they are abnormal and what potential effects being out of range for an extended period can have. I have experienced 15 pounds of weight gain in six to seven months, hair falling out in clumps, and thinning fingernails. None of these symptoms are normal, and they all started around the end of last year. I want to know if these values sound normal from an endocrine perspective. Could adrenal fatigue or a pituitary or adrenal tumor be potential causes? A postmenopausal woman should have a minimum testosterone level of 10 ng/dL, ideally ranging from 20 to 40 ng/dL. Mine is under three. Interestingly, my 73-year-old mother has better bone density numbers than I do. I have already seen a gastroenterologist, and there are no signs of celiac disease, internal bleeding, or gastrointestinal issues. I had a colonoscopy two years ago and underwent a pill cam study last month. I spent two years seeing a rheumatologist but have not received a diagnosis of any autoimmune condition.

I have never had children and have never experienced an eating disorder or engaged in drug or alcohol abuse. As I mentioned earlier, I had no health issues prior to the accident. All my other blood work, including liver and kidney function, is perfect. Should I continue with vitamin D and calcium supplements? Both my calcium and vitamin D levels are fine. Last year, I received a Reclast treatment for bone density. I stopped taking birth control pills two years ago. I need suggestions regarding my health issues. Thank you.

Answered by  Dr. Shaikh Sadaf


Welcome back to icliniq.com.

I understand the complexity of your medical situation. High cortisol levels can contribute to osteopenia, and you appear to have borderline low levels. You may consider testing for an ACTH (adrenocorticotropic hormone) stimulation test to assess for adrenal fatigue syndrome or Addison's disease. The low testosterone levels could be attributed to high SHBG (sex hormone-binding globulin) levels, which can also be associated with adrenal fatigue. The accident itself may have triggered osteopenia due to reduced mobility and increased risk factors. You can consider testing LH (luteinizing hormone), FSH (follicle-stimulating hormone), and prolactin levels to evaluate pituitary function. I understand that this may be a challenging situation for you, and ultimately, your choice is the extent of investigation and treatment. It is important for you to know that you have the option to pursue comprehensive assessments and treatment. I have provided two pathways, one involving extensive investigations while the treatment remains the same or proceeding with treatment regardless. Since you prefer a thorough assessment, you can pursue the tests mentioned above to better understand your condition. I hope this helps.

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