A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men With the Phenotypic Equivalent of Polycystic Ovarian Syndrome in Women

Abstract

IMPORTANCE Early androgenetic alopecia (AGA) is patterned hair loss occurring before age 30 years. Early AGA in men is frequently reported as the phenotypic equivalent of polycystic ovarian syndrome (PCOS) in women, which carries the risk of developing obesity, metabolic syndrome, and cardiovascular diseases. Very few studies have been conducted to evaluate this.OBJECTIVE To study the hormonal profile of men with early AGA and to evaluate if early AGA in men can be considered as the phenotypic equivalent of PCOS, the associated risks of which are well known. DESIGN, SETTING, AND PARTICIPANTSThis case-control study was conducted from January 1, 2014, to March 31, 2015, in a tertiary care government hospital. Fifty-seven men aged 19 to 30 years presenting with patterned hair loss were recruited as study participants. Thirty-two age-matched men with no evidence of hair loss were recruited as controls. Men who had any established endocrine disorder, diabetes mellitus, or cardiovascular disease and those who took any oral medication or hormonal treatment for hair loss were excluded from the study. The serum concentrations of total testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, fasting plasma glucose, and insulin levels were measured. Insulin resistance (IR) and free androgen index (FAI) were calculated and compared with age-and sex-matched controls. MAIN OUTCOMES AND MEASURESThe primary outcome was to measure the clinico-endocrinological profiles (LH, FSH, SHBG, DHEAS, and testosterone levels) of men with early AGA and to compare it with the PCOS profile; the secondary outcome was to establish a relationship between this endocrinological profile and IR.RESULTS Compared with the 32 controls, the 57 participants with AGA showed significantly increased mean (SD) levels of testosterone (24.61 [7.97] vs 20.57 [4.9] nmol/L; P = .04), DHEAS (3.63 [2.19] vs 2.64 [1.49] μg/mL; P = .02), LH (7.78 [3.19] vs 4.56 [2.01] mIU/mL; P < .001), and prolactin (14.14 [9.48] vs 9.97 [3.12] ng/mL; P = .01) and decreased mean levels of FSH (4.02 [2.69] vs 5.66 [1.93] mIU/mL; P < .001) and SHBG (35.07 [11.11] vs 46.41 [14.03] nmol/L; P < .001). The mean FAI and LH/FSH ratio were was also increased in the AGA group. These hormonal parameters resemble the well-known profile of women with PCOS. The mean (SD) insulin levels did not show any significant difference between the cases and controls (6.34 [3.92] vs 5.09 [3.38] μIU/mL; P = .07). There was no statistically significant association between hormone levels and AGA or IR grade severity.CONCLUSIONS AND RELEVANCE Men with early AGA could be considered as male phenotypic equivalents of women with PCOS. They can be at risk of developing the same complications associated with PCOS, including obesity, metabolic syndrome, IR, cardiovascular diseases, and infertility.

The combination of overweight and smoking increases the severity of androgenetic alopecia

“…AGA is characterized by miniaturization of hair follicles with the transformation of terminal hair follicles into vellus‐like ones. Increased levels of testosterone have been found among men with early AGA . Women do not have higher levels of circulating androgens, but they have higher levels of type I and II 5 alpha reductase, more androgen receptors, and lower levels of aromatase enzyme …”

“…Increased levels of testosterone have been found among men with early AGA. 7 Women do not have higher levels of circulating androgens, but they have higher levels of type I and II 5 alpha reductase, more androgen receptors, and lower levels of aromatase enzyme. 2 It has been suggested that AGA is an androgen-related condition in genetically predisposed individuals; 8 however, genetic predisposition cannot explain the whole risk associated with the condition neither with its severity.…”

Hormonal and reproductive factors and risk of upper gastrointestinal cancers in men: A prospective cohort study within the UK Biobank

“…If real, this could reflect that male pattern male pattern baldness, or androgenetic alopecia, is mediated by dihydrotestosterone, the potent metabolite of testosterone . There is growing evidence suggesting that male pattern balding status could serve as a clinical marker for circulating sex hormone concentrations . Moreover, preclinical experimental evidence supports a gastric cancer‐promoting effect for testosterone and androgen receptor overexpression in vivo has been shown to promote cell migration, invasion and proliferation in gastric cancer .…”

“…35 There is growing evidence suggesting that male pattern balding status could serve as a clinical marker for circulating sex hormone concentrations. [36][37][38] Moreover, preclinical experimental evidence supports a gastric cancerpromoting effect for testosterone 12 and androgen receptor overexpression in vivo has been shown to promote cell migration, invasion and proliferation in gastric cancer. 20 Taken together, it is possible that androgens might play a role in the development of these cancers, and could provide a logical explanation for the male dominance in their incidence.…”

Circulating and intraprostatic sex steroid hormonal profiles in relation to male pattern baldness and chest hair density among men diagnosed with localized prostate cancers

“…21,22 Direct comparison of results from epidemiological studies on circulating sex hormones in relation to male pattern baldness is challenging given differences in age, race, laboratory assays (eg, RIA, mass spectrometry, electrochemiluminescence immunoassay), health status (with/without malignancy/other metabolic diseases), and balding categories. Several small studies (n = 6) have assessed this relationship among apparently healthy younger (<45 years old) men and found conflicting associations; some reported that bald men were more likely to have increased testosterone, 15,42 increased testosterone/SHBG ratio, 42,43 increased DHT 15 and decreased SHBG levels, [42][43][44] whereas others have reported either null or opposing findings. 45,46 On the other hand, a cross-sectional study among older (>65 years) healthy Greek men specifically compared vertex balding to those without (ie, no/minimal plus frontal balding only) and did not find associations for serum testosterone, estradiol, DHEA-S, or SHBG.…”