Testosterone metabolism in the skin. A review of its function in androgenetic alopecia, acne vulgaris, and idiopathic hirsutism including recent studies with antiandrogens

Price, Vera H.

doi:10.1001/archderm.111.11.1496

Cited by 48 publications

(11 citation statements)

References 57 publications

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“…36 The skin has been recognized as a major site of the androgen metabolism along with the prostate and male genitalia. 37 While both testosterone and DHT can bind to AR, DHT has ten-fold higher affinity to AR than F I G U R E 8 Funnel plots for publication bias of studies investigating the relationship between testosterone and PSA testosterone. 38 AR, when bound to its ligand (ie, DHT or testosterone), moves from the cytosol to the nucleus and acts as a transcription factor that regulates the expression of target genes such as PSA.…”

Section: Discussionmentioning

confidence: 99%

Association between prostate‐specific antigen and serum testosterone: A systematic review and meta‐analysis

et al. 2020

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Background Serum testosterone assays are an important tool in the clinical evaluation of a number of endocrine disorders including male hypogonadism. However, serum testosterone has a limited role in real clinical use due to its inaccuracy. We aimed to assess the association between prostate‐specific antigen (PSA) and testosterone as well as the effects of various types of testosterone replacement therapy (TRT) for PSA level. Methods Two electronic databases were screened: PubMed (1966 through December 2018) and Cochrane Library (1993 through December 2018). The first strategy compared the overall increase in PSA following testosterone treatment compared with placebo. The second strategy analyzed the overall association between PSA and testosterone among the observational studies. Results In the first strategy, 22 articles were included in the final analysis. In the second strategy, 18 studies were included. Testosterone replacement therapy (TRT) showed a significant change in PSA level compared to that in the placebo group (mean difference [MD]: 0.13, 95% CI: 0.01‐0.25, P = .04). Compared to placebo, only intramuscular (IM) TRT shows a significant change in PSA level group (MD: 0.16, 95% CI: 0.01‐0.30, P = .04), as neither the oral nor topical type showed a significant change in PSA. In the second strategy analysis, there was no overall correlation found between PSA and testosterone (z = 0.04, 95% CI: −0.04 to 0.12, P = .04; r = 0.039). However, in the subgroup of non‐BPH (benign prostate hyperplasia), a significant correlation between PSA and testosterone (z = 0.07, 95% CI: 0.01‐0.13, P = .009; r = 0.089) was found. Conclusions We found that TRT, particularly IM TRT, significantly changed the PSA level compared with the placebo group. Furthermore, there was a significant correlation between PSA and testosterone in patients with non‐BPH. According to these findings, we suggest the possibility of PSA as a surrogate marker of testosterone.

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Section: Discussionmentioning

confidence: 99%

Association between prostate‐specific antigen and serum testosterone: A systematic review and meta‐analysis

et al. 2020

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“…DHT, which is formed by the peripheral conversion of testosterone by 5a-reductase, is thought to be responsible for the characteristic miniaturization of scalp hair follicles in AGA. In genetically susceptible hair follicles, DHT binds to the androgen receptor, and the hormone-receptor complex then activates the genes responsible for the gradual transformation of large, terminal follicles to small, miniaturized follicles (Price, 1975;Uno et al, 1985;Messenger, 1993;Kaufman, 1996). Over successive hair cycles in AGA, the duration of anagen shortens and matrix size decreases, resulting in smaller follicles that produce shorter, ¢ner, miniaturized hairs that cover the scalp less and less well.…”

Section: Pathophysiologymentioning

confidence: 99%

“…In women with AGA, the extent of hair loss is generally less than in men. It has been assumed that the hormonal basis for AGA is similar in women as in men although earlier studies did not include female subjects (Price, 1975;Frieden and Price, 1986). In order to compare and clarify the underlying hormonal basis, a study was conducted in 12 young women (ages 14^33) and 12 young men (ages 18^30) with AGA (Sawaya and Price, 1997).…”

Section: Pathophysiologymentioning

confidence: 99%

Androgenetic Alopecia in Women

Price¹

2003

Journal of Investigative Dermatology Symposium Proceedings

162

122

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Androgenetic alopecia (AGA), also known in women as female pattern hair loss, is caused by androgens in genetically susceptible women and men. The thinning begins between ages 12 and 40 years, the inheritance pattern is polygenic, and the incidence is the same as in men. In susceptible hair follicles, dihydrotestosterone binds to the androgen receptor, and the hormone-receptor complex activates the genes responsible for the gradual transformation of large terminal follicles to miniaturized follicles. Both young women and young men with AGA have higher levels of 5alpha reductase and androgen receptor in frontal hair follicles compared to occipital follicles. At the same time, young women have much higher levels of cytochrome p-450 aromatase in frontal follicles than men who have minimal aromatase, and women have even higher aromatase levels in occipital follicles. The diagnosis of AGA in women is supported by early age of onset, the pattern of increased thinning over the frontal/parietal scalp with greater density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs. Most women with AGA have normal menses and pregnancies. Extensive hormonal testing is usually not needed unless symptoms and signs of androgen excess are present such as hirsutism, severe unresponsive cystic acne, virilization, or galactorrhea. Topical minoxidil solution is the only drug available for promoting hair growth in women with AGA. Efficacy has been shown in double-blind studies using hair counts and hair weight.

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“…It is known that follicles of the scalp and body (beard, chest) respond differently to androgens and to other hormones. (34) Even different regions of the scalp behave variably; in hereditary thinning, hair on the top of the scalp is affected, but hair along the temporal and occipital fringe is spared. (35) This illustrates the tissue-specific and location-specific variability that hormonal signals can have on the hair follicle.…”

Section: Discussionmentioning

confidence: 99%

Investigating the effects of metabolic dysregulation on hair follicles: a comparison of HIV‐infected women with and without central lipohypertrophy

et al. 2013

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Background Normal lipid metabolism and functioning of the peroxisome proliferator activated receptor gamma (PPAR-gamma) in the sebaceous gland is critical to maintaining a normal hair follicle. Human immunodeficiency virus (HIV) infection affects lipid metabolism; some have hypothesized a link between PPAR-gamma function and lipodystrophy in HIV infection. Our objective was to determine whether lipodystrophy is associated with altered hair characteristics in HIV-infected women from the Women’s Interagency HIV Study (WIHS). Methods Hair characteristics and scalp inflammation were assessed by an interviewer-administered questionnaire. Central lipohypertrophy and peripheral lipoatrophy was defined by self report of moderate to severe fat gain in central body sites and fat loss in peripheral body sites, respectively confirmed by clinical examination. Additional covariates considered in the analyses included demographics, behavioral characteristics, medical history, and HIV-related factors. Results There were 1037 women with data on all study variables. 76 women reported central lipohypertrophy; only 4 women reported lipoatrophy. Women with central lipohypertrophy were more likely to be older, have a self-reported history of injection drug use, statin medication use, diabetes, elevated cholesterol, and have self-reported less hair and shorter eyelashes. After adjustment for age, central lipohypertrophy was associated with shorter eyelashes (OR 2.3; 95% CI 1.4-3.8). Conclusions Central lipohypertrophy was not associated with change in scalp hair texture or scalp inflammation in this cohort. Rather, we found an association between central lipohypertrophy and shorter eyelash length. This finding may be explained by an influence of prostaglandin E2 mediators on eyelash follicles.

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Testosterone metabolism in the skin. A review of its function in androgenetic alopecia, acne vulgaris, and idiopathic hirsutism including recent studies with antiandrogens

Cited by 48 publications

References 57 publications

Association between prostate‐specific antigen and serum testosterone: A systematic review and meta‐analysis

Association between prostate‐specific antigen and serum testosterone: A systematic review and meta‐analysis

Androgenetic Alopecia in Women

Investigating the effects of metabolic dysregulation on hair follicles: a comparison of HIV‐infected women with and without central lipohypertrophy

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