This article refers to the issues of alopecia and acne pathogenesis: anatomy of hair and sebaceous glands, biological factors affecting the stages of hair development and function of sebaceous glands. Alopecia is divided into two large groups: scaring and non-scaring alopecia, the later is represented by alopecia areata, telogen effluvium, and female pattern hair loss/androgenetic alopecia (FPHL/AGA). Before starting the search for systemic causes it is necessary to predetermine the type of alopecia on the basis of medical history and external manifestations. FPHL /AGA as a most common form of alopecia can often coexist with another common pathology – telogen effluvium, this fact determines therapeutic approaches and their results.Main pathogenetic mechanisms, approaches to differential diagnostics and treatment of the main specified types of non-scarring alopecia are reviewed. FPHL/AGA is a main type of alopecia which is often referred to gynecologists/endocrinologists. It is now regarded a multifactorial pathology with the involvement of a genetic component, androgen receptor gene expression, dihydrotestosterone synthesis and local low grade inflammation specifics. FPHL/AGA can be with and without hyperandrogenism, in both cases it can be accompanied by an increased risk of metabolic syndrome. In case of FPHL/AGA with hyperandrogenism the success of treatment depends on the consistent coordinated work of gynecologist/endocrinologist and dermatologist/trichologist, which allows combining systemic and local therapy in a timely manner.Also contemporary views on the acne pathogenesis are reviewed. Given the complex nature of acne its therapy is also complex and stepwise. According to current clinical guidelines and recent studies of the microbial component of acne pathogenesis the following conclusions are formulated. Patients with acne require assessment of androgen status, determination of the hyperandrogenism source, including evaluation of tissue androgens; phenotype of the syndrome and cardio-metabolic risks should be determined in patients with polycystic ovary syndrome; it is advisable to determine antimicrobial susceptibility of pathogens isolated from the inflamed pilosebaceous unit if acne form requires the local or systemic antibacterial therapy.

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According to the Princeton Consensus, female sexual dysfunction can be a sign of androgen deficiency (AD) in women of reproductive age, which necessitates the inclusion of appropriate therapy in fertility rehabilitation protocols for patients with biochemically confirmed AD. Most often, AD is associated with ovarian dysfunction. With ovarian hypofunction of autoimmune origin, an increase in inhibin B production occurs, in contrast to ovarian insufficiency of another etiology, which is due to selective damage to theca interna cells, while granulosa cells synthesizing inhibin B remain intact. Aim of the research. The study of the value of inhibin B as a prognostic marker of fertility recovery in women with androgen deficiency and sexual dysfunction. Materials and methods. The study design included 77 women of reproductive age of the main group with sexual dysfunction and androgen deficiency: 45 women with sexual dysfunction and the presence of thyroperoxidase Ak (I-a group), I-b group of 32 women with sexual dysfunction without antibodies to any organism tissues. Control group – 31 healthy women of reproductive age. Diagnostic laparoscopy was performed on anOLYMPUS device using a standard technique. Hormone testing was performed using a Johnson & Johnson Vitros automated system. Blood samples for the study were taken in the morning (8–11) on an empty stomach with venipuncture of the ulnar vein in the 1st phase of the menstrual cycle. Ultrasound test was performed on an Aloka Hitachi apparatus (Japan) with a sensor frequency of 7 MHz. Sexual dysfunction was determined by the Skindex-16V questionnaire. The diagnosis of the examined “Violation of female sexual desire / arousal” was done according to the classification DSM-5. Clinical manifestation of sexual dysfunction was >6 months. Results. The average age of the examined main group was 32.3±1.7 years, in the control group – 33.9±1.6 years. The average age of menarche for women of both groups was 13–14 years (in the main 13.3±0.34, in the control – 13.0±0.23 (p>0.05). The study of the hormonal background showed a pronounced, statistically significant in compare with healthy women, a decrease in the concentrations of not only estradiol, but also androgens, total testosterone, free testosterone, as well as dehydroepiandrosterone sulfate. Concentrations of sex steroids directly and statistically significantly correlated with the I-a group with concentrations of gonadotropins (luteinizing hormone (LH) and estradiol r=0.67; follicle-stimulating hormone (FSH) and estradiol r=0.64; LH and total testosterone r=0.47; FSH and total testosterone r=0.42; for all p <0.001). LH and DHEA-S p=0 <33 (p=0 <02), FSH and DHEA-S p=0<27 (p=0 <03). In group I-b, LH correlation and total testosterone r=0.58 p<0.001 were noted. Diagnostic laparoscopy with ovarian biopsy was performed in 12 women of group I-a and group 23 of group I-b. At the same time, the presence of lymphoid infiltration, autoantibodies and complement on growing follicles was established, with primordial and primary follicles intact. Tissue fibrosis, the presence of activated B and T lymphocytes: CD8+, CD4+, natural killer cells (NK), polyclonal plasmocytes, macrophages of primordial and primary follicles were characteristic for group I-b. Conclusions. The level of inhibin B can serve as an early marker of autoimmune ovarian damage in women of reproductive age with female sexual dysfunction. Therapy of androgen deficiency should be carried out taking into account the pathogenesis of the disease.

According to the consensus of An Endocrine Society Clinical Practice in Princeton, USA, worsening well-being and dystrophic mood, permanent weakness and altered sexual function, including libido decline and lack of orgasm, were considered as typical signs of androgen deficiency syndrome. Particular attention is required to study the state of the genitourinary system, which is hormone dependent, so it is obvious that age-associated symptoms of pathological processes of the lower urinary tract are likely to be considered as a "urological mask" of the deficiency of sex hormones. Aim of the work. Identify and describe the most common urogenital disorders in women of reproductive age with androgen deficiency. Materials and methods. The study was conducted at the Ukrainian Scientific and Practical Center of Endocrine Surgery, Endocrine organs and tissues transplantation of the Ministry of Health of Ukraine during 2017–2018 years. A survey was conducted on 80 women of reproductive age who had major complaints of sexual disturbances (decreased libido and lack of orgasm, as well as dyspareunia as the main manifestations of androgen deficiency in women) and 30 healthy reproductive women without complaints of sexual dysfunction. General clinical methods were used (questionnaire of patients with a detailed study of socio-economic status, somatic, gynecological, obstetric and sexual history). The condition of external and internal genital organs was evaluated in the study of cervix and vagina in mirrors and gynecological bimanual study. At the same time, batches of analyzes for bacteriological research and colpocytology studies were conducted. The “HAWK 2102 EXL” (Germany) apparatus was used for ultrasound examination of pelvic organs using transabdominal and transvaginal convection sensors with frequencies of 3.5 and 5 MHz, respectively. Consultation of the urologist in order to exclude organic urological pathology and, if necessary, cystoscopy was also done. In the plasma of venous blood, the following hormonal indices were also determined by solid phase IFA, namely, content: free testosterone, DHEA, androstenedione, prolactin, ACTH, cortisol, FSH, LH, estradiol, progesterone. Results. It was revealed after exclusion of the urologist of the organic pathology of the urinary tract, in 49 % (39) of the main group, there were disturbances of urination associated with atrophic changes in the distal sections of the urinary tract. The revealed signs of vulvovaginal atrophy: pH 6.1±0.7 in women of the main group and pH 4.3±0.5 in women of the control group, in addition reduction of the karyopyknotic index and increase of the ripening index as signs of atrophic changes in the vaginal mucosa and cervical canal, was detected in 70 % (56) women in the main group and not found in the control group. At the same time, the prolapse of the genitalia of mild degree in women of the main group was detected in 32 % (27), and in the control group, this pathology was not found. Conclusions. Detection of these changes, which was considered characteristic of women in perimenopause and postmenopausal, makes it important and valid for the continuation of the study of patients with androgen deficiency, the discovery of clinical and laboratory criteria for diagnosis and the development of methods for correcting androgen deficiency in women of all ages.