Role of androgens in female-pattern androgenetic alopecia, either alone or associated with other symptoms of hyperandrogenism

Abstract

The roles of androgen hypersecretion, in situ enzyme activity, and androgen receptors in androgenetic alopecia in women are still a matter of debate. We studied 187 women with alopecia, which we graded I, II, or III, according to Ludwig's classification, and 21 healthy control women. All participants were subjected to full basal and 1 h post-beta-1-24 corticotropin stimulation endocrine profiles. Abnormal hormone profiles were observed in 67% of the patients with alopecia alone (group A, n = 110) and in 84% of the patients with alopecia plus other symptoms of hyperandrogenism including acne, hirsutism, and menstrual cycle disturbances (group B, n = 77). Mean serum 5alpha-androstane-3alpha,17beta-diol glucuronide (3alpha-AdiolG) levels in all three patient groups (6.50+/-4.10, 8.90+/-5.80, and 14.70+/-8.90 nmol/l, respectively) correlated with the grade of alopecia (I-III) and were significantly higher than in the control group (4.80+/-2.05 nmol/l, P < 0.005). Mean serum sex hormone-binding globulin (SHBG) levels were inversely correlated with the grade of alopecia (I-III) and were significantly lower in all three patient groups (50.55+/-23.50, 40.00+/-17.65, and 38.80+/-14.10 nmol/l, respectively) than in the control group (61.15+/-17.65 nmol/l, P < 0.05). Mean serum levels of delta4-androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and 3alpha-AdiolG were higher in group B than in group A, and higher in group A than in the control group. The significant correlations found between adrenal secretion - either positive (with 3alpha-AdiolG levels and the body mass index) or negative (with SHBG levels) - might reflect the important contribution of secretory and metabolic components in the development of alopecia, the severity of which has been shown to be very closely related to observed levels of two of these parameters (3alpha-AdiolG and SHBG).

Female pattern hair loss in complete androgen insensitivity syndrome

“…Futterweit et al 10 studied 109 women with hair loss and reported that 38AE5% showed clinical or biochemical evidence of androgen excess. In a series of 187 women with hair loss, Vexiau et al 11 reported abnormal hormonal profiles, mostly of minor degree, in 67% of women with hair loss alone and in 84% of women who were also hirsute. In a series of 89 women presenting to a trichology clinic with hair loss, 67% showed ultrasound evidence of polycystic ovaries compared with 27% in a control group of 73 women, and 21% were significantly hirsute compared with 4% of controls.…”

The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report

“…In a study of 110 patients with alopecia and no other clinical signs of hyperandrogenism, Vexiau and colleagues observed that only 10% had PCOS (54). Overall, it would appear that the proportion of women with alopecia only who have PCOS is considerably less than that of women with hirsutism, with or without alopecia.…”

Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals

“…Although sensitivity of the scalp to androgens is the important component of the pathophysiology of MPB, it may be unrelated to the epidemiological association between MPB and CHD. Moreover, androgen excess is not always present in men with MPB nor in women with androgenic alopecia (Futterweit et al 1988, Vexiau et al 2000, and among subjects in whom androgens have induced MPB CHD morbidity and mortality are not necessarily increased (e.g. 293 F<M transsexuals during the 2418 person-years of androgen treatment (van Kesteren et al 1997) and 319 women with PCOS followed for 31 years (Wild et al 2000)).…”