|Year : 2020 | Volume
| Issue : 2 | Page : 106-111
Role of serum androgens and prostate-specific antigen levels in men with androgenetic alopecia
Hesham N Khaled MD, PhD 1, Azza M Abdu Allah2, Ahmad A Abdelhameed3, Wafaa A Shehata1
1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt; Faculty of Applied Medical Sciences, Taibah University, Yanbou, Kingdom of Saudi Arabia
3 Department of Dermatology and Andrology, Khanka Central Hospital, Qliubya, Egypt
|Date of Submission||29-Aug-2019|
|Date of Acceptance||04-May-2020|
|Date of Web Publication||09-Jun-2020|
Hesham N Khaled
40 Mosadak Street, Dokki, Giza, 12611
Source of Support: None, Conflict of Interest: None
Background Androgenetic alopecia (AGA) is the most common form of hair loss. It is caused by continuous miniaturization of affected hair follicles. Genetic factors and androgenic factors especially dihydrotestosterone (DHT), which is a testosterone tissue metabolite, play major roles in the pathogenesis of AGA. Many studies suggest that AGA may be a marker of increased risk of prostate cancer.
Objective The aim of the study was to determine the role of serum androgens and prostate-specific antigen (PSA) in men with AGA.
Patients and methods The study included 80 participants: 40 men were diagnosed with AGA and 40 age-matched healthy male volunteers served as a control group. The authors also divided patient groups into two subgroups: frontal AGA group and vertical AGA group. All participants were subjected to measurement of serum level of T, DHT, and PSA by enzyme-linked immunosorbent assay.
Results This study showed that mean serum level of testosterone and DHT in patients with AGA was higher than that in the control group and mean serum level of testosterone in the vertical AGA group was higher than that in the frontal AGA group. There was no significant difference between patients and controls regarding mean serum level of PSA.
Conclusion This study showed that serum androgens play an important role in the development of AGA and there is a strong association between serum level of androgens and staging of AGA, whether frontal or vertical.
Keywords: androgenetic alopecia, androgens, prostate-specific antigen
|How to cite this article:|
Khaled HN, Abdu Allah AM, Abdelhameed AA, Shehata WA. Role of serum androgens and prostate-specific antigen levels in men with androgenetic alopecia. Egypt J Dermatol Venerol 2020;40:106-11
|How to cite this URL:|
Khaled HN, Abdu Allah AM, Abdelhameed AA, Shehata WA. Role of serum androgens and prostate-specific antigen levels in men with androgenetic alopecia. Egypt J Dermatol Venerol [serial online] 2020 [cited 2020 Aug 12];40:106-11. Available from: http://www.ejdv.eg.net/text.asp?2020/40/2/106/286288
| Introduction|| |
Androgenetic alopecia (AGA) − also termed male-pattern alopecia, common baldness, and male-pattern hair loss − is the most common type of alopecia occurring after puberty. It is typically manifested as progressive hair thinning and shortening in the affected areas. Although regarded as a minor dermatological condition, it affects self-image and is a great cause of anxiety and depression in some patients, particularly younger ones ,,. A link between male-pattern baldness and androgens has previously been documented ,. The effects of androgens on follicles vary depending on the body site. Although androgens stimulate beard growth and body hair in other sites in men, they suppress hair growth in the scalp in AGA. This reciprocal effect has been described as the androgen paradox . Androgens also play a role in the development and growth of prostate cancer. That is why finasteride, which is a type II 5-α reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT), is used for the treatment of AGA and has been shown to decrease the incidence of prostate cancer ,. Despite this, a direct link between male-pattern baldness and prostate cancer has not been consistently shown ,,,,,. Authors have suggested that inconsistencies in results may be due to differences in the pattern of hair loss and in the time frame of development of androgenic alopecia. AGA occurring in younger males (before the age of 30 years), as well as hair loss implicating the vertex, may be a precursor to developing prostate cancer later in life ,,.
| Aim|| |
The aim was to study role of serum androgens and prostate-specific antigen (PSA) on AGA by measuring their levels in serum of males with AGA and to correlate their levels with the available clinical data.
| Patients and methods|| |
This case–control study was conducted on a total of 80 participants: 40 male patients with AGA and 40 age-matched healthy male volunteers as a control group. The study was approved by the medical ethical committee of the Faculty of Medicine, Menoufia University. The study included diagnosed men with AGA irrespective of age and excluded patients with alopecia other than androgenetic etiology (alopecia areata or cicatricial alopecia), patients who used finasteride or dutasteride, or any other drug capable of impairing androgen action (saw palmetto, antidepressants, GnRH agonists, isotretinoin, NSAIDs, statins, thiazide) used in the last 6 months prior to study initiation, patients with pre-existing medical conditions of the scalp, which could have an impact on the results of the study, and patients with benign prostatic hyperplasia, prostatic carcinoma diagnosis, urinary retention history, renal failure, urinary incontinence, and urinary tract infection.
All studied patients were subjected to complete history taking, clinical, general and dermatological examination. Patients were classified according to the pattern of hair loss as per the Hamilton–Norwood classification system into 11 stages including stage I, II, III, III vertex, IIIa, IV, IVa, V, Va, VI, and VII. The patient group was also divided into two subgroups: frontal AGA group which included satges I, II, III, IIIa, IV, and IVa and vertical AGA group which included stages Ill-vertex, V, Va, VI, and VII) . Blood sample was obtained from every participant under complete aseptic conditions by sterile venipuncture and put into a dry sterile plain tube for assessment of serum T, DHT, and PSA. Measurement of serum testosterone was determined by BioCheck testosterone enzyme immunoassay kit manufactured by BioCheck Inc. (South San Francisco, California, USA). This kit is based on the principle of competitive binding between testosterone in the test specimen and testosterone–horseradish peroxidase conjugate, for a constant amount of rabbit antitestosterone. Measurement of serum DHT was determined by human DHT enzyme-linked immunosorbent assay kit manufactured by Shanghai Sunred Biological Technology Co., Ltd, Baoshan District, Shanghai, China. This kit is based on the principle of double-antibody sandwich technique. Measurement of PSA was determined by human PSA enzyme-linked immunosorbent assay kit manufactured by Shanghai Sunred Biological Technology Co. This kit is based on the principle of double-antibody sandwich technique.
Data collected were tabulated and analyzed by SPSS version 22 (the Statistical Package for the Social Sciences software) (SPSS, IBM Corp., Armonk, NY, USA) on an IBM compatible computer. Quantitative data were expressed as mean and SD and analyzed by applying Student’s t-test for comparison of two groups of normally distributed variables and Mann–Whitney U-test for non-normally distributed ones. Qualitative data were expressed as number and percentage and analyzed by applying the χ2-test.
| Results|| |
Age of patients ranged from 22 to 41 years with 31.05±5.39 as the mean±SD value. Age of controls ranged from 22 to 44 years with 32.70±5.84 as mean±SD value ([Table 1]).
Regarding other clinical data of studied patients, age of onset of AGA ranged from 18 to 30 years with 23.15±2.88 as the mean±SD value. Course of AGA was progressive in 20 (50%) cases and was stationary in 20 (50%) cases. Family history of AGA was positive in 23 (57.5%) cases ([Table 1]).
According to the Norwood–Hamilton classification system, five (12.5%) cases were of stage I, five (12.5%) cases were of stage II, three (7.5%) cases were of stage III, 14 (35%) cases were of stage III vertex, two (5%) cases were of stage IIIa, one (2.5%) case was of stage IV, four (10%) cases were of stage IVa, one (2.5%) case was of stage V, three (7.5%) cases were of stage Va, one (2.5%) case was of stage VI, and one (2.5%) case was of stage VII ([Table 3]). There were 20 (50%) cases classified as frontal AGA including stages I, II, III, IIIa, IV, and IVa and 20 (50%) cases were classified as vertical AGA including stages III vertex, V, Va, VI, and VII ([Table 2]).
|Table 2 Staging of the studied cases according to the Norwood–Hamilton grading system (N=40)|
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|Table 3 Correlation between mean serum level of T, DHT, and PSA and duration of AGA of the studied cases|
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There was a negative correlation (r=−0.282) between mean serum level of T and duration of AGA in the studied patients ([Table 3]).
Mean serum level (mean±SD) of T in cases was 9.46±3.78 and in controls was 2.58±1.39 with P value less than 0.001 ([Table 4] and [Figure 1]).
|Table 4 Comparison between cases and controls regarding mean serum levels of T, DHT, and PSA|
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|Figure 1 Comparison between cases and controls regarding mean serum level of T and dihydrotestosterone (N=80).|
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Mean serum level (mean±SD) of DHT in cases was 604.30±1093.07 and in controls was 672.38±279.22 with P value 0.002 ([Table 4] and [Figure 1]).
Mean serum level (mean±SD) of PSA in cases was 0.46±0.13 and in controls was 0.43±0.07 with P value greater than 0.05 ([Table 4] and [Figure 1]).
Mean serum level (mean±SD) of T in the vertical AGA group was 30.65–6785.7 and in the frontal AGA group was 7.89±2.6 with P value less than 0.001 ([Table 5] and [Figure 2]).
|Table 5 Comparison between cases with frontal AGA and cases with vertical AGA regarding mean serum levels of T, DHT, and PSA|
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|Figure 2 Comparison between cases with frontal androgenetic alopecia and cases with vertical androgenetic alopecia regarding mean serum level of T (N=40).|
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Mean serum level (mean±SD) of DHT in the vertical AGA group was 672.38±279.22 and in the frontal AGA group was 567.64±1348.8 with P value greater than 0.05 ([Table 5] and [Figure 2]).
Mean serum level (mean±SD) of PSA in the vertical AGA group was 0.45±0.2 and in the frontal AGA group was 0.46±0.079 with P value greater than 0.05 ([Table 5] and [Figure 2]).
| Discussion|| |
In our study, of the 40 patients with AGA, 23 (57.5%) cases had a positive family history of AGA which supports the genetic predisposition in AGA. This result was nearly similar to a study by Devi et al. , who conducted a study on 27 men clinically diagnosed as AGA and reported that 66.7% of the patients had a positive family history of AGA.
In this study, a negative correlation was found between mean serum level of T and duration of AGA, denoting that there is a steady progressive deterioration of serum T level with age, which is in agreement with a study by Lapauw et al. , who found a negative correlation between mean serum level of testosterone and aging in men regardless of having AGA or not.
Our study showed that there was a statistically significant difference between cases and controls regarding the mean serum level of testosterone (P<0.001), being higher in AGA cases. This result was in agreement with a study by Narad et al.  and a study by Sanke et al. .
In this study, there was a statistically significant difference between cases and controls regarding the mean serum level of DHT (P=0.002), being higher in cases than in controls. This result was in agreement with a study by Bang et al.  and a study by Zhang et al. . However, no significant difference between cases and controls regarding mean serum level of PSA was found.
In the current study, there was a statistically significant difference between vertical AGA group and frontal AGA group regarding mean serum level of testosterone (P<0.001), being higher in vertical AGA than in frontal AGA group but there was no significant difference between frontal AGA group and vertical AGA group regarding mean serum level of DHT or PSA. Such finding has no clear explanation in the literature, but we think that it may be due to the fact that frontal hair follicles are more sensitive to androgen action and it starts the process of miniaturization even at low levels of androgen in comparison to vertical hair follicles that need higher levels of androgen. These results do not agree with a study made by Lis-Święty et al.  who found that the mean value of DHT levels in the serum of men with vertex baldness was higher than those in men with frontal baldness with statistical significance (P<0.05). And the groups did not show significant differences in the mean value of serum T.
In this study, no clear connection was found between serum levels of T, DHT, or PSA and clinical grades of AGA in patients denoting that an advanced case of AGA does not necessarily mean a higher level of androgen in comparison to early cases of AGA and vice versa.
The idea that AGA is associated with androgen serum levels is not new but this association is a matter of controversy. On the basis of studies performed on 52 patients of both sexes with early AGA, Sreekumar et al.  found no increase in androgen concentrations (DHT and T), but did note the presence of a significantly elevated ratio of DHT/T. However, Vierhapper et al.  reported that the level of DHT is significantly higher in men with MAGA, and its determination is necessary before antiandrogen treatment.
However, we believe that the relationship between AGA and androgens and also the exact impact of androgens on the etiopathogenesis of AGA need further studies on larger groups of patients. Also, whether AGA in men can point to the possibility of having prostate cancer in the future is a point of debate that may be clarified in the near future by more deep studies on the possible link between AGA and prostate cancer.
| Conclusion|| |
From this study, we could conclude the following:
- Patients with AGA have higher serum level of testosterone and DHT than normal healthy individuals.
- Serum level of androgens plays an important and crucial role in the development of AGA.
- There is a strong association between serum level of androgens and the staging of AGA whether frontal or vertical.
- Genetic predisposition plays an important role in the development of AGA.
- There is no association between AGA and the risk of development of prostate cancer.
The intricate relationship between androgens and AGA necessitates further studies on larger groups of patients. This may ultimately help in finding an effective treatment for AGA that targets reducing androgen levels only on the level of the scalp without affecting serum levels of androgens.
The manuscript has been read and approved by the authors. All the authors had equally contributed to this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]