Early-onset Androgenetic Alopecia Research Articles

Factors associated with early-onset androgenetic alopecia: A scoping review.

Early-onset androgenetic alopecia (AGA) has been associated with various chronic conditions, including metabolic syndrome (MetS). Gaining a deep understanding of early-onset AGA may enable earlier intervention in individuals at high risks. This scoping review aims to explore the risk factors and etiology, associated conditions, and adverse effects on wellbeing in early-onset AGA. Electronic literature searches were conducted in MEDLINE, EMBASE and CENTRIAL. Eligible studies included case-control, cohort, cross-sectional, and meta-analysis studies. Selected studies needed to clearly define early-onset AGA cases or include only cases starting before the age of 40 and compare them with appropriate controls. The exclusion criteria comprised editorials, commentaries, case series, and non-systematic reviews, among others. Data extraction involved collecting study characteristics, methodologies, main outcomes, and findings. Descriptive tables were used to summarize key information and relevant variables when necessary. Among the 65 eligible articles, 67.69% were case-control studies and 78.46% evaluated only male patients. "Early-onset" was defined as cases developing before the age of 30 years in 43.08% of the studies. The Hamilton-Norwood scale was the most frequently used method for evaluating the severity of alopecia in men (69.23%). Reported risk factors for early-onset AGA included a family history of AGA, cigarette smoking, unhealthy dietary habits, and a high body mass index. Early-onset AGA may also be associated with hormonal profiles, 5α-reductase enzyme activity, androgen receptor genes, and some susceptibility loci. Comorbidities investigated included MetS, cardiovascular disease, insulin resistance, dyslipidemia, and Parkinson's disease. Men with early-onset AGA may have reduced treatment efficacy with drug like rosuvastatin, metformin or lisinopril for dyslipidemia, prediabetes, or hypertension. Additionally, young men with AGA tended to suffer from psychological issues such as anxiety and low self-esteem compared to those without hair loss. Early-onset AGA is a complex condition with various risk factors and etiology, associated comorbidities, and potential implications for treatment response and psychological health.

SERUM VITAMIN D LEVELS IN PREMATURE ANDROGENETIC ALOPECIA- A CASE -CONTROL STUDY.

Background: Androgenetic alopecia is a hereditary, androgen-dependent disorder characterized by a gradual conversion of terminal hair into miniaturized hair and causes progressive hair loss. Studies have showed lowered vitamin D levels in patients with androgenetic alopecia, which also correlated to their severity. The purpose of this study is to determine the association and correlation of Serum vitamin D levels in premature onset of androgenetic alopecia Methods and methodology: A total of fty males clinically diagnosed with androgenetic alopecia and fty age matched healthy controls were recruited. Serum Vitamin D levels of the cases and controls obtained were assessed. The data was analysed statistically. Results: In this study the mean levels of serum vitamin D were signicantly decreased in cases, compared to controls (13.90 vs. 28.4 nmol/L; P ≤ 0.001). Eighty seven percent of the cases had deciency of vitamin D (<25 nmol/L), while 13% had insufcient vitamin D levels (25-75 nmol/L). However, there was no correlation between severity of androgenetic alopecia and serum vitamin D levels. (P value =1.65). Conclusion: This study shows that majority of cases with early onset androgenetic alopecia had deciency of vitamin D levels. However, there was no correlation between severity of androgenetic alopecia and serum vitamin D levels

Is early onset androgenetic alopecia related to hyperuricemia? A case control study

Introduction and Aim: Early onset androgenetic alopecia (AGA) ensues before age of 35 years and develops stage 3 in Hamilton-Norwood classification. AGA is more noticeable in males. Early onset AGA has been linked to hyperuricemia (a metabolic disorder characterised by elevated levels of serum uric acid) but has been explored inadequately. Hyperuricemia (HU) corroborates with the presence of hypertension, obesity, type 2 diabetes mellitus, metabolic syndrome and chronic kidney disease (CKD). Given the above and lack of data in this context, a study in this regard was necessary. This study was intended to relate the prevalence of HU and level of serum uric acid (SUA) levels in patients of early onset AGA versus matched controls and determine correlation between the severity of alopecia and serum uric acid and between the SUA and age (secondary objectives). Materials and Methods: Each patient was evaluated by taking history, clinical examination and laboratory investigation. Results: The groups were not different from each other with respect to age (p=0.5). The SUA in the AGA patient group was greater than in the control group; however the difference was not statistically significant. (p=0.2). AGA patients were found to have higher number of hyperuricemics as compared to the control group (Chi square test P=0.03, Odds ratio=0.39). There was no correlation between the severity of alopecia or the age of the subject with SUA. Conclusion: Our study found that men who have early onset AGA tend to have higher serum uric acid levels; also, hyperuricemics are commoner in patients who have early onset AGA than in controls.

Clinical and metabolic characteristics of males with early-onset androgenetic alopecia.

Background Men with early-onset androgenetic alopecia (AGA) often have an abnormal hormonal milieu. Objective To ascertain the clinico-phenotypic characteristics and the prevalence of hormonal and metabolic changes in men with early-onset AGA. Methods Consecutive male patients less than 30 years of age with a Norwood-Hamilton grade ≥3 AGA were recruited in this comparative cross-sectional study. After endocrine evaluation they were classified into two groups, that is, Group A consisting of subjects with an altered hormonal profile and Group B with normal hormonal profiles. The groups were assessed for differences in disease phenotype and severity (Norwood-Hamilton grade), insulin resistance and parameters of metabolic syndrome (ATP III guidelines). Results Altered hormonal profiles were seen in 34 of the 100 subjects with AGA, while insulin resistance and metabolic syndrome were noted in 44 and 26 respectively. Altered hormonal profiles were significantly associated with insulin resistance and severe alopecia (grade 4 and above Hamilton-Norwood Scale). Insulin resistant Group A patients had a significantly higher prevalence of severe alopecia (>grade 4) (P = 0.0036). The prevalence of metabolic syndrome was similar in both groups. Limitation The cross sectional study design was a drawback of this study. Further, a control arm without AGA was not included and the sample size of 100 was selected arbitrarily. Conclusion An altered hormonal profile and insulin resistance was noted in a third of the males with early-onset AGA. Subjects with altered hormonal profiles had a higher prevalence of insulin resistance and were likely to have severe grades of AGA.

Pediatric androgenetic alopecia: a retrospective review of clinical characteristics, hormonal assays and metabolic syndrome risk factors in 23 patients

BackgroundAndrogenetic alopecia in the pediatric population is rarely discussed in the literature. Although the prevalence of the metabolic syndrome is increased in patients with early-onset androgenetic alopecia, the presence of metabolic syndrome risk factors in pediatric androgenetic alopecia is unknown. ObjectiveTo evaluate the demographics, medical and family histories, clinical and trichoscopic features, androgenic hormones, and metabolic syndrome risk factors in pediatric androgenetic alopecia. MethodsThe medical reports of pediatric patients with androgenetic alopecia were reviewed. ResultsThe study included 23 patients (12 females and 11 males) with a mean age of 15,3 ± 2,1 years. Sixteen patients had adolescent androgenetic alopecia and seven, had childhood alopecia. Nine patients reported a family history, all of whom had adolescent androgenetic alopecia. Hyperandrogenism was noted in three patients with adolescent androgenetic alopecia. The most common hair loss pattern was diffuse thinning at the crown with preservation of the frontal hairline which was noted in 10 patients (43.5%), six of whom were males. Fourteen patients (60.9%) had at least one metabolic syndrome risk factor. The most common risk factor was obesity or overweight (47.8%) followed by insulin resistance (21.7%), high fasting blood glucose (13%), high blood pressure (4.4%) and lipid abnormalities (4.4%). Study limitationsRetrospective study; lack of a control group. ConclusionPediatric androgenetic alopecia is often associated with metabolic syndrome risk factors. Therefore, androgenetic alopecia in the pediatric population may indicate a future metabolic syndrome which warrants an accurate and prompt diagnosis for early screening and treatment.

Minoxidil, Platelet-Rich Plasma (PRP), or Combined Minoxidil and PRP for Androgenetic Alopecia in Men: A Cost-Effectiveness Markov Decision Analysis of Prospective Studies.

BackgroundAndrogenetic alopecia (AGA) is the most common cause of hair loss in men. In this study, we evaluated the cost-effectiveness of minoxidil monotherapy, minoxidil and platelet-rich plasma (PRP) combined therapy, and PRP monotherapy for the long-term treatment of early-onset AGA Hamilton-Norwood stages I-V in men.MethodologyMarkov modeling was performed to analyze the base-case parameters from 18 level I/II studies. The model base-case assumes a healthy 25-year-old man presenting to a dermatologist or plastic surgeon’s office as a new patient for the evaluation and treatment of AGA Hamilton-Norwood stages I-V (non-severe AGA in men). Simulations began at an age of 25 years and ran over 35 years. Analyses were conducted from healthcare and societal perspectives. Outcomes included incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay (WTP) thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty over 10,000 simulations.ResultsFrom a healthcare perspective, compared to minoxidil monotherapy, the ICER for minoxidil+PRP was $52,036/quality-adjusted-life-year (QALY) and the ICER for PRP monotherapy was $439,303/QALY. The NMB of minoxidil monotherapy was $914,887, minoxidil+PRP was $914,350, and PRP monotherapy was $904,572 at a WTP threshold of $50,000. When the WTP threshold was increased to $100,000, the NMB of minoxidil+PRP was $1,843,908, minoxidil monotherapy was $1,831,237, and PRP monotherapy was $1,822,246. Societal trends were similar.ConclusionsMinoxidil 5% topical twice-daily monotherapy provided cost-effective treatment for men with AGA Hamilton-Norwood stages I-V at a WTP threshold of $50,000, whereas combining minoxidil 5% with PRP provided cost-effective treatment at a WTP threshold of $100,000.Level of evidence: Level II.

The impact of levothyroxine on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity in men with autoimmune hypothyroidism and early-onset androgenetic alopecia.

Administration of testosterone or dehydroepiandrosterone to subjects with low levels of these hormones was found to reduce thyroid antibody titres. Male-pattern baldness is accompanied by mildly increased androgen levels. The present study was aimed at investigating whether early-onset androgenetic alopecia determines the impact of exogenous levothyroxine on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity in young men with autoimmune hypothyroidism. The study included 2 thyroid-antibody-matched groups of men with autoimmune hypothyroidism: subjects with early-onset androgenetic alopecia (group 1; n = 24) and subjects with no evidence of hair loss (group 2; n = 24). All patients were treated with exogenous levothyroxine. Circulating titres of thyroid peroxidase and thyroglobulin antibodies, as well as levels of thyrotropin, free thyroxine, free triiodothyronine, prolactin, total testosterone, calculated bioavailable testosterone, dehydroepiandrosterone-sulphate, and oestradiol were measured before levothyroxine treatment and 6 months later. In both study groups, levothyroxine decreased thyroid antibody titres, reduced thyrotropin levels and increased free thyroid hormone levels. However, these effects were less pronounced in the men with early-onset male-pattern baldness than in the control men. The degree of reduction in antibody titres and thyrotropin levels correlated with baseline levels of total and calculated bioavailable testosterone, as well with baseline insulin sensitivity and treatment-induced improvement in insulin sensitivity. Concentrations of the remaining variables remained unchanged throughout the study period. The results of the current study suggest that the benefits of levothyroxine therapy in men with autoimmune hypothyroidism are less pronounced in individuals with early-onset androgenetic alopecia.

Efficacy and Tolerability of N-Acetyl-Cysteine for Treatment of The Early-onset Androgenetic Alopecia in Men

Abstract Background Androgenetic alopecia (AGA), the most common form of hair loss in men, involves the progressive loss of visible pigmented terminal hair on the scalp in response to circulating androgens. AGA is an autosomal disorder which begins in puberty in genetically predisposed individuals. Aim of the Work To study the effectiveness and safety of the reactive oxygen species scavenger Nacetyl-cysteine (NAC) as a single therapy and in combination with the topically applied minoxidil for treatment of the early-onset androgenetic alopecia in men. Patients and Methods The present study included 100 patients with male pattern hair loss whose age ranged from 18 to 30 years old, recruited from dermatology clinics in Ain Shams University Hospital and Kafr El Sheik University Hospital. Results Overall, all treatments could improve significantly some of the trichoscopic parameters as compared to the control group who did not receive any treatment. The number of terminal hair count increased and the vellus hair count decreased in response to either of treatments; minoxidil, NAC, or both as compared to control. These changes were noticed at both the vertex and frontotemporal sites. The treatment was generally tolerable and the side effects encountered did not necessitate stoppage of the treatment course. Conclusion On the basis of the findings of current study we can conclude that, the role of trichoscopy in increasing the accuracy for diagnosing hair disorders as well as to detect response or failure to treatment, N-acetylcysteine (NAC) improved significantly most of the trichoscopic features of AGA and it was was generally tolerable and the side effects encountered did not necessitate stoppage of the treatment course.

Impact of Lisinopril on Cardiometabolic Risk Factors in Men With Hypertension and Early-onset Androgenetic Alopecia: A Pilot Study.

Women with polycystic ovary syndrome are at a high cardiometabolic risk. Early-onset male-pattern baldness is considered the phenotypic equivalent of polycystic ovary syndrome in men. The aim of this study was to assess whether early-onset androgenetic alopecia modifies cardiometabolic effects of lisinopril in men with arterial hypertension. The study population consisted of 62 young men with grade 1 hypertension, 31 of whom were diagnosed with early-onset male-pattern baldness (group A). Thirty-one blood pressure-matched men with normal hair growth (group B) served as a control group. All participants were treated with lisinopril (10-40 mg daily). Blood pressure, glucose homeostasis markers, urinary albumin-to-creatinine ratio (UACR), as well as plasma levels of uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, total and calculated free testosterone, dehydroepiandrosterone sulfate, and estradiol were assessed before lisinopril treatment and 6 months later. At baseline, levels of all cardiometabolic risk factors were higher in group A than group B. Although lisinopril reduced systolic and diastolic blood pressure, UACR, hsCRP, and fibrinogen in both study groups, these effects were stronger in group B than in group A. Only in group B, the drug decreased levels of uric acid and homocysteine, as well as improved insulin sensitivity. The impact of lisinopril on uric acid, hsCRP, fibrinogen, homocysteine, and UACR correlated weakly with its hypotensive properties, androgen levels, and insulin sensitivity. The obtained results suggest that cardiometabolic effects of lisinopril in men are less pronounced in case of coexisting early-onset androgenetic alopecia.

Prevalence of early-onset androgenetic alopecia and its relationship with lifestyle and dietary habits.

Early-onset androgenetic alopecia (AGA) is the most common cause of alopecia in men under 30 years of age; however, its prevalence and non-genetic risk factors are not well documented. The aim of our study was to determine the early-onset AGA prevalence and to evaluate its relationship with lifestyle and dietary habits. This study was conducted on 1507 male university students aged 18-30 years. Students with AGA were grouped as mild and moderate-severe according to the Hamilton-Norwood classification. They were asked to complete a questionnaire regarding information about lifestyle and dietary habits including the Adolescent Food Habits Checklist (AFHC) and International Physical Activity Questionnaire (IPAQ) short form. The prevalence of early-onset AGA was 19.2% in the students. Each year over the 18 years age, positive family history, unhealthy vegetable-fruit and red meat consumption, presence of a hair disease apart from AGA and smoking were associated with increased risk for early-onset AGA. The median score of AFHC was lower than those without early-onset AGA which reflects the unhealthy dietary habit. Students with moderate-severe AGA had a higher body mass index and waist circumference than those with mild AGA (P<0.05). In addition to family history, lifestyle and dietary habits have roles in early-onset AGA. Therefore, regulation of lifestyle and dietary habits may have a possible contribution in the prevention of early-onset AGA.

Association of Early-onset Androgenetic Alopecia and Metabolic Syndrome.

To evaluate the association of early-onset AGA (androgenetic alopecia) and metabolic syndrome in the younger male population. Case-control study. Department of Dermatology, Mayo Hospital Lahore, from October 2017 to March 2018. A total of 202 patients were enrolled, 101 male patients with early-onset AGA (cases with a alopecia between 20-36 years of age), and were matched with 101 controls. All measurements regarding BMI, metabolic syndrome, and grades of alopecia were recorded on a pre-designed proforma. Of the 101 cases (mean age 27.77 ± 5.04 years), 27 (26.7%) had grade 3, 41 (40.6%) had grade 4, 29 (28.7%) had grade 5 and 4 (4%) had grade 6 AGA. Patients of AGA had an approximate four times increased frequency of metabolic syndrome. Of the cases 12 (11.9%) had metabolic syndrome whereas it was found in 3 (3%) of the control group. A significant association was found between cases of AGA and metabolic syndrome (p=0.016). This study suggests a significant association of AGA with metabolic syndrome. Key Words: Androgenetic alopecia, Metabolic syndrome, Early-onset alopecia, Cardiovascular disease.

Implications of cigarette smoking on early-onset androgenetic alopecia: A cross-sectional Study.

Androgenetic alopecia (AGA) is a condition affecting both males and females. Aims We aimed to assess the demographic and clinical features of early-onset AGA among smokers and nonsmokers and to evaluate whether prevalence of AGA was affected by smoking. One thousand (1000) healthy males aged between 20 and 35years not complaining of any local scalp condition and free of any mental illness were recruited for this study and divided into two groups of 500 each based on their smoking attitudes. Androgenetic alopecia was classified according to the Hamilton baldness scale, and trichoscopy was used to confirm the diagnosis of AGA. A designed questionnaire to determine basic physical and smoking habits completed and results was interpreted and analyzed. The majority of smokers (425) had a form of AGA, while only (200) nonsmokers had a degree of AGA (P<.01). Of the smokers group, 235 (47%) had grade III AGA and 120 subjects (24%) had grade IV AGA. In the nonsmokers group, 100 subjects (20%) had grade II AGA and 50 subjects (10%) had either grade III or IV AGA. The prevalence of AGA among smokers was statistically higher than among nonsmokers, while severity of AGA was not associated with the intensity of smoking. Nicotine and its derivative cotinine might be responsible for accelerating AGA progress pending further validation.

Early-onset androgenetic alopecia in China: a descriptive study of a large outpatient cohort.

ObjectiveTo describe the clinical features of early-onset androgenetic alopecia (AGA) in a large cohort of Chinese patients.MethodsThis descriptive study recruited consecutive patients seeking medical treatment for AGA between 1 January 2013 and 30 November 2018. Patients were included in the study if they reported being ≤35 years old at AGA onset and if their pattern of hair loss was documented with photographs. The age of onset, sex, body mass index (BMI), BAsic and SPecific classification of hair loss and family history of alopecia were collected in an electronic database.ResultsA total of 3897 patients with early-onset AGA were recruited to the study. The majority of patients (70.6%; 2751 of 3897) were 21–30 years old and male (72.7%; 2834 of 3897). No association was found between high BMI (≥25 kg/m2) and early-onset AGA. There were significantly more overweight male AGA patients than overweight female patients (86.8% [632 of 728] versus 13.2% [96 of 728], respectively). The overall prevalence of familial AGA was 72.8% (2837 of 3897) and the condition was inherited more often from the father (52.8%; 1498 of 2837) than from the mother (24.3%; 688 of 2837).ConclusionsEarly-onset AGA primarily affects male patients between 21–30 years of age. Males with early-onset AGA are likely to have inherited AGA from their fathers.

Increased DHEAS and Decreased Total Testosterone Serum Levels in a Subset of Men with Early-Onset Androgenetic Alopecia: Does a Male PCOS-Equivalent Exist?

Background Increased dehydroepiandrosterone sulfate (DHEAS) levels have been reported in men with early-onset (<35 years) androgenetic alopecia (AGA). It has been suggested that a male polycystic ovarian syndrome- (PCOS-) equivalent, defined as an endocrine syndrome with a metabolic background and a PCOS-like hormonal pattern, predisposing to type II diabetes mellitus (DM II), cardiovascular and prostate diseases later in life, may occur in at least a part of these men. The gonadal function, including sperm parameters and total testosterone (TT) levels, has been investigated in a low number of these men. Objective The aim of the study was to assess gonadal and adrenal function in a subset of men with early-onset AGA and controls. Methods 43 men with early-onset AGA and 36 controls were screened for DHEAS, TT, glycaemia, insulin, gonadotropins, 17α-hydroxyprogesterone (17α-hydroxyprogesterone (17n = 21), as those with at least one of the following parameters: body mass index (BMI) >25 kg/m2, insulin resistance (IR), and/or SHBG <25 nmol/l. Results Patients with early-onset AGA had higher mean (±SD) BMI (25.5 ± 3.8 vs. 23.7 ± 3.0 kg/m2; P < 0.05) and 17α-hydroxyprogesterone (17P < 0.05) and 17P < 0.05) and 17P < 0.05) and 17P < 0.05) and 17μg/dl; P < 0.05) and 17P < 0.05) and 17P < 0.05) and 17P < 0.05) and 17Conclusion Men with early-onset AGA and at least one among BMI >25 kg/m2, IR, and SHBG <25 nmol/l have increased DHEAS levels and a worse gonadal steroidogenesis. They might have a greater risk to develop gonadal dysfunction later in life. These criteria may be used to define male PCOS-equivalent.

YKL-40 A Sensitive Biomarker for Early Androgenetic Alopecia and Early Hidden Metabolic Syndrome.

Background:Androgenetic alopecia (AGA) is a common dermatological problem, Does the onset of the AGA matters in the general health? YKL 40 may have role in the pathogenesis of early AGA and associated metabolic syndrome (MS). YKL 40, released by many inflammatory cells and its biological role is not well known.Aim of the Work:The estimation of serum level of YKL-40 in patients with AGA to detect its role in AGA and MS pathogenesis, onset and severity.Materials and Methods:This case–control study, 100 individuals were enrolled in our study; 70 AGA patients and 30 healthy controls. We obtained an informed written consent from each individual prior the participation. AGA was diagnosed clinically, and onset was evaluated as early onset alopecia (by the age of 30 years or earlier), YKL-40 level was measured by ELISA technique.Results:Patients showed highly significant higher serum YKL-40 level more than that of the healthy subjects (P < 0.001). There was highly significant increase in YKL-40 level among early onset male and female cases compared to late onset cases (P < 0.001 each). There was significant increase in MS elements in AGA cases than controls (P < 0.05), and highly significant increase in MS associations and severity among early onset male and female cases compared to late onset cases (P < 0.001 each). AGA patients with MS showed highly significant higher serum YKL-40 level more than that without (P < 0.001). There was highly significant increase in YKL-40 level among early onset AGA with MS compared to late onset cases with MS (P < 0.001 each).Conclusions:High serum YKL-40 considered not only a biomarker of early onset AGA but also considered a potential sensitive predictor for early onset MS development and severity in patients with early onset AGA.

Male Equivalent Polycystic Ovarian Syndrome: Hormonal, Metabolic, and Clinical Aspects.

Recent studies identified the presence of a male polycystic ovarian syndrome (PCOS), which mainly affects men whose female relatives are afflicted with PCOS, caused by genes responsible for the susceptibility of this syndrome in women. Similar hormonal, metabolic, and clinical alterations occurring in PCOS women have also been reported in their male relatives, suggesting a association between the male and female forms of the syndrome. Although the remarkable clinical manifestation of the male equivalent PCOS is diagnosed by the early-onset androgenetic alopecia, characterized by hair recession, pronounced hypertrichosis, insulin resistance, biochemical and hormonal abnormalities, the hormonal/metabolic profile is still controversial. Men affected by early-onset androgenetic alopecia (AGA) are at risk of developing hyperinsulinemia, insulin-resistance, dyslipidaemia, and cardiovascular diseases. However, there is no consensus on the association of male equivalent PCOS with hypertension and obesity. Moreover, reduced levels of sex hormone-binding globulin have been detected in these male patients, accompanied by increased free androgens. Conversely, literature reported lower concentrations of testosterone in male equivalent PCOS when compared with the normal range, indicating a crucial role for the conversion of cortical androgens. Finally, further studies are warranted to investigate a possible link among AGA, metabolic/hormonal alterations, and acne. Our study assessed the hormo- nal, metabolic and clinical aspects of male equivalent PCOS syndrome reported in the literature to evaluate similar and divergent elements involved in the female version of the syndrome.

Androgenetic Alopecia and its Association with Metabolic Syndrome: A Systematic Review and Meta-analysis

Objectives. The study aimed to confirm the association between androgenetic alopecia (AGA) and Metabolic Syndrome (MetS). It also aimed to determine if early-onset AGA among males and AGA among females increases the risk of developing MetS, and if severity of AGA increases the odds of developing MetS.&#x0D; Methods. Observational studies from electronic databases were selected by the consensus of three independent review authors. The Newcastle-Ottawa Scale for assessing the quality of non-randomized studies in meta-analysis was used. Statistical analyses were accomplished using Review Manager software.&#x0D; Results. A total of 11 case-control studies, one prospective cohort study, and five cross-sectional studies were selected. In the meta-analysis of ten case-control studies and three cross-sectional studies (3840 participants), AGA was significantly correlated with MetS (OR 2.59, 95% CI 1.51 to 4.44; p&lt;0.0005). Early-onset AGA among males (&lt;35 years old) showed significant association (OR 3.69, 95% CI 2.15 to 6.33; p&lt;0.00001). AGA among females also increased the odds of developing MetS (OR 5.59, 95% CI 2.06 to 15.12; p&lt;0.0007). Moderate to severe AGA in males, Norwood-Hamilton IV or higher, was also significant (OR 1.65, 95% CI 1.12 to 2.42; p=0.01). The same trend was noted for females with Ludwig II and III (OR 5.82, 95% CI 2.54 to 13.34; p&lt;0.00001).&#x0D; Conclusion. Although the pathophysiology still remains under investigation, the present study points to an association between AGA and MetS. It can be used as a marker to identify patients who should be screened for MetS and managed accordingly.

Male PCOS equivalent and nutritional restriction: Are we stepping forward?

Polycystic ovarian syndrome (PCOS) is an endocrine disorder characterized by alteration of menses, polycystic ovaries, clinical and or biochemical signs of hyper-androgenism in the context of metabolic abnormalities such as obesity and insulin resistance that play a fundamental role in pathogenesis of the disease as well as in development of long-term complications including cardiovascular disease (CVD) and type II diabetes mellitus (DM II). Latest evidence supports the hypothesis of a genetic component in the aetiology of PCOS that seems to be inherited through an oligo-genic mechanism and cluster in families. Recent studies identified the existence of a male PCOS correspondent syndrome in which the genes responsible for PCOS susceptibility in women may be inherited by male relatives of women with PCOS. The same hormonal, clinical and metabolic alterations of women with PCOS have been found in their male relatives suggesting a relation between the syndrome in its male equivalent.Considering clinical manifestations of male PCOS equivalent, the early onset andro-genetic alopecia (AGA) is considered a clinical marker of insulin resistance, supported by the findings of a case-control study that reported an increased prevalence of hyperinsulinemia and insulin-resistance-associated disorders such as dyslipidaemia, hypertension and obesity, in men with early onset of alopecia (<35), compared with age-matched controls. Moreover, AGA and insulin resistance show higher levels of active androgens, highlighting that low SHBG levels occur in both the diseases and that the two conditions may concur to a worsening of the disease. With regards to the existence of a male PCOS equivalent syndrome, in particular with refer to its phenotypic hallmark of early onset AGA, our hypothesis supposes a beneficial effect of diet restriction used for PCOS as therapy for male patients affected by PCOS equivalent syndrome. Several observational studies and some randomized trials reported that modest reductions of body weight decrease the risk of development of many diseases, including diabetes and cardiovascular disease and contributes to increase insulin sensitivity in PCOS women. Weight reduction may be adopted for men affected by PCOS equivalent syndrome in order to reduce both levels of circulating androgens, insulin resistance and related-complications such as CVD and DM II.

The Association of Metabolic Syndrome and Insulin Resistance in Early-Onset Androgenetic Alopecia in Males: A Case-Control Study.

Background:Men with premature androgenetic alopecia (AGA) are found to be susceptible to cardiovascular diseases, metabolic syndrome (MS), diabetes mellitus and hypertension, and also premature baldness can have a definite negative impact on self-image and self-esteem in these patients. The aim of this study was to assess the strength of association between MS and/or insulin resistance (IR) in males with early-onset AGA.Methods:A total of 50 male patients with premature AGA and equal number of age-matched controls were enrolled in the study. Anthropometric measures, blood pressure, fasting glucose, fasting insulin, high-density lipoprotein cholesterol, and triglycerides were measured for all the participants. Association of IR and MS was evaluated.Results:Most common grade of hair loss was Grade IIIa (32%) of Hamilton–Norwood Scale of hair loss. Five out of 50 cases (10%) and 2 out of 50 controls (4%) had shown association with IR and the difference between the groups was statistically insignificant (P=0.23). Fifteen out of 50 cases (30%) and 4 out of 50 controls had shown association with MS and the difference between the groups was statistically significant (P=0.005).Conclusion:Male patients with early-onset AGA were not associated with IR. MS was associated with male patients with early-onset AGA. The results observed in our study may raise awareness in susceptible individuals that lifestyle changes in early life can reduce the risk of coronary heart diseases in the long term.

Association of early-onset androgenetic alopecia with metabolic syndrome: A case–control study on 46 patients in a tertiary care hospital in South India

Background: Androgenetic alopecia (AGA) has a significant psychosocial impact on the patient, especially early-onset AGA patients. The severity and prevalence increase with age in all races worldwide. “Metabolic syndrome” (MetS) is a combination of risk factors of cardiovascular and diabetes-related parameters. Aim of the Study: The aim of the study is to study the association of early-onset AGA with MetS. Materials and Methods: A case–control study was done in a tertiary care hospital, Bengaluru, from December 2015 to November 2016 with 46 cases and controls in the age group of 20–30 years. The Norwood–Hamilton classification was used to grade the AGA patients. Diagnosis of MetS was done based on the national cholesterol education program adult treatment Panel III. Independent t-test will be used as a test of significance. Categorical data were assessed using Chi-square test of significance. Value of P