Androgenetic alopecia - just a cosmetic defect or a biomarker and risk factor for systemic diseases? - literature review
DOI:
https://doi.org/10.12775/JEHS.2025.83.61813Keywords
androgenetic alopecia, quality of life, cardiovascular disease, hair loss, metabolic syndrome, comorbidityAbstract
Introduction: Androgenetic alopecia (AGA) is the most common cause of hair loss. It has traditionally been considered a cosmetic defect, but a growing body of evidence suggests that it may serve as a biomarker and risk factor for systemic diseases, suggesting its potential role in early disease detection and prevention.
Purpose: The aim of this study is to review the available literature, analyze and summarize the current state of knowledge on the relationship between AGA and systemic diseases.
Materials and research methods: The article is based on an analysis of PubMed and Google Scholar research. A literature review was conducted using the following keywords and medical subject headings: androgenetic alopecia; quality of life; cardiovascular disease; hair loss; metabolic syndrome; comorbidity. The analysis included clinical trials, systematic reviews, meta-analyses.
Results: The analysis showed that patients with AGA were more likely to have cardiovascular disease, metabolic or endocrine disorders. Cases of increased risk of prostate and scalp cancers have also been described, as well as negative effects on mental health in people with AGA. These links underscore the need for an interdisciplinary approach to the patient and collaboration between the dermatologist and other specialists.
Conclusion: AGA is not only an aesthetic problem, but can act as a biomarker for systemic diseases and be a signal for further diagnosis. Therefore, screening should be considered, as well as collaboration between dermatologists and other specialists. Future research should focus on the mechanisms linking AGA to other conditions, developing screening protocols, and analyzing the age of onset of AGA as a potential risk for systemic diseases.
References
1. Piraccini, B. M., and A. Alessandrini. "Androgenetic Alopecia." Giornale Italiano Di Dermatologia E Venereologia: Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, vol. 149, no. 1, Feb. 2014, pp. 15-24.
2. O iwoh, Sebastine Oseghae, et al. "Androgenetic Alopecia: A Review." The Nigerian Postgraduate Medical Journal, vol. 31, no. 2, Apr. 2024, pp. 85-92, https://doi.org/10.4103/npmj.npmj_47_24.
3. Wang, T. L., et al. "Prevalence of Androgenetic Alopecia in China: A Community-Based Study in Six Cities." The British Journal of Dermatology, vol. 162, no. 4, Apr. 2010, pp. 843-47, https://doi.org/10.1111/j.1365-2133.2010.09640.x.
4. Krupa Shankar, DS, et al. "Male Androgenetic Alopecia: Population-Based Study in 1,005 Subjects." International Journal of Trichology, vol. 1, no. 2, 2009, pp. 131-33, https://doi.org/10.4103/0974-7753.58556.
5. Norwood, O. T. "Incidence of Female Androgenetic Alopecia (Female Pattern Alopecia)." Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.], vol. 27, no. 1, Jan. 2001, pp. 53-54.
6. Gupta, Sanjeev, et al. "Quality of Life Assessment in Patients with Androgenetic Alopecia." International Journal of Trichology, vol. 11, no. 4, 2019, pp. 147-52, https://doi.org/10.4103/ijt.ijt_6_19.
7. Williamson, D., et al. "The Effect of Hair Loss on Quality of Life." Journal of the European Academy of Dermatology and Venereology: JEADV, vol. 15, no. 2, Mar. 2001, pp. 137-39, https://doi.org/10.1046/j.1468-3083.2001.00229.x.
8. Cash, T. F. "The Psychological Effects of Androgenetic Alopecia in Men." Journal of the American Academy of Dermatology, vol. 26, no. 6, June 1992, pp. 926-31, https://doi.org/10.1016/0190-9622(92)70134-2.
9. Aukerman, Erica L., and Mohammad Jafferany. "The Psychological Consequences of Androgenetic Alopecia: A Systematic Review." Journal of Cosmetic Dermatology, vol. 22, no. 1, 2023, pp. 89-95, https://doi.org/10.1111/jocd.14983.
10. Arias-Santiago, Salvador, et al. "A Comparative Study of Dyslipidaemia in Men and Woman with Androgenic Alopecia." Acta Dermato-Venereologica, vol. 90, no. 5, Sept. 2010, pp. 485-87, https://doi.org/10.2340/00015555-0926.
11. Vora, Rita V., et al. "Clinical Profile of Androgenic Alopecia and Its Association with Cardiovascular Risk Factors." Indian Journal of Dermatology, vol. 64, no. 1, 2019, pp. 19-22, https://doi.org/10.4103/ijd.IJD_526_16.
12. Cela, Ester, et al. "Prevalence of Polycystic Ovaries in Women with Androgenic Alopecia." European Journal of Endocrinology, vol. 149, no. 5, Nov. 2003, pp. 439-42, https://doi.org/10.1530/eje.0.1490439.
13. Vila-Vecilla, Laura, et al. "Genomic Markers and Personalized Medicine in Androgenetic Alopecia: A Comprehensive Review." Cosmetics, vol. 11, no. 5, Oct. 2024, p. 148, https://doi.org/10.3390/cosmetics11050148.
14. Heilmann, Stefanie, et al. "Androgenetic Alopecia: Identification of Four Genetic Risk Loci and Evidence for the Contribution of WNT Signaling to Its Etiology." Journal of Investigative Dermatology, vol. 133, no. 6, June 2013, pp. 1489-96, https://doi.org/10.1038/jid.2013.43.
15. Salman, Kubra Esen, et al. "Frequency, Severity and Related Factors of Androgenetic Alopecia in Dermatology Outpatient Clinic: A Hospital-Based Cross-Sectional Study in Turkey*." Anais Brasileiros de Dermatologia, vol. 92, Feb. 2017, pp. 35-40, https://doi.org/https://doi.org/10.1590/abd1806-4841.20175241.
16. Kidangazhiathmana, Ajithkumar, and Parvathy Santhosh. "Pathogenesis of Androgenetic Alopecia." Clinical Dermatology Review, vol. 6, no. 2, Dec. 2022, p. 69, https://doi.org/10.4103/cdr.cdr_29_21.
17. Sawaya, Marty E., and Vera H. Price. "Different Levels of 5α-Reductase Type I and II, Aromatase, and Androgen Receptor in Hair Follicles of Women and Men with Androgenetic Alopecia." Journal of Investigative Dermatology, vol. 109, no. 3, Sept. 1997, pp. 296-300, https://doi.org/10.1111/1523-1747.ep12335779.
18. Elgobashy, Alshimaa, et al. "A Review on Androgenic Alopecia: Etiology, Pathogenesis, Pharmacological and Non-Pharmacological Treatment Approaches." Ain Shams Medical Journal, vol. 75, no. 3, Sept. 2024, pp. 587-602, https://doi.org/10.21608/asmj.2024.299393.1282.
19. Nestor, Mark S., et al. "Treatment Options for Androgenetic Alopecia: Efficacy, Side Effects, Compliance, Financial Considerations, and Ethics." Journal of Cosmetic Dermatology, vol. 20, no. 12, Dec. 2021, pp. 3759-81, https://doi.org/10.1111/jocd.14537.
20. Upton, James H., et al. "Oxidative Stress-Associated Senescence in Dermal Papilla Cells of Men with Androgenetic Alopecia." Journal of Investigative Dermatology, vol. 135, no. 5, May 2015, pp. 1244-52, https://doi.org/10.1038/jid.2015.28.
21. Bahta, Adiam W., et al. "Premature Senescence of Balding Dermal Papilla Cells In Vitro Is Associated with P16INK4a Expression." Journal of Investigative Dermatology, vol. 128, no. 5, May 2008, pp. 1088-94, https://doi.org/10.1038/sj.jid.5701147.
22. Prie, BE, et al. "Oxidative Stress in Androgenetic Alopecia." Journal of Medicine and Life, vol. 9, no. 1, 2016, pp. 79-83, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152608/.
23. Fortes, Cristina, et al. "Mediterranean Diet: Fresh Herbs and Fresh Vegetables Decrease the Risk of Androgenetic Alopecia in Males." Archives of Dermatological Research, vol. 310, no. 1, Jan. 2018, pp. 71-76, https://doi.org/10.1007/s00403-017-1799-z.
24. Bazmi, Sina, et al. "Androgenic Alopecia Is Associated with Higher Dietary Inflammatory Index and Lower Antioxidant Index Scores." Frontiers in Nutrition, vol. 11, Aug. 2024, https://doi.org/10.3389/fnut.2024.1433962.
25. Elsaie, Lotfy T., et al. "Cross Sectional Quality of Life Assessment in Patients with Androgenetic Alopecia." Dermatologic Therapy, vol. 33, no. 4, July 2020, p. e13799, https://doi.org/10.1111/dth.13799.
26. Yi, Yanhua, et al. "Severity of Androgenetic Alopecia Associated with Poor Sleeping Habits and Carnivorous Eating and Junk Food Consumption-A Web-Based Investigation of Male Pattern Hair Loss in China." Dermatologic Therapy, vol. 33, no. 2, Mar. 2020, p. e13273, https://doi.org/10.1111/dth.13273.
27. Agaoglu, Esra, et al. "Prevalence of Early-Onset Androgenetic Alopecia and Its Relationship with Lifestyle and Dietary Habits." Italian Journal of Dermatology and Venereology, vol. 156, no. 6, Dec. 2021, pp. 675-80, https://doi.org/10.23736/S2784-8671.21.06874-7.
28. Yi, Yanhua, et al. "Effect of Behavioral Factors on Severity of Female Pattern Hair Loss: An Ordinal Logistic Regression Analysis." International Journal of Medical Sciences, vol. 17, no. 11, 2020, pp. 1584-88, https://doi.org/10.7150/ijms.45979.
29. Ding, Qi, et al. "Early-Onset Androgenetic Alopecia in China: A Descriptive Study of a Large Outpatient Cohort." The Journal of International Medical Research, vol. 48, no. 3, Mar. 2020, p. 0300060519897190, https://doi.org/10.1177/0300060519897190.
30. Gopinath, Hima, and Gatha M. Upadya. "Metabolic Syndrome in Androgenic Alopecia." Indian Journal of Dermatology, Venereology and Leprology, vol. 82, no. 4, 2016, pp. 404-08, https://doi.org/10.4103/0378-6323.174421.
31. Dharam Kumar, K. C., et al. "Association of Androgenetic Alopecia with Metabolic Syndrome: A Case-Control Study on 100 Patients in a Tertiary Care Hospital in South India." Indian Journal of Endocrinology and Metabolism, vol. 22, no. 2, 2018, pp. 196-99, https://doi.org/10.4103/ijem.IJEM_650_17.
32. QIU, Yueqi, et al. "Systematic Review and Meta-Analysis of the Association Between Metabolic Syndrome and Androgenetic Alopecia." Acta Dermato-Venereologica, vol. 102, Feb. 2022, p. 1012, https://doi.org/10.2340/actadv.v101.1012.
33. Ding, Xiaoxia, et al. "Exploring the Causal Relationship and Molecular Mechanisms Between Fasting Insulin and Androgenetic Alopecia: A Mendelian Randomization Study with Bioinformatics Analysis." Clinical, Cosmetic and Investigational Dermatology, vol. 18, Feb. 2025, pp. 355-65, https://doi.org/10.2147/CCID.S492958.
34. Du, Fanpan, et al. "Oxidative Stress in Hair Follicle Development and Hair Growth: Signaling Pathways, Intervening Mechanisms and Potential of Natural Antioxidants." Journal of Cellular and Molecular Medicine, vol. 28, no. 12, 2024, p. e18486, https://doi.org/10.1111/jcmm.18486.
35. Hamed, Ahmed Mohammed, et al. "Androgenetic Alopecia and Metabolic Syndrome: Is Alarin a Missing Link?" The Journal of Clinical and Aesthetic Dermatology, vol. 15, no. 7, July 2022, pp. 32-37, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345189/.
36. Bakry, Ola Ahmed, et al. "Androgenetic Alopecia, Metabolic Syndrome, and Insulin Resistance: Is There Any Association? A Case-Control Study." Indian Dermatology Online Journal, vol. 5, no. 3, 2014, pp. 276-81, https://doi.org/10.4103/2229-5178.137776.
37. Vinay, Keshavamurthy, et al. "Clinical and Metabolic Characteristics of Males with Early-Onset Androgenetic Alopecia." Indian Journal of Dermatology, Venereology and Leprology, vol. 89, no. 4, 2023, pp. 530-35, https://doi.org/10.25259/IJDVL_949_2021.
38. Kim, Bo-Kyung, et al. "Gender-Specific Risk Factors for Androgenetic Alopecia in the Korean General Population: Associations with Medical Comorbidities and General Health Behaviors." International Journal of Dermatology, vol. 57, no. 2, Feb. 2018, pp. 183-92, https://doi.org/10.1111/ijd.13843.
39. Su, Lin-Hui, et al. "Association of Androgenetic Alopecia With Mortality From Diabetes Mellitus and Heart Disease." JAMA Dermatology, vol. 149, no. 5, May 2013, pp. 601-06, https://doi.org/10.1001/jamadermatol.2013.130.
40. Amamoto M, Yamada T, Hara K. Updated meta-analysis of the relation between heart disease and androgenic alopecia or alopecia areata. Australas Med J. 2018;11:25-33. doi: 10.21767/AMJ.2017.3270
41. Sharma, Lata, et al. "Androgenetic Alopecia and Risk of Coronary Artery Disease." Indian Dermatology Online Journal, vol. 4, no. 4, Oct. 2013, pp. 283-87, https://doi.org/10.4103/2229-5178.120638.
42. Yamada, Tomohide, et al. "Male Pattern Baldness and Its Association with Coronary Heart Disease: A Meta-Analysis." BMJ Open, vol. 3, no. 4, Jan. 2013, p. e002537, https://doi.org/10.1136/bmjopen-2012-002537.
43. Ahouansou, Serge, et al. "Association of Androgenetic Alopecia and Hypertension." European Journal of Dermatology: EJD, vol. 17, no. 3, 2007, pp. 220-22, https://doi.org/10.1684/ejd.2007.0152.
44. Clark, Charlotte M., et al. "Dermatologic Manifestation of Hyperandrogenism: A Retrospective Chart Review." Skinmed, vol. 12, no. 2, 2014, pp. 84-88.
45. Quinn, Molly, et al. "Prevalence of Androgenic Alopecia in Patients with Polycystic Ovary Syndrome and Characterization of Associated Clinical and Biochemical Features." Fertility and Sterility, vol. 101, no. 4, Apr. 2014, pp. 1129-34, https://doi.org/10.1016/j.fertnstert.2014.01.003.
46. Schmidt, J. B. "Hormonal Basis of Male and Female Androgenic Alopecia: Clinical Relevance." Skin Pharmacology: The Official Journal of the Skin Pharmacology Society, vol. 7, no. 1-2, 1994, pp. 61-66, https://doi.org/10.1159/000211275.
47. Kjaergaard, Alisa D., et al. "Thyroid Function, Sex Hormones and Sexual Function: A Mendelian Randomization Study." European Journal of Epidemiology, vol. 36, no. 3, Mar. 2021, pp. 335-44, https://doi.org/10.1007/s10654-021-00721-z.
48. Liang, Weijun, et al. "Possible Association between Androgenic Alopecia and Risk of Prostate Cancer and Testicular Germ Cell Tumor: A Systematic Review and Meta-Analysis." BMC Cancer, vol. 18, no. 1, Mar. 2018, p. 279, https://doi.org/10.1186/s12885-018-4194-z.
49. Amoretti, Aline, et al. "Androgenetic Alopecia and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis." Journal of the American Academy of Dermatology, vol. 68, no. 6, June 2013, pp. 937-43, https://doi.org/10.1016/j.jaad.2012.11.034.
50. Kucerova, R., et al. "Androgenetic Alopecia and Polymorphism of the Androgen Receptor Gene (SNP Rs6152) in Patients with Benign Prostate Hyperplasia or Prostate Cancer." Journal of the European Academy of Dermatology and Venereology: JEADV, vol. 29, no. 1, Jan. 2015, pp. 91-96, https://doi.org/10.1111/jdv.12468.
51. Wesolowska A, Tuszynska A, Szlendak-Sauer K, Smolarczyk R, Grabowska-Derlatka L, Przytula E. Ovarian Leydig cell tumour in a postmenopausal woman with alopecia. Eur J Gynaecol Oncol. 2019;40:154-156
52. Sun, Li-Min, et al. "Women with Alopecia Exhibit a Higher Risk for Thyroid Cancer: A Nationwide Cohort Study." Journal of Dermatological Science, vol. 74, no. 1, Apr. 2014, pp. 18-22, https://doi.org/10.1016/j.jdermsci.2013.12.005.
53. de Gálvez, María Victoria, et al. "Human Hair as a Natural Sun Protection Agent: A Quantitative Study." Photochemistry and Photobiology, vol. 91, no. 4, 2015, pp. 966-70, https://doi.org/10.1111/php.12433.
54. Li, Wen-Qing, et al. "Male Pattern Baldness and Risk of Incident Skin Cancer in a Cohort of Men." International Journal of Cancer, vol. 139, no. 12, Dec. 2016, pp. 2671-78, https://doi.org/10.1002/ijc.30395.
55. Ong, Jue-Sheng, et al. "Uncovering the Complex Relationship between Balding, Testosterone and Skin Cancers in Men." Nature Communications, vol. 14, no. 1, Oct. 2023, p. 5962, https://doi.org/10.1038/s41467-023-41231-8.
56. Terry RL: Further evidence on components of facial attractiveness. Percept Mot Skills 1977; 45:130.
57. Huang, Chun-Hsien, et al. "Health-Related Quality of Life, Depression, and Self-Esteem in Patients With Androgenetic Alopecia: A Systematic Review and Meta-Analysis." JAMA Dermatology, vol. 157, no. 8, Aug. 2021, pp. 963-70, https://doi.org/10.1001/jamadermatol.2021.2196.
58. Alzoabi, Nasser M., et al. "Assessing the Impact of Alopecia on Quality of Life, Depression, and Self-Esteem in Saudi Arabia." Cureus, vol. 15, no. 12, Dec. 2023, p. e49864, https://doi.org/10.7759/cureus.49864.
59. Passchier, J. "Quality of Life Issues in Male Pattern Hair Loss." Dermatology (Basel, Switzerland), vol. 197, no. 3, 1998, pp. 217-18, https://doi.org/10.1159/000017999.
60. Lee, Solam, et al. "Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-Analysis." Acta Dermato-Venereologica, vol. 99, no. 1, Jan. 2019, pp. 12-17, https://doi.org/10.2340/00015555-3035.
61. Cortez, Gabriel Lazzeri, et al. "Male Androgenetic Alopecia." Anais Brasileiros De Dermatologia, vol. 100, no. 2, 2025, pp. 308-21, https://doi.org/10.1016/j.abd.2024.08.004.
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Copyright (c) 2025 Dawid Suwała, Natalia Pokrywka, Marcelina Polak, Klaudia Koryszko, Paulina Hetnar, Magdalena Tomala, Sebastian Kiper, Milena Fortuna, Sławomir Toczek, Katarzyna Jastrowicz-Chęć
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