What is the prognosis of androgenetic alopecia?

Updated: Feb 12, 2018
  • Author: Robert P Feinstein, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The prognosis of androgenetic alopecia is unknown. Some patients progress to the point where they lose almost all of the hair on the scalp. Others have a patterned or nonpatterned thinning but retain a considerable number of scalp hairs. Women with androgenetic alopecia usually show thinning of the crown rather than developing truly bald areas.

Along with affecting the patient psychologically, [9] androgenetic alopecia is significant in that it allows ultraviolet light to reach the scalp and, thus, increases the amount of actinic damage. In addition, males with androgenetic alopecia may have an increased incidence of myocardial infarction. [10]

An increase in benign prostatic hypertrophy has also been associated with androgenetic alopecia. [11] Arias-Santiago et al measured prostatic volume by transrectal ultrasound and urinary flow by urinary flowmetry in order to study this hypothesis. Their findings suggest that a relationship exists between early onset androgenetic alopecia and prostate growth associated urinary symptoms, most likely owing to their pathophysiological similarity. They suggest that future studies may clarify whether treatment of patients with androgenetic alopecia might benefit concomitant benign prostatic hypertrophy. [12]

If these associations are proven conclusively, androgenetic alopecia will be of greater clinical significance.

A study by Sanke et al indicated that early androgenetic alopecia (ie, prior to age 30 years) in males is the phenotypic equivalent of polycystic ovarian syndrome (PCOS) and that these males may be at risk of developing complications found in association with PCOS, such as obesity, metabolic syndrome, insulin resistance, cardiovascular disease, and infertility. The investigators reported that the endocrinologic profile of the males with early androgenetic alopecia was similar to that of females with PCOS. Compared with controls, mean levels of testosterone, dehydroepiandrosterone (DHEA)-sulfate, luteinizing hormone, and prolactin were significantly higher in individuals with early androgenetic alopecia, while the mean free androgen index was also higher and mean levels of follicle-stimulating hormone were lower. [13]

A study by Polat et al indicated that men with androgenetic alopecia have a higher likelihood of developing urolithiasis than do those with no hair loss, with the risk being 1.3-fold greater in males with vertex-pattern alopecia, and 2.1-fold greater in those with total alopecia. The study included 200 men with urolithiasis and 168 males with no history of renal stones. [14]


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