Original article
Androgenetic alopecia as an early marker of benign prostatic hyperplasia

Presented as a pilot study at the 68th Annual Meeting of the American Academy of Dermatology in Miami, Florida, in March 2010 and received the First Award: “Urinary symptoms in patients with androgenetic alopecia.”
https://doi.org/10.1016/j.jaad.2010.12.023Get rights and content

Background

Androgenetic alopecia (AGA) and benign prostatic hyperplasia are both androgen-dependent entities that respond to the blocking of 5-alpha-reductase.

Objectives

The objective of this study was to determine whether prostatic volumes and urinary flow changes were higher in patients with early-onset AGA than in healthy control subjects.

Methods

This was an observational case-control study of 87 men: 45 with early-onset AGA diagnosed in the dermatology department and 42 control subjects. End-point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. A hormone study was performed on all participants, and the International Prostate Symptom Score and International Index of Erectile Function score were determined.

Results

The groups did not significantly differ in mean age (cases, 52.7 years vs control subjects, 49.8 years; P = .12). Patients with AGA had significantly higher mean prostate volume (29.65 vs 20.24 mL, P < .0001), International Prostate Symptom Score (4.93 vs 1.23, P < .0001), and prostate-specific antigen value (1.53 vs 0.94 ng/mL, P < .0001) and significantly lower maximum urinary flow (14.5 vs 22.45 mL/s, P < .0001) versus control subjects. Binary logistic regression analysis showed a strong association between the presence of AGA and benign prostatic hyperplasia after adjusting for age, urinary volume, urination time, International Prostate Symptom Score, abdominal obesity, glucose levels, systolic blood pressure, insulin levels, fibrinogen, and C-reactive protein (odds ratio = 5.14, 95% confidence interval 1.23-47.36, P = .041).

Limitations

The study of larger sample sizes would facilitate stratified analyses according to the Ebling type of androgenetic alopecia.

Conclusion

There is a relationship between the presence of AGA and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology. Future studies may clarify whether treatment of patients with AGA may benefit the concomitant benign prostatic hypertrophy, which would be present at an earlier stage in its natural evolution.

Section snippets

Study subjects and design

This case-control study included 87 Caucasian participants aged 35 to 65 years: 45 with AGA consecutively examined in the outpatient clinic of San Cecilio University Hospital, Granada, Spain, and 42 without AGA. Control subjects were recruited among workers at the hospital (guards, security guards, health care workers). Study inclusion criteria for the patient group were: early-onset (age <35 years) type III, IV, or V AGA on the Ebling scale; age between 35 and 65 years; and written informed

Results

All 87 participants completed the study: 45 in the early-onset AGA group and 42 in the control group. The groups did not significantly differ in age (AGA, 52.7 years vs control, 49.8 years, P = .128) or body mass index (27.71 vs 27.08 kg/m2, P = .062). The mean age at AGA onset was 27.6 years; 36.5% of the AGA group was Ebling type III, 31.1% type IV, and 33.3% type V. The AGA group more frequently reported a family history of alopecia (88% vs 12%, P < .0001; OR 59.2, 95% CI 15.85-221.11) and

Discussion

In this study, patients with early-onset AGA were found to have a larger prostate as measured by transrectal ultrasound, lower urinary flow value, and higher IPSS in comparison with individuals without AGA. AGA proved to be an independent risk factor for a prostate volume greater than 30 mL, urinary flow less than 15 mL/s, and BPH. None of the patients or control subjects reported a history of obstructive urinary symptoms or any consultations for this problem. No differences were detected

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    Funding sources: None.

    Conflicts of interest: None declared.

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