lucid&alive
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- Joined
- Mar 24, 2021
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After some recent blood tests I became interested in the hormonal profile of men with early MPB. The studies below measure serum levesl of various hormones of younger balding men and compare them to the hormone levels of non-balding men. Some of the papers from their hypothesis as whether or not men with early MPB have the same hormonal profile as women with PCOS. Although it doesn't seem to be universally true, it seems reasonable to assume men with MPB have some hormonal abnormalities that could be able to be addressed.
Note: Several of the studies below calculate Free Androgen Index (FAI). [FAI = (Test) * (100/SHBG)] and is meant to measure the dissociation of testosterone from the binding globulin which is then free to be used by the tissues.
Cipriani - 1983 - Sex Hormone-Binding Globulin and Saliva Testosterone Levels in Men with Androgenetic Alopecia
Design: 64 males aged 16-41 years (average age 26 ± 5 years) with androgenetic alopecia and forty males within the
same age range without androgenetic alopecia were studied.
Tests Performed: DHT, SHBG, Total Testosterone, Saliva Testosterone, T3, T4, TSH, LH, FSH, prolactin, estradiol,
estrone
Results:
- SHBG significantly lower than controls
- Saliva testosterone significantly higher than controls
From Discussion: The decrease of SHBG would seem to suggest an increase of the unbound and active fraction of
testosterone. Such increase appears to be confirmed by the statistically significant increase, in men with
androgenetic alopecia as compared with controls, of saliva testosterone which is closely correlated with free
testosterone (Smith et al., 1979).
Knussmann - 1992 - Relations Between Sex Hormone Level and Characters of Hair and Skin in Healthy Young Men
Design: One hundred and seventeen healthy young men between the ages of 20 and 30 years (average = 24.1)
Full Scalpe Hair (n = 95)
Reduced Scalp hair (n = 15)
Tests Performed: Serum Testosterone (Tser), DHT, Salival Testosterone (Tsal), DHT/Tser, Tsal/Tser
Results:
- The ratio of Tsal/Tser correlates positivley with balding
- Testosterone and DHT were significantly lower in balding men
From Discussion: Yet we found a relationship, not between the disposition to balding and the ratio DHT/Tser but
between the disposition to balding and Tsal/Tser. An elevated rate of dissociation from the binding globulin
fits in well with the findings of Cipriani et al. (1983) that men with androgenic alopecia exhibit a significant
reduction in sex hormone binding globulin (the same is true for bald-headed women: Mortimer et al., 1984).
Schmidt - 1991 - Hormonal Parameters in Androgenetic Hair Loss in the Male
Design: 65 males with MPB average age of 24.31 years of age compared against 58 males w/o MPB average of 24.61 years of age
Tests Performed: Testosterone, DHEAS, Free testosterone, progesterone, LH, FSH, Estradiol, SHBG, prolactin
Results:
Signficiantly elevated hormones
- Androstenedione
- LH
- Estradiol
- Cortisol
From Discussion:
Androstenedione was the only androgen significantly elevated in hair loss patients. This androgen has only weak
intrinsic androgen activity but has its relevance mainly as precursor hormone for the active androgens testosterone
and dihydrotestosterone.
A most interesting aspect of the investigation is the role of cortisol. Increased cortisol levels support the role
of the suprarenal glands and thus a possible stress component in hair loss. This finding may serve as starting
point for systemic treatment approaches that aim at the suppression of increased adrenal funtion.
Schmidt - 1994 - Hormonal Basis of Male and Female Androgenic Alopecia: Clinical Relevance
Design 65 male and 46 female patients with AGA compared against 58 age-matched male and 45 female controls
Tests performed: Androstenedione, LH, estradiol, cortisol, DHEAS, free testosterone, progesterone, FSH, SHBG,
prolactin, testosterone
MEN
Significantly elevated hormones
- Androstenedione
- LH
- Estradiol
- cortisol
Hormones elevated but not significantly
- DHEAS
- Free testosterone
- Progesterone
- FSH
- SHBG
- Prolactin
- Testosterone
WOMEN
- Cortisol significantly elevated
- Prolactin significantly elevated
- Normal androgen levels
- Secondary hypothyroidism
From Discussion:
An interesting finding was the significant elevation of cortisol in 18% of patients. Cortisol was also
significantly elevated in females with androgenic hair loss, who had normal levels of all androgens. E2,
in contrast, was significantly decreased in these patients [7] (table 2). On the other hand, males had elevated E2
and LH levels.
From the endocrinological point of view, the importance of androstenedione lies in its peripheral activity [8], as
supported by Schweikert et al. [9], who found androstenedione as a major metabolite in hair roots of patients with
androgenic alopecia. The involvement of androstenedione and the noninvolvement of major androgens suggest a mainly
peripheral increase of androgen metabolism in both males and females with androgenic hair loss. This is supported by
elevated E2 levels, as 80% of E2 in the male stems from peripheral conversion of androgens to estrogens.
The association with increased LH levels suggests a role of the hypophyseal-adrenal axis.
Starka - 2004 - Hormonal Profile of Men with Premature Balding
Tests Performed: 37 men with premature blading compared against normal references values obtained ina group fo 256 males ages 20 - 40
(interesting thing about this reference group is it is from a study of iodine deficinecy, not picked specifically for
this study so there may be some prematurley balding men in that group.)
Tests Performed: Testosterone, TSH, Free thryoxin, Prolactin, Cortisol, Estradiol, Progesterone, Androstenedione,
FSH, LH, DHT, Epitestosterone, SHBG
Results:
Significantly sub-normal values
- SHBG
- FSH
- epitestosterone
- testosterone
From Discussion: In the group presented here of premature balding men rather lower total testosterone levels were
found; however the free androgen index FAI was not reduced in comparison with the control male group, even though
there was an insignificant higher number of elevated values of FAI. This is due to significantly lower SHBG values
in balding men. Low SHBG is often associated with insulin resistance or hyperinsulinaemia.
Note: The last paragraph of the paper describes a paper (Choi et al., 2001) in which epitestosterone was found
to be lower in balding scalps and the author mentions epitestosterone epitestosterone is often lower
in the serum of balding men. In this study 22% of balding men had levels of epitestosterone below
the reference range. Epitestosterone is a 5AR inhibitor.
Starka - 2006 - Premature Androgenic Alopecia and Insulin Resistance. Male Equivalent of Polycistic Ovary Syndrome?
Design: 30 men with premature hair loss compared against normal references values obtained ina group fo 256 males ages
20 - 40 (same reference group as in the Starka 2004 paper)
Tests: Total testosterone, androstenedione, DHEAS, epitestosterone, DHT, estradiol, SHBG, TSH, LH, FSH, FAI,
insulin tolerance, prolactin
Results:
Significantly subnormal values
- SHBG
- FSH
- Total Testosterone
- epitestosterone
Balding men further broken down into two hormonally distinct groups:
- Group 1 (n = 19): No hormonal changes or only SHBG is low compared to controls
- Group 2 (n = 11): Low SHBG and low FSH or low SHBG and high FAI compared to controls and was more insulin
resistant
From Discussion: It is obvious from our results that the males with precocious hair loss starting under the
age of 30 and exhibiting similar hormonal changes as females with PCOS (e.g. low SHBG and low FSH or low
SHBG and high FAI) show higher frequency of reduced insulin sensitivity, which is also reported in a part of
females with PCOS. These males might therefore represent a male equivalent of PCOS.
Note: This study also measured various physical traits and found bald men to be significantly shorter than
non-balding men. In every other measure they were found to be less 'masculine' however the differences were
not statistically significant.
Narad - 2013 - Hormonal Profile in Indian Men with Premature Androgenetic Alopecia
Design: 50 men with AGA younger than 30 compared against 50 age matched controls
Tested: Total testosterone, DHEAS, LH, FSH, SHBG, insulin, fasting blood sugar
Results: Decreased SHBG and high FAI in men with AGA
From Discussion: To summarize we could state that in spite of normal levels of total testosterone in balding men,
lower levels SHBG reveals genetic susceptibility for the action of free testosterone in balding men. However it
does not fulfill all criterions corresponding to PCOS in females like hyperandrogenism, altered pituitary hormones
and increased insulin resistance.
Sanke - 2016 - A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men with the Phenotypic
Equivalent of Polycystic Ovarian Syndrome in Women
Design: 57 men aged 19 - 30 with AGA compared against 32 age-matched men with no evidence of hair loss
Tests Performed: Testosterone, SHBG, DHEAS, LH, FSH, prolactin, glucose, insulin, insulin resistance, FAI
Results:
- Hormones significantly increased in AGA men: LH, DHEAS, total testosterone, prolactin
- Hormones significantly decreasd in AGA men: FSH, SHBG
- The LH/FSH ratio and FAI was significantly higher in men with AGA
From Results: The mean (SD) value of insulin was higher in the AGA group (6.34 [3.92] μIU/mL) than among controls
(5.09 [3.38] μIU/ mL),but the difference was not statistically significant (P = .07). Twelve men with AGA (21%)
had IR compared with 3 men (9%) in the control group. There was no statistically significant association between
severity of grades of AGA (grades 3-7) with the various hormone levels or with IR. There was no significant
association between positive family history of AGA with grades of AGA or hormone levels.
From Discussion: Twelve (21%) of our participants with AGA showed IR compared with only 3 (9%) of the controls.
Though this difference in IR was not statistically insignificant (P = .06), it is clear that a larger proportion
of those with AGA than controls showed IR.
From Conclusion: We found significantly increased LH, DHEAS, total testosterone, and prolactin levels along with
significantly decreased FSH and SHBG levels in our AGA group. The LH/FSH ratio was higher in men with AGA. These
hormonal parameters more or less resemble the profile of women with PCOS, and we propose that these men can be
considered phenotypic equivalents to women with PCOS.
Here's a table I made showing tests performed and whether the values were significantly elevated, decreased, or had no difference
Note: Several of the studies below calculate Free Androgen Index (FAI). [FAI = (Test) * (100/SHBG)] and is meant to measure the dissociation of testosterone from the binding globulin which is then free to be used by the tissues.
Cipriani - 1983 - Sex Hormone-Binding Globulin and Saliva Testosterone Levels in Men with Androgenetic Alopecia
Design: 64 males aged 16-41 years (average age 26 ± 5 years) with androgenetic alopecia and forty males within the
same age range without androgenetic alopecia were studied.
Tests Performed: DHT, SHBG, Total Testosterone, Saliva Testosterone, T3, T4, TSH, LH, FSH, prolactin, estradiol,
estrone
Results:
- SHBG significantly lower than controls
- Saliva testosterone significantly higher than controls
From Discussion: The decrease of SHBG would seem to suggest an increase of the unbound and active fraction of
testosterone. Such increase appears to be confirmed by the statistically significant increase, in men with
androgenetic alopecia as compared with controls, of saliva testosterone which is closely correlated with free
testosterone (Smith et al., 1979).
Knussmann - 1992 - Relations Between Sex Hormone Level and Characters of Hair and Skin in Healthy Young Men
Design: One hundred and seventeen healthy young men between the ages of 20 and 30 years (average = 24.1)
Full Scalpe Hair (n = 95)
Reduced Scalp hair (n = 15)
Tests Performed: Serum Testosterone (Tser), DHT, Salival Testosterone (Tsal), DHT/Tser, Tsal/Tser
Results:
- The ratio of Tsal/Tser correlates positivley with balding
- Testosterone and DHT were significantly lower in balding men
From Discussion: Yet we found a relationship, not between the disposition to balding and the ratio DHT/Tser but
between the disposition to balding and Tsal/Tser. An elevated rate of dissociation from the binding globulin
fits in well with the findings of Cipriani et al. (1983) that men with androgenic alopecia exhibit a significant
reduction in sex hormone binding globulin (the same is true for bald-headed women: Mortimer et al., 1984).
Schmidt - 1991 - Hormonal Parameters in Androgenetic Hair Loss in the Male
Design: 65 males with MPB average age of 24.31 years of age compared against 58 males w/o MPB average of 24.61 years of age
Tests Performed: Testosterone, DHEAS, Free testosterone, progesterone, LH, FSH, Estradiol, SHBG, prolactin
Results:
Signficiantly elevated hormones
- Androstenedione
- LH
- Estradiol
- Cortisol
From Discussion:
Androstenedione was the only androgen significantly elevated in hair loss patients. This androgen has only weak
intrinsic androgen activity but has its relevance mainly as precursor hormone for the active androgens testosterone
and dihydrotestosterone.
A most interesting aspect of the investigation is the role of cortisol. Increased cortisol levels support the role
of the suprarenal glands and thus a possible stress component in hair loss. This finding may serve as starting
point for systemic treatment approaches that aim at the suppression of increased adrenal funtion.
Schmidt - 1994 - Hormonal Basis of Male and Female Androgenic Alopecia: Clinical Relevance
Design 65 male and 46 female patients with AGA compared against 58 age-matched male and 45 female controls
Tests performed: Androstenedione, LH, estradiol, cortisol, DHEAS, free testosterone, progesterone, FSH, SHBG,
prolactin, testosterone
MEN
Significantly elevated hormones
- Androstenedione
- LH
- Estradiol
- cortisol
Hormones elevated but not significantly
- DHEAS
- Free testosterone
- Progesterone
- FSH
- SHBG
- Prolactin
- Testosterone
WOMEN
- Cortisol significantly elevated
- Prolactin significantly elevated
- Normal androgen levels
- Secondary hypothyroidism
From Discussion:
An interesting finding was the significant elevation of cortisol in 18% of patients. Cortisol was also
significantly elevated in females with androgenic hair loss, who had normal levels of all androgens. E2,
in contrast, was significantly decreased in these patients [7] (table 2). On the other hand, males had elevated E2
and LH levels.
From the endocrinological point of view, the importance of androstenedione lies in its peripheral activity [8], as
supported by Schweikert et al. [9], who found androstenedione as a major metabolite in hair roots of patients with
androgenic alopecia. The involvement of androstenedione and the noninvolvement of major androgens suggest a mainly
peripheral increase of androgen metabolism in both males and females with androgenic hair loss. This is supported by
elevated E2 levels, as 80% of E2 in the male stems from peripheral conversion of androgens to estrogens.
The association with increased LH levels suggests a role of the hypophyseal-adrenal axis.
Starka - 2004 - Hormonal Profile of Men with Premature Balding
Tests Performed: 37 men with premature blading compared against normal references values obtained ina group fo 256 males ages 20 - 40
(interesting thing about this reference group is it is from a study of iodine deficinecy, not picked specifically for
this study so there may be some prematurley balding men in that group.)
Tests Performed: Testosterone, TSH, Free thryoxin, Prolactin, Cortisol, Estradiol, Progesterone, Androstenedione,
FSH, LH, DHT, Epitestosterone, SHBG
Results:
Significantly sub-normal values
- SHBG
- FSH
- epitestosterone
- testosterone
From Discussion: In the group presented here of premature balding men rather lower total testosterone levels were
found; however the free androgen index FAI was not reduced in comparison with the control male group, even though
there was an insignificant higher number of elevated values of FAI. This is due to significantly lower SHBG values
in balding men. Low SHBG is often associated with insulin resistance or hyperinsulinaemia.
Note: The last paragraph of the paper describes a paper (Choi et al., 2001) in which epitestosterone was found
to be lower in balding scalps and the author mentions epitestosterone epitestosterone is often lower
in the serum of balding men. In this study 22% of balding men had levels of epitestosterone below
the reference range. Epitestosterone is a 5AR inhibitor.
Starka - 2006 - Premature Androgenic Alopecia and Insulin Resistance. Male Equivalent of Polycistic Ovary Syndrome?
Design: 30 men with premature hair loss compared against normal references values obtained ina group fo 256 males ages
20 - 40 (same reference group as in the Starka 2004 paper)
Tests: Total testosterone, androstenedione, DHEAS, epitestosterone, DHT, estradiol, SHBG, TSH, LH, FSH, FAI,
insulin tolerance, prolactin
Results:
Significantly subnormal values
- SHBG
- FSH
- Total Testosterone
- epitestosterone
Balding men further broken down into two hormonally distinct groups:
- Group 1 (n = 19): No hormonal changes or only SHBG is low compared to controls
- Group 2 (n = 11): Low SHBG and low FSH or low SHBG and high FAI compared to controls and was more insulin
resistant
From Discussion: It is obvious from our results that the males with precocious hair loss starting under the
age of 30 and exhibiting similar hormonal changes as females with PCOS (e.g. low SHBG and low FSH or low
SHBG and high FAI) show higher frequency of reduced insulin sensitivity, which is also reported in a part of
females with PCOS. These males might therefore represent a male equivalent of PCOS.
Note: This study also measured various physical traits and found bald men to be significantly shorter than
non-balding men. In every other measure they were found to be less 'masculine' however the differences were
not statistically significant.
Narad - 2013 - Hormonal Profile in Indian Men with Premature Androgenetic Alopecia
Design: 50 men with AGA younger than 30 compared against 50 age matched controls
Tested: Total testosterone, DHEAS, LH, FSH, SHBG, insulin, fasting blood sugar
Results: Decreased SHBG and high FAI in men with AGA
From Discussion: To summarize we could state that in spite of normal levels of total testosterone in balding men,
lower levels SHBG reveals genetic susceptibility for the action of free testosterone in balding men. However it
does not fulfill all criterions corresponding to PCOS in females like hyperandrogenism, altered pituitary hormones
and increased insulin resistance.
Sanke - 2016 - A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men with the Phenotypic
Equivalent of Polycystic Ovarian Syndrome in Women
Design: 57 men aged 19 - 30 with AGA compared against 32 age-matched men with no evidence of hair loss
Tests Performed: Testosterone, SHBG, DHEAS, LH, FSH, prolactin, glucose, insulin, insulin resistance, FAI
Results:
- Hormones significantly increased in AGA men: LH, DHEAS, total testosterone, prolactin
- Hormones significantly decreasd in AGA men: FSH, SHBG
- The LH/FSH ratio and FAI was significantly higher in men with AGA
From Results: The mean (SD) value of insulin was higher in the AGA group (6.34 [3.92] μIU/mL) than among controls
(5.09 [3.38] μIU/ mL),but the difference was not statistically significant (P = .07). Twelve men with AGA (21%)
had IR compared with 3 men (9%) in the control group. There was no statistically significant association between
severity of grades of AGA (grades 3-7) with the various hormone levels or with IR. There was no significant
association between positive family history of AGA with grades of AGA or hormone levels.
From Discussion: Twelve (21%) of our participants with AGA showed IR compared with only 3 (9%) of the controls.
Though this difference in IR was not statistically insignificant (P = .06), it is clear that a larger proportion
of those with AGA than controls showed IR.
From Conclusion: We found significantly increased LH, DHEAS, total testosterone, and prolactin levels along with
significantly decreased FSH and SHBG levels in our AGA group. The LH/FSH ratio was higher in men with AGA. These
hormonal parameters more or less resemble the profile of women with PCOS, and we propose that these men can be
considered phenotypic equivalents to women with PCOS.
Here's a table I made showing tests performed and whether the values were significantly elevated, decreased, or had no difference