Role of androgens in female-pattern androgenetic alopecia, either alone or associated with other symptoms of hyperandrogenism

Abstract The roles of androgen hypersecretion, in situ enzyme activity, and androgen receptors in androgenetic alopecia in women are still a matter of debate. We studied 187 women with alopecia, which we graded I, II, or III, according to Ludwig’s classification, and 21 healthy control women. All participants were subjected to full basal and 1 h post-β-1-24 corticotropin stimulation endocrine profiles. Abnormal hormone profiles were observed in 67% of the patients with alopecia alone (group A, n = 110) and in 84% of the patients with alopecia plus other symptoms of hyperandrogenism including acne, hirsutism, and menstrual cycle disturbances (group B, n = 77). Mean serum 5α-androstane-3α,17β-diol glucuronide (3α-AdiolG) levels in all three patient groups (6.50 ± 4.10, 8.90 ± 5.80, and 14.70 ± 8.90 nmol/l, respectively) correlated with the grade of alopecia (I–III) and were significantly higher than in the control group (4.80 ± 2.05 nmol/l, P < 0.005). Mean serum sex hormone-binding globulin (SHBG) levels were inversely correlated with the grade of alopecia (I–III) and were significantly lower in all three patient groups (50.55 ± 23.50, 40.00 ± 17.65, and 38.80 ± 14.10 nmol/l, respectively) than in the control group (61.15 ± 17.65 nmol/l, P < 0.05). Mean serum levels of Δ4-androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and 3α-AdiolG were higher in group B than in group A, and higher in group A than in the control group. The significant correlations found between adrenal secretion – either positive (with 3α-AdiolG levels and the body mass index) or negative (with SHBG levels) – might reflect the important contribution of secretory and metabolic components in the development of alopecia, the severity of which has been shown to be very closely related to observed levels of two of these parameters (3α-AdiolG and SHBG).