Premature Balding in Men Role of Hormones and Hair Follicles

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Premature Balding

Premature balding in men has been suggested as a feature of the male equivalent of the polycystic ovary syndrome (PCOS) in women. Though the similarity of the hormonal pattern of men with premature balding to those with women with PCOS syndrome has been investigated in only a few studies it provides interesting clues. These studies have confirmed the relation both at genetic and biochemical level.

It has been shown that women with PCOS can have both excess of body hair growth (hirsutism) and/or balding. A number of hormones in the metabolism of androgens are responsible for the symptoms and effect. The blood testosterone is converted to a hormone called dihydrotestosterone which directly stimulates the body hair follicles to grow, incidentally it is the same hormone which is also responsible for scalp hair loss. Body hair grows in response to testosterone much more while the head (crown) hair follicles are actually sensitive to too much testosterone and balding is the result. As discussed earlier there are studies which show that there is genetic predisposition to premature balding in men (before age 30) who are siblings of women with polycystic ovary syndrome - PCOS.


The Sensitivity of Hair Follicles

The sensitivity of hair follicles to androgens in different areas differs. The head hair follicles are just supersensitive to the dihydrotestosterone and the hairs fall out instead of growing. This difference in androgen sensitivity is due in part to the presence or absence of androgen receptors. The hormones act on the dermal papilla cells at the base of the hair follicle which have androgen receptors. There is a greater concentration of androgen receptors in pubic hair follicle dermal papilla cells whereas there is a lower concentration in the in the beard dermal papilla and an even lower number of androgen receptors in scalp hair follicle dermal papilla cells. In part this is the reason why the hair follicles behave differently to the androgens in different areas.


Women and Excess Androgen Level

If women have excess testosterone or other androgens such as dihydroepiandosterone (DHEA), the very fine body hairs will turn into coarse, dark hairs on the abdomen, which grow towards the navel, and on the face in a mustache pattern. If such women have a genetic predisposition to baldness and the androgens are high enough, balding results. If the testosterone blood levels are extremely high resulting from an ovarian or adrenal gland tumor, then balding can occur even without a genetic predisposition.


Is Premature Balding Related to Inheritance of Polycystic Ovarian Syndrome ?

The tendency for polycystic ovarian syndrome to occur in families has been confirmed for many years now. One study from the United Kingdom found evidence that PCOS associated with male pattern baldness was probably inherited as an autosomal dominant trait, i.e., one half of the female offspring of a woman carrying this gene will have PCOS Male members of these families have about a 20-25% incidence of premature balding. Thus this situation is still consistent with a genetic control of premature balding.

In summary, a male susceptibility phenotype in the brothers of women with PCOS has been identified. This consists of elevations in circulating DHEAS levels. There was no increase in the prevalence of balding in this U.S. population of male first-degree relatives. DHEAS levels were highly correlated between brothers and their proband sisters, consistent with a heritable trait.

In a separate hormone profile study of 37 men with premature balding (defined as frontoparietal and vertex hair loss before the age of 30 years with alopecia defined as grade 3 vertex or more on the alopecia classification scale of Hamilton with Norwood modification) have been made . The plasma concentrations of total testosterone, dihydrotestosterone, epitestosterone and related metabolites was measured. The frequency of subnormal values of these hormones was significant in balding men. The study could provide substantial evidence that the hormonal pattern of men with premature balding resembles in some respects the hormonal pattern of women with polycystic ovary syndrome.