The effects of hair loss in European men: A survey in four countries

Article (PDF Available)inEuropean journal of dermatology: EJD 10(2):122-7 · April 2000with 2,771 Reads
Source: PubMed
Cite this publication
Abstract
Despite the high prevalence and the accepted psychological aspects of male pattern hair loss, few have characterized the effects of hair loss in representative samples of men in different countries. A representative sample of households in 4 European countries (France, Germany, Italy and the United Kingdom) was contacted by an interviewer and resident males 18-40 years of age (n = 1,717) completed a questionnaire designed specifically to evaluate attitudes to hair loss. The questionnaire was comprised of 78 questions translated and pilot-tested using standard methodology into each local language. Questionnaires queried about self-rated hair loss, satisfaction with hair appearance, noticeability of hair loss to others, and bother, concerns and perceptions about hair loss, as well as general physical health (the SF-12 questionnaire) plus three additional questions about mental health. The self-reported degree of hair loss in men was statistically significantly associated (p < 0.001) with all hair-loss specific effects measured, except "limiting job opportunities". The impact of hair loss was generally consistent in the four countries surveyed, although less pronounced in the United Kingdom. Age was significantly correlated with hair loss (rs = 0.34, p < 0.001). Men with greater hair loss were more bothered, more concerned about looking older due to their hair loss, and less satisfied with their hair appearance. Male pattern hair loss has significant negative effects on hair-loss specific measures in men 18 to 40 years of age in France, Italy, Germany and the UK. The degree that hair loss is perceived as noticeable to others appears to be a significant contributor to these negative effects.
Figures - uploaded by David Himmelberger
Author content
All content in this area was uploaded by David Himmelberger
Content may be subject to copyright.
No caption available
… 
The effects of hair loss in European men: a survey in four countries
European Journal of Dermatology. Volume 10, Number 2, 122-7, March 2000, Cas
cliniques
Author(s) : D. Budd, D. Himmelberger, T. Rhodes, T.E. Cash, C.J. Girman, Department of Epidemiology, Merck Research Laboratories,
BL 1-7, 10 Sentry Parkway, Blue Bell, PA 19422, USA. rhodes@merck.com.
Summary : Despite the high prevalence and the accepted psychological aspects of
male pattern hair loss, few have characterized the effects of hair loss in representative
samples of men in different countries. A representative sample of households in 4
European countries (France, Germany, Italy and the United Kingdom) was contacted by
an interviewer and resident males 18-40 years of age (n = 1,717) completed a
questionnaire designed specifically to evaluate attitudes to hair loss. The questionnaire
was comprised of 78 questions translated and pilot-tested using standard methodology
into each local language. Questionnaires queried about self-rated hair loss, satisfaction
with hair appearance, noticeability of hair loss to others, and bother, concerns and
perceptions about hair loss, as well as general physical health (the SF-12
questionnaire) plus three additional questions about mental health. The self-reported
degree of hair loss in men was statistically significantly associated (p < 0.001) with all
hair-loss specific effects measured, except “limiting job opportunities”. The impact of
hair loss was generally consistent in the four countries surveyed, although less
pronounced in the United Kingdom. Age was significantly correlated with hair loss (rs =
0.34, p < 0.001). Men with greater hair loss were more bothered, more concerned about
looking older due to their hair loss, and less satisfied with their hair appearance. Male
pattern hair loss has significant negative effects on hair-loss specific measures in men
18 to 40 years of age in France, Italy, Germany and the UK. The degree that hair loss is
perceived as noticeable to others appears to be a significant contributor to these
negative effects.
Keywords : androgenetic alopecia,
psychosocial.
Pictures
ARTICLE
Background
Androgenetic alopecia, or male pattern hair loss (MPHL), is a common condition that
has been reported to affect 29-40% of men between 18 and 59 years of age [1-3].
Despite the accepted psychological effects of MPHL, few studies have been conducted
to investigate and quantify this relationship. Of those which have been reported [4-6]
most have relied on selected samples of men seeking medical attention for their hair
loss and may not be representative of the general population. In addition, many of the
earlier studies that investigated the psychosocial effects of MPHL used scales that are
not specific to this condition. However, these global psychological measures may not be
sensitive enough to detect meaningful effects in men with hair loss.
Using measures specific to hair loss, Cash et al. [6] documented the negative
psychological effects of hair loss on men and women in a US survey of patients seeking
treatment for androgenetic alopecia, compared to female control patients. These results
were supported by a recent study conducted in men recruited from a community near
Dayton, Ohio [7], which found that men with hair loss are significantly more distressed,
self-conscious and dissatisfied with their hair appearance relative to men without hair
loss. However, no studies using measures specific to hair loss and population sampling
methodology have been conducted to investigate the effects of hair loss on men in the
general population of various European countries.
This study was designed to address this void by using measures specific to the
problems and concerns expressed by men with hair loss [8] and a sampling
methodology that included men representative of the general population in four major
European countries (Germany, France, Italy and the United Kingdom).
Materials and methods
Randomly selected samples of men 18 to 40 years of age were surveyed in each
country. This survey was a part of a larger omnibus survey that is routinely conducted in
the UK and Italy every 2 to 4 weeks. The demographic characteristics of the sample in
each country were comparable to that of the general population in that country. A
personal interviewer identified participants, and the respondent then completed a
questionnaire in his primary language without any assistance from the interviewer.
The questionnaire was initially developed in the United States in American English to
evaluate the impact of hair loss on men's health-related quality of life. The instrument
was translated from American-English into French for use in France, German for use in
Germany, Italian for use in Italy and British-English for use in the UK using the standard
forward-backward method [9-11]. Prior to data collection, each translated version of the
questionnaire was pilot-tested for comprehension [12] with 10 men in each country.
Men rated their hair loss using a categorical scale with seven responses: "a full head of
hair", "only a little hair loss", "some hair loss", "moderate hair loss", "a good bit of hair
loss", "a lot of hair loss", and "I am bald". In addition, men circled the classification that
they felt best matched their hair loss pattern, using the Norwood/Hamilton scale [1, 2].
Men were also asked questions that were specific to hair loss, including previously
validated measures [8] of satisfaction with their hair appearance (on top of their head,
frontal hairline, and overall), degree of bother due to hair loss, extent of concern about
aging, and perceived noticeability to others [13]. A "hair loss distress" domain score was
calculated as the sum of responses to questions regarding bother and concern about
looking older due to hair loss, whereas a domain score for thinning/shedding included
three questions pertaining to shedding while grooming [7]. Demographic data,
respondent's medical history and data about hairstyle, hair color, hair length and family
history of disease were also collected. Other questions, identified as most relevant in a
previous survey [6], were included on an exploratory basis to investigate the relationship
between hair loss and worry about appearance and relationships, helplessness, self-
confidence and self-consciousness, preoccupation, impact on social life and job
opportunities, and other pertinent areas specifically related to hair loss. The response
scales of these questions were modified to better conform to the rest of the present
survey. Additionally, data were collected about men's awareness of hair loss products
and remedies, such as surgery, drug therapy, wigs, and hair styling.
Respondents were categorized into one of the four groups based on their self-reported
degree of hair loss: "a full head of hair", "a little hair loss", "some hair loss" or "moderate
hair loss", and finally, "a good bit of hair loss", "a lot of hair loss" or "bald".
Differences among men with various degrees of hair loss were assessed using general
linear models (GLM) [14]. Covariates in the model included marital status (never
married, married/cohabitating/widowed/divorced), age (18-25, 26-30, 31-40), education
level high school, > high school), and interactions of hair loss and age. Analyses
were performed separately for each country. Bonferroni adjustments for multiple testing
were made for all statistical tests [15]. Spearman rank correlations were used where
appropriate to investigate relationships between individual variables.
Results
A total of 1,717 men with varying degrees of MPHL were surveyed in France (n = 502),
Germany (n = 508), Italy (n = 383), and the UK (n = 324). The average SD) age of
participants was 29.3 (± 6.4) years and age distributions were comparable among
countries. About half of the men had never been married (51.2%) and half were
currently married or cohabiting (47.7%). Marital status was fairly consistent among
countries, except that fewer men in the UK had never been married (34.6%) and more
were married or cohabiting (59.9%). Overall, 30.1% of the men had completed college
or graduate school; differences between countries probably reflect the different
educational systems. The majority of participants worked full-time (75%) or part-time
(5.7%) and 8.0% were students.
Slightly more than half of the participants (53.5%) in the survey reported that they had a
full head of hair and few men (8.8%) reported more than moderate hair loss (Table I).
The degree of self-reported hair loss was highly dependent upon patient age (r
s
= 0.34,
p < 0.001). Of men under 20 years of age, 81.3% reported that they had "a full head of
hair", but only 35.2% of men 35 years or older reported "a full head of hair" with about
30% reporting at least "moderate hair loss".
Among men reporting hair loss, the average SD) age at which they began to notice
hair loss was 23.9 6.8) years of age; however, men in Italy reported a significantly
lower age at which hair loss began (20.8 years), compared to the other countries (24.6-
25.6 years); (p = < 0.01).
For all four countries, mean scores for the shedding/thinning domain increased with
increasing degree of hair loss (p < 0.0001) (Fig. 1a). These increases were typically
independent of age except in France (p < 0.005) where 18-25 year old men reported
higher shedding/thinning scores than either the 26-30 or the 31-40 year old men (mean
± s.e.: 6.1 ± 0.30, 5.3 ± 0.28, 5.3 ± 0.23 respectively).
Mean scores for the hair loss distress domain also increased with increasing degree of
hair loss in all four countries (p < 0.002) (Fig. 1b). The increase in distress was
independent of age for France and Italy. For Germany, the distress domain scores were
generally greater in younger men, decreasing slightly with increasing age (mean ± s.e.:
4.1 ± 0.33, 3.5 ± 0.19, 3.2 ± 0.14 for men 18-25, 26-30 and 31-40 respectively).
However in the UK, men 26-30 reported the highest distress scores with the older men
(31-40 years) reporting the same average level of distress as the younger men. Hair
loss distress in all countries appeared to be driven mainly by the question pertaining to
how bothered they were by their hair loss rather than concern about looking older due to
hair loss. Marital status and education level were generally not related to the hair loss
distress domain, although a consistent relationship between education and hair loss
measures was found for men in the UK (p < 0.05). Likewise, the degree of bother due to
hair thinning increased with increasing hair loss in all countries. The degree of concern
about looking older due to hair loss also increased with the degree of hair loss, except
in the UK where the relationship was not significant.
Perceived noticeability of hair loss to others was highly correlated with self-reported
degree of hair loss in all four countries (r
s
= 0.73-0.83). Overall, 98% of men with a "full
head of hair" reported that hair loss was "not at all" or "slightly" noticeable while 75% of
the men who reported "a lot of hair loss" or "I am bald" reported that their hair loss was
"very" or "extremely" noticeable to others. In addition, perceived noticeability to others
was strongly related to the satisfaction measures and degree of bother in each country
(r
s
= 0.58-0.60). Overall, perceived noticeability to others was somewhat more strongly
related to bother (r
s
= 0.58) than degree of hair loss (r
s
= 0.51). As with the other hair loss
specific measures, perceived noticeability also increased with increasing degree of hair
loss independent of age for all countries (p < 0.0001) (Fig. 1c).
In all four countries, men with greater hair loss reported significantly less satisfaction
with their hair appearance (hairline in front, hair on top of their heads, and hair in
general) than men with less hair loss (p < 0.0001).
The exploratory analyses of measures of worry, helplessness, self-consciousness,
preoccupation and impact on social life yielded results similar to those presented
previously. Men with greater self-reported hair loss reported significantly greater
negative effects for all measures except "opportunity in your job" (Table 3). As with
previous results, "perceived noticeability to others" was significantly indicative of greater
negative effects for most of the measures.
The general health measures, SF-12 physical (PCS-12) [16] and mental (MCS-12)
domains and the MHI-5 [17], were not related to self-reported hair loss and were not
significantly different from published norms for men in the United States between the
ages of 18 and 34 [16-17].
Discussion
Although less than 12% of men 18 to 40 years of age reported that they had "a good bit
of loss" or greater hair loss, significant negative effects of hair loss were reported for
men surveyed who reported any degree of hair loss. Men who reported greater hair loss
expressed less satisfaction with hair appearance, a greater degree of bother due to hair
loss and more concern about growing older. In addition, men with greater hair loss
appeared to be more worried, less self-confident and, in general, to have more negative
effects specific to their hair loss than men who reported less hair loss. Even men
reporting only "a little" or "some" to "moderate" hair loss showed significant negative
effects of hair loss relative to men without hair loss.
Although others have documented the negative effects of hair loss on men, this is the
first study to document the consistency of such effects across cultures. Generally,
trends in the negative effects of hair loss on men 18 to 40 years of age were similar in
France, Germany, Italy, and the UK. In addition to the degree of self-reported hair loss,
"perceived noticeability to others" was found to be significantly related to most hair-loss
specific measures. Men who perceived their hair loss as more noticeable to others were
less satisfied with their hair appearance and more bothered by their hair loss. This
variable captures the person's self-conscious awareness of their hair loss. Demographic
characteristics were generally not associated with the hair-loss specific measures.
Unlike the findings from a community study conducted in the US [7] that surveyed men
up to 50 years of age and another former survey [5], we did not consistently find that
younger men were more negatively affected by their hair loss. It is unknown whether
  • Article
    Full-text available
    Wprowadzenie. Jakość włosów stanowi ważny element wyglądu i wpływa na przekonanie o atrakcyjności fizycznej, co w konsekwencji oddziałuje na ogólny nastrój, samoocenę i poczucie własnej wartości. Cel. Wstępna charakterystyka pacjentów z łysieniem androgenowym, dotycząca poziomu samooceny i wstydu przypisywanego własnej chorobie oraz funkcji pełnionych przez emocje wstydu. Materiały i metody. Badanie przeprowadzono dwuetapowo, w latach 2013-2016. Najpierw ustalono listę 35 najbardziej wstydliwych chorób, która – z udziałem 314 osób badanych – została zawężona do 10. Drugi etap polegał na zbadaniu 39 mężczyzn z łysieniem androgenowym, którzy wypełnili autorską ankietę oraz Skalę Samooceny Rosenberga (SES). Wyniki. Za najbardziej wstydliwą chorobę pacjenci z łysieniem androgenowym uznali AIDS (79%) oraz kiłę (78%). Za najmniej wstydliwe choroby uznano grzybicę paznokci (25%) i gruźlicę (29%). Zdaniem badanych, że wyjątkowy wstyd budzą te choroby, które: 1. wywołują wstręt i niechęć do chorego; 2. dotyczą intymnych miejsc ludzkiego ciała; 3. są powiązane z płciowością, a chorzy nie przyznają się do nich; 4. łatwo się nimi zarazić. Według osób badanych, wstyd pełni funkcję sygnalizowania tego, co jest moralne, a co nie, jak również funkcję hamującą własną spontaniczność. Wnioski. Łysienie androgenowe jest obarczone niższym poziomem wstydu, niż na to wskazują dotychczasowe badania. Poczucie wstydu, doznawane przez pacjentów z łysieniem androgenowym, jest o ok. 70% słabsze niż przeżywane przez chorych na AIDS czy na kiłę. Słowa kluczowe: łysienie androgenowe, samoocena, wstyd
  • Article
    Full-text available
    Wprowadzenie. Jakość włosów stanowi ważny element wyglądu i wpływa na przekonanie o atrakcyjności fizycznej, co w konsekwencji oddziałuje na ogólny nastrój, samoocenę i poczucie własnej wartości. Cel. Wstępna charakterystyka pacjentów z łysieniem androgenowym, dotycząca poziomu samooceny i wstydu przypisywanego własnej chorobie oraz funkcji pełnionych przez emocje wstydu. Materiały i metody. Badanie przeprowadzono dwuetapowo, w latach 2013-2016. Najpierw ustalono listę 35 najbardziej wstydliwych chorób, która – z udziałem 314 osób badanych – została zawężona do 10. Drugi etap polegał na zbadaniu 39 mężczyzn z łysieniem androgenowym, którzy wypełnili autorską ankietę oraz Skalę Samooceny Rosenberga (SES). Wyniki. Za najbardziej wstydliwą chorobę pacjenci z łysieniem androgenowym uznali AIDS (79%) oraz kiłę (78%). Za najmniej wstydliwe choroby uznano grzybicę paznokci (25%) i gruźlicę (29%). Zdaniem badanych, że wyjątkowy wstyd budzą te choroby, które: 1. wywołują wstręt i niechęć do chorego; 2. dotyczą intymnych miejsc ludzkiego ciała; 3. są powiązane z płciowością, a chorzy nie przyznają się do nich; 4. łatwo się nimi zarazić. Według osób badanych, wstyd pełni funkcję sygnalizowania tego, co jest moralne, a co nie, jak również funkcję hamującą własną spontaniczność. Wnioski. Łysienie androgenowe jest obarczone niższym poziomem wstydu, niż na to wskazują dotychczasowe badania. Poczucie wstydu, doznawane przez pacjentów z łysieniem androgenowym, jest o ok. 70% słabsze niż przeżywane przez chorych na AIDS czy na kiłę. Słowa kluczowe: łysienie androgenowe, samoocena, wstyd
  • Chapter
    Hair loss (alopecia) is a common dermatological condition that affects men and women of all ages. It can be due to a wide variety of causes including scarring and non-scarring diseases. Although alopecia is not a life-threatening condition, it has significant psychological impact on the quality of life. Mental disorders such as anxiety, depression, social phobia, posttraumatic stress disorder, and suicidal thoughts are increased among alopecia patients. On the other hand, alopecia frequency increases during the course of psychological disorders. In this chapter, psychosocial aspects of hair loss and the relationship between alopecia and psychological disorders are reviewed.
  • Article
    Full-text available
    Introduction: Since the early 1970s, Platelet-rich plasma (PRP) has been used in many fields as a potential remedy for having regenerative properties. In dermatology, its use is extended to different hair diseases: alopecia areata, traction alopecia, androgenetic alopecia (AGA), and even cicatricial alopecia. Despite its increasing use in the clinical practice, the protocol used to produce PRP differs greatly between researchers and its efficacy has not been clearly demonstrated. Particularly, AGA is an illness characterized by a progressive hair thinning and miniaturization caused by the effect of dihydrotestosterone (DHT) on the hair follicle. This type of alopecia is the most common in men, increasing its incidence with age. Until the date, there are only two efficient treatments approved by the FDA: Finasteride and Minoxidil. PRP seems to be a potential new candidate according to recent studies, but multiple PRP obtaining techniques have raised ambiguous results about the real efficacy of PRP in patients with AGA. Thus, we have elaborated a methodology to help researchers designing future clinical trials on PRP therapy. We propose a randomized clinical trial with a uniformed PRP obtaining technique in order to properly assess the PRP efficacy as a treatment for AGA. Objective: Analyze the objective data published until the date in order to define the real efficacy of PRP as a treatment for AGA, and offer a design of a clinical phase trial with a standardized methodology to obtain proper scientific evidence of PRP efficacy. Methods: Retrospective systematic review of the literature published and a randomized placebo-controlled, double-blind, half-head study clinical trial proposal with a uniformed PRP obtaining methodology to properly assess its efficacy as a future AGA treatment. Keywords: Male-pattern hair loss (MPHL) – Androgenetic alopecia (AGA) – Platelet-rich plasma (PRP) – Efficacy – Growth factors (GFs).
  • Article
    Androgenetic alopecia, the gradual, progressive loss of hair frequently results in psychological despair, in part related to changes in self-image. Current androgenetic alopecia treatments are limited to hair transplantation and medications that inhibit dihydrotestosterone, a potent androgen associated with follicular micronization. Users of finasteride, which prevents dihydrotestosterone production, report serious physical and emotional adverse effects, collectively known as post-finasteride syndrome. Psychiatric illnesses and personality traits, specifically neuroticism influence emotional well-being. Limited research exists exploring the psychological corollaries of post-finasteride syndrome and preexisting Axis I and Axis II mental health conditions. The aim of this study was to explore how having a preexisting personal and/or familial history of a psychiatric diagnosis and certain personality traits may influence anxiety and depression among finasteride users. Participants in this online survey completed the Beck Depression Inventory, the Beck Anxiety Inventory, and Ten-Item Personality Inventory. An important finding in this study was that almost 57% (n = 97) of men reported a psychiatric diagnosis and 28% (n = 27) had a first-degree relative with a mental health disorder, of this group 17 only had a family history. Nearly 50% of the men surveyed reported clinically significant depression as evidenced by Beck Depression Inventory score and 34% experienced anxiety on the Beck Anxiety Inventory. There were no statistically significant trends in personality traits reported. Results provide evidence on the need to screen for psychiatric history and counseling patients about the potential psychological consequences of finasteride. Prescribing clinicians should carefully weigh the risk/benefit ratio with these patients.
  • Article
    Full-text available
    Low-level laser/light therapy (LLLT) has been increasingly used for promoting hair growth in androgenetic alopecia (AGA). Our institute developed a new home-use LLLT device, RAMACAP, with optimal penetrating energy, aiming to improve therapeutic efficacy and compliance. To evaluate the efficacy and safety of the new helmet-type LLLT device in the treatment of AGA, a 24-week, prospective, randomized, double-blind, sham device-controlled clinical trial was conducted. Forty subjects with AGA (20 men and 20 women) were randomized to treat with a laser helmet (RAMACAP) or a sham helmet in the home-based setting for 24 weeks. Hair density, hair diameter, and adverse events were evaluated at baseline and at weeks 8, 16, and 24. Global photographic assessment for hair regrowth after 24 weeks of treatment was performed by investigators and subjects. Thirty-six subjects (19 in the laser group and 17 in the sham group) completed the study. At week 24, the laser helmet was significantly superior to the sham device for increasing hair density and hair diameter (p = 0.002 and p = 0.009, respectively) and showed a significantly greater improvement in global photographic assessment by investigators and subjects. Reported side effects included temporary hair shedding and scalp pruritus. In conclusion, the novel helmet-type LLLT device appears to be an effective treatment option for AGA in both male and female patients with minimal adverse effects. However, the limitations of this study are small sample size, no long-term follow-up data, and use of inappropriate sham devices, which do not reflect the true negative control. Trial registration: http://clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=2061, identifier TCTR20160910003.
  • Article
    Purpose: We aimed to evaluate the associations between androgenetic alopecia at a young age and subsequent development of aggressive prostate cancer (PC). Methods: Using a case-control design with self-administered questionnaire, we evaluated the association between aggressive PC and very early-onset balding at age 20, and early-onset balding at age 40 years in 1,941 men. Cases were men with high-grade and/or advanced stage cancer and controls were clinic based men who had undergone biopsy and were found to be histologically cancer negative. Additionally, for cases we assessed whether early-onset balding was associated with earlier onset of disease. Results: Men with very early-onset balding at age 20 years were at increased risk for subsequent aggressive PC [odds ratio (OR) 1.51, 95% confidence interval (CI) 1.07-2.12] after adjustment for age at baseline, family history of PC, smoking status, alcohol intake, body shape, timing of growth spurt and ejaculatory frequency. Additionally, these men were diagnosed with PC approximately 16 months earlier than cases without the exposure. The effect was present particularly for men with advanced stage pT3+ disease (OR 1.68, 95% CI 1.14-2.47) while men with organ-confined high-grade (8-10) PC did not exhibit the same relationship. No significant associations were observed for men who were balding at age 40 years, given no balding at age 20. Conclusion: Men with androgenetic alopecia at age 20 years are at increased risk of advanced stage PC. This small subset of men are potentially candidates for earlier screening and urological follow-up.
  • Background: Post-marketing reports suggest that finasteride causes sexual dysfunction despite a low incidence reported in clinical trials. Therefore, the extent of risk remains unknown. Objective: To determine whether the risk of sexual dysfunction is higher among individuals treated with finasteride compared to a baseline risk for all other drugs using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Methods: A case by non-case disproportionality approach was used whereby a Reporting Odds Ratio (ROR) with 95% confidence interval (CI) was calculated. The National Ambulatory Medical Care Survey (NAMCS) was used to confirm results. Results: A significant disproportionality in reporting of sexual dysfunction with the use of finasteride was observed whether finasteride was indicated for hair loss (ROR = 138.17, 95% CI: 133.13, 143.4), prostatic hyperplasia (ROR= 93.88, 95% CI: 84.62, 104.16) or any indication (ROR= 173.18, 95% CI: 171.08, 175.31). When these results were stratified by age, disproportionality was strongest at 31-45 years. Conclusion: Use of finasteride has led to an increase in reports of sexual dysfunction where it is believed to be the primary suspect. This article is protected by copyright. All rights reserved.
  • Chapter
    Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle with a usually characteristic pattern distribution in genetically predisposed men and women. Although AGA is the most common form of hair loss in adults, little is known about its prevalence and response to treatments in the pediatric population. As in adults, the diagnosis of this type of alopecia in adolescents is made by recognizing the pattern and progression of hair loss in the context of the family history. A negative family history does not exclude the diagnosis. Early-onset AGA can be the presenting sign of an underlying endocrine disorder. Adolescents are invariably sensitive about their external features and, thus, may easily withdraw psychologically and avoid social activities due to AGA development. They can feel anxious and unattractive with a negative body image about themselves. Accurately recognizing AGA in adolescents will help patients and their families understand the diagnosis and its natural progression, allowing timely medical intervention for hair loss and any associated endocrine or psychosocial morbidity. Treatment of adolescent AGA has not been well studied, and currently there are no FDA-approved treatments for this condition. This article provides an overview of the embryology and normal hair development, pathogenesis, diagnosis, and management of adolescent androgenetic alopecia.
  • Article
    One Sample Normal Theory Nonnormality Effect Dependence Exercises Two Samples Normal Theory Nonnormality Unequal Variances Dependence Exercises One-Way Classification Fixed Effects Normal Theory Nonnormality Unequal Variances Dependence Random Effects Normal Theory Nonnormality Unequal Variances Dependence Exercises Two-Way Classification Fixed Effects Normal Theory Nonnormality Unequal Variances Dependence Mixed Effects Normal Theory Departures from assumptions Random Effects Normal Theory Departures from Assumptions Exercises Regression Regression Model Normal Linear Model Nonlinearity Nonnormality Unequal Variances Dependence Errors-in-Variables Model Normal Theory Departures from Assumptions Exercises Ratios Normal Theory Departures from Assumptions Exercises Variances Normal Theory Nonnormality Dependence Exercises
  • Article
    La nécessité se fait sentir, pour les psychologizes qui travaillent dans une perspective interculturelle, d'expliciter leurs méthodes et de parvenir à un certain consensus qui permette de juger et de comparer les résultats. L'auteur propose ici un cadre de travail méthodologique pour la recherche interculturelle, qui s'inspire des discussions passées de certains anthropologues. Trois conditions s'avèrent nécessaires si l'on veut donner quelque validité aux comparaisons interculturelles des comportements: 1° Il faut d'abord démontrer qu'il y a équivalence fonctionnelle des comportements dans l'une et l'autre des cultures considérées; c'est-à-dire que seul, un comportement qui cst une réponse à un problème identique peut ětre comparé. 2° On peut, à titre d'essai, partir d'une conception du comportement observe qui est indépendante des cultures considérées (généralité hypothétique) à condition que ce soit seulement comme point de départ et que ce comportement soit ensuite conçu dans les termes měmes de chaque culture (particularité). Les aspects communs peuvent alors ětre utilisés pour construire un cadre de comparaison valide pour les deux cultures (généralité dérivée) et měme pour toutes les autres cultures (universalité). 3° Des instruments et des techniques de mesure peuvent alors ětre inventés, qui seront basés sur ce cadre de comparaison, pour autant qu'on puisse atteindre une équivalence conceptuclle. A titre d'exemple, les notions d'intelligence et de dépendance du champ sont discutées dans cette perspective méthodologique. L'auteur invite les lecteurs à commenter et à discuter le cadre de travail qu'il propose.
  • Article
    BACKGROUND: Male-pattern hair loss (androgenetic alopecia) is a common clinical condition in adult men that is often associated with negative self-perception and has been the target of a number of therapeutic interventions. Despite the importance of self-perceptions of hair growth and appearance with such interventions, no standardized validated questionnaire exists for use in clinical trials. OBJECTIVE: Develop and evaluate a questionnaire to measure patient-perceived changes in hair growth and appearance in clinical trials of medical intervention for androgenetic alopecia in men. METHODS: Literature review and focus groups with men having androgenetic alopecia initially identified 28 potential questions. These questions were assessed in an observational study (n = 204) and a placebo-controlled clinical trial (n = 181). RESULTS: The final questionnaire contained seven global questions addressing change since the start of the study in satisfaction with hair appearance (three questions), hair growth and appearance, size of the bald spot, and slowing of hair loss. Significant differences favoring active treatment over placebo were evident for all seven questions by 6 months in a clinical trial. CONCLUSIONS: This standardized questionnaire can be used to assess patient perceptions of hair growth in clinical trials of men with androgenetic alopecia.
  • Article
    Two aspects of translation were investigated: (1) factors that affect translation quality, and (2) how equivalence between source and target versions can be evaluated. The variables of language, content, and difficulty were studied through an analysis of variance design. Ninety-four bilinguals from the University of Guam, representing ten languages, translated or back-translated six essays incorporating three content areas and two levels of difficulty. The five criteria for equivalence were based on comparisons of meaning or predictions of similar responses to original or translated versions. The factors of content, difficulty, language and content-language interaction were significant, and the five equivalence criteria proved workable. Conclusions are that translation quality can be predicted, and that a functionally equivalent translation can be demonstrated when responses to the original and target versions are studied.