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The Contribution of Endogenous and Exogenous Factors to Male Alopecia: A Study of Identical Twins
Abstract
: The purpose of this study was to investigate the potential contribution of environmental factors and testosterone on male alopecia.
: Ninety-two identical male twins were recruited from 2009 to 2011. A comprehensive questionnaire was completed followed by the acquisition of sputum samples for testosterone analysis and standardized digital photography. Frontal, temporal, and vertex hair loss was assessed from these photographs. Hair loss was then correlated with survey responses and testosterone levels between twin pairs. Two independent, blinded observers also rated the photographs for hair thinning.
: Increased smoking duration (p < 0.001) and the presence of dandruff (p = 0.028) were significantly associated with increased frontal hair loss. Increased exercise duration (p = 0.002), consumption of more than four alcoholic drinks per week (p = 0.042), and increased money spent on hair loss products (p = 0.050) were all associated with increased temporal hair loss. Daily hat use (p = 0.050), higher body mass index (p = 0.012), and higher testosterone levels (p = 0.040) were associated with decreased temporal hair loss. Factors that were significantly associated with increased vertex hair loss included abstinence from alcohol consumption (p = 0.030), consumption of more than four alcoholic drinks per week (p = 0.004), increased smoking duration (p = 0.047), increased exercise duration (p = 0.050), and increased stress duration (p = 0.010). Lower body mass index, more children, increased caffeine consumption, history of skin disease, and abstinence from alcohol were significantly associated with increased hair thinning scores (p < 0.05).
: This study offers substantial evidence that exogenous factors may have a clinically significant impact on hair loss.
: Risk, III.
... Hair grows appro ximately 0.3mm/day or 6 inches per year, while the scalp sheds 100 hairs per day. Hair is co mposed of hair fo llicle (the part beneath the skin) and bulb (seen at the root when pulled fro m the skin ) [11][12][13][14][15]. ...
... The other miscellaneous factors include industrial to xins, intoxicated water (with high levels or minerals and metals), local dermal infection, parasitic infestation, oxidative stress and local allergic ailment [11,15,24,25]. ...
... Natural products can be prepared by chemical synthesis (both semi-synthesis and total synthesis) and have important role in development of the field of organic chemistry by providing challenging synthetic targets. Commercially, natural product refers to cosmetics, dietary supplements, and foods produced from natural sources without added artificial ingredients [15,26]. ...
Alopecia is a dermatological disorder also expressed as loss of hair. Psycho-social importance of hair is the main cause of the focus of cosmaceutical industry on hair growth formulations. Various medicinal systems consist of the therapy for alopecia but very few of them are promising. Use of herbs and medicinal plants in the treatment of alopecia is a well-known folklore practice. The conventional synthetic drugs are associated with the one or more significant side effects when used in the long term for alopecia treatment. The herbal drugs can provide a safer and more effective alternative to the treatment. Understanding of physiological factors affecting hair growth and mechanism of herbs in promoting hair growth can be helpful in the hair growth research. The article reviews the alopecia as a disorder, the present status of the nonsurgical treatment options for alopecia and the discussion on the systematic research going on the herbal drugs to treat alopecia.
... Hair grows appro ximately 0.3mm/day or 6 inches per year, while the scalp sheds 100 hairs per day. Hair is co mposed of hair fo llicle (the part beneath the skin) and bulb (seen at the root when pulled fro m the skin ) [11][12][13][14][15]. ...
... The other miscellaneous factors include industrial to xins, intoxicated water (with high levels or minerals and metals), local dermal infection, parasitic infestation, oxidative stress and local allergic ailment [11,15,24,25]. ...
... Natural products can be prepared by chemical synthesis (both semi-synthesis and total synthesis) and have important role in development of the field of organic chemistry by providing challenging synthetic targets. Commercially, natural product refers to cosmetics, dietary supplements, and foods produced from natural sources without added artificial ingredients [15,26]. ...
... Genetic predisposition and hormonal changes are involved in AGA pathogenesis [5]; for instance, a genome-wide association study identified 624 genomic sites related to AGA [6]. Studies on monozygotic and dizygotic twins have shown that genetic factors are strong [7,8], while studies on monozygotic twins have shown that internal and external factors affect alopecia [9], suggesting the involvement of factors other than heredity. Environmental factors affecting the scalp include sebum and microorganisms. ...
... The involvement of the microbiota in scalp hypersensitivity and alopecia has been investigated. In a hypersensitive scalp, colonization by the lipophilic C. acnes increases with increasing sebum secretion, Microorganisms 2021, 9,2132 2 of 14 which disrupts the skin barrier [14]. C. acnes, Staphylococcus, and Malassezia have been implicated in AGA [15,16] and in dandruff production [17,18]. ...
... There was a greater degree of Malassezia colonization in the AGA group than in the non-AGA group at all ages. The total Malassezia species colonization levels were determined via real-time PCR using a TaqMan probe.Microorganisms 2021,9, 2132 ...
The skin microbiome and sebum may be associated with inflammation-related diseases of the scalp. To assess the pathogenesis and progression of androgenetic alopecia (AGA), we analyzed the composition of sebum and the bacterial and fungal microbiomes of the scalps of 118 Japanese male individuals with and without AGA, then discussed their roles in the pathogenesis of AGA. Sebum triglyceride and palmitic acid contents were higher in the AGA group than in the non-AGA group. Malassezia restricta, a lipophilic fungus that consumes palmitic acid, was abundant on the scalps of patients with AGA. Cutibacterium, Corynebacterium, and Staphylococcus were the most common genera in both groups, and patients with AGA exhibited scalp dysbiosis (increased abundance of Cutibacterium and decreased abundance of Corynebacterium). Our findings suggest that both sebum and the bacterial and fungal microbiomes of the scalp may be involved in the development of AGA.
... [40,46,98]. Recent studies show evidence that air pollutants, especially environmental cigarette smoke, are closely related with AGA [25,78,82]. It is well known that genetic factors are highly associated with AGA, but the study of balding patterns between active smoker and nonsmoker twins shows that environmental factors also play a key role in the development of baldness. ...
... It is well known that genetic factors are highly associated with AGA, but the study of balding patterns between active smoker and nonsmoker twins shows that environmental factors also play a key role in the development of baldness. Although the twins were genetically identical, those with a longer smoking history showed increased hair loss in the frontal hair area [25]. Within twin pairs, smokers had significantly more hair loss in the vertex lesion compared with nonsmokers, suggesting the adverse effects of environmental factors on baldness [25]. ...
... Although the twins were genetically identical, those with a longer smoking history showed increased hair loss in the frontal hair area [25]. Within twin pairs, smokers had significantly more hair loss in the vertex lesion compared with nonsmokers, suggesting the adverse effects of environmental factors on baldness [25]. Also, analysis of odds ratios for smoking status, smoking number per day, and smoking intensity indicated a significant positive correlation between cigarette smoke and AGA [78] . ...
Environmental air pollution encompasses various particulate matters (PMs). The increased ambient PM from industrialization and urbanization is highly associated with morbidity and mortality worldwide, presenting one of the most severe environmental pollution problems. This article focuses on the correlation between PM and skin diseases, along with related immunological mechanisms. Recent epidemiological studies on the cutaneous impacts of PM showed that PM affects the development and exacerbation of skin diseases. PM induces oxidative stress via production of reactive oxygen species and secretion of pro-inflammatory cytokines such as TNF-α, IL-1α, and IL-8. In addition, the increased production of ROS such as superoxide and hydroxyl radical by PM exposure increases MMPs including MMP-1, MMP-2, and MMP-9, resulting in the degradation of collagen. These processes lead to the increased inflammatory skin diseases and skin aging. In addition, environmental cigarette smoke, which is well known as an oxidizing agent, is closely related with androgenetic alopecia (AGA). Also, ultrafine particles (UFPs) including black carbon and polycyclic aromatic hydrocarbons (PAHs) enhance the incidence of skin cancer. Overall, increased PM levels are highly associated with the development of various skin diseases via the regulation of oxidative stress and inflammatory cytokines. Therefore, anti-oxidant and anti-inflammatory drugs may be useful for treating PM-induced skin diseases.
... Androgenetic alopecia develops as a response of the hair follicle cells to androgens in individuals with genetic predisposition, even though the androgen concentration in blood is normal (Gatherwright et al., 2013). ...
... The excessive free radicals produced by the body metabolism, the environmental exposure (ultraviolet radiation, pollutants, chemical irritants, microbes), and lifestyle (smoking, for example) are sources of oxidative stress that impact the hair during and after its production (Trüeb, 2015). This way, behavior modification can potentially decrease the extent of the clinical manifestations (Gatherwright et al., 2013). ...
... For example, multiple marriages, longer sleep duration, higher stress severity, smoking history, diabetes mellitus, polycystic ovarian syndrome, and hypertension were associated with frontal hair loss (Gatherwright et al., 2012). In another study, 92 identical male twins were interviewed (Gatherwright et al., 2013). Smoking, excessive alcohol intake and increased exercise duration influenced on frontal, temporal, and vertex hair loss in a distinct spatiotemporal fashion. ...
Androgenetic alopecia (AGA) is the most diagnosed hair loss dysfunction. Its physiopathology comprises a genetic predisposition affording an exacerbated response of the hair follicles cells to androgens aggravated by scalp inflammation and extrinsic factors.
Objective:
To review the mechanisms and extrinsic factors involved in the AGA physiopathology as well as its conventional and emerging treatments.
Design:
The research focused on reports regarding AGA physiopathology and treatments published between January 2001 and July 2019 in medical and related journals.
Results:
The most used medical treatments for AGA - minoxidil and finasteride - present non-satisfactory results in some cases. Currently, the low-level laser therapy is recognized as a safe and effective treatment for AGA. Some minimally invasive techniques - mesotherapy, microneedling, carboxytherapy and platelet-rich plasma - are also used to stimulate hair growth. Pharmaceutical substances with mechanisms differing from the anti-androgen activity are under current investigation and many of them have botanical origins; however, formulations with higher performance are required, and the hair follicles ability of being a drug and nanoparticle reservoir has been researched.
Conclusions:
The association of different strategies, i.e., substances with synergic mechanisms and the use of advantageous technologies associated with lifestyle changes could improve the treatment outcomes. This article is protected by copyright. All rights reserved.
... The majority of epidemiologic studies recognize a positive association between smoking and alopecia, particularly in patients with AGA [3,[8][9][10][11][12][13]53]. One surveybased study of 740 Asian men with a diagnosis of AGA reported that current smokers of twenty cigarettes or more per day, with a history of smoking, or those with a greater smoking intensity (defined as smoking duration × amount per day) were at a higher risk of moderate or severe AGA (Norwood type IV) [8]. ...
... The subjects with a current smoking history had higher rate of U-type pattern alopecia according to the basic and specific classification system (p = 0.004) [9]. Twin studies on male (n = 92) and female (n = 98) patients with AGA conclude that increased pack-years of smoking was associated with more dramatic frontal hairline thinning [10,11]. The twin female smokers had increased temporal hair loss (p = 0.096; n = 10), while male smokers had more vertex hair loss than nonsmokers (p = 0.047, n = 20) [10,11]. ...
... Twin studies on male (n = 92) and female (n = 98) patients with AGA conclude that increased pack-years of smoking was associated with more dramatic frontal hairline thinning [10,11]. The twin female smokers had increased temporal hair loss (p = 0.096; n = 10), while male smokers had more vertex hair loss than nonsmokers (p = 0.047, n = 20) [10,11]. A cross-sectional study conducted by Fortes et al. [12] focused specifically on severe cases of AGA and noted a 3 times greater risk of developing moderate/severe alopecia in those with a higher frequency of smoking (≥10 cigarettes daily) (n = 351). ...
Smoking is not only a preventable cause of significant systemic disease but also affects the follicular growth cycle and fiber pigmentation. Ambient tobacco smoke exposure results in nicotine accumulation in hair follicles and the hair shaft. This review summarizes the evidence on the association between smoking and hair health, as denoted by alopecia and premature hair graying (PHG). In July 2020, a review of the literature using PubMed/MEDLINE and CINAHL databases identified 32 studies investigating the relationship between smoking, PHG, and alopecia (androgenetic alopecia and frontal fibrosing alopecia). The prevalence of hair loss and PHG is more prevalent in smokers than nonsmokers. Smoking is associated with negative effects on hair health as evidenced in PHG and alopecia. Smoking status should be assessed in patients who are presenting to their dermatologist for evaluation of alopecia and PHG.
... Its prevalence increases with age and ranges from 30 to 80% of the general population [7,8]. Although its etiopathogenesis is related to androgen in genetically predisposed individuals, epigenetics such as smoking, obesity, and stress are also reported to have a clinically significant impact on AGA [9]. However, the relationship between sleep disturbance and AGA is poorly understood, and results from available research have led to considerable debate [10,11]. ...
... We hypothesize that follicular microinflammation due to increased oxidative stress in hair follicles could be a possible explanation [17,18]. Sleep deprivation and several stress factors may promote the development of AGA through this pathway [9]. Research evidence has supported a correlation between stress and severity of AGA, in which stress negatively affects hair growth [19]. ...
Purpose
Sleep disturbances affect human health and contribute to several comorbidities. In men, androgenetic alopecia (AGA) is a common, non-scarring form of hair loss that affects a patient’s self-esteem. There are limited data regarding the association between poor sleep quality and male AGA. We aimed to compare the prevalence of sleep abnormalities between male patients with AGA and controls to identify an association between the two conditions.
Methods
A case–control study on patients with AGA and age-matched controls was conducted. Participants completed a standardized questionnaire that contained self-evaluated sleep measures, including Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and STOP-BANG questionnaire. Patients with AGA were classified into mild, moderate, and severe subgroups according to the Hamilton-Norwood classification for stratified analyses. Data between groups and among subgroups were compared.
Results
Of 446 male participants, 223 (50%) were in the AGA group, and the remainder (50%) were in the control group. Multivariable logistic regression analysis revealed that hypertension (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.16–3.11, p = 0.011) and STOP-BANG score ≥ 5 (OR = 2.05, 95%CI = 1.15–3.66, p = 0.015) were associated with AGA. For subgroup analyses, ordinal logistic regression model showed a significant association between severe AGA and three sleep profiles, namely total sleep time ≤ 6 h (OR = 2.16, 95%CI = 1.02–4.57, p = 0.044), PSQI > 5 (OR = 3.72, 95%CI = 1.42–9.72, p = 0.008), and STOP-BANG score ≥ 5 (OR = 3.01, 95%CI = 1.11–8.13, p = 0.030).
Conclusion
Our findings revealed an association between sleep disturbances and AGA, which may help guide appropriate management in these patients.
... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w F o r P e e r R e v i e w 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Hair loss is deeply stressful for the affected patients, [1][2][3][4][5] while perceived stress might aggravate hair loss such as male and female pattern androgenetic alopecia (AGA) or diffuse alopecia. [6][7][8] Animal models have shown that stress impairs hair growth by catagen induction mediated by substance P (SP), mast cell activation and nerve growth factor (NGF), [9][10][11][12][13] as confirmed also in human hair follicles (HF) ex vivo. 14,15 Stress can be mediated by oxidative stress or stress hormones. ...
Background:
Human hair is highly responsive to stress, and human scalp hair follicles (HFs) contain a peripheral neuroendocrine equivalent of the systemic hypothalamic-pituitary-adrenal (HPA) stress axis. Androgenetic alopecia (AGA) is supposed to be aggravated by stress. We used corticotropin-releasing hormone (CRH), which triggers the HPA axis, to induce a stress response in human ex vivo male AGA HFs. Caffeine is known to reverse testosterone-mediated hair growth inhibition in the same hair organ culture model.
Objectives:
To investigate whether caffeine would antagonize CRH-mediated stress in these HFs.
Methods:
HFs from balding vertex area scalp biopsies of men affected by AGA were incubated with CRH (10-7 mol L-1 ) with or without caffeine (0·001% or 0·005%).
Results:
Compared to controls, CRH significantly enhanced the expression of catagen-inducing transforming growth factor-β2 (TGF-β2) (P < 0·001), CRH receptors 1 and 2 (CRH-R1/2) (P < 0·01), adrenocorticotropic hormone (ACTH) (P < 0·001) and melanocortin receptor 2 (MC-R2) (P < 0·001), and additional stress-associated parameters, substance P and p75 neurotrophin receptor (p75NTR ). CRH inhibited matrix keratinocyte proliferation and expression of anagen-promoting insulin-like growth factor-1 (IGF-1) and the pro-proliferative nerve growth factor receptor NGF-tyrosine kinase receptor A (TrkA). Caffeine significantly counteracted all described stress effects and additionally enhanced inositol trisphosphate receptor (IP3 -R), for the first time detected in human HFs.
Conclusions:
These findings provide the first evidence in ex vivo human AGA HFs that the stress mediator CRH induces not only a complex intrafollicular HPA response, but also a non-HPA-related stress response. Moreover, we show that these effects can be effectively antagonized by caffeine. Thus, these data strongly support the hypothesis that stress can impair human hair physiology and induce hair loss, and that caffeine may effectively counteract stress-induced hair damage and possibly prevent stress-induced hair loss. What is already known about this topic? Caffeine stimulates hair growth in male and female human hair follicles (HFs) in vitro. What does this study add? For the first time, corticotropin-releasing hormone induction of the hypothalamic-pituitary-adrenal (HPA) stress axis is documented in male human HFs from biopsies (balding vertex area) of men with androgenetic alopecia. First time, the non-HPA neurogenic stress axis is shown in the same male human HFs. Caffeine counteracts both stress axes. Inositol trisphosphate receptor was newly identified in human HFs. What is the translational message? Stress can impair human hair physiology and induce hair loss. Caffeine may effectively counteract stress-induced hair damage and possibly prevent stress-induced hair loss.
... Male pattern baldness (also known as androgenic alopecia) is the most common type of hair loss in men. Affecting B50% of men above 40 years of age (Randall, 2010), it is caused by interplay of genetic predisposition, hormones, and lifestyle factors including smoking, alcohol drinking and stress (Randall, 2010;Gatherwright et al, 2013). From a hormonal perspective, the primary contributor is dihydrotestosterone (DHT) (Randall, 2010). ...
Background:
Male pattern baldness is positively associated with androgens as well as insulin-like growth factor 1 (IGF-1) and insulin, all of which are implicated in pathogenesis of colorectal neoplasia.
Methods:
From 1992 through 2010, we prospectively followed participants in the Health Professionals Follow-Up Study. Hair pattern at age 45 years was assessed at baseline with five image categories (no baldness, frontal-only baldness, frontal-plus-mild-vertex baldness, frontal-plus-moderate-vertex baldness, and frontal-plus-severe-vertex baldness). Cancer analysis included 32 782 men and used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted to men who underwent at least one endoscopy over the study period, adenoma analysis included 29 770 men and used logistic regressions for clustered data to estimate odds ratios (ORs) and 95% CIs.
Results:
Over the mean follow-up of 15.6 years, 710 cases of colorectal cancer (478 for colon, 152 for rectum, and 80 unknown site) developed. Significantly increased risks associated with frontal-only baldness and frontal-plus-mild-vertex baldness relative to no baldness were observed for colon cancer with respective HR being 1.29 (95% CI, 1.03-1.62) and 1.31 (95% CI, 1.01-1.70). Over the 19-year study period, 3526 cases of colorectal adenoma were detected. Evidence for an increased risk of colorectal adenoma relative to no baldness was significant with frontal-only baldness (OR, 1.16; 95% CI, 1.06-1.26) and borderline insignificant with frontal-plus-severe-vertex baldness (OR, 1.14; 95% CI, 0.98-1.33).
Conclusions:
Subtypes of male pattern baldness at age 45 years were positively associated with colorectal neoplasia. Future studies are warranted to confirm our results and to determine the predictive value of male pattern baldness to identify those at high risk for colorectal neoplasia.
... 4 The pathogenesis is generally considered as an androgen-mediated process in genetically susceptible individuals, and environmental and lifestyle risk factors are likely to be triggers. [3][4][5][6][7] Male pattern baldness has been associated with increased risk of prostate cancer. 8,9 A potential androgen basis of melanoma has been proposed to explain the differential gender distribution of melanoma, 10,11 based on which we reported increased risk of melanoma but not keratinocyte carcinoma (KC, also known as non-melanoma skin cancer) associated with personal history of prostate cancer in the Health Professionals' Follow-up Study (HPFS). ...
We examined the association between male-pattern baldness and risk of incident skin cancer, including invasive melanoma, invasive squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) in a prospective analysis, based on 36,032 participants from the Health Professionals' Follow-up Study. In 1992, participants reported their status of male-pattern baldness at age 45 years by choosing from five crown-view pictograms based on Norwood's classification. Diagnosis of skin cancers was reported biennially and information on melanoma and SCC was pathologically confirmed. We identified 327 melanoma cases, 1324 SCC cases, and 8438 BCC cases during the follow-up. Male-pattern baldness was not significantly associated with risk of incident melanoma, but was significantly associated with increased risk of SCC and BCC. The multivariate-adjusted hazard ratio (HR) (95% confidence interval, CI) for the highest category of baldness (frontal plus severe vertex baldness) was 1.33 (1.06-1.68) for SCC (Ptrend=0.001) and 1.23 (1.12-1.35) for BCC(Ptrend<0.0001), compared with no baldness. Analyses by body sites found significant associations between frontal plus moderate to severe vertex baldness and risk of melanoma (HR=1.83, 95% CI: 1.01-3.34) and SCC (HR=1.30, 95% CI: 1.02-1.66) at head and neck. The associations were particularly stronger for scalp melanoma (HR=7.15, 95% CI: 1.29-39.42) and scalp SCC (HR=7.09, 95% CI: 3.84-13.08), but not for non-scalp head and neck sites. Information on body sites was not available for BCC. In conclusion, male pattern baldness may be associated with increased risk of skin cancer, but the associations may only exist for those occurring at head and neck, particularly at scalp. This article is protected by copyright. All rights reserved.
... The progress of hair loss in twins is influenced by such things as lifestyle, environmental factors (smoking, alcohol, caffeine, dandruff, Body Mass Index), physical activity, a history of skin disease, stress, diabetes, hypertension, smoking, multiple marriages, multiple children, divorce, separation, and use of sun protection. [17][18][19] These are studied as epigenetic factors that alter genetic expression without altering the nucleotide sequence of the genes. 5 ...
Abstract:
Patients are losing faith in our hair loss management due to fear of side effects. Researchers today agree that it is not raised DHT, but the altered tissue response of the follicles at the tissue level, which is responsible for hair loss (1,2). The altered response is in the form of disturbance of metabolism, disturbance of ATP formation, energy utilization, accumulation of free radicals, reactive oxygen species (ROS), reactive nitrogen species (RNS), peroxides and other free radicals, creating inflammation, compromising immunity, making the follicle weak and vulnerable. The hair loss occurring today is not hormonal. Hair loss can occur without raised androgens and without family history, it can skip siblings and skip generations (3,4). Therefore it is not called androgenetic alopecia anymore. It is referred to as male pattern hair loss (MPHL) and female pattern hair loss (FPHL). Should we still insist on treating it like androgenetic alopecia?
The male hormone was in focus in the beginning, when it was thought that only men go bald and hair loss runs in families. We were trying to search and treat a cause. But hair loss is not a sickness or a disease, it is more of a disturbance or slowing down of the biological cycles due to unfavourable conditions at the cellular level. Baldness progresses gradually over a few years. Only the weak hair are lost in a pattern or in a diffuse manner. Rising exposure to pollution, stress, UV rays, sleep cycles, fast foods, poor nutrition, depleting nutrition in the soil, chemicals and EDCs through food and water, altered climatic and season patterns, smoking, alcohol, lifestyle, lack of exercise are making the hair roots weak. The hair loss seen presently is not hormonal, it does not respond to anti androgens alone. We can strengthen the follicles, provide nutrition for energy, repair, restoration, control hair loss and achieve hair growth, as concluded through data from this controlled clinical trial. There is another dimension to hair loss which needs to be explored and deciphered.
Data from clinical trial:
A controlled clinical trial for hair loss management, using antioxidants, iron, calcium, aminoacids, B-complex, biotin, in men and women without the use of anti androgens or DHT blocker, finasteride, showed an average improvement in density of 18% at 2 months and 30% and at 4 months. Hair loss was controlled within 4-6 weeks (6). The average improvement in calibre in 2 months was 9% and at 4 months was 21% (6,7). The improvement was seen in all the patients, there were no non responders to this regimen, as are reported in finasteride and minoxidil studies (8,9). The approach has also helped in hair loss due to smoking (10), hair loss due to pollution (11), hair shaft disorders like monilethrix caused due to poor hair structure too have benefited from nutritional support (12). It has also helped a unusual case of hair loss from exposure to cell phone radiation (13), apart from being consistently effective in management of routine hair loss. Two study groups and two control groups of 100 men, 100 women of similar age and grades of hair loss were compared with a one year follow up. Tattooed areas of hair loss were marked and analyzed by folliscope counts of density and caliber in addition to global photography and personal patient evaluation scores.
... In a study of identical twins, increased caffeine consumption was reported to be associated with hair thinning. 3 Higher caffeine concentration did not always exhibit more favourable effects on organ-cultured HFs vs. lower concentrations. 2 In addition, considering the diverse effects of caffeine, 7 an optimal and stable caffeine concentration needs to be achieved locally, not systemically. ...
Linked Article: Fischer et al. Br J Dermatol 2021; 184:96–110.
... To our knowledge, this was the first study to broadly evaluate environmental factors known to impact facial aging specifically to determine an influence on ptosis. 9,10,15,16 Ptosis can be visualized and measured on an anterior to posterior view photograph taken with subjects in repose, but care must be taken to eliminate other influencing factors. All subjects with potential medical causes, neurological causes, and previous ocular trauma or surgery were eliminated from the study. ...
Current literature provides little information about the impact of environmental exposures on the severity of acquired blepharoptosis.
The authors assessed environmental factors that may contribute to eyelid ptosis in a population of identical twins.
Photographs of 286 sets of twins from a prospectively collected database from 2008 to 2010 were reviewed. The authors identified 96 sets of identical twins (192 individual persons) who had differing severity of ptosis. Digital photographs were analyzed, and the degree of ptosis was measured in each eye of every subject. The external factors that could potentially contribute to blepharoptosis were taken into consideration. The authors then assessed the correlations of 9 different environmental risk factors with ptosis. Generalized linear mixed model were constructed to determine the associations of ptosis measurements with environmental risk factors obtained from the subject survey database.
The mean level of upper eyelid ptosis in the study population was 1.1 mm. The mean difference in ptosis between twins was 0.5 mm. Wearing contact lenses, either hard or soft, was significantly associated with ptosis. The mean ptosis measurement among twins who did not wear contact lenses was 1.0 mm; for those who wore soft contact lenses, the mean was 1.41 mm, and for those who wore hard contact lenses, the mean was 1.84 mm.
Acquired ptosis is not linked to body mass index, smoking behavior, sun exposure, alcohol use, work stress, or sleep. Wearing either hard or soft lenses was associated with an increased risk of ptosis. These influences are independent of genetic predisposition.
3 Diagnostic.
© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.
... This facilitates the entrance of DHT into dermal papillary cells, causing an increase in the sebaceous gland and 5αR activity and the release of pro-inflammatory cytokines from follicular keratinocytes inhibiting the hair growth. 44,52 Smoking also leads to impaired circulation and eventually local ischemia, compromising the hair follicle nutrition. It also favors the androgendependent hair thinning by hydroxylation of estradiol and inhibition of the aromatase enzyme. ...
Androgenetic alopecia (AGA) is the most common form of hair loss in men and women. Although female pattern hair loss (FPHL) and male AGA share a final common pathway that causes follicular regression but current knowledge suggests that the etiology is not necessarily the same in both sexes. There are many known and unknown factors that govern the development of AGA. We aim to review recent advances in the pathophysiology and molecular mechanism of pattern hair loss in males, females, and children.
... Lai et al reported that AGA patients frequently presented with oily scalps, and this was associated with moderate to severe AGA. 26 Their findings correspond with ours: increased vertex SSL in the AGA group, and a positive correlation between SSL and AGA severity. In addition to genetic susceptibility and androgen involvement, scalp 32 Skin with low SCH exhibits increased levels of local and systemic pro-inflammatory cytokines. [33][34][35] In contrast, SCH improvement appears to reduce these inflammatory substances. ...
Background:
Androgenetic alopecia (AGA) is the most common type of hair loss in men. Its prevalence increases with advancing age. Characteristics of hair loss in male AGA reveal the possibility of different biophysical and physiological profiles between androgen-sensitive (vertex) and androgen-insensitive (occipital) scalps. However, these variations have not been well investigated.
Objective:
We aimed to evaluate and compare scalp biophysical and physiological characteristics in male AGA patients and healthy controls.
Methods:
Scalp biophysiological profiles were evaluated by non-invasive measuring techniques, including skin surface lipids (SSL), transepidermal water loss (TEWL), and stratum corneum hydration (SCH) on both vertex and occipital areas. Values were compared between scalp areas and study groups. Participants with AGA were further categorized based on disease severity (Hamilton-Norwood classification) for subgroup analyses. Correlation coefficients were evaluated to determine the effects of AGA severity and age on each functional parameter.
Results:
Participants were 31 AGA subjects and 31 healthy controls. The vertex scalp of AGA patients had significantly higher SSL (p = 0.03) and lower SCH (p = 0.02) compared to the occipital scalp. TEWL was not significantly different (p = 0.31). AGA group SSL showed a positive correlation with severity of hair loss (r = 0.61, p = 0.03). When compared to controls, the AGA group vertex scalp had significantly higher SSL (p = 0.03) and lower TEWL (p < 0.001). The occipital area showed no statistically significant differences.
Conclusion:
Male AGA presents with different biophysical and physiological characteristics in androgen-sensitive and androgen-insensitive areas, and with further differences from controls. These findings could direct further research and aid in the development of optimal hair and scalp treatments to improve scalp functional profiles in particular patients.
The skin is a target-organ for systemic and local reactions to stress, and hair loss may indeed occur after acutely stressful conditions, such as trauma and severe disease.
Androgenetic alopecia (AGA) or common baldness is the most prevalent form of hair loss in males. Familial predisposition has been recognized, and heritability estimated in monozygotic twins suggests an important genetic predisposition. Several studies indicate that the numbers of CAG/GGC repeats in exon 1 of the androgen receptor gene (AR) maybe associated with AGA susceptibility.
To investigate a possible correlation between AR CAG/GGC haplotypes and the presence or not of alopecia in sibships with two or more brothers among them at least one of them has AGA.
Thirty-two trios including an alopecic man, one brother alopecic or not, and their mother were enrolled. Sanger sequencing of the exon 1 of the AR gene was conducted to ascertain the number of CAG/GGC repeats in each individual. Heterozygous mother for the CAG/GGC haplotypes was an inclusion criterion to analyze the segregation haplotype patterns in the family. Concordance for the number of repeats and AGA among brothers was evaluated using kappa coefficient and the probability of association in the presence of genetic linkage between CAG and GGC repeats and AGA estimated by means of the family-based association test (FBAT).
The median for the CAG and GGC repeats in the AR is similar to that reported in other populations. The CAG/GGC haplotypes were less polymorphic than that reported in other studies, especially due to the GGC number of repeats found. Kappa coefficient resulted in a concordance of 37.3% (IC 95%, 5.0-69.0%) for the AGA phenotype and identical CAG/GGC haplotypes. There was no evidence of linkage disequilibrium.
Our results do not confirm a possible correlation or linkage disequilibrium between the CAG/GGC haplotypes of the AR gene and androgenetic alopecia in Mexican brothers.
© 2015 Wiley Periodicals, Inc.
Male baldness is the most common diagnosis in men that present with hair loss. It is a genetically determined condition that is clearly an androgen-dependent trait, mainly driven by dihydrotestosterone action on the hair follicles, leading to miniaturization. Although in general this condition is socially accepted as a natural process in a man's life, for some individuals it might significantly impact quality of life, reducing self-esteem and increasing stress. This chapter encompasses the most important aspects of the practical evaluation (clinical features, trichoscopy, trichogram, histopathology, relevant blood tests) and management of male baldness, diffuse baldness and senescent alopecia.
The present 35th book deals with hair loss that is important for human psychological and sociological wellbeing and identity. Are there any descriptions of hair loss in the Bible? Which character was affected? What are types of hair loss, etiology, clinical characteristics, associated diseases, comorbidities, and contemporary approach to hair loss?
What can we learn from the biblical description of the disease? All biblical texts were examined and verses dealing with hair loss in one character were studied closely.
Objective:
The goal of this study was to assess the perceived efficacy of a standardized nutraceutical to improve hair growth and quality in men and women of various ethnicities with self-perceived hair thinning.
Methods:
This prospective, single-blind study enrolled healthy men aged 20 to 55 years (n=47) and premenopausal women aged 20 to 45 years (n=51) with self-perceived, mild-to-moderate hair thinning and included African American, Asian, Hispanic Caucasian and Non-Hispanic Caucasian participants. The nutraceutical supplement (Nutrafol® Men or Women Capsules, Nutraceutical Wellness Inc., New York, New York) was taken daily for six months. Subjects were evaluated in the clinic at baseline and Weeks 12 and 24 with two self-assessments at Weeks 4 and 8. Study endpoints were standardized digital imaging and investigator rated assessments. Self-assessment questionnaires rated hair growth, hair satisfaction, and lifestyle factors.
Results:
Investigator ratings for baseline hair growth, coverage, density, and volume were significant at Weeks 12 and 24 for all subjects (for each, p<0.001). These significant improvements were seen in 83.7 percent of men and 79.5 percent of women at Week 24. Results were similar across ethnic subgroups with significant benefit at Weeks 12 and 24 (for each, p<0.05). All subjects reported significant improvements in baseline hair appearance/quality, volume/fullness, scalp coverage, thickness, and shedding at Weeks 4, 8, 12 and 24 (for each, p<0.01).
Conclusion:
A standardized nutraceutical supplement improved visible hair growth with less notable shedding based on subjects' and investigators' overall perception of treatment benefit for men and women of various ethnic backgrounds.
Androgenetic Alopecia (AGA) is by far the most common cause of hair loss in men, and its high prevalence has been reported in detail for many decades [1]. Several different terms in international medical bibliography have been suggested by several authors, such as androgenic alopecia, male pattern baldness, androgen-dependent alopecia, common baldness, and genetic hair loss. However, the term “Androgenetic Alopecia” is considered the most appropriate since it summarizes the etiology of the condition, with the term “andro-” referring to the hormonal and “-genetic”, implying the inherited parameter of its pathogenesis.
Background:
There are several ways by which aging is identified, of which graying of hair is perhaps the most common way. Nowadays, graying of hairs, which was expected to occur after 40s, can be easily observed among younger age group, even before 20s. The present study aims to estimate the prevalence of graying of hairs and its correlates among young adults in Srinagar, Uttarakhand, India.
Methodology:
A community-based cross-sectional study was conducted among 384 young adults between 15 and 30-year age group in the urban area of Srinagar tehsil of Pauri district. Graying of hair was assessed on the basis of the number of white hairs on examination of scalp.
Results:
The prevalence of premature graying of hairs (PMGHs) was found to be 27.3%. Binary logistic regression analysis showed that a paternal history of PMGH, history of smoking, maternal history of PMGH, sunlight exposure, and body mass index were significant predictors of PMGH.
Limitations:
The factors found associated could be better determined through a follow-up study which could not be done in the current study. The present study was carried in a tehsil of one district of Uttarakhand therefore has limited external validity.
Conclusion:
The present study highlights the importance of maintaining a healthy lifestyle as well as adequate exposure to sunlight in preventing PMGH.
In traditional geriatrics, the study and treatment of diseases follow the same criteria of general medicine, i.e., the diseases are first of all divided according to the affected anatomical or functional system. For example, in the Broklehurst’s Textbook of Geriatric Medicine and Gerontology (Fillit et al. 2017), the subject is divided into the sections Cardiovascular system, Respiratory system, Nervous system, Musculoskeletal system, Gastroenterology, Urinary tract, Women’s health, Endocrinology, Hematology and Oncology, Skin and Special senses, which mirrors the division of general medicine into various specializations.
Purpose:
Meibomian glands are subject to regulation by sex hormones. We have now investigated the possible relation between benign prostate hyperplasia (BPH) and meibomian gland dysfunction (MGD).
Methods:
Men diagnosed with BPH and receiving treatment with tamsulosin and age-matched male control subjects who attended Itoh Clinic, Saitama, Japan, were enrolled. An ocular symptom score, lid margin abnormality score, and superficial punctate keratopathy score as well as the meiboscore (0-6), meibum grade, breakup time of the tear film, and Schirmer test values were evaluated. Male pattern baldness was also graded according to the Hamilton-Norwood scale.
Results:
Forty-four eyes of 44 men with BPH (mean age ± SD, 76.1 ± 2.2 years) and 46 eyes of 46 control subjects (mean age ± SD, 75.3 ± 6.2 years) were enrolled. The meiboscore in the BPH group (4.5 ± 1.4) was significantly higher than that in the control group (1.8 ± 1.5, P < 0.0001). Breakup time of the tear film was significantly shorter (3.6 ± 1.7 vs. 5.6 ± 2.5 seconds, P < 0.0001), and Schirmer test value was significantly smaller (9.8 ± 4.8 vs. 13.3 ± 8.0 mm, P = 0.048) in the BPH group than that in the control group. Other ocular parameters did not differ significantly between the 2 groups. The proportion of men with androgenic alopecia was also higher in the BPH group than that in the control group.
Conclusions:
BPH was associated with meibomian gland loss and instability of the tear film as well as with the presence of androgenic alopecia.
Frontal fibrosing alopecia (AFF) is a primary cicatricial alopecia that was described in 1994. It predominantly affects women, most often in menopause. Studies have shown that alopecias, in general, may have stress as a trigger and maintenance factor. Regarding cicatricial alopecia, especially AFF, the relevance of these factors was little studied, however, studies suggest that stressful events may be associated with the onset of alopecia conditions. The objective of this study is to evaluate the relevance of suffering as a stressful event as a possible triggering factor for AFF patients. To perform this evaluation a socio-demographic form, a quality of life inventory in Dermatology (DQLI) and a semi-structured interview was held in a single meeting with the research volunteers. The 12 volunteers in the study present life stories with intense reports of frustration, impotence, insecurity, loss, shame and loneliness. DQLI, used to assess the impact of AFF on the life of the volunteers, was consistent with the observations made by them, that the disease accompanies a high degree of stress and suffering.
Hair loss affects millions of people worldwide and can have devastating effects on an individual's psychoemotional well-being. Today hair restoration technologies through hair transplantation have advanced with the use of robots and follicular unit extraction and grafting that it is possible to offer to patient's excellent clinical results. Adjuvant modalities such as platelet-rich plasma injections, lasers, and stem cells can further enhance the durability, health, and appearance of hair transplants.
Background:
Moderate consumption of alcohol is inversely related with coronary disease, but its association with mortality is controversial. We performed a meta-analysis of prospective studies on alcohol dosing and total mortality.
Methods:
We searched PubMed for articles available until December 2005, supplemented by references from the selected articles. Thirty-four studies on men and women, for a total of 1 015 835 subjects and 94 533 deaths, were selected. Data were pooled with a weighed regression analysis of fractional polynomials.
Results:
A J-shaped relationship between alcohol and total mortality was confirmed in adjusted studies, in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality, maximum protection being 18% in women (99% confidence interval, 13%-22%) and 17% in men (99% confidence interval, 15%-19%). Higher doses of alcohol were associated with increased mortality. The inverse association in women disappeared at doses lower than in men. When adjusted and unadjusted data were compared, the maximum protection was only reduced from 19% to 16%. The degree of association in men was lower in the United States than in Europe.
Conclusions:
Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women. Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival.
This study examined the effects of training volume and competition on the salivary cortisol (Sal-C) concentrations of Olympic weightlifters. Male (n = 5) and female (n = 4) Olympic weightlifters provided saliva samples across a 5-week experimental = period. The first aim was to assess the weekly effects of high (≥ 200 sets) and low (≤ 100 sets) training volume on Sal-C. The second aim was to compare Sal-C concentrations and 1 repetition maximum (1RM) performance during 2 simulated and 2 actual competitions. Performance was assessed using the snatch, clean and jerk, and the Olympic total lift. Data from each competition setting were pooled before analysis. There were no significant weekly changes in Sal-C levels (p > 0.05). The actual competitions produced higher (128-130%) Sal-C concentrations (p < 0.001) and superior 1RM lifts (1.9-2.6%) for the clean and jerk, and the Olympic total, than the simulated competitions (p < 0.05). Individual Sal-C concentrations before the simulated competitions were positively correlated to all of the 1RM lifts (r = 0.48-0.49, p < 0.05). In conclusion, actual competitions produced greater Sal-C responses than simulated competitions, and this appeared to benefit the 1RM performance of Olympic weightlifters. Individuals with higher Sal-C concentrations also tended to exhibit superior 1RM lifts during the simulated competitions. Given these findings, greater emphasis should be placed upon the monitoring of C to establish normative values, training standards and to assist with performance prediction.
Patients with hair loss are seeking treatment at a younger age and during earlier stages. Not all need hair transplants. Because of the lack of assured management and the fear of side-effects, patients are turning to ineffective alternative remedies from self-claimed experts. In this report, we discuss the available treatment options and how best they can be used in combination to produce satisfactory results. The traditional approach consists of administration of drugs such as minoxidil and finasteride. We propose a hypothesis that nutritional supplements, 2% ketoconazole shampoo and low-level laser therapy along with finasteride 1 mg used once in 3 days with 2% minoxidil used everyday, given in a cyclical medicine program may be useful to manage hair loss and achieve new hair growth. The scientific rationale for such an approach is explained. The need for further studies to establish the efficacy of the regime is stressed upon.
Human scalp skin is normally protected from sunlight and ultraviolet radiation by the presence of hair. When hair loss occurs, for example, in androgenetic alopecia, this protective factor declines.
We report a series of 10 type IV and V skin patients with a male predominance (60-85 years). All patients suffered from androgenetic alopecia starting from the age of around 40 to 45 years. They all noticed asymptomatic, well-defined, depigmented macules, which were seen only in areas that have been afflicted by androgenetic alopecia. The depigmented macules remain within the confines of the hair margin. There has been no depigmented lesion elsewhere on the body. The patients did not report any association with any drug that they may have started taking. There is no history of vitiligo in these patients or their families. Biopsy samples taken from three of the patients showed solar elastosis.
The entity of ultraviolet-induced scalp leukoderma and androgenetic alopecia has not been acknowledged in dermatology textbooks but needs consideration for its importance in differential diagnoses. The term senescent actinic depigmentation of the scalp is suggested.
Tobacco smoke contains many toxic, carcinogenic and mutagenic chemicals, as well as stable and unstable free radicals and reactive oxygen species (ROS) in the particulate and the gas phase with the potential for biological oxidative damage. Epidemiological evidence established that smoking is one of the most important extrinsic factor of premature morbidity and mortality. The objective of this study was to investigate oxidative and carcinogenic mechanisms of tobacco and synergistic action with other respirable particles in the respiratory system of smokers. Electron Paramagnetic Resonance (EPR) and spin-trapping techniques were used to study stable free radicals in the cigarette tar, and unstable superoxide anion (O2 (*-)) and hydroxyl (HO(*)) radicals in the smoke Results showed that the semiquinone radical system has the potential for redox recycling and oxidative action. Further, results proved that aqueous cigarette tar (ACT) solutions can generate adducts with DNA nucleobases, particularly the mutagenic 8-hydroxy-2'-deoxyguanosine (a biomarker for carcinogenesis). Also, we observed synergistic effects in the generation of HO(*), through the Fenton reaction, with environmental respirable particles (asbestos fibres, coal dust, etc.) and ambient particulate matter (PM), such as PM(10), PM(2.5) and diesel exhaust particles (DEP). The highest synergistic effects was observed with the asbestos fibres (freshly grounded), PM(2.5) and DEP. Finally, we discuss results from our previous study of conventional cellulose acetate filters and "bio-filters" with hemoglobin impregnated activated carbon, which showed that these filters do not substantially alter the free radical content of smoke in the particulate and in the gaseous phase.
Although diurnal variation of testosterone and other hormones in men has been well documented, the effect of this variation on sampling during typical clinic hours has not been examined.
Our objective was to examine temporal variation in serum testosterone and five other hormones in men over normal clinic hours.
Blood samples were collected at six separate visits, three morning visits 1-3 d apart and three afternoon visits 1-3 d apart.
In Boston, MA, 66 men participated, 30-80 yr of age, randomly selected from the Boston Area Community Health Survey who completed at least five visits.
The age-specific ratio of hormone level at times ranging from 0801-1600 h to hormone level at 0800 h was calculated. Ratios were calculated from parameter estimates obtained from cosinor models.
In men 30-40 yr old, testosterone levels were 20-25% lower at 1600 h than at 0800 h. The difference declined with age, with a 10% difference at 70 yr. 17 men with at least one of three measurements less than 300 ng/dl (10.4 nmol/liter) after 1200 h had normal testosterone levels at all three visits before 1200 h (five of eight men 30-47 yr old, four of nine men 66-80 yr old). Much lower levels of diurnal variation were found for dihydrotestosterone, SHBG, LH, FSH, and estradiol at all ages.
Our results support the recommendation of restricting testosterone measurements to morning hours in both young and older men. Limited diurnal variation in other hormones indicates that sampling through the day is appropriate.
In obese men, sex hormone-binding globulin levels (SHBG) as well as total plasma testosterone (T) levels are decreased. Data concerning the levels of nonprotein-bound testosterone (FT) are discordant, with some researchers reporting normal levels, and other reporting decreased levels. The latter imply an impairment of the feedback regulation mechanism of FT levels. We investigated whether an eventual decrease in FT levels and, hence, functional impairment of the gonadostat might occur only at a more severe degree of obesity than that required for a decrease in SHBG and total T levels. We, therefore, determined androgen and precursor levels in three groups of male subjects: nonobese controls [body mass index (BMI), G (kg)/L2 (m) < 26; n = 70]; moderately (BMI, 30-35; n = 18), and severely (BMI, > 40; n = 22) obese men, respectively. In a subgroup of these controls, moderately and severely obese subjects, respectively, we studied LH levels as well as LH pulsatility. Moreover, as a decrease in FT levels might affect the metabolic pattern of the androgens and, more specifically, 5 alpha-reductase activity, we determined the plasma levels of the major 5 alpha-reduced metabolites, androstanediol glucuronide and androsterone glucuronide (AG), as well as the urinary excretion of the major 5 alpha (androsterone glucuronide) and the major 5 beta (etiocholanolone glucuronide) metabolite of the androgens. In moderately obese men, T levels were decreased, which was the consequence of the decreased SHBG-binding capacity. FT levels, however, were normal as were LH levels and both pulse amplitude and frequency of LH pulses, suggesting a normal hypothalamic control of LH secretion. In severely obese men (BMI, > 40), total T, FT, and LH levels as well as LH pulse amplitude were decreased, indicating a functional impairment of the gonadostat. Even in massively obese subjects with decreased FT levels, androgen metabolism and 5 alpha-reductase activity appeared to be normal, as suggested by similar androstanediol glucuronide and AG levels, determined by RIA or calculated from the conversion rates of precursors obtained in nonobese subjects. This was confirmed by the similar AG/eticholanolone glucuronide ratios in obese and nonobese men.(ABSTRACT TRUNCATED AT 400 WORDS)
To investigate from the HERITAGE Family Study database, 13 steroid hormones (androstane-3alpha, 17beta-diol glucuronide, androsterone glucuronide, cortisol, dehydroepiandrosterone (DHEA), DHEA ester (DHEAE), DHEA sulfate (DHEAS), dihydrotestosterone (DHT), estradiol, 17-hydroxyprogesterone, progesterone, pregnenolone ester, sex hormone binding globulin (SHBG) and testosterone in each sex for their relationships with age, body mass index (BMI), race and key lifestyle variables. Sample sizes varied from 676 to 750 per hormone. Incremental regression methods were used to examine the contributions of the variables to steroid hormone variability.
Age was a major predictor for most steroid hormones. The greatest contribution of age was a negative relationship with DHEAS (R(2)=0.39). BMI was also associated with the variability of several steroid hormones, being the most important predictor of SHBG (R(2)=0.20) and of testosterone (R(2)=0.12) concentrations. When age and BMI were included, race still contributed significantly to the variations in cortisol (R(2)=0.02 for men and 0.04 for women), DHT (R(2)=0.02 for men and 0.03 for women), and progesterone (R(2)=0.03 for women). Nevertheless, race appeared to be less important than age and BMI. In addition, lifestyle indicators (food and nutrient intakes, smoking and physical activity) influenced steroid hormone variability. Their contributions, however, were minor in most cases once age, BMI and race had been taken into account.
We conclude that age was the most important factor, followed by BMI, race and lifestyle factors in explaining steroid hormone variability.
Previous pharmacological and pathological studies have reported negative relationships between circulating testosterone and certain stress hormones (i.e., cortisol and prolactin) in humans. These relationships have subsequently been used in hypotheses explaining the subclinical resting testosterone levels often found in some endurance-trained males, but as of yet no one has specifically examined these relationships as they relate to exercise. Thus, we examined the relationship between total and free testosterone levels and cortisol, and between total and free testosterone and prolactin following prolonged endurance exercise in trained males. Twenty-two endurance-trained males volunteered to run at 100% of their ventilatory threshold (VT) on a treadmill until volitional fatigue. Blood samples were taken at pre-exercise baseline (B0); volitional fatigue (F0); 30 min (F30), 60 min (F60), and 90 min (F90) into recovery; and at 24 h post-baseline (P24 h). At F0 [mean running time = 84.8 (3.8) min], exercise induced significant changes (P<0.05) from B0 in total testosterone, cortisol and prolactin. All three of these hormones were still significantly elevated at F30; but at F60 only cortisol and prolactin were greater than their respective B0 values. Free testosterone displayed no significant changes from B0 at F0, F30, or the F60 time point. At F90, neither cortisol nor prolactin was significantly different from their B0 values, but total and free testosterone were reduced significantly from B0. Cortisol, total testosterone and free testosterone at P24 h were significantly lower than their respective B0 levels. Negative relationships existed between peak cortisol response (at time F30) versus total testosterone (at F90, r=-0.53, P<0.05; and at P24 h, r=-0.60, P<0.01). There were no significant relationships between prolactin and total or free testosterone. In conclusion, the present findings give credence to the hypothesis suggesting a linkage between the low resting testosterone found in endurance-trained runners and stress hormones, with respect to cortisol.
Cigarette smoking is an important modifiable cardiovascular risk factor and pathophysiological mechanisms may include a stiff vascular tree. Although smokers have stiffer arteries, whether smoking cessation is associated with reduced arterial stiffness is not known. We compared never-treated patients with essential hypertension (n=554) aged 18 to 80 years (56% females) classified as current smokers (n=150), ex-smokers (n=136), and nonsmokers (n=268). Ex-smokers were categorized into <1 year, >1 and <10 years, and >10 years of smoking cessation. Measurements included aortic stiffness, assessed as pulse wave velocity (Complior), wave reflection (augmentation index [AIx]), and transit time (T(R)) (Sphygmocor). Current and ex-smokers had significantly higher pulse wave velocity and AIx compared with nonsmokers (pulse wave velocity for current smokers: 10.7+/-0.2; ex-smokers: 10.6+/-0.2; nonsmokers: 9.9+/-0.1 m/s; P<0.001; AIx for current smokers: 31+/-1; ex-smokers: 30+/-1; nonsmokers: 27+/-0.8%; P<0.05), whereas T(R) was lower in current and ex-smokers compared with nonsmokers (T(R) for current smokers: 131+/-1.0; ex-smokers: 135+/-1; nonsmokers: 137+/-0.8 m/s; P<0.0001). There was a significant linear relationship between smoking status and pulse wave velocity (P<0.001), AIx (P<0.001), and T(R) (P<0.001), even after adjusting for age, sex, mean arterial pressure, heart rate, and body mass index. In ex-smokers, duration of smoking cessation had a significant linear relationship with improvement in pulse wave velocity (P<0.001), AIx (P<0.001), and T(R) (P<0.001), with arterial stiffness parameters returning to nonsignificant levels after a decade of smoking cessation.
Androgenetic alopecia (AGA), a hereditary disorder that involves the progressive thinning of hair in a defined pattern, is driven by androgens. The hair follicle dermal papilla (DP) expresses androgen receptors (AR) and plays an important role in the control of normal hair growth. In AGA, it has been proposed that the inhibitory actions of androgens are mediated via the DP although the molecular nature of these interactions is poorly understood. To investigate mechanisms of AGA, we cultured DP cells (DPC) from balding and non-balding scalp and confirmed previous reports that balding DPC grow slower in vitro than non-balding DPC. Loss of proliferative capacity of balding DPC was associated with changes in cell morphology, expression of senescence-associated beta-galactosidase, as well as decreased expression of proliferating cell nuclear antigen and Bmi-1; upregulation of p16(INK4a)/pRb and nuclear expression of markers of oxidative stress and DNA damage including heat shock protein-27, super oxide dismutase catalase, ataxia-telangiectasia-mutated kinase (ATM), and ATM- and Rad3-related protein. Premature senescence of balding DPC in vitro in association with expression of p16(INK4a)/pRB suggests that balding DPC are sensitive to environmental stress and identifies alternative pathways that could lead to novel therapeutic strategies for treatment of AGA.
Prevalence and risk factors of androgenetic alopecia (AGA) in policemen are not known. This study aimed to compare the prevalence and risk factors of AGA between policemen and the general population. A cross-sectional survey was conducted by recruiting a total of 758 (78%) of 972 policemen and 740 (80%) of 924 participants in a community-based integrated screening served as a comparison group. The Norwood classification system was used to assess the degree of hair loss. Information on age, family history of androgenetic alopecia, and other possible risk factors was collected with questionnaire interviews. The association analysis between policemen and the general population was limited to participants aged 40-59 years. After controlling for other significant factors, policemen aged 40-59 years had an increased risk of developing AGA compared with the general population (OR = 2.23, 95% CI 1.14, 4.36, p = 0.02). Obesity measured by waist circumference and body mass index made contribution to higher risk for AGA in younger policemen (20-39 years). A statistically significant association was noted between AGA and sunlight exposure in policemen aged 40-59 years. We concluded the prevalence of AGA in policemen was twofold higher than that in the general population. Obesity at young age and sunlight exposure may be responsible for higher risk of AGA in policemen. However, further studies are warranted to confirm the current findings.
Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region. The surgical management of this complication is also discussed. Cicatricial alopecia was treated by two-stage surgery with tissue expanders. There were no complications in the postoperative period and healing was uneventful. We conclude that although FUE has many advantages, necrosis of the donor site may be a serious problem.
A computer-morphing procedure was used to produce a "full cranial hair" photograph for comparisons of perceptions by 96 undergraduates of a photograph of a naturally bald 30-yr.-old man on 13 dependent measures derived from 30 semantic differential scales. Analysis showed the full-hair condition was rated significantly more dominant, dynamic, and masculine than the bald condition. While the model was also perceived as younger in the full-hair condition, there was no difference in mean ratings of attractiveness between photographs.
Follicular unit extraction is becoming an increasingly popular technique for hair transplantation, as it obviates the linear scarring associated with strip harvesting, and can provide highly presentable results. Using this technique, a few reports have described the small scale use of nonhead hair for head hair transplantation in men with inadequate head hair donor supply. In this report, 3 patients who were severely bald had hair transplanted from the chest, abdomen, legs, shoulders, or beard, as well as the head to achieve full coverage and excellent hairlines. Of the 3 cases, 2 had undergone previously unsuccessful hair transplant surgeries. Approximately 80% to 85% of the transplanted grafts survived. Although hair length and quality, surgery time, and the requirement for improved surgical skills remain challenges when using this technique, the sufficiently good outcomes from these selected candidates suggest that this technique may offer the possibility of restoring even severely bald states to normality in patients who would otherwise not be candidates for traditional hair transplantation surgery.
Hormonal responses to exercise could be used as a marker of overreaching. A short exercise protocol that induces robust hormonal elevations in a normal trained state should be able to highlight hormonal changes during overreaching. This study compared plasma and salivary cortisol and testosterone responses to 4 exercise trials; these were (a) continuous cycle to fatigue at 75% peak power output (Wmax) (FAT); (b) 30-minute cycle alternating 1-minute 60% and 1 minute 90% Wmax (60/90); (c) 30-minute cycle alternating 1-minute 55% and 4-minute 80% Wmax (55/80); and (d) Squatting 8 sets of 10 repetitions at 10 repetition maximum (RESIST). Blood and saliva samples were collected pre-exercise and at 0, 10, 20, 30, 40, 50, and 60 minute postexercise. Pre- to postexercise plasma cortisol increased in all exercise trials, except 60/90. Increases in 55/80 remained above pre-exercise levels for the entire postexercise period. Salivary cortisol increased from pre- to postexercise in FAT and 55/80 trials only. Once elevated after 55/80, it remained so for the postexercise period. Plasma testosterone increased from pre- to postexercise in all trials except 55/80. Saliva testosterone increased from pre- to postexercise in all trials with the longest elevation occurring after 55/80. Area under the curve analysis indicated that the exercise response of salivary hormones was greater in all cycle trials (cortisol) and in the 60/90 and 55/80 trials (testosterone) compared with the other trials. This study indicates that the 55/80 cycle protocol induces a prolonged salivary and plasma cortisol and salivary testosterone response compared with the other trials and so may be a useful diagnostic tool of overreaching.
Interest in the hair follicle (HF) has recently increased, yet the detailed mechanisms of HF function and immune privilege (IP) have not yet been elucidated. This review discusses the critical points of immunobiology and hormonal aspects of HFs. The HF is a unique mini-organ because it has its own immune system and hormonal milieu. In addition, the HF immune and hormonal systems may greatly affect skin immunobiology. Therefore, knowledge of HF immunobiology and hormonal aspects will lead to a better understanding of skin biology. The HF has a unique hair cycle (anagen, catagen and telogen) and contains stem cells in the bulge area. The HF is closely related to sebaceous glands and the nervous system. This article reviews the interaction between the endocrine/immune system and HFs, including the pathogenesis of alopecia areata associated with stress.
Surgical complications in hair transplantation can sometimes be a serious matter. Most of the published literature on this issue deals with individual case reports rather than larger series of patients.
The authors analyze complications in 425 consecutive patients undergoing 533 hair transplantations.
Patients with androgenetic alopecia (407 men and 17 women), cicatricial alopecia (9 men and 8 women), and malformations (1 man and 3 women) with a mean age of 36.9 years (standard deviation, 10.4 yrs) underwent hair transplantation between 1995 and 2006 and were followed up postoperatively for at least 1 year. Data on surgical complications were retrospectively analyzed.
The overall complication rate in our series was 4.7%, including enlarged scar (1.2%), folliculitis (1.0%), necrosis in the donor area (0.8%), keloids (0.4%), bleeding (0.2%), hiccups (0.2%), infection (0.2%), and pyogenic granuloma (0.2%). The frequency of enlarged scar increased proportionally according to the number of surgical procedures.
The hair transplantation complication rate in this series was 4.7%. Good communication between patient and surgeon, a complete clinical and laboratory assessment of the patient, accurate surgical technique, specific equipment, a trained surgical team, and careful postoperative attention to the patient are crucial for successful hair transplantation and for decreasing complication rates.).
Hair restoration surgery has emerged as a leading technique for rejuvenation of the upper third of the face. Using contemporary techniques, the results are generally indistinguishable from the appearance of native scalp hair. Unfortunately, older techniques of hair transplantation did not produce this quality result. As a result, there are a considerable number of patients who bear the visual and psychological burden of older hair transplant techniques. In addition, there are regrettably additional patients who have similar unnatural hair transplant results from poorly performed procedures completed in recent time. Understanding the anatomic problems associated with the unnatural-appearing hair transplant is fundamental to the successful correction of the deformity. The most common problems associated with the unsatisfactory hair transplant seen in clinical practice are reviewed, and possible approaches to treatment are presented. The challenge for the hair restoration surgeon is to provide a level of expertise and honesty to these unfortunate patients to restore their appearance and self-confidence. Fortunately, a tremendous benefit for the patient can be achieved when a correction of the unsightly transplant is performed.
Currently, the predominant hypothesis explains androgenetic alopecia (AGA) as a process reliant upon affected follicles being individually programmed to accumulate dihydrotestosterone (DHT), which then causes progressive follicular miniaturisation. The goal of this paper is to suggest that such miniaturisation may result from an exaggeration of the bone remodelling process causing a reduction in blood supply to the capillary network within the affected region. The bones of the human skull continue to grow during adulthood and observations made of those with AGA suggest that such growth may be responsible for the development of this condition. Studies of human cranial anatomy indicate that frontal and parietal bone growth can account for the development of the male pattern baldness (MPB) profile and the variations that can occur in the rate and location of hair loss. Steroid hormones such as DHT promote facial and body hair growth. Logically, this suggests that DHT should stimulate hair growth within the MPB region and not hair loss. However, DHT also has an anabolic effect on bone formation, and it is hypothesised that this stimulation of bone growth will overwhelm the hair growth promoting effects of DHT. Androgen receptor sites, 5-alpha-reductase (5alpha-R) and DHT have all been associated with AGA, but they also exist within numerous types of bone cells. DHT will stimulate the proliferation of osteoblast cells and the formation of new bone. Verification of this hypothesis would imply that DHT is primarily involved with AGA through its stimulation of the skull expansion process rather than through interaction with individual follicles. Also, increased androgen receptor gene expression, 5alpha-R activity and subsequent production of DHT within the MPB region of balding individuals, may simply represent the body's attempt to compensate for the skull expansion expression of hair follicle miniaturisation. Furthermore, it suggests that MPB region follicles are not individually programmed for hair loss. A redirection of genetic research towards the identification of those genes responsible for skull shape and development would be appropriate, and may reveal the genetic connection to AGA including its paternal link.
The predominant cultivable microbiota of periodontosis lesions was studied in 5 patients using a specially designed anaerobic sampling device and current anaerobic methodology. Two samples from the apical portion of periodontosis lesions and one sample from clinically normal sites were taken from each patient. The results indicated that samples obtained from pocket sites consisted of significantly increased proportions of Gram negative anaerobic rods when compared to a predominantly Gram positive flora in the control sites. Many of these organisms could not be classified. An additional 9 periodontosis patients were sampled and it was determined that groups of Gram negative anaerobic rods from similar to the first 5 patients were isolated. These organisms were differentiated into 5 groups based on morphologic, cultural, and biochemical characteristics.
The need for a widely accepted, accurate, and reproducible standard of classification for male pattern baldness has increased with the advent and increasing popularity of hair transplant surgery. This report establishes such a classification, and reports its use in determining the incidence of male pattern baldness at various ages in 1,000 white adult male subjects. The action of testosterone as an incitant in male pattern baldness is well known, but this study points out the continued effect of time, even in later years. Since most hair transplant surgery is peformed on subjects with male pattern baldness, and because the success of hair transplant surgery is largely dependent on proper patient selection, a complete understanding of male pattern baldness is essential for consistently good results with hair transplantation.
Hair is more than meets the eye. Despite arguments that the study of its psychologic and sociologic implications is frivolous, hair is important. Another person's hair is one of the first characteristics we notice upon meeting. Our own hair is one of the first and last characteristics we attend to before a meeting or a social engagement.Observations of contemporary culture suggest that hair has significance to society as a whole and in the lives of individuals. Existing social science research on hair is not voluminous but recently has noted that “the psychology of hair is a subject of growing interest.”1 At present, social science research addresses hair both directly and indirectly. Direct research focuses on psychologic and sociologic dimensions of hair. While scant, this research investigates color, length/style, and amount (in terms of baldness). Indirect research reflects a greater quantity and involves hair as a determinant of an individual's physical attractiveness. As such, selective social science data about physical attractiveness that is partially determined by hair can be reasonably generalized as social science data that specifically focuses on hair. Given interdependences between hair and physical attractiveness, these relationships reflect a straightforward extrapolation of knowledge. As a result, psychologic and sociologic knowledge of hair exists in a robust body of social science reseach.Accordingly, this article discusses research on “the physical attractiveness phenomena” as well as an overview on the psychologic and sociologic dimensions of an individual's hair.
This study was performed to determine the acute effect of cigarette smoking on proximal and distal epicardial conduit and coronary resistance vessels.
Cigarette smoking causes constriction of epicardial arteries and a decrease in coronary blood flow in patients with coronary artery disease, despite an increase in myocardial oxygen demand. The role of changes in resistance vessel tone in the acute coronary hemodynamic effect of smoking has not been examined.
Twenty-four long-term smokers were studied during cardiac catheterization after vasoactive medications had been discontinued. The effect of smoking one cigarette 10 to 15 mm long on proximal and distal conduit vessel segments was assessed before and immediately after smoking and at 5, 15 and 30 min after smoking (n = 8). To determine the effect of smoking on resistance vessels, coronary flow velocity was measured in a nonobstructed artery with a 3F intracoronary Doppler catheter before and for 5 min after smoking (n = 8). Eight patients were studied without smoking to control for spontaneous changes in conduit arterial diameter (n = 5) and resistance vessel tone (n = 3).
The average diameter of proximal coronary artery segments decreased from 2.56 +/- 0.12 mm (mean +/- SEM) before smoking to 2.41 +/- 0.09 mm 5 min after smoking (-5 +/- 2%, p < 0.05). Distal coronary diameter decreased from 1.51 +/- 0.07 to 1.39 +/- 0.06 mm (-8 +/- 2%, p < 0.01). Marked focal vasoconstriction after smoking was observed in two patients. Coronary diameter returned to baseline by 30 min after smoking. There was no change in vessel diameter in control patients. Despite a significant increase in the heart rate-mean arterial pressure product, coronary flow velocity decreased by 7 +/- 4% (p < 0.05) and coronary vascular resistance increased by 21 +/- 4% (p < 0.01) 5 min after smoking. There was no change in these variables in the control subjects.
Smoking causes immediate constriction of proximal and distal epicardial coronary arteries and an increase in coronary resistance vessel tone, despite an increase in myocardial oxygen demand. These acute coronary hemodynamic effects may contribute to the adverse cardiovascular consequences of cigarette smoking.
Several studies have examined the psychological impact of androgenetic alopecia on men but scientific evidence is absent regarding its effects on women.
Our purpose was to determine the psychosocial sequelae of androgenetic alopecia in women and, comparatively, in men.
Subjects were newly referred patients with androgenetic alopecia (96 women and 60 men) and 56 female control patients. Subjects completed standardized questionnaires to assess their psychological reactions to their respective conditions and to measure body image, personality, and adjustment.
Androgenetic alopecia clearly was a stressful experience for both sexes, but substantially more distressing for women. Relative to control subjects, women with androgenetic alopecia possessed a more negative body image and a pattern of less adaptive functioning. Specific correlates of the adversity of patients' hair-loss experiences were identified.
The results confirm the psychologically detrimental effects of androgenetic alopecia, especially on women. The implications for patient care are discussed.
Cancer of the prostate is the leading cancer among American men, yet few risk factors have been established. Hair growth and development are influenced by androgens, and it has long been suspected that prostate cancer also is responsive to these hormones. A blinded, case-control study was undertaken to determine if hair patterning is associated with risk of prostate cancer, as well as specific hormonal profiles. The study accrued 315 male subjects who were stratified with regard to age, race, and case-control status (159 prostate cancer cases/156 controls). Hair-patterning classification and serum levels of total and free testosterone (T), sex hormone binding globulin, and dihydrotestosterone (DHT) were performed. Data indicate that hair patterning did not differ between prostate cancer cases and controls; however, significant hormonal differences were detected between the two groups. Free T was greater among cases than in controls (16.4 +/- 6.1 vs. 14.9 +/- 4.8 pg/ml, P = 0.02). Conversely, DHT-related ratios were greater among controls (P = 0.03 for DHT/T and P = 0.01 for DHT/free T). Several strong associations also were found between hormone levels and hair patterning. Men with vertex and frontal baldness had higher levels of free T (16.5 +/- 5.5 and 16.2 +/- 8.0 pg/ml, respectively) when compared to men with either little or no hair loss (14.8 +/- 4.7 pg/ml) (P = 0.01). Data suggest that increased levels of free T may be a risk factor for prostatic carcinoma. In addition, although no differences in hair patterning were detected between cases and controls within this older population, further research (i.e., prospective trials or case-control studies among younger men) may be necessary to determine if hair patterning serves as a viable biomarker for this disease, especially given the strong association between free T levels and baldness.
Previous studies investigating the prevalence of male pattern hair loss (MPHL) typically used biased samples of men recruited from clinical populations which may limit generalizability of findings to broader populations.
To obtain an updated and improved estimate of the occurrence of MPHL in healthy men residing in the community.
Community-based sample of healthy men aged 18-49 years participated in a study investigating the effects of MPHL. Participants completed a brief questionnaire self reporting degree of hair loss, general health-related quality of life (HRQL) and hair-loss-specific measures. A trained observer also rated each participant using standardized classification for MPHL.
The proportion of men with moderate to extensive hair loss (type III or greater) was 42%. The proportion of men with moderate to extensive hair loss increased with increasing age, ranging from 16% for men 18-29 years of age to 53% of men 40-49. Twelve percent of the men were classified as having predominantly frontal baldness (type A variants).
MPHL, especially frontal baldness, may be more common than previously reported.
We rigorously evaluated gender differences in the measurement validity of salivary testosterone. Matched serum, saliva, and finger stick blood spot specimens were collected from 40 (20 males) young adults (aged 18-27 years). Saliva was assayed for testosterone by two independent (isotopic and non-isotopic) immunoassay methods. Serum was assayed by commercially available immunoassay kits for free and total testosterone. An immunoassay was developed for the measurement of testosterone in dried blood spots and is presented in detail so as to be reproducible from this report. Regardless of assay method, salivary testosterone levels are modestly correlated with serum levels for males but not necessarily for females. Blood spot assay results were highly correlated with serum total and free testosterone for both males and females. Substitution of saliva assay results for serum values substantially underestimates known testosterone-behavior associations, and this effect is much more pronounced for females than for males. The findings have important implications for the use and potential misuse of noninvasive measures of testosterone, and with respect to statistical power, the probability of observing significant testosterone-behavior relationships.
Androgenetic alopecia (AGA) is hereditary and androgen-dependent, progressive thinning of the scalp hair that follows a defined pattern. While the genetic involvement is pronounced but poorly understood, major advances have been achieved in understanding principal elements of the androgen metabolism involved: androgen-dependent processes are predominantly due to the binding of dihydrotestosterone (DHT) to the androgen receptor (AR). DHT-dependent cell functions depend on the availability of weak androgens, their conversion to more potent androgens via the action of 5 alpha-reductase, low enzymatic activity of androgen inactivating enzymes, and functionally active AR present in high numbers. The predisposed scalp exhibits high levels of DHT, and increased expression of the AR. Conversion of testosterone to DHT within the dermal papilla plays a central role, while androgen-regulated factors deriving from dermal papilla cells are believed to influence growth of other components of the hair follicle. Current available treatment modalities with proven efficacy are oral finasteride, a competitive inhibitor of type 2 5 alpha-reductase, and topical minoxidil, an adenosine-triphosphate-sensitive potassium channel opener which has been reported to stimulate the production of vascular endothelial growth factor in cultured dermal papilla cells. Since the clinical success rate of treatment of AGA with modulators of androgen metabolism or hair growth promoters is limited, sustained microscopic follicular inflammation with connective tissue remodeling, eventually resulting in permanent hair loss, is considered a possible cofactor in the complex etiology of AGA.
The epidemiology of androgenetic alopecia (AGA) is not fully understood. Although a strong genetic basis has long been identified, little is known of its non-genetic causes.
To estimate the prevalence of and to determine risk factors for AGA in men aged 40-69 years in Australia.
Men (n = 1390) were recruited at random from the electoral rolls to serve as controls in a population-based case-control study of prostate cancer. All were interviewed in person and direct observations of AGA were made. Men were grouped into the following categories; no AGA, frontal AGA, vertex AGA and full AGA (frontal and vertex AGA). Epidemiological data collected from these men were used for an analysis of risk factors for each AGA category using unconditional logistic regression with AGA category as the response variable adjusting for age, education and country of birth.
The prevalence of vertex and full AGA increased with age from 31% (age 40-55 years) to 53% (age 65-69 years). Conversely, the proportion of men with only frontal AGA was very similar across all age groups (31-33%). No associations were found between pubertal growth spurt or acne, reports of adult body size at time of interview, urinary symptom score, marital status, or current smoking status or duration of smoking and the risk of any form of AGA. The consumption of alcohol was associated with a significant increase in risk of frontal and vertex AGA but not full AGA. Men with vertex AGA had fewer female sexual partners but average ejaculatory frequency did not differ between men in different AGA categories. Reported weight and lean body mass at reaching maturity at about 21 years of age were negatively associated with vertex balding (P for trend < 0.05) but not with frontal AGA or full AGA.
Evidence for environmental influences on AGA remains very slight. Our study failed to confirm previously reported or hypothesized associations with smoking and benign prostatic hypertrophy. The associations that we found with alcohol consumption and with lean body mass at age 21 years would be worthy of further research if they were able to be replicated in other studies.
In this paper, the authors describe fractional polynomials and cubic splines with which to represent smooth dose-response relations in summarizing meta-analytical aggregate data. Use of these two curve-fitting families can help prevent the problems arising from inappropriate linearity assumptions. These methods are illustrated in the problem of estimating the shape of the dose-response curve between alcohol consumption and all-cause mortality risk. The authors considered aggregate data from 29 cohort studies investigating this issue (1966-2000). J-shaped curves with a nadir at approximately 5-7 g/day of alcohol consumption and a last protective dose of 47-60 g/day were consistently obtained from fractional polynomials and cubic splines. The authors conclude that both of the curve-fitting families are useful tools with which to explore dose-response epidemiologic questions by means of meta-analytical approaches, especially when important nonlinearity is anticipated.
Maximal strength, power, muscle cross-sectional area, maximal and submaximal cycling endurance characteristics and serum hormone concentrations of testosterone, free testosterone and cortisol were examined in three groups of men: weightlifters (n = 11), amateur road cyclists (n = 18) and age-matched controls (n = 12). Weightlifters showed 45-55% higher power values than road cyclists and controls, whereas the differences in maximal strength and muscle mass were only 15% and 20%, respectively. These differences were maintained when average power output was expressed relative to body mass or relative to muscle cross-sectional area. Road cyclists recorded 44% higher maximal workloads, whereas submaximal blood lactate concentration was 50-55% lower with increasing workload than in controls and weightlifters. In road cyclists, workloads associated with blood lactate concentrations of 2 and 4 mmol.l-1 were 50-60% higher and occurred at a higher percentage of maximal workload than in weightlifters or controls. Basal serum total testosterone and free testosterone concentrations were lower in elite amateur cyclists than in age-matched weightlifters or untrained individuals. Significant negative correlations were noted between the individual values of maximal workload, workloads at 2 and 4 mmol.l-1 and the individual values of muscle power output (r = -0.37 to -0.49), as well as the individual basal values of serum total testosterone and free testosterone (r = -0.39 to -0.41). These results indicate that the specific status of the participants with respect to training, resistance or endurance is important for the magnitude of the neuromuscular, physiological and performance differences observed between weightlifters and road cyclists. The results suggest that, in cycling, long-term endurance training may interfere more with the development of muscle power than with the development of maximal strength, probably mediated by long-term cycling-related impairment in anabolic hormonal status.
Androgenetic alopecia is the most common type of hair loss in men, but little is known about the etiology of androgenetic alopecia in elderly men and its impact on perceived age. Here we used a population-based twin study of men aged 70+ to assess the magnitude of the genetic component affecting hair loss and to examine the association between baldness and perceived age.
In the fourth wave of The Longitudinal Study of Aging Danish Twins we obtained digital photos of the face and photos of the vertex area of 739 elderly male twins, including 148 intact twin pairs. The degree of baldness and perceived age were assessed in each twin by five and nine nurses, respectively. The heritability of balding was estimated using structural-equation analysis, and it was tested whether baldness was associated with estimations of age.
The intrapair correlation of degree of balding was consistently higher for monozygotic than for dizygotic twin pairs regardless of the baldness categorization used, and structural-equation analysis revealed a heritability of 79% (95% confidence interval, 0.40--0.85) for the mean baldness index. The remaining variation could be attributed to non-shared environmental effects. There was only a very weak and statistically nonsignificant association between baldness and overestimation of age.
The majority of the variation in baldness in elderly men can be explained by genetic factors, and hair quantity has little impact on perceived age in elderly men.
Hair plays an important role in determining self-image, social perceptions, and psychosocial functioning. The objectives of this survey were to identify the impact of hair loss on the self-image of men in five European countries and their level of concern about hair loss with regard to image and personal attractiveness. Moreover, we evaluated participants' use of treatments for hair loss and whether treatment success was associated with psychological benefit.
A structured questionnaire of closed-ended questions was administered by telephone in major cities in Germany, France, Italy, Spain, and the United Kingdom. Random sampling was used, and eligible respondents were men from 18 to 45 years old.
Of the 1536 men responding to the telephone survey, 729 (47%) reported hair loss; these men are the subject of this report. Over 70% of these men reported hair to be an important feature of image, and 62% agreed that hair loss could affect self-esteem. The realization that they were losing hair was linked to concern about losing an important part of personal attractiveness (43% of men), fear of becoming bald (42%), concern about getting older (37%), negative effects on social life (22%), and feelings of depression (21%). Reduced self-confidence in personal attractiveness was also reported by 38% of men who were not in stable romantic relationships. Less than 10% of men were currently pursuing treatment for hair loss, and three out of four had never pursued treatment for hair loss, either at present or in the past. Those few men who pursued treatment and reported success (n = 73) also reported psychosocial benefits as a result: from 43% to 59% experienced improvements in parameters of self-esteem and perception of personal attractiveness. Reliance on self-reporting of hair loss and use of nonvalidated instruments to measure psychological outcomes are important study limitations.
The results of this survey indicate a gap between the need for treatment of hair loss and initiation of such treatment among men in five European countries. Further research is needed into the factors affecting men's willingness to seek treatment for hair loss.
Moderate red wine consumption has been associated with decreased risk of coronary heart disease. Reduced plasma viscosity and fibrinogen levels have been launched as possible contributors to this risk reduction. The effect of moderate red wine consumption on plasma viscosity, however, has not been investigated in a prospective, randomized trial. We wanted to evaluate the effect of moderate red wine consumption on plasma viscosity, fibrinogen concentration and fibrinogen subfractions. Healthy, nonsmoking volunteers were assigned to consume one glass of red wine daily for 3 weeks in a prospective, randomized cross-over study. In the second 3-week period the volunteers abstained from alcohol use. The plasma viscosity, fibrinogen concentration and the distribution of the main fibrinogen subfractions were determined at inclusion, after wine drinking and after abstention. Plasma viscosity was reduced by 0.026 and 0.024 mPa.s in the two groups following wine intake (95% confidence interval, 0.009-0.043, P = 0.004; 95% confidence interval, 0.0083-0.039, P = 0.003). The decrease in plasma viscosity was maintained following 3 weeks of abstention. The fibrinogen concentration was reduced by 0.17 g/l following wine drinking in the group starting with abstention (95% confidence interval, 0.04-0.29, P = 0.01). The distribution of the fibrinogen subfractions remained unaltered. We conclude that a daily glass of red wine for 3 weeks significantly reduces plasma viscosity. Fibrinogen concentrations are also significantly reduced, when preceded by an abstention period. The decreased viscosity levels are maintained after 3 weeks of abstention, suggesting a sustained viscosity lowering effect of red wine.
The main aim in surgical hair restoration is to restore hair, making the scalp look natural. Interviews with earlier patients who received hair transplants revealed that their complaints were - a straight anterior hairline that looked unnatural, and hair that looked like 'sprouted grass'. The use of follicular unit transplantation (FUT) technique, where hair roots are harvested under magnification, is becoming widespread. In this technique, hair roots are harvested into natural follicular units that contain 1-4 hair roots. In this article, we present our results related to hair transplantation by FUT technique, performed on 120 patients between the ages of 21 and 75 years with male-pattern hair loss. We made simple yet useful interventions to avoid the occurrence of the above-mentioned problems. Initially, drawings based on the middle line and the two temporal regression points were made for a natural-looking anterior hairline. Following this, irregular seeding was done instead of seeding in rows, to obtain a natural hairline. To avoid the 'sprouted grass' look, single hair roots were placed on the anterior hairline taking into consideration the direction of hair growth. However, the FUT technique is not adequate on its own for natural-looking hair restoration. Good planning and creation of an anterior hairline suited to the individual's forehead structure is fundamental for successful results. In addition, we believe that hair texture is very important in hair transplantation and additional care should be given particularly to patients with dark-coloured and hard hair.
To evaluate the association of androgenetic alopecia (AGA) with smoking and to estimate its prevalence among Asian men.
Population-based cross-sectional survey.
Tainan County, Taiwan.
The eligible population consisted of all male residents 40 years or older in Tainan County. A total of 740 subjects aged 40 to 91 years participated in the survey between April 10, 2005, and June 12, 2005.
Norwood and Ludwig classifications were used to assess the degree of hair loss. Information on smoking, together with other possible risk factors and age at onset of AGA, was collected using a questionnaire interview.
After controlling for age and family history, statistically significant positive associations were noted between moderate or severe AGA (Norwood types > or =IV) and smoking status (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.14-2.76), current cigarette smoking of 20 cigarettes or more per day (OR, 2.34; 95% CI, 1.19-4.59), and smoking intensity (OR, 1.78; 95% CI, 1.03-3.07). The OR of early-onset history for AGA grades increased in a dose-response pattern. Risk for moderate or severe AGA increased for family history of first-degree and second-degree relatives, as well as for paternal relatives.
The age-specific prevalence of AGA in Taiwan was compatible to that among Korean men but was lower than that among persons of white race/ethnicity. Smoking status, current amount of cigarette smoking, and smoking intensity were statistically significant factors responsible for AGA after controlling for age and family history. Patients with early-onset AGA should receive advice early to prevent more advanced progression.
The purpose of this study was to investigate the relationship between alcohol consumption and the prevalence of the metabolic syndrome (MetS), type 2 diabetes mellitus (DM), coronary heart disease (CHD), stroke, peripheral arterial disease (PAD), and overall cardiovascular disease (CVD) in a Mediterranean cohort. It consisted of a cross-sectional analysis of a representative sample of Greek adults (n = 4,153) classified as never, occasional, mild, moderate, or heavy drinkers. Cases with overt CHD, stroke, or PAD were recorded. In our population, 17% were never, 23% occasional, 27% mild, 24% moderate, and 9% heavy drinkers. Moderate alcohol consumption was associated with a lower trend for the prevalence of the MetS (P = .0001), DM (P < .0001), CHD (P = .0002), PAD (P = .005), and overall CVD (P = .001) but not stroke compared with no alcohol use. Heavy drinking was associated with an increase in the prevalence of all of these disease states. Wine consumption was associated with a slightly better effect than beer or spirits consumption on the prevalence of total CVD, and beer consumption was associated with a better effect than spirits consumption. Alcohol intake was positively related with body weight, high-density lipoprotein cholesterol levels, and hypertension. Moderate alcohol consumption is associated with a lower prevalence of the MetS, DM, PAD, CHD, and overall CVD but not stroke compared with no alcohol use in a Mediterranean population. Heavy drinking was associated with an increase in the prevalence of all of these disease states. Advice on alcohol consumption should probably mainly aim at reducing heavy drinking.
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