Cent Eur J Publ Health 2006; 14 (2): 78–81
ASSOCIATION OF INSULIN RESISTANCE LINKED
DISEASES AND HAIR LOSS IN ELDERLY MEN.
FINNISH POPULATION-BASED STUDY
, Mauri Laakso
, Veikko Matilainen¹, Liisa Hiltunen
1, 2, 3
, Ulla Rajala ¹, Jari Jokelainen
University of Oulu, Department of Public Health Science and General Practice, University of Oulu, Finland
Unit of General Practice, Oulu University Hospital, Finland
Oulu Health Center, City of Oulu, Finland
Previous investigations have shown an association of androgenetic alopecia (AGA) with insulin resistance related disorders such as ischemic
heart disease.An associationbetweenAGAand anthropometric abnormalities linked with insulin resistance and heredity in women aged63 years has
also been shown. We therefore compared 63-year-old men with AGA and ones with normal hair status for insulin resistance linked parameters.
A population of 245 men aged 63 years, who were participants in a population-based cross-sectional study in the City of Oulu, underwent
a medical check-up including assessment of hair status on the Hamilton-Norwood scale and determination of anthropometric measures, blood
pressure, fasting glucose and serum lipids.
Fifty eight per cent of the men reported extensive hair loss (grade III-VII). Hypertension and the use of antihypertensive drugs were common
among men with AGA (61% vs. 45% and 50% vs. 26%, respectively). The rates of diabetes and hyperinsulinemia (21% vs. 12% and 61% vs. 49%)
were higher among men with AGA compared to those with normal hair status but no difference was seen in other factors.
Our ndings show that AGA is common among Finnish men aged 63 years but that it is also associated with insulin linked disturbances, such
as hypertension and diabetes. Such men developing AGA might benet from attention in medical check-up.
Key words: androgenetic alopecia, hair loss, insulin resistance
Address for correspondence: P. Hirsso, BOX 5000, Department of Public Health Science and General Practice, University of Oulu, FIN-900014
University of Oulu, Finland. E-mail: paivi.hirsso@oulu.
An association between androgenetic alopecia (AGA)
and cardiovascular events such as myocardial infarction and
ischemic heart disease has been previously reported (1–5).
Finnish case-control studies have suggested an increased risk of
hyperinsulinaemia and insulin resistance related disorders such
as hypertension and dyslipidaemia and of severe coronary heart
disease among men with early onset AGA compared to men with
normal hair status (6–7). Associations between female AGA
(grade II or III on Ludwig`s scale) among 63-year-old women
and some markers of insulin resistance, android-type obesity and
heredity have been reported recently (8). The aim of the present
study was to test the association of male-pattern AGA in men
aged 63 with insulin resistance-linked disorders.
SUBJECTS AND METHODS
This study was a population-based cross-sectional study. All
the participants (n=831) of a previous population-based follow-
up study carried out in 1990–1992 (9) in the City of Oulu were
invited to participate in this study in 1996–1998, and 593 of them
participated (245 men). Questionnaires, interviews, clinical exa-
minations and laboratory tests were used to collect data during the
follow-up period in 1996–1998. The material and methods have
been described in more detail in previous publications (8,10).
The hair status of 221 men was assessed by a trained nurse
as part of the clinical examination using the Hamilton-Norwood
scale (11). The original classes I–II were merged form to larger
categories: normal hair/mild alopecia (classes I–IIIb) and exten-
sive hair loss (classes IIIvertex–VII). Additional questions asked
about the most plentiful hair loss if any significant had existed
and the family history of hair loss also.
The potential insulin resistance linked factors; body mass
index (BMI, weight in kilograms divided by the square of height
in meters), neck/hip and waist circumference, and systolic and
diastolic blood pressure were measured. Height and weight in
light clothing for calculating BMI were measured in the clinical
examination. Two measurements of blood pressure (BP) were
made by the physician from both arms in sitting and recumbent
positions. The mean value of these four measurements was used
in analyses. Hypertension was defined as either a systolic blood
pressure ≥160 mmHg or a diastolic blood pressure ≥ 90 mmHg
or being on antihypertensive medication regardless of the blood
pressure values. Drug treatment for hypertension was recorded
in an interview conducted by a physician. In addition to this, the
postal questionnaire included the following questions: “Do you
have diabetes mellitus/hypertension diagnosed by a physician?”
and “Do you use any antidiabetic medication?” Smoking habits
were asked in the postal questionnaire.
The following biochemical data concerning the traditional
cardiovascular risk factors were recorded: fasting total cholesterol
(chol), high-density lipoprotein (HDL)-cholesterol, triglyceride
(TG) and insulin concentrations as well as fasting and two-hour
glucose concentrations after a 75 g glucose load measured from
a blood-sample taken after an overnight (10 h) fast.A standardized
75 g oral glucose tolerance test (OGTT) was performed according
to the instructions of the WHO Study Group (12). Subjects with
impaired glucose tolerance and normal glucose tolerance were
combined as non-diabetic subjects. Serum immunoreactive insulin
concentrations were measured by RIA using the Phadeseph Insu-
lin RIA 100 kit (Pharmacia Diagnostics AB, Uppsala, Sweden),
which also detects proinsulin and proinsulin conversion products
with considerable sensitivity. The cross-reactivity of proinsulin
in this assay is about 41%. Insulin levels were not analysed from
the samples of the diabetic patients with insulin treatment. Urine
albumin and creatine concentrations were measured from an
overnight spot urine sample. The highest decile of the urinary
albumin to creatine ratio (≥2.5 mg/mmol) was used as a measure
of microalbuminuria. To measure insulin sensitivity, an insulin
sensitivity check index (Quicki) was used (13–14). The deter-
minations mentioned above were made in the laboratory with
a standardized quality control system.
Table 1. Means/medians and standard deviations (SD) /
interquartile range of background characteristics among men
aged 63 years with extensive hair loss and normal hair
Extensive hair loss
Sd Mean Sd
Weight (kg) 82.9 12.6 85.5 12.6
Length (cm)* 173.0 5.6 174.6 6.3
) 27.6 3.6 27.9 3.7
Neck circ. (cm) 40.7 2.6 41.1 2.6
Hip circ. (cm) 101.4 7.1 102.4 7.2
Waist circ. (cm) 95.8 10.7 97.3 9.9
WHR 0.94 0.06 0.95 0.05
SBP (mmHg) 142.8 18.5 141.9 18.3
DBP (mmHg) 79.3 8.0 79.4 6.9
Fs-chol (mmol/l) 5.7 0.9 5.6 0.8
1.3 0.3 1.3 0.3
6.9 2.2 6.8 2.1
Median Q1-Q3 Median Q1-Q3
1.3 0.9–1.7 1.2 0.9–1.8
Fb-gluk (mmol/l) 4.9 4.6–5.6 5.0 4.8–5.5
Fs-ins (mU/l) 10.0 8.0–15.0 9.0 8.0–14.0
U-alb/krea ratio 0.92 0.68–1.18 0.91 0.71–1.54
0.33 0.32–0.35 0.34 0.32–0.35
*p = 0.021 (t-test)
The summary statistics for normally distributed continuous
variables were expressed as mean and standard deviation and as
median with interquartile range (25th and 75th percentiles) for
non-normally distributed variables. The statistical differences
between the continuous variables were tested by the t-test when
the distribution was normal and with the Mann-Whitney U-test in
a non-normal situation. For categorical variables, the χ
used to calculate the unadjusted odds rations (OR) and their 95%
confidence intervals (CI) for each dichotomized variable. On the
basis of bivariate logistic regression analysis, adjustments were
performed only for the potential risk factors that were significantly
associated with hair loss. Statistical analyses were performed
using SPSS for Windows (version 10.0)
The prevalence of extensive hair loss was 58.4% among these
63-year-old men. Twenty-two per cent of the men with extensive
than 35 years. The means or medians of the continuous variables
relative to hair status are presented in Table 1. The men with
extensive hair loss were shorter (173 cm vs. 175 cm, p = 0.021)
but their body weight was lower compared to those with normal
hair status, while no difference in BMI or the other biochemical
markers of insulin resistance was seen.
The absolute numbers and percentages of insulin resistance
associated states, such as diabetes, dyslipidemia and hypertension
as well as hyperinsulinemia and microalbuminuria, smoking status
and the presence of maternal or paternal hair loss in the subgroups
of hair status classes are presented in Table 2. Adjustment for
hyperinsulinemia, hypertension, diabetes and paternal heredity
did not alter these associations (Table 3). The use of antihyper-
tensive medication was clearly more frequent among the men
with extensive hair loss (50% vs. 26%, p = 0.0003) and those
with extensive hair loss used more frequently β-channel blockers
(30% vs. 15%, p=0.010) and angiotensin-converting enzyme
Table 2. Percentages of insulin resistance associated disease,
hyperinsulinemia, microalbuminuria, smoking and heredity
among men aged 63 years with extensive hair loss and nor-
Extensive hair loss
n % n % p
78 61 44 49 0.078
27 21 11 12 0.081
45 35 34 37 ns.
77 62 41 45 0.016
11 9 7 8 ns.
Paternal heridity 57 47 21 23 0.0003
Maternal heredity 3 3 1 1 ns.
Smoking 25 19 19 21 ns.
Hyperinsulinemia: fs-insulin ≥10U/l.
Diabetes: according to WHO 1997 criteria
or antidiabetic drugs.
Dyslipidemia: hypertriglyceridemia ≥1.7 mmol/l, HDL-chol
<1.0 mmol/l or lipid-lowering agents.
Hypertension: systolic blood pressure
≥160 mmHg or diastolic blood pressure ≥90 mmHg or antihypertensive drugs.
Microalbuminuria: urinary albumin-to-serum creatinine ratio ≥2.5
Table 3. Odds ratios (OR) and 95 % condence intervals (95%
CI) of extensive hair loss associated with hyperinsulinemia,
diabetes, hypertension and paternal heredity in men
95% CI OR 95% CI
1.63 0.95-2.81 1.56 0.85-5.53
1.96 0.92-4.20 1.94 0.82-4.59
1.96 1.13-3.38 1.81 0.97-3.37
Paternal heredity 3.01 1.65-5.51 2.71 1.44-5.13
Hyperinsulinemia: fs-insulin ≥10U/l
Diabetes: according to WHO 1997 criteria or antidiabetic drugs.
Hypertension: systolic blood pressure ≥160 mmHg or diastolic blood pressure
≥90 mmHg or antihypertensive drugs
inhibitors (ACE) (17% vs. 7%, p=0.020) compared to the men
with normal hair status.
This population-based study revealed an association of AGA
with insulin resistance linked diseases among men aged 63 years,
but associations between AGA and markers of insulin resistance
were rare. Previous investigations have suggested a link between
AGA and elevated BMI in older men (1, 6–7), but some studies
have given negative results (5, 15–17). In one population-based
study (15) the preliminary association between AGA and cardio-
vascular risk factors disappeared after adjustment for age. In that
study, the final classification of AGA was based on self-reported
hair status and the age distribution of study population differs from
those used in our study of 63 years old men. Lotufo et al. (5) and
Trevisan et al. (17), who focused on selected populations, found
higher BP and higher concentration of serum cholesterol among
men with AGA. A Finnish case-control study suggests that AGA
is not associated only with cardiovascular risk factors (6) but also
with severe coronary heart disease (7).
In this study, the prevalence of hair loss was 58% among
northern Finnish men aged 63 years. The prevalence of male-
pattern hair loss is known to increase with age. For example, the
occurrence of extensive hair loss has been reported to be 40% in
subjects aged 40–49 years, 50% in subjects aged 50–59 years,
and 60% in subjects aged 60–69 years (11). In the Framingham
study hair loss in men aged 55–64 years amounted to 68% (3),
which results are in accordance with our findings. The recent
studies from Australia (16) and Singapore (18) both reported
higher prevalence of AGA in men of this age. There are ethnic
differences in the study populations and the classification ofAGA
had been modified by authors. In a Korean study, the prevalence
of AGA in men aged 60–69 years was 34% (19) which is lower
than among Caucasian men.
As previously reported in women in our study (8), paternal
heredity was also associated with AGA in men. The association
was stronger than earlier reported in Korean men (19) and as we
know, the heritability and genetic background of hair loss have
been under consideration for decades (20). Hair loss in female
relatives was rarely reported, which could be partly due to the
difficulty to recognize female-type hair loss. The most intensive
hair loss starting at an age younger than 35 years in 22% of men
with hair loss was quite low. This might be due to the memory-
bias or misunderstanding of the question.
The strengths of our study include the population-based sample
and the standard classification scale used by trained nurses. The
Hamilton-Norwood scale is considered to be well reproducible
(4). One limitation is that we could not determine the effect of
antihypertensive drugs on AGA. According the previous studies,
antihypertensive drugs (α- and β-channel blockers, ACE, calcium
channel blockers) may induce hair loss (21–22) and, on the other
hand, men with extensive hair loss used more frequently β-channel
blockers or ACEs than men with normal hair.
To sum up, AGA seems to connect with insulin resistance
linked diseases in men at older age but not with the markers of
insulin resistance. It remains unclear whether insulin resistance
has led to development of the disease because of aging among
subjects withAGAor whether there are some connections between
the use of drugs andAGA. In a retrospective study of this kind, the
effects of drugs on hair status and the impacts of health education
given to balding men with diabetes and hypertension cannot be
excluded. The risk of AGA increases with age in general, and
regardless of diseases or medication, there is also a tendency to
hair loss in the healthy population and such men developing AGA
might benefit from attention in medical check-up.
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Received May 3, 2005
Accepted November 14, 2005
WHAT IS CANCER?
Cont. from p. 73
o Up to one third of the cancer burden could be reduced by implement
ing cancer preventing strategies which are aimed at reducing the
exposure to cancer risk mainly by:
- changes in tobacco and alcohol use, and dietary and physical activity
- immunization against HPV infection
- the control of occupational hazards
- reducing exposure to sunlight
o Another third of the cancer burden could be cured if
and treated adequately.
Early detection of cancer is based on the observation that treatment
is more effective when cancer is detected earlier. The aim is to detect the
cancer when it is localized.
There are two components of early detection programmes for cancer:
- Education to promote early diagnosis by recognizing early signs
of cancer such as: lumps, sores, persistent indigestion, persistent
coughing, and bleeding from the body’s orifices; and the importance
of seeking prompt medical attention for these symptoms.
Screening is the identification by means of tests of people with
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tests are available for breast cancer (mammography) and cervical
cancer (cytology tests).
Treatment of cancer is aimed at curing,prolonginglifeandimprov-
ing quality of life of patients with cancer. Some of the most common
cancertypes such asbreast cancer,cervicalcancerandcolorectalcancer
have a high cure rate when detected early and treated according to best
evidence. The principal methods of treatment are surgery, radiotherapy
and chemotherapy. Fundamental for adequate treatment is an accurate
diagnosis by means of investigations involving imaging technology
(ultrasound, endoscopy, radiography) and laboratory (pathology).
Relief from pain and other problems can be achieved in over 90% of all
cancer patients by means of palliative care. Effective strategies exist
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families, even in low resource settings.
WHO‘S STRATEGY FOR PREVENTION AND CONTROL
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