Androgenetic Alopecia Linked to Psychosocial Comorbidities

Erica Auckerman, BS

A recent systematic review into the psychosocial implications of androgenetic alopecia found that the dermatologic condition offered a significant psychosocial stressor in the lives of affected patients.

Androgenetic alopecia, a condition defined by progressive hair loss, affects up to 80% of males and 50% of females of the course of a lifetime.

The efficacy of current treatments such as minoxidil, hormonal therapy, and hair transplantation vary significantly, and the condition has been associated with various psychological complications.

Additionally, a majority of systematic reviews have focused solely on alopecia areata, a condition with an autoimmune origin that requires different treatments.

As such, investigators led by Erica Auckerman, BS, Indiana University School of Medicine, focuses on the psychosocial comorbidity associated with androgenetic alopecia.

The current systematic review, which followed the PRISMA reporting guidelines, analyzed literature from PubMed from inception to August 20, 2021.

Search terms included androgenetic alopecia, anxiety, depression, psychological and psychosocial, and self-esteem. At this time, investigators also examined article reference lists.

Studies were excluded if they focused on alopecia areata, treatment efficacy, or were published in a language other than English.

Investigators analyzed studies that related to the psychological sequela of androgenetic alopecia that dated back to the 1990s. A total of 13 studies were retained following the initial search process, with a time range of 1992 to 2021.

One study in particular featured 145 male participants, none of whom were seeking dermatological treatment.Based on data gathered from a Hair Loss Effects Questionnaire, more than 30% of high-hair-loss males reported increased cognitive preoccupation and behavioral coping due to hair loss.

Behavioral coping measures such as compensating for hair loss by improving physique, dressing nice, wearing hats, and seeking reassurance of their appearance were observed.

A separate study compared the psychological effects of androgenetic alopecia in males and females. Newly referred patients -96 females and 60 males, in addition to 56 female control patients- were selected from dermatology center in San Francisco and New Haven.

Despite androgenetic alopecia predominantly affecting male patients, the female hair-loss group reported more negative feeling regarding their appearance than the male hair-loss group or the control group.

A separate study from 1994 measured the psychosocial ramifications of androgenetic alopecia in an all-female patient population. Of the 58 participants included in the study, 88% reported hair loss to have a negative effect on their daily life, 75% reported that their hair loss had a negative impact on their self-esteem, and 50% reported social problems due to hair loss.

Briefly, a recent meta-analysis from last year confirmed the overarching theme regarding androgenetic alopecia and a moderate impairment of health-related quality of life and emotions.

“A psychotherapy referral should be considered in those who present with any level of psychological distress,” the team wrote. “Given the knowledge that stress exacerbates hair loss, it is important to encourage the implementation of stress-coping strategies and psychotherapy when warranted.”

The study, "The Psychological Consequences of Androgenetic Alopecia: A Systematic Review," was published online in the Journal of Cosmetic Dermatology.