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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 245-248

One year cross-sectional study of association between androgenetic alopecia and benign prostatic hyperplasia in a tertiary care hospital


1 Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, KLE'S Dr. Prabhakar Kore Hospital and MRC, KLE University, Belgaum, Karnataka, India
2 Department of Urology, Jawaharlal Nehru Medical College, KLE'S Dr. Prabhakar Kore Hospital and MRC, KLE University, Belgaum, Karnataka, India

Date of Web Publication5-Sep-2017

Correspondence Address:
Prarthana B Desai
Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, KLE'S Dr. Prabhakar Kore Hospital and MRC, KLE University, Belgaum - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.ijhs_306_16

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  Abstract 


Background: Androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH) are both androgen-dependent disorders in which the enzyme 5-alpha reductase plays a key role in conversion of testosterone to dihydrotestosterone. The purpose of this study is to analyze the association between AGA and BPH.
Materials and Methods: Male patients between the age group of 25–45 years attending dermatology outpatient department at a tertiary care hospital with AGA during the period January 2015–December 2015 were included in the study. Ethical clearance was obtained from the Institutional Ethics Committee of Human Subjects Research. A short questionnaire recording their particulars and a detailed dermatological evaluation of the patient was done. All patients in the study were graded using Modified Hamilton-Norwood Classification, underwent transabdominal ultrasonogram and serum prostate-specific antigen (PSA) level estimation. Data were analyzed by ANOVA and Spearman's rank correlation.
Results: Sixty-four patients were enrolled in the study. Nearly 39.1% of patients had Grade III AGA, 32.8% had Grade IV AGA, 25% had Grade V AGA, and 3.1% had Grade VI AGA. The minimum PSA level was 0.1 ng/ml and maximum was 4.8 ng/ml. The minimum prostate volume was 8.08 ml and maximum was 32.2 ml.
Conclusion: Even though an increase in the prostate volume in AGA patients was noted, this study showed no association between AGA, prostate volume, and serum PSA levels.

Keywords: Androgenetic alopecia, benign prostatic hyperplasia, prostate volume, serum prostate-specific antigen level


How to cite this article:
Desai PB, Manjunath Swamy B S, Nerli R B. One year cross-sectional study of association between androgenetic alopecia and benign prostatic hyperplasia in a tertiary care hospital. Indian J Health Sci Biomed Res 2017;10:245-8

How to cite this URL:
Desai PB, Manjunath Swamy B S, Nerli R B. One year cross-sectional study of association between androgenetic alopecia and benign prostatic hyperplasia in a tertiary care hospital. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2017 Dec 12];10:245-8. Available from: http://www.ijournalhs.org/text.asp?2017/10/3/245/213996




  Introduction Top


Androgenetic alopecia (AGA) is the most widely recognized cause of nonscarring hair loss among males.[1] It is a progressive, patterned hair loss that occurs on exposure to androgens in hereditarily predisposed individuals.[2] Even though the age of onset has been reported at 40 years, there are reports that demonstrate the onset of alopecia at 20 years.[3]

Both AGA and benign prostatic hyperplasia (BPH) are androgen-dependent diseases in which the enzyme 5-alpha reductase (5-AR) plays a key role in conversion of testosterone to dihydrotestosterone (DHT).[4] The 5-AR family includes 5-AR1, 5-AR2, and 5-AR3. In adults, 5-AR1 is present in nongenital skin, the liver, and certain areas of the brain and at lower levels in the prostate, genital skin, epididymis, seminal vesicles, testis, adrenal gland, and kidney. 5-AR2 is present at generally high levels in the prostate, genital skin, epididymis, seminal vesicles, and liver.[5] DHT responsible for follicular miniaturization on the scalp is mainly produced by the action of 5-AR2 on testosterone.[4] In the prostate, both isoenzymes 5-AR1 and 2 convert testosterone to DHT which is responsible for the growth and development of prostate gland.[4]

Various studies were carried out to evaluate the association between AGA and BPH with varying results.[6],[7],[8],[9],[10] There is no study evaluating BPH symptoms in AGA patients of younger age group, so this study was carried out to determine the association between AGA, prostate volume, and serum prostate-specific antigen (PSA) level.


  Materials and Methods Top


This cross-sectional study was performed on 64 men between the age group of 25–45 years, who visited the outpatient Department of Dermatology, Venereology, and Leprosy between January 2015 and December 2015. Ethical clearance was obtained.

Informed consent was taken from all the patients included in the study. All patients in the study underwent a detailed history taking, general physical, systemic, and dermatological examination.

All patients were subjected to transabdominal ultrasonography and serum PSA level estimation. Records were maintained and analyzed statistically using ANOVA and Spearman's rank correlation.


  Results Top


A total of 64 patients with AGA who fulfilled the inclusion and exclusion criteria were enrolled in this study.

Mean age of the patients was 30.9 ± 6.62 years. The youngest patients in the study were 25 years old, whereas the oldest were 45 years old. The shortest duration of disease was 1 year, whereas the longest duration was 20 years. The mean duration of the disease was 5.5 ± 4.17 years. The lowest age of onset in the study was 18 years old, whereas the highest was 37 years old. The mean age of onset was 25.4 ± 4.01 years.

Out of 64 AGA patients, 56 (87.5%) patients had a positive family history for AGA, whereas 3 (4.6%) patients had positive family history for BPH and family history of prostatic cancer was negative in all patients, 64 (100%).

The most commonly observed grade of AGA was Grade III in 25 (39.1%) followed by Grade IV 21 (32.8%), Grade V 16 (25%), and Grade VI 2 (3.1%) [Figure 1].
Figure 1: Grades of androgenetic alopecia in 64 patients

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All 64 patients of AGA underwent transabdominal ultrasound which showed that maximum number of patients had prostate volume ranging between 21 and 25 ml. In 64 patients, 2 (3.1%) patients had prostate volume between 5 and 10 ml, 8 (12.5%) had between 11 and 15 ml, 4 (6.25%) between 16 and 20 ml, 36 (56.2%) between 21 and 25 ml, 12 (18.7%) between 26 and 30 ml [Figure 2], and 2 (3.1%) between 31 and 35 ml [Figure 3] and [Figure 4].
Figure 2: Prostate volume in 64 androgenetic alopecia patients

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Figure 3: Prostate volume 29ml

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Figure 4: Prostate volume 32 ml

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Out of 64 patients, 63 (98.4%) had serum PSA level <4 ng/ml and 1 (1.6%) had serum PSA level >4 ng/ml.

Results were analyzed statistically using ANOVA and Spearman's rank correlation. Spearman's rank correlation between grades of AGA and prostate volume was found to be 0.147 indicating that as grades of AGA increased prostate volume was reduced. However, this correlation was not statistically significant (P = 0.247). There was poor correlation between AGA grades and serum PSA level, Spearman's rank correlation being 0.016, statistically not significant (P = 0.902).


  Discussion Top


AGA is a progressive, patterned hair loss that occurs on exposure to androgens in hereditarily predisposed individuals. It affects both genders and is characterized by hair loss in a distinctive and reproducible pattern from the scalp.[2] The most common benign neoplasm in men is BPH, which affects nearly 70% of men of 60 years and older, with or without any obstructive symptoms.[11] Both AGA and BPH are androgen-dependent diseases, in which the enzyme 5-AR plays a key role in conversion of testosterone to DHT.[4]

Various studies were carried out to determine the relation between AGA and BPH, but some discrepancies were noted in their results [Table 1].
Table 1: Comparison between present study and others

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The present study did not show any relation between AGA, prostate volume and serum PSA level; however, it showed an increase in prostate volume in most of the AGA patients, which was not statistically significant.


  Conclusion Top


On comparison of prostate volume and serum PSA levels in different grades of AGA, no significance was found between them.

Even though there was an increase in the prostate volume among AGA patients, it was not statistically significant. The study of larger sample sizes of AGA patients with a control group from the general population who can be followed up for a considerable amount of time would further strengthen this association.

Patients with early-onset AGA had an increase in prostate volume. This association has been explained by the common pathophysiology of these two entities where androgens play an important role. If this observation is further confirmed in additional studies, dermatologists and physicians can monitor patients with early-onset AGA for development of any urinary symptoms which permits for an early diagnosis of BPH. Additional studies may also confirm if treatment of AGA patients can prove beneficial to BPH which might be present in its initial stage of development.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician 2003;68:93-102.  Back to cited text no. 1
[PUBMED]    
2.
Sinclair R. Male pattern androgenetic alopecia. BMJ 1998;317:865-9.  Back to cited text no. 2
[PUBMED]    
3.
Sinclair RD, Dawber RP. Androgenetic alopecia in men and women. Clin Dermatol 2001;19:167-78.  Back to cited text no. 3
[PUBMED]    
4.
Bingham KD, Shaw DA. The metabolism of testosterone by human male scalp skin. J Endocrinol 1973;57:111-21.  Back to cited text no. 4
[PUBMED]    
5.
Wang K, Fan DD, Jin S, Xing NZ, Niu YN. Differential expression of 5-alpha reductase isozymes in the prostate and its clinical implications. Asian J Androl 2014;16:274-9.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Chen W, Yang CC, Chen GY, Wu MC, Sheu HM, Tzai TS. Patients with a large prostate show a higher prevalence of androgenetic alopecia. Arch Dermatol Res 2004;296:245-9.  Back to cited text no. 6
[PUBMED]    
7.
Oh BR, Kim SJ, Moon JD, Kim HN, Kwon DD, Won YH, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology 1998;51:744-8.  Back to cited text no. 7
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8.
Arias-Santiago S, Arrabal-Polo MA, Buendía-Eisman A, Arrabal-Martín M, Gutiérrez-Salmerón MT, Girón-Prieto MS, et al. Androgenetic alopecia as an early marker of benign prostatic hyperplasia. J Am Acad Dermatol 2012;66:401-8.  Back to cited text no. 8
    
9.
Kaplan SA. Re: Androgenetic alopecia as an early marker of benign prostatic hyperplasia. J Urol 2012;188:1846-7.  Back to cited text no. 9
[PUBMED]    
10.
Dastgheib L, Shirazi M, Moezzi I, Dehghan S, Sadati MS. Is there a relationship between androgenic alopecia and benign prostatic hyperplasia? Acta Med Iran 2015;53:30-2.  Back to cited text no. 10
[PUBMED]    
11.
Swyer GI. Post-natal growth changes in the human prostate. J Anat 1944;78(Pt 4):130-45.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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