Hormonal profile of androgenetic alopecia in adolescents and its association with metabolic dysfunction: single center retrospective study

Androgenetic alopecia (AGA) has not been commonly reported in adolescents compared to adults. As puberty has shifted toward younger ages, early recognition of AGA and changes in androgen or metabolic function are paid more attention. So we investigated the clinical features and hormonal profile of AGA in adolescents. Based on the clinical and trichoscopic findings, 21 subjects (8 boys and 13 girls) were enrolled. Mean age was 16.1 years and family history of AGA in first- or second-degree relatives was observed in 61.9%. Diffuse thinning at crown with frontal hairline preservation was most common (61.9%), followed by vertex and bitemporal thinning (28.6%) and ‘Christmas tree’ pattern (9.5%). Acne was accompanied in 10 (4 boys and 6 girls) with mean severity score of 1.8 and 1.1 respectively. Total/free testosterone (T) and dehydroepiandrosterone sulfate (DHEA-S) were normal in boys. However, 2 girls showed elevated total T and DHEA-S, while 5 girls only in DHEA-S. Nine subjects (3 boys and 6 girls) showed elevated random insulin or concurrent type 2 diabetes mellitus (DM). Five girls satisfied the Rotterdam criteria of PCOS, while 4 girls, who showed abnormal androgen profile and metabolic dysfunction (increased random insulin or concurrent DM), did not. Adolescents with AGA showed different androgen profile between boys and girls, while concurrent metabolic dysfunction was observed similarly in both sexes. It is suggestive that AGA in adolescents should be dealed differently by their sex and distinguished from adult. Especially in girls, the features of hyperandrogenism and metabolic dysfunction should be carefully investigated.