Female pattern hair loss in men: A distinct clinical variant of androgenetic alopecia

To the Editor: Female pattern hair loss (FPHL) is characterized by a reduction in density over mid-frontal aspect of scalp and crown with retention frontal hairline. FPHL known to affect small subset men,1Paik J.H. Yoon J.B. Sim W.Y. et al.The prevalence types androgenetic alopecia Korean men women.Br J Dermatol. 2001; 145: 95-99Crossref PubMed Scopus (139) Google Scholar but descriptions this entity are, our knowledge, limited 2 case reports.2Trüeb R.M. baldness men.J Am Acad 1993; 29: 782-783Abstract Full Text PDF (11) Scholar,3Carlson J.A. Malysz J. Schwartz Female-patterned teenage brothers unusual histologic features.J Cutan Pathol. 2006; 33: 741-748Crossref (3) We retrospectively reviewed records seen clinic between November 2017 March 2020. Men diffuse on preservation hairline sparing back sides were included (see Supplemental Fig 1; available via Mendeley at https://data.mendeley.com/datasets/tzb85ccrgp/3). All patients complained progressive thinning months years absence significant shedding had negative hair-pull test away from area loss. The diagnosis (AGA) was confirmed dermoscopically (hair shaft diameter variability >20%, vellus hairs, increased 1-haired follicular units). treated low-dose oral minoxidil (LDOM) and/or 5α-reductase inhibitor (finasteride or dutasteride). Response assessed only those who completed least 6 treatment. Hair severity before after treatment graded 5-point Sinclair scale independent blinded dermatologists using standardized clinical photographs. From 2020, 2140 AGA center, whom 84 (3.9%) diagnosed (Table I). Blood results for 36 (42.9%) patients. Low levels total testosterone, free 25-hydroxyvitamin D, zinc detected 7 (19.4%), 3 26 (11.5%), 9 31 (29.0%), 25 (8.0%), respectively. Thirty-one (36.9%) Of those, (80.6%) LDOM inhibitor, whereas (19.4%) received monotherapy. mean daily doses LDOM, finasteride, dutasteride 2.35 mg, 0.72 0.50 Twenty-one combination therapy achieved grade, 0.92 duration 16.9 (range, 6.0-84.0) (P = .001; r 0.60) (Fig 1). Four monotherapy 19.0 12.0-24.0) .05; 0.54). Five reported reduced libido erectile dysfunction. Other adverse effects hypertrichosis (n 2), postural hypotension palpitations 1) lethargy mild did not result discontinuation.Table IBaseline characteristics female lossCharacteristicsValuesAge onset, y, (range)25.5 (11.0-47.0)Age presentation, (range)28.7 (14.0-49.0)Race/ethnicity, n (%) European43 (51.2) South Central Asian (eg, Indian)25 (29.8) Southeast Vietnamese)4 (4.8) Northeast Chinese)3 (3.6) North African Middle Eastern8 (9.5) Sub-Saharan African1 (1.7)Family history loss, Androgenetic alopecia70 (83.3) Alopecia areata2 (2.4) None10 (11.9) Not recorded4 (4.8)Baseline 2.015 (17.6) 2.5∗Some grade 2.5 4.5 because scores assessors different (ie, 2/3 4/5, respectively).6 (7.1) 3.040 (47.6) 3.5∗Some respectively).0 (0.0) 4.018 (21.4) 4.5∗Some respectively).2 5.03 (3.6)Blood values outside reference range, (%)†Blood Total low: 10-35 nmol/L7 (19.4) Free 225-725 nmol/L3 (11.5) Prolactin, high: 45-375 mIU/L2 (5.0) DHEAS, high‡Normal blood differ according age.: μmol/L3 (8.8) >50 nmol/L9 (29.0) TSH, 0.5-5.5 mIU/L1 (2.8)§The patient normal triiodothyronine thyroxine levels. Zinc, 10-18 μmol/L2 (8.0) Ferritin, 30-320 μg/L0 (0.0)DHEAS, Dehydroepiandrosterone sulfate; thyroid-stimulating hormone.∗ Some respectively).† patients.‡ Normal age.§ Open table new tab hormone. observed all ethnic groups, most commonly white men. However, it noteworthy that relatively underrepresented, overrepresented, given European individuals constitute 68.5% 21.4% greater Melbourne population, Hypotestosteronemia hypovitaminosis D proportion testosterone deficiency has previously been described women AGA. Although lower have found FPHL,4Banihashemi M. Nahidi Y. Meibodi N.T. Serum vitamin D3 level loss.Int Trichology. 2016; 8: 116-120Crossref (17) no such association shown MPHL. Both inhibitors increase counts MPHL.5York K. Meah N. Bhoyrul B. R. A review male loss.Expert Opin Pharmacother. 2020; 21: 603-612Crossref (36) In study, longer resulted improvement superior Limitations study include sample size, retrospective design, referral bias specialist clinic. distinct variant resembles women. Further research required confirm role pathogenesis Our supports use authors thank Basem Fawzy Abd-Almoaty Abd-Allah Ali, freelance statistician, performed statistical analyses.