Androgen Dependence of Hirsutism, Acne, and Alopecia in Women

    January 2009 in “ Medicine ”
    Sandra Karrer-Voegeli, François Rey, Marianne J. Reymond, Jean‐Yves Meuwly, Rolf C. Gaillard, Fulgencio Gómez
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    TLDR Hirsutism is more linked to high androgen levels than acne or hair loss, and a mix of hormonal tests is best for diagnosis; certain treatments can reduce symptoms.
    The document from 2009 presents a study on the androgen dependence of hirsutism, acne, and alopecia in women, analyzing hormonal data from 279 patients. It found that hirsutism is more strongly associated with hyperandrogenism than alopecia and acne, with patients with hirsutism having higher levels of androstenedione, DHEAS, and salivary testosterone, and lower levels of SHBG. The study also showed that salivary testosterone is a better marker for hirsutism than total testosterone. Treatment with ethinylestradiol and high-dose cyproterone acetate significantly reduced hirsutism scores by 53.5% at 1 year and was also effective for acne and alopecia. Spironolactone alone was effective for treating isolated alopecia in patients with normal androgens. The study concluded that no single androgenic parameter could identify all cases of hyperandrogenism, but a combination of parameters was most effective. Ethnic origin did not affect the clinical-biological correlation, and the prevalence of nonclassic adrenal hyperplasia (NCAH) was found to be 4.7% among the study population. The study suggests that while antiandrogenic therapy is less beneficial for alopecia than for hirsutism or acne, it still offers some improvement, indicating a lesser androgen dependence of alopecia.
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