Work

Association Between Circulating Androgens and Androgenetic Alopecia in Adult Males: A Systematic Review

Year: 2026

Type: review

Abstract: Purpose To evaluate systemically whether men with androgenetic alopecia (AGA) and controls differ in terms of circulating androgens such as dihydrotestosterone (DHT), total testosterone (TT), sex hormone–binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA‐S), luteinizing hormone (LH), and follicle‐stimulating hormone (FSH). Methods We followed PRISMA guidelines in conducting this systematic review, and our protocol was registered on PROSPERO (CRD420251114788). We searched PubMed, Google Scholar, Scopus, Cochrane, and Science Direct for observational studies that quantitatively measured at least one prespecified hormone in clinically diagnosed AGA adult males. We included data from serum or plasma from case–control, cross‐sectional, or cohort study designs. Data were extracted and assessed for bias (Newcastle–Ottawa Scale) in duplicate. Narrative synthesis was undertaken due to methodological heterogeneity. Results There were 13 studies in total ( n = 1,389; 672 AGA cases and 717 controls). The strongest and most consistent elevation was seen in DHT, which was reported in 4 out of 7 studies. Case–control differences ranged from 25% to 85%, particularly in studies that used production‐rate assays or phenotype‐stratified analysis. Three studies showed a higher TT, two showed a lower TT, and five showed no change. Three out of 7 studies showed a decrease in SHBG, while 3 out of 6 studies showed an increase in DHEA‐S, though not all of them did. There were slight phenotype‐sensitive changes in LH and FSH. Signal strength was influenced by the assay technique (LC–MS/MS vs. immunoassay, for example) and the makeup of the phenotype. There were insufficient and contradictory secondary findings (genotype and PSA). To our knowledge, this review represents one of the first to apply phenotype‐stratified interpretation systematically across multiple hormone classes in AGA, distinguishing signals by hair‐shaft thickness, severity grade, and DHT‐defined subgroups. Conclusion Circulating DHT consistently distinguishes AGA from controls and aligns with scalp‐level biology and therapeutic targeting. Variable patterns are seen with other hormones and support the need for standardized assays, phenotype‐directed analysis, and rigorous preanalytical control in subsequent research.

Source: Dermatologic Therapy

DOI: 10.1155/dth/5574276