Endocrine Abstracts

Importance: Early-onset androgenetic alopecia (AGA) has been suggested as a phenotypic sign of the male polycystic ovary syndrome (PCOS)-equivalent since men with this feature have a PCOS-like hormonal pattern. No study has evaluated the gonadal function of these men.

Objective: To study the gonadal function of men with early-onset AGA and to identify suggestive criteria of male PCOS-equivalent.

Design: This case-control study was conducted from January 2014 to June 2016.

Setting: The study was carried out on patients referring to hospital for andrological check-up.

Participants: Forty-four men with early-onset AGA (19–30 years) and 37 aged-matched healthy men (controls) were enrolled. A subgroup of patients was assumed to have the male PCOS-equivalent (sAGA) when at least one of the following parameter was present: BMI >25 kg/m², insulin-resistance (IR) (HOMA index >2.5), SHBG <25 nmol/l. The remaining patients were considered to have AGA alone (aAGA).

Main outcome(s) and measure(s): The primary outcome was to evaluate the gonadal function and the metabolic/hormonal features of men with early-onset AGA. The secondary outcome was to identify which parameters may be used to suspect the male PCOS-equivalent syndrome among men with early-onset AGA.

Results: Patients had higher mean (±S.D.) BMI (25.5±3.8 vs 23.7±3.0 kg/m²; P<0.05) and 17αOH-progesterone (2.05±0.90 vs 1.51±0.62 ng/ml; P<0.05) compared to controls. sAGA had higher levels of insulin (11.8±1.7 vs 6.0±0.4 μU/ml; P<0.01) and LH (4.9±2.1 vs 3.8±1.4 mIU/ml; P<0.05), lower total testosterone (TT) levels (5.2±1.7 vs 6.3±1.6 ng/ml; P<0.05) and left testicular volume (TV) (12.3±2.8 vs 15.4±4.1 ml; P<0.05) compared to aAGA. sAGA also had higher fat-mass percentage (17.6±4.1 vs 13.2±5.3%; P<0.05), DHEAS (323.3±112.6 vs 257.8±107.1 μg/dl; P<0.05) and seminal fluid volume (4.2±2.8 vs 2.8±1.3 ml; P<0.05), lower TT (5.16±1.70 vs 6.47±4.30 ng/ml; P=0.016) and left TV (12.3±2.8 vs 15.0±4.3 ml; P<0.05) compared to controls.

Conclusion and relevance: Men with early-onset AGA and at least one among the following parameters BMI >25 kg/m², IR, SHBG <25 nmol/l had a borderline-low left TV and a impaired gonadal steroidogenesis. Hence, they might have a greater risk to develop a gonadal dysfunction later in life. These criteria may be used to suspect the male PCOS-equivalent.