ALTERATIONS IN ANDROGEN CONJUGATE LEVELS IN WOMEN AND MEN WITH ALOPECIA

Objective: To assess levels of androgen metabolites thought to reflect , at least in part, peripheral androgen activity in women with androge nic alopecia and men with premature balding in an effort to determine if a common abnormality exists. Design: Prospective study in various g roups of women and men. Setting: Reproductive Endocrine Clinic at our university medical center. Patients: Ten normal ovulatory female contr ols and 50 hyperandrogenic women divided on the basis of hirsutism and alopecia as follows: [1] 8 hirsute women with androgenic alopecia; [2 ] 12 nonhirsute women with androgenic alopecia; [3] 18 hirsute women w ithout androgenic alopecia; and [4] 12 nonhirsute women without androg enic alopecia. Ten normal men and 10 young premature balding men match ed for age and weight also were compared. Intervention: Blood was obta ined from all subjects. Main Outcome Measure: Comparison of blood horm one levels in the various groups. Results: Serum T, androstenedione, a nd DHEAS were similarly elevated in hyperandrogenic women with and wit hout alopecia, compared with controls. The female groups were then div ided on the basis of hirsutism. Hirsute groups with and without alopec ia had similarly elevated levels of unconjugated 3 alpha-androstanedio l, 3 alpha-androstanediol glucuronide, 3 alpha-androstanediol sulfate, androsterone glucuronide, and androsterone sulfate compared with cont rols. In the nonhirsute groups, androgenic alopecia patients were comp ared with hyperandrogenic females and cycling controls. The androgenic alopecia patients had elevated levels of 3 alpha-androstanediol (0.75 +/- 0.12 versus 0.46 +/- 0.1 and 0.41 +/- 0.1 nmol/L), 3 alpha-andros tanediol sulfate (200 +/- 31 versus 79.6 +/- 6 and 67.0 +/- 4.0 nmol/L ), elevated ratios of 3 alpha-androstanediol sulfate:3 alpha-androstan ediol (267 +/- 49 versus 170 +/- 20 and 164 +/- 49 nmol/L), elevated r atios of 3 alpha-androstanediol sulfate:3 alpha-androstanediol glucuro nide (32.2 +/- 6 versus 10.8 +/- 1 and 10.0 +/- 1) and lower ratios of 3 alpha-androstanediol glucuronide:30 alpha-androstanediol glucuronid e (8.3 +/- 1.8 versus 17 +/- 1.7 and 15.2 +/- 1.6 nmol/L). In men the premature balding group had lower levels of 3 alpha-androstanediol glu curonide compared with the male controls (29.8 +/- 4.4 versus 15.2 +/- 1.6 nmol/L). Also, the ratio of 3 alpha-androstanediol glucuronide:3 alpha-androstanediol was significantly decreased, whereas the ratio of 3 alpha-androstanediol sulfate:3 alpha-androstanediol glucuronide was elevated. Conclusions: These data provided evidence confirming that e nhanced 5 alpha-reductase activity occurs in androgenic alopecia but a lso suggests that a disorder of androgen conjugation, favoring sulfury lation over glucuronidation, may be a characteristic feature of scalp hair loss.