Health-Related Quality of Life, Depression, and Self-esteem in Androgenetic Alopecia | Depressive Disorders | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Health-Related Quality of Life, Depression, and Self-esteem in Patients With Androgenetic AlopeciaA Systematic Review and Meta-analysis

Educational Objective
To examine the association of androgenetic alopecia with health-related quality of life and psychiatric disorders.
1 Credit CME
Key Points

Question  Is androgenetic alopecia associated with patients’ health-related quality of life?

Findings  In this systematic review and meta-analysis of 41 studies with 7995 patients, the pooled Dermatology Life Quality Index score for androgenetic alopecia was higher than for other common dermatoses. The pooled Hair-Specific Skindex-29 score showed moderate impairment in the emotion dimension of this assessment tool, whereas the pooled Center for Epidemiologic Studies Depression Scale score did not show an association with depression.

Meaning  Results of this study show an association between androgenetic alopecia and moderate impairment of not only health-related quality of life but also emotions, suggesting that patients with this disease may need psychological and psychosocial support.

Abstract

Importance  Androgenetic alopecia (AGA) is associated with trichodynia, anxiety, low self-esteem, and depression, which have implications for quality of life. However, no systematic evaluation has been performed on the association of AGA with health-related quality of life (HRQOL).

Objective  To systematically examine the association of AGA with HRQOL and psychiatric disorders.

Data Sources  Cochrane Library, PubMed, Embase, and WanFang databases were searched from inception through January 24, 2021.

Study Selection  Case series, case-control studies, cross-sectional studies, cohort studies, and randomized clinical trials that examined either HRQOL or psychiatric disorders in patients with AGA were included. Studies published in languages other than English and Mandarin were excluded.

Data Extraction and Synthesis  The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used. The risk of bias in included studies was assessed with the Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) tool. A random-effects model meta-analysis was performed to calculate the pooled effect on HRQOL. A subgroup analysis according to sex and geographic regions was also conducted.

Main Outcomes and Measures  The outcome was HRQOL of patients with AGA.

Results  A total of 41 studies involving 7995 patients was included. The pooled Dermatology Life Quality Index score was 8.16 (95% CI, 5.62-10.71). The pooled Hair-Specific Skindex-29 score indicated moderate impairment of emotions, with the meta-analysis showing a score of 29.22 (95% CI, 24.17-34.28) in the emotion dimension. The pooled Center for Epidemiologic Studies Depression Scale score did not indicate depression, with the meta-analysis showing a score of 14.98 (95% CI, 14.28-15.68). Factors that had a direct association with HRQOL included married or coupled status and receipt of medical treatments, whereas factors that had an inverse association with HRQOL included higher self-rated hair loss severity, lower visual analog scale score, and higher educational level.

Conclusions and Relevance  This systematic review and meta-analysis found a significant association of AGA with moderate impairment of HRQOL and emotions, but no association was found with depressive symptoms. The findings suggest that patients with AGA may need psychological and psychosocial support.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: May 9, 2021.

Published Online: July 7, 2021. doi:10.1001/jamadermatol.2021.2196

Corresponding Author: Ching-Chi Chi, MD, MMS, DPhil, Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, Taoyuan 33305, Taiwan (chingchi@cgmh.org.tw).

Author Contributions: Prof Chi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Huang.

Critical revision of the manuscript for important intellectual content: Fu, Chi.

Statistical analysis: Chi.

Administrative, technical, or material support: Chi.

Supervision: Chi.

Conflict of Interest Disclosures: None reported.

References
1.
Rhodes  T , Girman  CJ , Savin  RC ,  et al.  Prevalence of male pattern hair loss in 18-49 year old men.   Dermatol Surg. 1998;24(12):1330-1332. doi:10.1111/j.1524-4725.1998.tb00009.x PubMedGoogle ScholarCrossref
2.
Wang  TL , Zhou  C , Shen  YW ,  et al.  Prevalence of androgenetic alopecia in China: a community-based study in six cities.   Br J Dermatol. 2010;162(4):843-847. doi:10.1111/j.1365-2133.2010.09640.x PubMedGoogle ScholarCrossref
3.
Paik  JH , Yoon  JB , Sim  WY , Kim  BS , Kim  NI .  The prevalence and types of androgenetic alopecia in Korean men and women.   Br J Dermatol. 2001;145(1):95-99. doi:10.1046/j.1365-2133.2001.04289.x PubMedGoogle ScholarCrossref
4.
Tang  PH , Chia  HP , Cheong  LL , Koh  D .  A community study of male androgenetic alopecia in Bishan, Singapore.   Singapore Med J. 2000;41(5):202-205.PubMedGoogle Scholar
5.
Nyholt  DR , Gillespie  NA , Heath  AC , Martin  NG .  Genetic basis of male pattern baldness.   J Invest Dermatol. 2003;121(6):1561-1564. doi:10.1111/j.1523-1747.2003.12615.x PubMedGoogle Scholar
6.
Piraccini  BM , Alessandrini  A .  Androgenetic alopecia.   G Ital Dermatol Venereol. 2014;149(1):15-24.PubMedGoogle Scholar
7.
Cash  TF .  The psychosocial consequences of androgenetic alopecia: a review of the research literature.   Br J Dermatol. 1999;141(3):398-405. doi:10.1046/j.1365-2133.1999.03030.x PubMedGoogle ScholarCrossref
8.
Hunt  N , McHale  S .  The psychological impact of alopecia.   BMJ. 2005;331(7522):951-953. doi:10.1136/bmj.331.7522.951 PubMedGoogle ScholarCrossref
9.
Kivanç-Altunay  I , Savaş  C , Gökdemir  G , Köşlü  A , Ayaydin  EB .  The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia.   Int J Dermatol. 2003;42(9):691-693. doi:10.1046/j.1365-4362.2003.01847.x PubMedGoogle ScholarCrossref
10.
Willimann  B , Trüeb  RM .  Hair pain (trichodynia): frequency and relationship to hair loss and patient gender.   Dermatology. 2002;205(4):374-377. doi:10.1159/000066437 PubMedGoogle ScholarCrossref
11.
Moher  D , Liberati  A , Tetzlaff  J , Altman  DG .  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.   PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097 PubMedGoogle Scholar
12.
Sterne  JA , Hernán  MA , Reeves  BC ,  et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.   BMJ. 2016;355:i4919. doi:10.1136/bmj.i4919 PubMedGoogle Scholar
13.
Treadwell  JR , Tregear  SJ , Reston  JT , Turkelson  CM .  A system for rating the stability and strength of medical evidence.   BMC Med Res Methodol. 2006;6:52. doi:10.1186/1471-2288-6-52 PubMedGoogle ScholarCrossref
14.
Deeks  JJ , Higgins  JPT , Altman  DG . Analysing data and undertaking meta-analyses. In: Higgins  JPT , Thomas  J , Chandler  J ,  et al, eds.  Cochrane Handbook for Systematic Reviews of Interventions version 6.1. Cochrane Training; 2020.
15.
Lin  HB .  Investigation and study of the quality of life and depression in patients with androgenetic alopecia and alopecia areata.   China Modern Med. 2018;25(23):4.Google Scholar
16.
Liu  F , Miao  Y , Li  X ,  et al.  The relationship between self-esteem and hair transplantation satisfaction in male androgenetic alopecia patients.   J Cosmet Dermatol. 2018;18(5):1441-1447. doi:10.1111/jocd.12839 PubMedGoogle ScholarCrossref
17.
Wang  X , Xiong  C , Zhang  L ,  et al.  Psychological assessment in 355 Chinese college students with androgenetic alopecia.   Medicine (Baltimore). 2018;97(31):e11315. doi:10.1097/MD.0000000000011315 PubMedGoogle Scholar
18.
Mao  Y , Dai  Y , Sun  C , Xu  A .  Analysis of quality of life and depression in patients with androgenetic alopecia or alopecia areata.   Chinese J Dermatol. 2017;50(5):4.Google Scholar
19.
Zhang  M , Zhang  N .  Quality of life assessment in patients with alopecia areata and androgenetic alopecia in the People’s Republic of China.   Patient Prefer Adherence. 2017;11:151-155. doi:10.2147/PPA.S121218 PubMedGoogle ScholarCrossref
20.
Yu  NL , Tan  H , Song  ZQ , Yang  XC .  Illness perception in patients with androgenetic alopecia and alopecia areata in China.   J Psychosom Res. 2016;86:1-6. doi:10.1016/j.jpsychores.2016.04.005 PubMedGoogle ScholarCrossref
21.
Lan  XM , Tan  H , Yang  XC .  Evaluation of the quality of life in male patients with androgenetic alopecia.   J Clin Dermatol. 2015;44(7):417-419.Google Scholar
22.
Zhuang  XS , Zheng  YY , Xu  JJ , Fan  WX .  Quality of life in women with female pattern hair loss and the impact of topical minoxidil treatment on quality of life in these patients.   Exp Ther Med. 2013;6(2):542-546. doi:10.3892/etm.2013.1126 PubMedGoogle ScholarCrossref
23.
Hu  XP , Wang  WJ , Zhong  QI , Yu  B , Ma  G .  Questionnaire analysis of related factors of male pattern alopecia and clinical efficacy of finasteride therapy in 320 patients.   J Xi'an Jiaotong University (Medical Sciences). 2009;30(5):620-623.Google Scholar
24.
Gonul  M , Cemil  BC , Ayvaz  HH , Cankurtaran  E , Ergin  C , Gurel  MS .  Comparison of quality of life in patients with androgenetic alopecia and alopecia areata.   An Bras Dermatol. 2018;93(5):651-658. doi:10.1590/abd1806-4841.20186131 PubMedGoogle ScholarCrossref
25.
Tas  B , Kulacaoglu  F , Belli  H , Altuntas  M .  The tendency towards the development of psychosexual disorders in androgenetic alopecia according to the different stages of hair loss: a cross-sectional study.   An Bras Dermatol. 2018;93(2):185-190. doi:10.1590/abd1806-4841.20185658 PubMedGoogle ScholarCrossref
26.
Sancak  EB , Oguz  S , Akbulut  T ,  et al.  Female sexual dysfunction in androgenetic alopecia: case-control study.   Can Urol Assoc J. 2016;10(7-8):E251-E256. doi:10.5489/cuaj.3582 PubMedGoogle ScholarCrossref
27.
Yayli  S , Tiryaki  A , Doǧan  S , Iskender  B , Bahadir  S .  The role of stress in alopecia areata and comparison of life quality of patients with androgenetic alopecia and healthy controls.   Turkderm-Turk Arch Dermatol Venereol. 2012;46(3):134-137. doi:10.4274/Turkderm.79653 Google Scholar
28.
Kutlu  Ö , Metin  A .  Systemic dexpanthenol as a novel treatment for female pattern hair loss.   J Cosmet Dermatol. 2021;20(4):1325-1330. doi:10.1111/jocd.13729 PubMedGoogle ScholarCrossref
29.
Russo  PM , Fino  E , Mancini  C , Mazzetti  M , Starace  M , Piraccini  BM .  HrQoL in hair loss-affected patients with alopecia areata, androgenetic alopecia and telogen effluvium: the role of personality traits and psychosocial anxiety.   J Eur Acad Dermatol Venereol. 2019;33(3):608-611. doi:10.1111/jdv.15327 PubMedGoogle ScholarCrossref
30.
Tabolli  S , Sampogna  F , di Pietro  C , Mannooranparampil  TJ , Ribuffo  M , Abeni  D .  Health status, coping strategies, and alexithymia in subjects with androgenetic alopecia: a questionnaire study.   Am J Clin Dermatol. 2013;14(2):139-145. doi:10.1007/s40257-013-0010-3 PubMedGoogle ScholarCrossref
31.
Maffei  C , Fossati  A , Rinaldi  F , Riva  E .  Personality disorders and psychopathologic symptoms in patients with androgenetic alopecia.   Arch Dermatol. 1994;130(7):868-872. doi:10.1001/archderm.1994.01690070062009 PubMedGoogle ScholarCrossref
32.
Vastarella  M , Cantelli  M , Patrì  A , Annunziata  MC , Nappa  P , Fabbrocini  G .  Efficacy and safety of oral minoxidil in female androgenetic alopecia.   Dermatol Ther. 2020;33(6):e14234. doi:10.1111/dth.14234 PubMedGoogle Scholar
33.
Reid  EE , Haley  AC , Borovicka  JH ,  et al.  Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia.   J Am Acad Dermatol. 2012;66(3):e97-e102. doi:10.1016/j.jaad.2010.11.042 PubMedGoogle ScholarCrossref
34.
Cash  TF , Price  VH , Savin  RC .  Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects.   J Am Acad Dermatol. 1993;29(4):568-575. doi:10.1016/0190-9622(93)70223-G PubMedGoogle ScholarCrossref
35.
Cash  TF .  The psychological effects of androgenetic alopecia in men.   J Am Acad Dermatol. 1992;26(6):926-931. doi:10.1016/0190-9622(92)70134-2 PubMedGoogle ScholarCrossref
36.
Shilpashree  P , Clarify  S , Jaiswal  AK , Shashidhar  T .  Impact of female pattern hair loss on the quality of life of patients.   J Pakistan Assoc Dermatologists. 2016;26(4):347-352.Google Scholar
37.
Sawant  N , Chikhalkar  S , Mehta  V , Ravi  M , Madke  B , Khopkar  U .  Androgenetic alopecia: quality-of-life and associated lifestyle patterns.   Int J Trichology. 2010;2(2):81-85. doi:10.4103/0974-7753.77510 PubMedGoogle ScholarCrossref
38.
Gupta  S , Goyal  I , Mahendra  A .  Quality of life assessment in patients with androgenetic alopecia.   Int J Trichology. 2019;11(4):147-152. doi:10.4103/ijt.ijt_6_19 PubMedGoogle ScholarCrossref
39.
Jun  M , Keum  DI , Lee  S , Kim  BJ , Lee  WS .  Quality of life with alopecia areata versus androgenetic alopecia assessed using Hair Specific Skindex-29.   Ann Dermatol. 2018;30(3):388-391. doi:10.5021/ad.2018.30.3.388 PubMedGoogle ScholarCrossref
40.
Han  SH , Byun  JW , Lee  WS ,  et al.  Quality of life assessment in male patients with androgenetic alopecia: result of a prospective, multicenter study.   Ann Dermatol. 2012;24(3):311-318. doi:10.5021/ad.2012.24.3.311 PubMedGoogle ScholarCrossref
41.
Danyal  M , Shah  SIA , Ul Hassan  MS , Qureshi  W .  Impact of androgenetic alopecia on the psychological health of young men.   Pakistan J Med Health Sci. 2018;12(1):406-410.Google Scholar
42.
Tahir  K , Aman  S , Nadeem  M , Kazmi  AH .  Quality of life in patients with androgenetic alopecia.   Ann King Edward Med University. 2013;19(2):150-154. Google Scholar
43.
Katoulis  AC , Liakou  AI , Koumaki  D ,  et al.  A randomized, single-blinded, vehicle-controlled study of a topical active blend in the treatment of androgenetic alopecia.   Dermatol Ther. 2020;33(4):e13734. doi:10.1111/dth.13734 PubMedGoogle Scholar
44.
Katoulis  AC , Liakou  AI , Alevizou  A ,  et al.  Efficacy and safety of a topical botanical in female androgenetic alopecia: a randomized, single-blinded, vehicle-controlled study.   Skin Appendage Disord. 2018;4(3):160-165. doi:10.1159/000480024 PubMedGoogle ScholarCrossref
45.
Ramos  PM , Sinclair  RD , Kasprzak  M , Miot  HA .  Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial.   J Am Acad Dermatol. 2020;82(1):252-253. doi:10.1016/j.jaad.2019.08.060 PubMedGoogle ScholarCrossref
46.
Guerra-Tapia  A , Buendía-Eisman  A , Ferrando Barbera  J ; en representación del grupo de validación Hair Specific Skindex-29; Componentes del grupo de Validación Hair Specific Skindex-29.  Final phase in the validation of the cross-cultural adaptation of the Hair-Specific Skindex-29 questionnaire into Spanish: sensitivity to change and correlation with the 12-Item Short-Form Health Survey.   Actas Dermosifiliogr. 2019;110(10):819-829. doi:10.1016/j.ad.2019.06.003 PubMedGoogle ScholarCrossref
47.
Ghimire  RB .  Impact on quality of life in patients who came with androgenetic alopecia for hair transplantion surgery in a clinic.   JNMA J Nepal Med Assoc. 2018;56(212):763-765. doi:10.31729/jnma.3500 PubMedGoogle ScholarCrossref
48.
Chyi  LW , Tan  ESS , Lee  CK , Rehman  N , Chao  LW , Keat  TC .  Quality of life in adults with androgenic alopecia.   Indian J Public Health Res Dev. 2019;10(4):1120-1125. doi:10.5958/0976-5506.2019.00860.X Google ScholarCrossref
49.
Sanclemente  G , Burgos  C , Nova  J ,  et al; Asociación Colombiana de Dermatología y Cirugía Dermatológica (Asocolderma).  The impact of skin diseases on quality of life: a multicenter study.   Actas Dermosifiliogr. 2017;108(3):244-252. doi:10.1016/j.ad.2016.11.008 PubMedGoogle ScholarCrossref
50.
Monselise  A , Bar-On  R , Chan  L , Leibushor  N , McElwee  K , Shapiro  J .  Examining the relationship between alopecia areata, androgenetic alopecia, and emotional intelligence.   J Cutan Med Surg. 2013;17(1):46-51. doi:10.2310/7750.2012.12003 PubMedGoogle ScholarCrossref
51.
Yamazaki  M , Miyakura  T , Uchiyama  M , Hobo  A , Irisawa  R , Tsuboi  R .  Oral finasteride improved the quality of life of androgenetic alopecia patients.   J Dermatol. 2011;38(8):773-777. doi:10.1111/j.1346-8138.2010.01126.x PubMedGoogle ScholarCrossref
52.
Hirsso  P , Rajala  U , Laakso  M , Hiltunen  L , Härkönen  P , Keinänen-Kiukaanniemi  S .  Health-related quality of life and physical well-being among a 63-year-old cohort of women with androgenetic alopecia; a Finnish population-based study.   Health Qual Life Outcomes. 2005;3:49. doi:10.1186/1477-7525-3-49 PubMedGoogle ScholarCrossref
53.
Schmidt  S , Fischer  TW , Chren  MM , Strauss  BM , Elsner  P .  Strategies of coping and quality of life in women with alopecia.   Br J Dermatol. 2001;144(5):1038-1043. doi:10.1046/j.1365-2133.2001.04195.x PubMedGoogle ScholarCrossref
54.
Biondo  S , Sinclair  R.   Quality of life in Australian women with female pattern hair loss.   Open Dermatol J. 2010;4:90-94. doi:10.2174/1874372201004010090 Google ScholarCrossref
55.
Elsaie  LT , Elshahid  AR , Hasan  HM , Soultan  FAZM , Jafferany  M , Elsaie  ML .  Cross sectional quality of life assessment in patients with androgenetic alopecia.   Dermatol Ther. 2020;33(4):e13799. doi:10.1111/dth.13799 PubMedGoogle Scholar
56.
Higgins  JPT , Savović  J , Page  MJ , Elbers  RG , Sterne  JAC . Assessing risk of bias in a randomized trial. In: Higgins  JPT , Thomas  J , Chandler  J ,  et al, eds.  Cochrane Handbook for Systematic Reviews of Interventions version 6.1. Cochrane Training; 2020.
57.
Schielein  MC , Tizek  L , Ziehfreund  S , Sommer  R , Biedermann  T , Zink  A .  Stigmatization caused by hair loss—a systematic literature review.   J Dtsch Dermatol Ges. 2020;18(12):1357-1368. doi:10.1111/ddg.14234PubMedGoogle Scholar
58.
Davis  DS , Callender  VD .  Review of quality of life studies in women with alopecia.   Int J Womens Dermatol. 2018;4(1):18-22. doi:10.1016/j.ijwd.2017.11.007 PubMedGoogle ScholarCrossref
59.
Cash  TF .  The psychology of hair loss and its implications for patient care.   Clin Dermatol. 2001;19(2):161-166. doi:10.1016/S0738-081X(00)00127-9 PubMedGoogle ScholarCrossref
60.
Lewinsohn  PM , Seeley  JR , Roberts  RE , Allen  NB .  Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults.   Psychol Aging. 1997;12(2):277-287. doi:10.1037/0882-7974.12.2.277 PubMedGoogle ScholarCrossref
61.
Otberg  N , Finner  AM , Shapiro  J .  Androgenetic alopecia.   Endocrinol Metab Clin North Am. 2007;36(2):379-398. doi:10.1016/j.ecl.2007.03.004 PubMedGoogle ScholarCrossref
62.
Kranz  D .  Young men’s coping with androgenetic alopecia: acceptance counts when hair gets thinner.   Body Image. 2011;8(4):343-348. doi:10.1016/j.bodyim.2011.06.006 PubMedGoogle ScholarCrossref
63.
Rencz  F , Gulácsi  L , Péntek  M , Wikonkál  N , Baji  P , Brodszky  V .  Alopecia areata and health-related quality of life: a systematic review and meta-analysis.   Br J Dermatol. 2016;175(3):561-571. doi:10.1111/bjd.14497 PubMedGoogle ScholarCrossref
64.
Basra  MK , Fenech  R , Gatt  RM , Salek  MS , Finlay  AY .  The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results.   Br J Dermatol. 2008;159(5):997-1035. doi:10.1111/j.1365-2133.2008.08832.x PubMedGoogle Scholar
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close