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This week we present the introduction to "The Contribution of Endogenous and Exogenous Factors to Male Alopecia: A Study of Identical Twins" by Guyuron et al.
Background: The purpose of this study is to investigate the potential contribution of environmental factors and testosterone on male alopecia.
Methods: Ninety-two identical male twins were recruited from 2009 to 2011. A comprehensive questionnaire was completed followed by the acquisition of sputum samples for testosterone analysis and standardized digital photography. Frontal (FHL), temporal (THL), and vertex (VHL) hair loss were assessed from these photographs. Hair loss was then correlated with survey responses and testosterone levels between twin pairs. Two independent, blinded observers also rated the photographs for hair thinning.
Results: While age and genetics were the predominant factors, increased smoking duration (p <0.001) and presence of dandruff (p =0.028) were significantly associated with increased FHL. Increased exercise duration (p =0.002), consumption of >4 alcoholic drinks per week (p =0.042), and increased money spent on hair-loss products (p =0.050) were all associated with increased THL. Daily hat use (p =0.050), higher body mass index (p =0.012), and higher testosterone levels (p =0.040) were associated with decreased THL. Factors that were significantly associated with increased VHL included abstinence from alcohol consumption (p =0.030), consumption of >4 alcoholic drinks per week (p = 0.004), increased smoking duration (p =0.047), increased exercise duration (p =0.050), and increased stress duration (p =0.010). Lower BMI, more children, increased caffeine consumption, history of skin disease, and abstinence from alcohol were significantly associated with increased hair thinning scores (p <0.05).
Conclusions: This study offers substantial evidence that exogenous factors may have a clinically significant impact on hair loss.
Stress and Vertex Hair Loss. Twins A and B, both 43 years of age. Twin B reported an increased duration of stress and had a lower BMI compared to Twin A. Twin B had an associated 0.17 increase in vertex hair loss.