Clinical Practice Guidelines Needed for patients with genetic hair loss
If you have genetic hair loss (male balding and female thinning), you may or may not know it, but the medical literature and past research would suggest you have a statistically higher chance of having abnormal cholesterol levels, high blood pressure, diabetes, and obesity. We call this constellation of symptoms the 'metabolic syndrome'. In other words, there is an increased risks of metabolic syndrome in individuals, both men and women, with androgenetic alopecia. Why does this matter? Well, metabolic syndrome increases the risk of heart attaches and strokes.
I'm sitting here this morning reading yet another study that piles on top of the numerous other studies that supports an association between androgenetic alopecia and one or more of high cholesterol, diabetes, obesity, and high blood pressure.
Researchers from Korea performed a study looking at 19 previous studies. They looked at levels of total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol in those with AGA compared to controls. Results showed that total cholesterol, TG, and LDL levels were significantly higher in individuals with AGA and HDL levels were lower. The authors concluded that individuals with androgenetic alopecia have statistically significant differences in their lipids profiles compared to those without AGA.
As a medical community, we have been slow to put these findings into action. Should we be screening patients with androgenetic alopecia for cholesterol and blood sugars? What about young patients? What about those with an early history of heart attacks and strokes? Nobody knows these answers yet. I'm not sure the medical community has really thought carefully enough about this yet. For two years in a row, I have even tried to speak at a major international meeting about the subject of hair loss and cardiovascular risk - but the request has been rejected two years in a row. Onwards and forwards.
Without clinical practice guidelines, physicians area left to do what they think is reasonable based on what they have read or learned. In a busy practice, filled with the emotions of hair loss, adding to this concerns about heart attacks and strokes is not an easy task. But we must act on behalf of our patients to provide them with the best possible care.
In the absence of clinical practice guidelines, we generally adhere to the following in my practice:
1. test baseline lipids, blood sugars, blood pressure and in all men and women under 25 with androgenetic hair loss
2. test baseline lipids, blood sugars, blood pressure and in all women with androgenetic alopecia with any endocrinopathy (such as polycystic ovarian syndrome)
3. test baseline lipids, blood sugars, blood pressure and in all men and women with a family history of a family member with heart attack or stroke before age 40 or cholesterol problem before age 40.
4. Refer patients with significant abnormalities results for specialty consultation
5. Encourage repeating of normal blood test results every 2-3 years with blood pressure recordings yearly.
In my opinion, there is truly a need, if not urgent need for physicians (cardiologists, general practicioners, endocrinology) to critically examine the relationship between androgenetic alopecia and metabolic syndrome and to develop clinical practice guidelines for blood pressure monitoring, cholesterol evaluation, diabetes testing in our patients.
Kim MW et al. Lipid profile in patients with androgenetic alopecia: a meta-analysis. J Eur Acad Dermatol Venereol 2016