A Meta-Analysis of the Effects of Smoking on AGA

Over 1 billion people in the world smoke - which here is defined as the consumption of nicotine-containing tobacco. Smoking is felt to be a risk factor for both the development of AGA and the worsening AGA. The subject, however, remains somewhat controversial.

Several studies have examined the relationship between smoking and androgenetic alopecia. To date, there are almost a dozen such studies.

Mosley and Gibbs, 1996

The Mosley and Gibbs study of 1996 often gets referenced when it comes to smoking and hair loss studies. This was one of the first reports that meant to address the relationship between smoking and hair loss meaningfully. The authors studied 606 patients (268 male and 338 female) aged 30 and over who were visiting a surgical outpatient department over the three months of the study. Patients who were smokers had a nearly two-fold greater risk for balding than non-smokers (odds ratio 1.93 (95% confidence interval [CI]: 1.13–3.28). Interestingly, in that same study, smokers were 4.4 times more likely to have greying of hair than non-smokers, implicating smoking in the greying of hair, too.

Gupta et al. 2024

The authors systematically searched the literature for published studies with suitable data better to understand the relationship between smoking and hair loss and then conducted a meta-analysis. In total, the authors found eight studies to include in their meta-analysis.

Results

The authors made several key observations in their study:

• The authors found that “ever smokers” were more likely than “never smokers” to develop AGA (pooled odds ratio (OR) = 1.82, 95% confidence interval (CI): 1.55–2.14).

• The odds of developing AGA were significantly higher in men who smoke ten or more cigarettes per day compared to men who smoke up to 10 cigarettes per day (pooled OR = 1.96, 95% CI: 1.17–3.29).

• For men with AGA, the odds of disease progression (from mild stages to more advanced stages) were significantly higher among ever-smokers than in never-smokers (pooled OR = 1.27, 95% CI: 1.01–1.60).

• There was no significant association that could be found between smoking intensity (less than 20 cigarettes per day vs 20 or more) and disease progression.

REFERENCES*

Gupta AK et al. A meta-analysis study on the association between smoking and male pattern hair loss. J Cosmet Dermatol. 2024 Apr;23(4):1446-1451. doi: 10.1111/jocd.16132. Epub 2024 Jan 4.

Dai X et al. Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control. 2022 Mar;31(2):129-137. doi: 10.1136/tobaccocontrol-2021-056535

Kavadya T and Mysore V. Role of Smoking in Androgenetic Alopecia: A Systematic Review. Int J Trichology. 2022 Mar-Apr; 14(2): 41–48.

Su LH and Chen T H-H. Association of Androgenetic Alopecia with Smoking and Its Prevalence Among Asian Men. Archives of Dermatology 2007 143; 1401-1406.

Mosley JG and Gibbs AC. Premature grey hair and hair loss among smokers: a new opportunity for health education? British Medical Journal 1996; 313: 1616.

Fortes C, Mastroeni S, Mannooranparampil TJ, Ribuffo M. The combination of overweight and smoking increases the severity of androgenetic alopecia. Int J Dermatol. 2017;56:862–7. [PubMed: 28555720]

Salem AS, Ibrahim HS, Abdelaziz HH, Elsaie ML. Implications of cigarette smoking on early-onset androgenetic alopecia: A cross-sectional study. J Cosmet Dermatol. 2021;20:1318–24. [PubMed: 32946667]

Park SY, Oh SS, Lee WS. Relationship between androgenetic alopecia and cardiovascular risk factors according to BASP classification in Koreans. J Dermatol. 2016;43:1293–300. [PubMed: 27028221]

Gatherwright J, Liu MT, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to female alopecia: A study of identical twins. Plast Reconstr Surg. 2012;130:1219–26. [PubMed: 22878477]

Vora RV, Kota RK, Singhal RR, Anjaneyan G. Clinical profile of androgenic alopecia and its association with cardiovascular risk factors. Indian J Dermatol. 2019;64:19–22. [PMCID: PMC6340244] [PubMed: 30745630]

Gatherwright J, Liu MT, Amirlak B, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to male alopecia: A study of identical twins. Plast Reconstr Surg. 2013;131:794e–801e.