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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 87-92

The psychosocial effect of androgenetic alopecia in males and females


1 Department of Dermatology, Andrology and Venereology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Dermatology, Andrology and Venereology, Ministry of Health, Etay Albaroud Hospital, Elbehira, Egypt

Date of Submission10-Sep-2019
Date of Decision15-Oct-2019
Date of Acceptance20-Oct-2019
Date of Web Publication27-Mar-2021

Correspondence Address:
Hala E Doma
Department of Dermatology, Andrology and Venereology, Ministry of Health, Etay Albaroud Hospital, Elbehira
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_268_19

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  Abstract 


Objective
The aim was to shed light on the psychosocial effect of androgenetic alopecia (AGA) in both males and females and its effect on quality of life of those patients.
Background
Hair loss can cause several psychological/psychiatric problems and lower self-confidence and sexual attractiveness, with impairment in school performance.
Materials and methods
A cross-sectional study was conducted that included 200 males and females diagnosed as having AGA.
Results
There were no significant differences between male and female, between urban and rural, between married patients and not married patients, and among nonworkers, manual workers, and professional workers regarding emotion, function, social, self-confidence, and total quality-of-life score. Moreover, there was a significant difference between married patients and not married patients regarding emotion score, with scores of 18.1 ± 1.54 and 15.97 ± 2.08, respectively (P < 0.001). There was a significant difference among nonworker, manual worker, and professional work regarding emotion score, where score 15.6 ± 1.21, 17.72 ± 1.42, and 18.22 ± 1.42, respectively (P = 0.005). There was a significant difference among nonworkers, manual worker, and professional work, regarding function score, with scores of 12.50 ± 1.51, 11.1 ± 1.77, and 10.65 ± 1.8, respectively. There was a positive significant correlation between age of studied patients and emotion score, and a negative significant correlation between age of studied patients and function score. On the contrary, there was a nonsignificant negative correlation between age of studied patients and social and total score and a nonsignificant positive correlation with self-confidence.
Conclusion
It was important to identify the psychological effect of AGA among the patients, as this was necessary to provide the psychological treatment with other line in these patients.

Keywords: alopecia, androgenic, effect, psychological, quality of life


How to cite this article:
Gaber MA, Doma HE. The psychosocial effect of androgenetic alopecia in males and females. Menoufia Med J 2021;34:87-92

How to cite this URL:
Gaber MA, Doma HE. The psychosocial effect of androgenetic alopecia in males and females. Menoufia Med J [serial online] 2021 [cited 2021 Jun 21];34:87-92. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/87/312044




  Introduction Top


Hair plays an important role in self-image, social perception, and psychosocial functioning. Androgenetic alopecia (AGA) was characterized by a progressive scalp hair loss taking a distinct pattern [1].

AGA was considered one of the most common causes of hair loss in both sexes. These patients were commonly affected by psychiatric comorbidities. AGA is present in 50% of men at 50 s years of age, whereas 70% of men and 38% of women are usually affected at older ages. Although this disorder is highly common, the current treatments have limited efficacy [1],[2].

Owing to this reason, even a clinically imperceptible hair loss had been associated with reduced quality of life (QoL). It can cause several psychological/psychiatric comorbidities such as embarrassment, depression, fatigue, anxiety, anger, lower self-confidence, impaired sexual life, and deteriorated school performance and higher incidence of suicidal ideation [2].

The current study aimed to shed light on the psychosocial effect of AGA in both males and females and its effect on QoL of those patients.


  Materials and methods Top


A cross-sectional study was conducted on 200 male and female patients diagnosed as having AGA within a time period from March 2019 to August 2019 after the study approval by the Ethical Committee Faculty of Medicine and after taking informed written consent from the patients.

Patients with systemic diseases (diabetes mellitus, heart failure, and liver cirrhosis), chronic infection, patients have autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus or other immunological disorders (immunodeficiency), patients with psychological disorders owing to other causes than AGA, and patients with alopecia owing to other causes (alopecia areata, telogen effluvium, anagen effluvium, trichotillomania, tinea capitis, and hair falling after chemotherapy) were excluded.

Every patient was evaluated by history taking and the concerned individual's general health, including the existence of previous AGA, triggering factors, presence of autoimmune disease, atopy, family history of AGA, and complete clinical, dermatological, and physical examination.

Data were collected, tabulated, and statistically analyzed using a personal computer with Statistical Package for the Social Sciences version 22 (IBM Corp., Armonk, NY, USA), where the following statistics were applied: descriptive statistics, which were presented as number, percentage, mean, and SD, and analytical statistics, such as Student's t-test, which was used for comparison between two groups having quantitative variables and with independent parametric data. One-way analysis of variance test was used for comparison between more than two groups having quantitative variables and with independent parametric data. Post-hoc test was used for multiple comparisons between subgroups of sample having quantitative variables. Pearson correlation was used to study the correlation between normally distributed quantitative variables. P value greater than 0.05 was considered to be statistically insignificant, P value less than or equal to 0.05 to be statistically significant, and P value less than or equal to 0.001 to be highly statistically significant.


  Results Top


The age range of the studied patients was 18–41 years, with a mean of 30 ± 5.51 years. Overall, 51.5% of the studied patients were males and 48.5% were females. Moreover, 75% of the studied patients were manual worker, 22% professional, and 3% were not working. In addition, 51% of studied patients had rural residency and 49% had urban residency. Furthermore, 81.5% of studied patients were married and 18.5% were not.

The emotion score of the studied patients was 17.7 ± 1.86, with a range of 13–22. The function score of the studied patients was 11.04 ± 1.79, with a range of 7–15. The social score of the studied patients was 18.8 ± 2.7, with a range of 11–25. The self-confidence score of the studied patients was 12.66 ± 1.55, with a range of 7–16. Total score of the studied patients was 60.32 ± 4.9, with a range of 47–72.

There were no significant differences between male and female regarding emotion, function, social, self-confidence, and total quality-of-life (QL) score (P > 0.05) [Table 1].
Table 1: Comparison of total quality life score of studied patients with alopecia according to sex (number of cases=200)

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There were no significant differences between urban and rural populations regarding emotion, function, social, and self-confidence scores (P > 0.05). There was a significant difference in total score between urban and rural populations, with scores of 61.05 ± 4.88 and 59.62 ± 4.86, respectively (P = 0.04) [Table 2].
Table 2: Comparison of total quality-of-life score of studied patients with alopecia according to residency (number of cases=200)

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There were no significant differences between married patients and not married patients regarding function, social, self-confidence, and total scores (P > 0.05). Moreover, there was a significant difference between married patients and not married patients regarding emotion score, with scores of 18.1 ± 1.54 and 15.97 ± 2.08, respectively (P < 0.001) [Table 3].
Table 3: Comparison of total quality-of-life score of studied patients with alopecia according to marital status (number of cases=200)

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There were no significant differences among nonworkers, manual workers, and professional workers regarding social, self-confidence, and total scores. There was a significant difference among nonworkers, manual workers, and professional workers regarding emotion scores, with scores of 15.6 ± 1.21, 17.72 ± 1.42, and 18.22 ± 1.42, respectively (P = 0.005). There was a significant difference among nonworkers, manual workers, and professional workers regarding function score with scores of 12.50 ± 1.51, 11.1 ± 1.77, and 10.65 ± 1.8, respectively (P = 0.04) [Table 4].
Table 4: Comparison of total quality-of-life score of the studied patients with alopecia according to occupation (number of cases=200)

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There was a positive significant correlation between age of studied patients and emotion score (P < 0.001 and r = 0.24) and a negative significant correlation between age of studied patients and function score (P = 0.02 and r=−0.15). On the contrary, there was a nonsignificant negative correlation between age of studied patients and social (P = 0.07 and r=−0.12) and total score (P = 0.76 and r=−0.02) and a nonsignificant positive correlation with respect to self-confidence (P = 0.59 and r = 0.03).


  Discussion Top


Because hair plays an important role in characteristic self-image, psychosocial functioning, and social perception, even a clinically mild hair loss can significantly affected the QoL [3]. In Egypt particularly, there is paucity in research exploring the patients' belief on AGA and how it relates to their mental health. So, we conducted this cross-sectional study to shed light on the psychosocial effect of AGA in both males and females and its effect on QoL of those patients. The association between AGA and psychological disorders is well documented [4]. In current study, the emotion score of studied patients was 17.7 ± 1.86, with a range of 13–22. The function score of studied patients was 11.04 ± 1.79. The social score of the studied patients was 18.8 ± 2.7. The self-confidence score of the studied patients was 12.66 ± 1.55. The total score of the studied patients was 60.32 ± 4.9. Studies have shown that anxiety and stress also contribute to hair loss owing to the biochemical and hormonal changes associated with such states [5]. Similarly, previous studies have also linked loss of hair to a decrease in the self-esteem [6],[7]. In agreement with current study, Mubki et al. [3] found the mean Dermatology Life Quality Index (DLQI) score was 7.8 ± 5.8 (range: 0–29). In 28.5% of cases, patients' QoL was affected very large to extremely large by AGA. The individual mean scores ranged from 0.21 to 1.48. Embarrassment and clothing had the most significant effect on patients with AGA. The lowest was for sexual life and sport activity. The results of Danyal et al. [8] showed that men with male-pattern baldness experienced significant anxiety in comparison with men with normal scalp hair distribution. Findings from the present study demonstrated that men with hair loss have a significantly lower self-esteem as compared with those without any evident hair loss, which is in harmony with us. Moreover, in accordance with our finding, Montgomery et al. [9] reported that more than 30% of their studied cases with hair loss experienced significant anxiety. In addition, all patients in the study by Ghimire had mean DLQI score of 2.79. Maximum score was 14 and minimum score was 0 [10]. Rencz et al. [11] conducted a meta-analysis on 2530 patients using the DLQI and SF-36 and demonstrated that alopecia significantly impaired the patients' QoL and mainly affected the emotional, mental, and vitality domains of these scores. Similar to our studies, the severity of scalp affection and presence of previous history of either anxiety or depression associated with more poorer QoL. Moreover, similar score was reported by Qi et al. [12], who studied 698 patients and found the mean DLQI score was 5.8 ± 5.6.

In addition, among 178 patients with AGA enrolled in the study by Zhang, the mean DLQI score was 6.3. The most severe effect on patients with hair loss was in the form of social embarrassment at leisure, work or study, whereas the least effect was noted in sports and relationships [13]. In addition, the study by Williamson et al. [14] on 70 patients with alopecia reported a mean DLQI score of 8.3 ± 5.6.

In contrast, the median Hospital Anxiety and Depression Scale (HADS) score for total patients was 7, which reflects no anxiety among patients with AGA according, in the study by Ng et al. [15]. In the present study, there were no significant differences between male and female patients regarding emotion, function, social, self-confidence, and total QL scores (P > 0.05). This may be owing to the fact that men with severe hair loss have an acceptance of their cosmetic appearance that no longer bothers them. Moreover, society also regards male hair loss as an expected event owing to its common occurrence, hence making it less bothersome for some men. In agreement with us, in the study by Zhang and Zhang [13], the mean DLQI scores in female patients were nonsignificantly slightly higher than in male patients. Moreover, this can be attributed to the fact that women are more conscious about their cosmetic appearance than men. Moreover, women with AGA commonly experience increased self-consciousness, emotional stress, and feel unattractive. The latter may lead to social withdrawal [16],[17],[18]. In disagreement with our observation, the study by Dolte et al. [19] showed that women with hair loss had increased self-consciousness, with higher feelings of unattractiveness, increased the social withdrawal, and more emotional distress than either healthy women or men with AGA. Our finding is in contrast to the study by Yu et al. [20] and Kranz et al. [21] who found men with more severe AGA had higher level of psychological distress, anxiety, and depression. In addition, in the study conducted by van der Donk et al. [17], which compared between the psychological characteristics of females with AGA and healthy women, and with men with AGA, they found the women with AGA had higher scores for social inadequacy and significantly lower scores for self-evaluation and esteem than the men. In addition, they showed lower scores for injuredness and higher scores of inadequacy and rigidity [17]. Moreover, Mubki et al. [3] found the QoL was impaired in women more than men. However, cultural differences may be present, as their population usually wears special costumes that cover men's head (Qutra) or women's head (Hijab). The study by Ng et al. [15] showed that females experienced depression significantly more compared with males with AGA. In current study, there were nonsignificant differences between urban and rural populations regarding emotion, function, social, and self-confidence scores (P > 0.05). There was a significant difference in total score between urban and rural populations, with scores of 61.05 ± 4.88 and 59.62 ± 4.86, respectively (P = 0.04). This is in disagreement with the study by Erol et al. [22], which aimed to find out the effects of chemotherapy-related alopecia on body image and QoL of Turkish women who have cancer with or without headscarves and factors affecting them. In univariate analysis, residence was found to be significantly associated with body image and QoL of the patients. Statistical analysis revealed that for body image of patients with cancer, only the degree of alopecia had considerable effects. In current study, there were no significant differences between married patients and not married patients regarding function, social, self-confidence, and total scores (P > 0.05). There was a significant difference between married patients and not married patients regarding emotion score, with scores of 18.1 ± 1.54 and 15.97 ± 2.08, respectively (P > 0.001). Single individuals were found to experience less anxiety and depression and were more dissatisfied with their hair condition compared with those who were married. This finding was supported by other studies [23],[24] and may be explained by the fact that physical attractiveness is known to affecting sexual relationship and dating. Both men and women believe that, hair loss will destroy any romantic relationship as baldness has unattractive appearance. This was also supported by the finding from Lee et al. [25] who showed that balding men had a disadvantage in either dating or marriage. In addition, Zhang and Zhang [13] found the QoL was not affected by marital status. In contrast, Mubki et al. [3] found the QoL was not affected by the patient's marital status and educational level. However, sex was associated with a significantly higher DLQI score (P < 0.001) [3]. Individuals who were single (P < 0.001) had significantly more anxiety and depression than married patients, which in contrast to us, as reported by Ng [15]. In the current study, there were no significant differences among nonworkers, manual workers, and professional workers regarding social, self-confidence, and total score (P > 0.05). On the contrary, there was a significant difference between nonworkers, manual workers, and professional workers regarding emotion score, with scores of 15.6 ± 1.21, 17.72 ± 1.42, and18.22 ± 1.42, respectively and regarding function score, with scores of 12.50 ± 1.51, 11.1 ± 1.77, and 10.65 ± 1.8, respectively. This could be owing to their increased awareness and self-consciousness about image and the need for high degree of social interaction in this group of patients [23],[26]. Similarly, Zhang and Zhang [13] found the QoL was not affected by educational level. In contrast to our results, there were no significant differences in median HADS-A and HADS-D scores among different education levels, ethnicities, and occupations according to the study by Ng et al. [15]. In the current study, there was a positive significant correlation between age of studied patients and emotion score (P < 0.001 and r = 0.24). Moreover, there was a negative significant correlation between age of studied patients and function score (P = 0.02 and r=−0.15). On the contrary, there was a nonsignificant negative correlation between age of studied patients and social (P = 0.07 and r=−0.12) and total scores (P = 0.76 and r=−0.02) and a non-significant positive correlation with respect to self-confidence (P = 0.59 and r = 0.03), as hair loss leads to increase in the feeling of stigmatization. In addition, it makes younger patients at higher risk for depression and anxiety [27]. A study also found that younger patients had negative perception of their hair condition [15], whereas another study did not find any relation between the age and severity of psychological effect on life [28]. When patients are psychologically disturbed by hair loss, it results in undesirable perception among them. On the contrary, many studies found across different age groups that there was no significant difference in either perception of hair condition [28] and psychological aspect [21], as older patients are more established in their marital life and their occupation, so, the external appearance had limited impact on their life quality. Moreover, in disagreements with our results, QoL was also not affected by the patient's age as reported by Mubki [3]. Other studies reported a worse QoL in younger age patients [13], as younger patients are probably more likely to have a negative effect of their appearance on their social life, as they are looking for work and partners. In addition, higher DLQI score was significantly correlated with younger age of patients with alopecia (P < 0.05) and hair loss for a duration of greater than 12 months (P < 0.05). Our limitations included the small sample size when compared with AGA-affected patients in Egypt. Moreover, the information regarding disease perception and psychological distress was subjective. All the patients were recruited from the same center, and this makes our results not generalized to other center or among another community people. To remove any bias affecting our results, we recommended to conducted more studies on a large sample size and recruit patients from multiple centers. Therefore, early psychological support to facilitate acceptance of disease is recommended in AGA management.


  Conclusion Top


The study provides valuable idea about the psychological aspects of AGA. As in these diseases with limited treatment modalities, it is important to detect the psychological aspect of these patients and initiate required medical and psychological treatment. Moreover, AGA has more psychological effect on female than male individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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