A new study by researchers from Jinnah Postgraduate Medical Centre-Pakistan, Dr DY Patil Medical College-India University and Medical Center Mainz-Germany has found that individuals especially males who are bald or who are balding have a higher risk of developing disease severity upon infection with the SARS-CoV-2 coronavirus or any of its variants.
The study found a correlation between androgenetic alopecia (AGA) and the higher risk of severity of coronavirus disease 2019 (COVID-19).
Androgenetic alopecia is a common form of hair loss in both men and women. In men, this condition is also known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic “M” shape.
It’s characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp. Women with this condition, called female pattern baldness, don’t experience noticeable thinning until their 40s or later. Women experience a general thinning over the entire scalp, with the most extensive hair loss at the crown.
A variety of genetic and environmental factors likely play a role in causing androgenetic alopecia. It has also been determined that this form of hair loss is related to hormones called androgens, particularly an androgen called dihydrotestosterone. Androgens are important for normal male sexual development before birth and during puberty.
Androgens also have other important functions in both males and females, such as regulating hair growth and sex drive.
The study findings were published in the peer reviewed Journal of Cosmetic Dermatology.
Androgenetic alopecia (AGA) is a genetically determined disorder caused by an extreme response to androgens.3 It affects up to 50% of men and women, occurs mostly after puberty, leading to progressive hair loss of the scalp.3 It follows a typical distribution in both genders. In men, hair loss is most marked in the front, temporal areas, and vertex, whereas in women the frontal hairline is spared with diffuse hair loss at the top of the head and crown; often, a loss is marked by a center wider part.4
In males, Hamilton-Norwood classification is the most commonly used classification for hair loss, and in females, the Ludwig scale is usually used.5 Several studies report severe COVID-19 symptoms and high mortality chiefly manifested in older adults especially adult males, during the SARS-CoV-2 (COVID-19) pandemic.
This sexual dimorphism in COVID-19 severity predisposed possibly due to increased androgens levels, regulating two receptors known as transmembrane serine protease (TMPRSS2) and angiotensin-converting enzyme 2 (ACE2) receptor.6, 7 SARS-CoV-2 uses these receptors to gain access into host cells. Increased androgen levels cause increased expression of TMPRSS2 in the lungs that leading to increased vulnerability to severe COVID-19 infection.6, 8
Moreover, ACE receptors expressed by an epidermal barrier and respiratory system are affected by androgens, which also leads to severe COVID-19 outcomes. Andy Goren in his article stresses to study COVID-19 patients epidemiology that is subjected to either decreased or increased androgen receptor expression, like men with benign prostatic hyperplasia, AGA, or females with polycystic ovary syndrome.6
The editorial by Goren et al at Spanish hospitals was the first to report the potential relationship of hospitalized patients of COVID-19 and AGA, which was further supported by several studies.9-14 There is also a report of less intensive care unit (ICU) admissions in patients taking anti-androgen drugs compared to the group that was not taking anti-androgens.13
This study is meant to appraise the association of AGA and severity of COVID-19, frequency of AGA in COVID-19 patients, and if the lung involvement associates with the AGA severity or if the extent of AGA is greater in critical COVID-19 patients, which could lead to help further support the hypothesis that anti-androgen therapy may signify an additive possible therapy against lethal COVID-19 infection.