Cancer Causes & Control

, Volume 24, Issue 5, pp 1045–1052 | Cite as

Androgenetic alopecia at various ages and prostate cancer risk in an equal-access multiethnic case–control series of veterans

  • Jean-Alfred Thomas
  • Jodi A. Antonelli
  • Lionel L. Banez
  • Catherine Hoyo
  • Delores Grant
  • Wendy Demark-Wahnefried
  • Elizabeth A. Platz
  • Leah Gerber
  • Kathryn Shuler
  • Enwono Eyoh
  • Elizabeth Calloway
  • Stephen J. FreedlandEmail author
Original paper



Epidemiological data are conflicting regarding the association between androgenetic alopecia (AA) and prostate cancer (CaP). We examined the relationship between these two conditions.

Materials and methods

We performed a case–control study at a Veterans Affairs Hospital among 708 men: 312 healthy controls, 167 men with CaP, and 229 men without CaP on prostate biopsy. Participants were asked to self-describe hair patterns at ages 30 and 40 and at study enrollment. We tested the association between hair pattern (overall, vertex, or frontal) and CaP status using logistic regression analysis adjusting for multiple clinical features. Disease grade was similarly examined as a secondary outcome.


Relative to healthy controls, younger age of AA onset was significantly associated with increased CaP risk (p = 0.008). Similar patterns were noted for frontal (p = 0.005) and not vertex balding (p = 0.22). When compared with biopsy-negative men, a similar pattern was seen with younger age of AA onset having higher risk of CaP, though this was not significant (p = 0.07). A suggestion for younger age of AA onset for frontal (p = 0.07) being associated with CaP versus biopsy-negative men was also observed. Overall balding (yes/no) was associated with greater than twofold increase in high-grade disease (p = 0.02).


Men reporting earlier AA onset were at increased CaP risk and suggestively had more aggressive disease. Contrary to other studies, frontal balding was the predominant pattern associated with elevated CaP risk. Further study is required to confirm these findings in a larger sample and to better understand the role of AA, androgens, and CaP biology.


Androgenetic alopecia Prostate cancer High-grade disease 



The authors received funding and support from the Department of Veterans Affairs, Department of Defense, T32 Training and the AUA Foundation/Astellas Rising Star in Urology Award.


  1. 1.
    Kaaks R, Lukanova A, Sommersberg B (2000) Plasma androgens, IGF-1, body size, and prostate cancer risk: a synthetic review. Prostate Cancer Prostatic Dis 3:157–172PubMedCrossRefGoogle Scholar
  2. 2.
    Platz EA, Giovannucci E (2004) The epidemiology of sex steroid hormones and their signaling and metabolic pathways in the etiology of prostate cancer. J Steroid Biochem Mol Biol 92:237–253PubMedCrossRefGoogle Scholar
  3. 3.
    Travis RC, Key TJ, Allen NE, Appleby PN, Roddam AW, Rinaldi S et al (2007) Serum androgens and prostate cancer among 643 cases and 643 controls in the European prospective investigation into cancer and nutrition. Int J Cancer 121:1331–1338PubMedCrossRefGoogle Scholar
  4. 4.
    Marks LS, Mazer NA, Mostaghel E, Hess DL, Dorey FJ, Epstein JI et al (2006) Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 296:2351–2361PubMedCrossRefGoogle Scholar
  5. 5.
    Ellis JA, Sinclair R, Harrap SB (2002) Androgenetic alopecia: pathogenesis and potential for therapy. Expert Rev Mol Med 4:1–11CrossRefGoogle Scholar
  6. 6.
    Otberg N, Finner AM, Shapiro J (2007) Androgenetic alopecia. Endocrinol Metab Clin North Am 36:379–398PubMedCrossRefGoogle Scholar
  7. 7.
    Hamilton JB (1951) Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci 53:708–728PubMedCrossRefGoogle Scholar
  8. 8.
    Oh BR, Kim SJ, Moon JD, Kim HN, Kwon DD, Won YH et al (1998) Association of benign prostatic hyperplasia with male pattern baldness. Urology 51:744–748PubMedCrossRefGoogle Scholar
  9. 9.
    Rapaport MJ (2004) Follow-up of 1 mg finasteride treatment of male pattern baldness-difference between clinical trials and private office follow-up: influences on prescribing habits evaluated. Dermatol Surg 30:761–763PubMedCrossRefGoogle Scholar
  10. 10.
    Thompson IM, Klein EA, Lippman SM, Coltman CA, Djavan B (2003) Prevention of prostate cancer with finasteride: US/European perspective. Eur Urol 44:650–655PubMedCrossRefGoogle Scholar
  11. 11.
    Demark-Wahnefried W, Schildkraut JM, Thompson D, Lesko SM, McIntyre L, Schwingl P et al (2000) Early onset baldness and prostate cancer risk. Cancer Epidemiol Biomarkers Prev 9:325–328Google Scholar
  12. 12.
    Giles GG, Severi G, Sinclair R, English DR, McCredie MR, Johnson W et al (2002) Androgenetic alopecia and prostate cancer: findings from an Australian case-control study. Cancer Epidemiol Biomarkers Prev 11:549–553PubMedGoogle Scholar
  13. 13.
    Wright JL, Page ST, Lin DW, Stanford JL (2010) Male pattern baldness and prostate cancer risk in a population-based case-control study. Cancer Epidemiol 34:131–135PubMedCrossRefGoogle Scholar
  14. 14.
    Hawk E, Breslow RA, Graubard BI (2000) Male pattern baldness and clinical prostate cancer in the epidemiologic follow-up of the first National Health and Nutrition Examination Survey. Cancer Epidemiol Biomarkers Prev 9:523–527PubMedGoogle Scholar
  15. 15.
    Greenwald P, Damon A, Kirmss V, Polan AK (1974) Physical and demographic features of men before developing cancer of the prostate. J Natl Cancer Inst 53:341–346PubMedGoogle Scholar
  16. 16.
    Hsieh CC, Thanos A, Mitropoulos D, Deliveliotis C, Mantzoros CS, Trichopoulos D (1999) Risk factors for prostate cancer: a case-control study in Greece. Int J Cancer 80:699–703PubMedCrossRefGoogle Scholar
  17. 17.
    Yassa M, Saliou M, De Rycke Y, Hemery C, Henni M, Bachaud JM et al (2011) Male pattern baldness and the risk of prostate cancer. Ann Oncol 22:1824–1827PubMedCrossRefGoogle Scholar
  18. 18.
    Cremers RG, Aben KK, Vermeulen SH, den Heijer M, van Oort IM, Kiemeney LA (2010) Androgenic alopecia is not useful as an indicator of men at high risk of prostate cancer. Eur J Cancer 46:3294–3299PubMedCrossRefGoogle Scholar
  19. 19.
    Hsing AW, Comstock GW (1993) Serological precursors of cancer: serum hormones and risk of subsequent prostate cancer. Cancer Epidemiol Biomarkers Prev 2:27–32PubMedGoogle Scholar
  20. 20.
    Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MJ (1996) Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 88:1118–1126PubMedCrossRefGoogle Scholar
  21. 21.
    Platz EA, Leitzmann MF, Rifai N, Kantoff PW, Chen YC, Stampfer MJ et al (2005) Sex steroid hormones and the androgen receptor gene CAG repeat and subsequent risk of prostate cancer in the prostate-specific antigen era. Cancer Epidemiol Biomarkers Prev 14:1262–1269PubMedCrossRefGoogle Scholar
  22. 22.
    Stough D, Stenn K, Haber R, Parsley WM, Vogel JE, Whiting DA et al (2005) Psychological effect, pathophysiology, and management of androgenetic alopecia in men. Mayo Clin Proc 80:1316–1322PubMedCrossRefGoogle Scholar
  23. 23.
    Randall VA (2007) Hormonal regulation of hair follicles exhibits a biological paradox. Semin Cell Dev Biol 18:274–285PubMedCrossRefGoogle Scholar
  24. 24.
    Ellis JA, Stebbing M, Harrap SB (2001) Polymorphism of the androgen receptor gene is associated with male pattern baldness. J Invest Dermatol 116:452–455PubMedCrossRefGoogle Scholar
  25. 25.
    Lesko SM, Rosenberg L, Shapiro S (1993) A case-control study of baldness in relation to myocardial infarction in men. JAMA: J Am Med Assoc 269:998–1003CrossRefGoogle Scholar
  26. 26.
    Shahar E, Heiss G, Rosamond WD, Szklo M (2008) Baldness and myocardial infarction in men: the atherosclerosis risk in communities study. Am J Epidemiol 167:676–683PubMedCrossRefGoogle Scholar
  27. 27.
    Schnohr P, Lange P, Nyboe J, Appleyard M, Jensen G (1995) Gray hair, baldness, and wrinkles in relation to myocardial infarction: the Copenhagen city heart study. Am Heart J 130:1003–1010PubMedCrossRefGoogle Scholar
  28. 28.
    Littman AJ, White E (2005) Reliability and validity of self-reported male balding patterns for use in epidemiologic studies. Ann Epidemiol 15:771–772PubMedCrossRefGoogle Scholar
  29. 29.
    Taylor R, Matassa J, Leavy JE, Fritschi L (2004) Validity of self reported male balding patterns in epidemiological studies. BMC Public Health 4:60PubMedCrossRefGoogle Scholar
  30. 30.
    Signorello LB, Wuu J, Hsieh C, Tzonou A, Trichopoulos D, Mantzoros CS (1999) Hormones and hair patterning in men: a role for insulin-like growth factor 1? J Am Acad Dermatol 40:200–203PubMedCrossRefGoogle Scholar
  31. 31.
    Platz EA, Pollak MN, Willett WC, Giovannucci E (2000) Vertex balding, plasma insulin-like growth factor 1, and insulin-like growth factor binding protein 3. J Am Acad Dermatol 42:1003–1007PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Jean-Alfred Thomas
    • 1
    • 2
  • Jodi A. Antonelli
    • 1
    • 2
  • Lionel L. Banez
    • 2
  • Catherine Hoyo
    • 4
  • Delores Grant
    • 3
  • Wendy Demark-Wahnefried
    • 6
  • Elizabeth A. Platz
    • 7
    • 8
    • 9
  • Leah Gerber
    • 1
    • 2
  • Kathryn Shuler
    • 1
    • 2
  • Enwono Eyoh
    • 1
    • 2
  • Elizabeth Calloway
    • 1
    • 2
  • Stephen J. Freedland
    • 1
    • 2
    • 5
    Email author
  1. 1.Division of Urology, Duke Prostate Center, Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Section of Urology, Department of Surgery, Durham Veterans Affairs HospitalDurhamUSA
  3. 3.Cancer Research Program, Department of Biology, JLC-Biomedical/Biotechnology Research InstituteNorth Carolina Central UniversityDurhamUSA
  4. 4.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  5. 5.Department of PathologyDuke University Medical CenterDurhamUSA
  6. 6.Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamUSA
  7. 7.Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  8. 8.James Buchanan Brady Urological Institute, Johns Hopkins Medical InstitutionsBaltimoreUSA
  9. 9.Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical InstitutionsBaltimoreUSA

Personalised recommendations