24 • Probe •Vol LXII • No. 3 • May–Aug 2023 The Association Between Hormones and Female Pattern Hair Loss The androgens such as testosterone, dihydrotestosterone, and their prohormones (dehydroepiandrosterone sulfate and androstenedione) play a key role in the growth of terminal hair. Additionally, the role of other hormones in female pattern hair loss is being explored. The influence of various female sex hormones, thyroid hormones, and growth-related hormones in the development of female pattern hair loss is discussed in this article. Estradiol Estradiol can significantly alter the hair follicle growth by binding to the locally expressed high-affinity estrogen receptors and affecting metabolism. Additionally, estradiol can also cause inhibition of aromatase activity, and thereby, contribute to a mild form of female pattern hair loss. Prolactin In addition to its role in lactation, prolactin also plays an important role in reproduction, angiogenesis, osmoregulation, and hair growth. Prolactin, through its receptors in the outer root sheath, proximal inner root sheath, and the matrix keratinocytes, can directly regulate hair growth by inhibiting shaft elongation and premature induction of the catagen phase. Thyroid Hormones Triiodothyronine and thyroxine can directly affect hair follicle functions such as prolongation of the anagen phase, stimulation of the hair matrix, proliferation and pigmentation of the keratinocytes, and modulation of intracellular keratin expression. Cortisol A high cortisol level can cause a reduction in the synthesis of and premature degradation of hyaluronan and proteoglycans, which are important modulators of hair follicle function. Galanin Galanin, a neuropeptide, can inhibit hair growth by decreasing the proliferation of matrix keratinocytes, shortening the anagen phase, and reducing hair shaft elongation. Further, other biochemical factors such as an imbalance in the levels of 5α-reductase in the frontal follicles and high levels of cytochrome p450 aromatase in the frontal and occipital follicles may also contribute to the development of female pattern hair loss. Hence, timely diagnosis and treatment of any potential systemic diseases are crucial for the management of female pattern hair loss. Various female sex hormones, thyroid hormones, and growth-related hormones can either directly or indirectly influence the development of female pattern hair loss. Sources: Grymowicz M, et al. Int J Mol Sci. 2020;21(15):5342. Chen S, et al. Dermatol Ther (Heidelb). 2022;12:2233–2247.
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