Adolescent Girls With Androgenic Alopecia Should be Screened for Polycystic Ovary Syndrome, Other Comorbidities

Androgenic alopecia (AGA) can present in some very young patients who may be at increased risk for comorbidities similar to those well documented in adults, such as diabetes, cardiovascular disease, and polycystic ovary syndrome (PCOS).

Cleveland Clinic physicians conducted a retrospective chart review of 63 adolescent girls diagnosed with AGA at a Cleveland Clinic dermatology outpatient clinic from 2007 to 2017, with the purpose of characterizing the clinical presentation of AGA in adolescent girls and determining which clinical findings were associated with an increased risk of PCOS. Demographics, medical history, family history, symptoms, and laboratory tests including total testosterone and free serum testosterone levels were all analyzed.

The most common symptoms during the initial presentation of hair loss were acne (54.0%), oligomenorrhea (36.5%), and hirsutism (20.6%). Patients with hair loss and PCOS also presented with oligomenorrhea (80.0%), acne (67%), and hirsutism (20%). Patients diagnosed with insulin resistance (P = 0.016) and symptoms of menstrual irregularities (P < 0.001) were less commonly found to have isolated hair loss without PCOS.

Young women who present with AGA pattern hair loss should be screened and followed for PCOS, particularly if they present with oligomenorrhea, acne, or hirsutism. Patients with AGA are also more likely to have underlying PCOS if they are found to have elevated total testosterone or free serum testosterone on initial workup.

Comparing Serum Values and Family History of Adolescent Females With Both Androgenetic Alopecia and Polycystic Ovary Syndrome vs Adolescent Females With Androgenic Alopecia Only.1 (N = 63)

2007 – 2017

N = AGA only (%) 48 AGA + PCOS (%)15 P value
Oligomenorrhea 11 (22.9) 12 (80.0) < 0.001
Insulin resistance or diabetes mellitus 4 (8.3) 5 (33.3) 0.016
Acne 24 (50.0) 13 (86.7) 0.012
**Serum Abnormalities**
Total testosterone, elevated 12 (25.5) 13 (86.7) < 0.001
Free testosterone, elevated 6 (13.3) 7 (46.7) 0.007
Dehydroepiandrosterone, elevated 31 (64.6) 12 (80.0) 0.27

AGA = Androgenic Alopecia, PCOS = Polycystic Ovary Syndrome

¹ Data not available for all subjects.