Human scalp hair: Modulation by various factors and hormones do estrogens inhibit or stimulate—A perplexing perspective

Evaluation of the relationship between serum G protein-coupled estrogen receptors (GPER-1) levels and the severity and duration of the disease in patients with androgenetic alopecia: A case-control study

There are studies revealing the effects of estrogen receptors alpha (α) and beta (β) on hair follicles. However, the effects of G protein-coupled estrogen receptors (GPER-1) on hair follicles have not been elucidated. This study aims to evaluate the relationship between serum GPER-1 levels and the severity and duration of the disease in patients with androgenetic alopecia (AGA). The study included 81 patients with AGA aged 18 to 50 years (22 men and 19 women with an onset of AGA more than 5 years, and 20 men and 20 women with an onset of AGA less than 5 years) and 40 healthy controls (20 men, 20 women). The mean age of participants with AGA was 29.12 ± 8.15 (18-50), and the mean age of the control group was 25.21± 4.71 (19-42). Serum GPER-1 levels were measured, and the relationship between GPER-1 levels and duration of the disease, severity of the disease, and sex was statistically evaluated. The serum level of GPER-1 was significantly higher in patients with AGA as compared to the control group (p < 0.001). A negative correlation was found between serum GPER-1 levels and the duration of the disease in both men and women (p < 0.001, r = 0.793; p < 0.001, r = 0.711, respectively). There was a significant relationship between serum GPER-1 levels and the severity of the disease in both men and women (p = 0.003; p = 0.002, respectively). Additionally, a significant difference in GPER-1 levels was noted between male and female patients with AGA (p = 0.001). However, no statistically significant relationship was identified between GPER-1 levels and estrogen levels (p = 0.097). The higher levels of GPER-1 in patients with AGA compared to the control group, and the significant relationship between GPER-1 levels and both the duration and severity of the disease, suggest an estrogen-independent role of GPER-1 in the pathogenesis of AGA. The fact that GPER-1 levels are high in the early stages of AGA when inflammation is prominent suggests that treatments targeting these receptors may be effective at this stage.

Efficacy and Pain Tolerance of Alexandrite Laser Hair Removal at Different Stages of the Menstrual Cycle

BACKGROUND

Several different parameters play a role in the transition of hair follicles to the anagen phase, with the role of androgens, progesterone, and estrogen hormones and receptors being significant.

OBJECTIVES

The effectiveness of laser hair removal (LHR) and pain tolerance during procedure were investigated during 3 different phases of the menstrual cycle.

METHODS

Forty-eight axillae were randomly divided into 3 groups: menstruation, ovulation, and luteal. Three laser sessions were performed on each axilla at a 1-month interval. Blood hormone levels were measured in the patients. An alexandrite laser was applied during LHR sessions. Before each LHR session and 1 month after the third session, hair follicles in 4-cm2 areas in the center of the axillae were counted. Patients self-assessed the pain they felt during the laser application in each session with a visual pain scale.

RESULTS

The average values for hair counting in the groups were as follows (M, menstruation; O, ovulation; L, luteinization): M0 = 47.6, M1 = 27.4, M2 = 16.1, M3 = 9.9; O0 = 41.8, O1 = 21.1, O2 = 13.8, O3 = 8.6; and L0 = 49.4, L1 = 27.1, L2 = 15.1, L3 = 9.8. The average values on the visual analog scale scores in the groups were: M1 = 3.94, M2 = 3.06, M3 = 1.94; O1 = 3.50, O2 = 3.06, O3 = 1.69; and L1 = 3.63, L2 = 2.50, L3 = 1.56. Statistical analysis was conducted with Tukey post hoc analysis after analysis of variance.

CONCLUSIONS

The results of LHR are not affected by changes in hormone levels during the menstrual cycle in females. Although not statistically significant, it has been observed that pain tolerance during laser application is lower during the menstruation cycle.

LEVEL OF EVIDENCE: 3

Evaluation of serum G protein-coupled estrogen receptor 1 (GPER-1) levels in patients with androgenetic alopecia

The effect of oestrogens in androgenetic alopecia (AGA) pathophysiology has not been clearly understood. However, they are considered to have a place in the AGA pathogenesis as the androgens do. The effects of estrogen occur via the estrogen receptors alpha and beta, and the recently discovered G protein-coupled estrogen receptor 1 (GPER-1). Aim of this study is to examine serum GPER-1 levels of AGA patients and to evaluate the place of them in AGA pathogenesis for the first time through the literature. 40 AGA patients with clinical AGA stage 2-3-4 diagnoses according to the Hamilton-Norwood classification for males, and AGA stage 2 according to Ludwig system for females and with normal serum dihydroepiandrosterone sulfate, estradiol, total testosterone, progesterone, follicle stimulating hormone and luteinizing hormone were included in the study in addition to 40 healthy controls with similar characteristics by means of age and gender. We received the medical history and performed the physical examinations. We measured serum GPER-1 levels. Serum GPER-1 levels of AGA patients and the control group were 30.43 ± 3.83 ng/mL and 14.18 ± 3.61 ng/mL (mean ± SD), respectively. The levels were detected as significantly increased in AGA group compared with the control group (p = 0.007). No serum GPER-1 level differences were found among female and male patients (p = 0.101). Significantly high levels of serum GPER-1 levels in AGA patients without any relationship between gender and GPER-1 Levels compared with healthy controls reminded us that GPER-1 might have a role in AGA pathogenesis independent from the gender.