Psychology's medicalization of male baldness

Psychosocial impact of androgenetic alopecia on men: A systematic review and meta-analysis

The adverse psychosocial impact of androgenetic alopecia (AGA) is often framed as an essential motivation for developing efficacious treatments to halt hair loss or promote regrowth, especially since AGA is common among men but does not result in physically harmful or life-limiting consequences. Yet, empirical evidence documenting the impact of AGA on men's psychological wellbeing and quality of life is patchy and has not previously been subject to systematic review. This systemic review and meta-analyses aim to integrate and evaluate evidence regarding the psychosocial impact of AGA on men. A database and manual reference search identified English-language articles which reported: 1) empirical research; of ii) psychosocial distress (mental health, depression, anxiety, self-esteem, or quality of life); and iii) data separately for male AGA participants. Screening of 607 articles resulted in 37 (6%) for inclusion. PRISMA guidelines, the (modified) AXIS quality assessment tool, and independent extraction were deployed. Heterogeneity in measures and study aims, moderate study quality (M = 7.37, SD = 1.31), probable conflicts of interest (78%) and biased samples (68%) suggest that results should be treated cautiously. Meta-analyses revealed no impact on depression (pooled M = 8.8, 95% CI = 6.8-10.8) and moderate impact on quality of life (pooled m = 9.12, 95% CI = 6.14-12.10). Men with AGA were found to have average or better mental health compared to those without AGA. Overall, there was limited evidence of a severe impact on mental health and quality of life for men experiencing hair loss, with most studies evidencing (at best) a moderate impact. Good dermatological care includes accurately educating about the psychosocial impact of AGA on men, taking care not to overstate levels of distress, and screening for distress using validated measures which have clear clinical thresholds.

Establishing the financial burden of alopecia areata and its predictors

Background

Alopecia areata (AA) can have a significant impact on wellbeing. Consequently, individuals with AA often seek treatments or products to promote hair regrowth or camouflage their hair loss that incur a financial cost to the individual.

Objectives

The current study aimed to examine the direct financial burden of AA to understand the wider impact of the condition and the factors which influence spending on products and services.

Methods

A total of 829 United Kingdom based participants completed an online survey. Demographic and condition-specific data were collected, alongside spending on AA-related products and services. Participants were asked about their use of products and services, the associated costs, how they financed these costs, and their household income to determine what percentage of income they spent on products and services.

Results

Participants predominantly identified as female (85.9%), white (92.7%) with a mean age of 42.7 years and a median AA duration of 10.94 years. Female gender, Asian ethnicity, lower income, and worse AA symptoms predicted higher spend from income. Wigs were the most common product used and incurred the greatest cost (median £700). The highest cost for men was private dermatology services (median = £550). On average people spent 3% of their disposable income (prior to housing costs) on AA-related products and services.

Conclusions

This study outlines the risk factors associated with higher financial burden from managing AA which require consideration by health providers, commissioners, and policy makers when designing services to support the wellbeing of people living with AA.

Minoxidil delivered via a stem cell membrane delivery controlled release system promotes hair growth in C57BL/6J mice

Objective: Umbilical cord-derived mesenchymal stem cell membrane-loaded minoxidil (MXD) nanoparticles (STCM-MXD-NPs) were prepared to investigate their effects on hair growth in C57BL/6J mice. Methods: STCM-MXD-NPs were obtained by freeze-thawing and differential centrifugation, and their effects on hair growth were evaluated using C57BL/6J mice. The mRNA and protein expression levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) were detected by real-time polymerase chain reaction and enzyme-linked immunosorbent assays, respectively. Protein expression levels of marker of proliferation Ki-67 (MKI67) and β-catenin (CTNNB) in skin tissue were detected by immunohistochemistry. Results: STCM-MXD-NPs improved MXD solubility. They released the drug slowly, increasing its transdermal properties, accumulation in the skin, and content in the hair bulb tissues with a better efficacy than that of ordinary MXD. Moreover, STCM-MXD-NPs significantly upregulated the mRNA and protein levels of VEGF and IGF-1 and promoted the protein expression of MKI67 and CTNNB in mouse skin tissues, promoting mouse hair growth. Conclusion: Stem cell membrane-loaded MXD nanoparticles with slow-release properties increased MXD accumulation in the skin by improving its transdermal properties, increasing VEGF, IGF-1, MKI67, and CTNNB expression levels and promoting hair growth in C57BL/6J mice.

AGA practitioner challenges: A mixed-methods pilot survey

BACKGROUND

Androgenetic alopecia (AGA) practitioner care may be hampered by commercial biases and hair loss' omission from most medical curricula.

AIM AND METHOD

Between November 2020 and September 2021, 34 AGA professionals (86% British; 62% trichologists), participated in a pilot, mixed-methods, survey. Practitioner views on: 1a-1j) AGA's commercial influences (e.g., participants were quantitatively assessed on their understanding of a popular, commercially-funded, AGA study) and 2a-2h) constraints on evidenced-based AGA responding (e.g., ethical dilemmas) were assessed. Quantitative responses are reported descriptively whilst qualitative responses are categorized alongside illustrative quotes.

RESULTS

On average, (1a-1d) 42% of participants were misled by the popular AGA study and (1e) participants underestimated the extent of commercial biases in AGA research as 25%; (2a-2e). Participants also indicated that AGA treatment limitations and misinformation ethically challenged them (e.g., "[It's difficult to know when] to treat or not without being able to confirm the outcome"). (2c) Most (77%) indicated society played a powerful role in exacerbating AGA distress (e.g., "Society is hyper critical of appearance") and 30% indicated greater "treatment" accessibility was needed: (e.g., "hair loss product [should] give clear indication of what the active ingredients are and how effective they are").

CONCLUSIONS

Despite the limited sample size, these finding cohere with previous identified challenges of the AGA practitioner role. Evidence based guidance and research scrutiny tools would help practitioners overcome such challenges.