July 2026 correspondence

Androgenic alopecia

Thank you for the article on androgenic alopecia (AJGP Nov 2025) by Leppan et al. In the article there was a paragraph stating: ‘Although there are no known physiological sequelae of androgenic alopecia…’. 

There are some important associations between androgenic alopecia (AGA) and general health. Early-onset AGA is a strong predictor of the early onset of severe coronary heart disease¹ and metabolic syndrome.² A higher body mass index is associated with more severe AGA.³ Assessment of hair loss might be a useful opportunity to discuss cardiovascular risk factors. A long-term consequence of hair loss is increased exposure of the scalp to sun damage and, thus, adequate sun protection measures might be discussed. Androgenic alopecia is a normal change in some people, and it might be prudent to resist medicalisation of such a process. However, it does invite discussion on potential health implications, regardless of active treatment or not.

Author

Philip Clarke MBBS, FRACGP, DFM, DDSc, FAAD, Visiting Medical Professional, Dermatologist, Launceston General Hospital, Launceston, Tas; Associate Professor, Medical School, University of Tasmania, Launceston, Tas

Competing interests: None.

AI declaration: The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

1. Matilainen VA, Mäkinen PK, Keinänen-Kiukaanniemi SM. Early onset of androgenetic alopecia associated with early severe coronary heart disease: A population-based, case-control study. J Cardiovasc Risk 2001;8(3):
   147–51. doi: 10.1097/00043798-200106000-00005.
2. Acibucu F, Kayatas M, Candan F. The association of insulin resistance and metabolic syndrome in early androgenetic alopecia. Singapore Med J 2010;51(12):931–36.
3. Yang CC, Hsieh FN, Lin LY, Hsu CK, Sheu HM, Chen W. Higher body mass index is associated with greater severity of alopecia in men with male-pattern androgenetic alopecia in Taiwan: A cross-sectional study. J Am Acad Dermatol 2014;70(2):297–302.e1. doi: 10.1016/j.jaad.2013.09.036.

Reply

We thank the author of this letter for their engagement with our work and for correctly highlighting that there are physiological sequelae that might be predicted by identifying androgenic alopecia. They provide evidence from observational studies that suggest early-onset androgenic alopecia is associated with coronary artery disease and metabolic syndrome, and that increased body mass index is associated with severe androgenic alopecia. They also draw attention to the logical connection between increased sun exposure on the scalp and sun damage in this region.

We agree with these points and believe they further emphasise the importance of considered consultations for patients presenting with androgenic alopecia. General aspects of preventive cardiovascular and metabolic medicine should be contemplated and discussed alongside a description of the potential side effects of common medications used to treat the condition. In addition, androgenic alopecia presents most commonly as a primary concern for young male patients, who are less likely to access general practitioner (GP) services in general.¹ Therefore, patients presenting with the condition might not have visited the GP for many years, creating an opportunity to discuss and manage important aspects of their general health such as smoking status, mental wellbeing, and alcohol consumption. Thank you again for giving us the opportunity to engage in this discussion, which builds on our work.

Authors

Oscar Leppan BPsych (Hons), Medical Student, Macquarie University, Sydney, NSW

Tim Tse BMed, MD, MMed, FRACGP, General Practitioner, Honorary Lecturer, Discipline of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW

Bosco Wu MBBS, BMedSci (Hons), FRACGP, General Practitioner, Honorary Lecturer, Discipline of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW

Competing interests: None.

AI declaration: The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Reference

1. Australian Bureau of Statistics (ABS). Patient experiences. ABS, 2025. Available at www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release [Accessed 13 February 2026].