The link between baldness, testosterone and prostate cancer

Very few men relish the thought of their hair deliberately falling out as they age.  Up to 20% of men beginning already in their twenties will have male pattern baldness with the rate increasing among men with each decade of life.  Whether a man tries to fight his baldness in every way he can or embraces it with pride, what is known is the possibility of a potential connection between male pattern baldness and prostate cancer.

Prostate cancer is the second most common type of cancer and the fifth leading cause of cancer-related death in men.  It occurs more frequently in the developed world but is the most common cancer in men in 84 countries.

A recent study found that male pattern baldness appears to be a strong and independent risk factor for prostate cancer.  The study published in the Canadian Urological Association Journal enrolled 394 patients who were to have a prostate biopsy but with no history of prostate cancer. Researchers also noted their male pattern baldness which was determined by looking at a validated Norwood score rating it as either no balding, frontal balding, mild vertex balding, moderate vertex balding, or severe vertex balding. 

The connection between male pattern baldness and prostate cancer

Androgenic alopecia or male pattern baldness is the most common type of hair loss in men.  More than 50% of all men over the age of 50 will be affected by male pattern baldness to some extent. 

The cause of baldness in men usually is a family history of baldness or the male sex hormones call androgens.  Androgen is a Greek word meaning “man-maker” which definitely rings true for the male species. The most potent androgen is testosterone which is responsible for deepening a man’s voice, increasing his muscle mass, and strengthening his bones. 

Testosterone can also be converted into another type of androgen called dihydrotestosterone (DHT).  DHT can cause acne in addition to putting hair on a man’s chest but with a tendency to take it hair a man’s scalp.  Even though male pattern baldness and prostate cancer are two separate conditions, DHT stimulates the growth of prostate cells that contributes to benign prostatic hyperplasia (BPH) in older men. 

The relationship between prostate cancer and male pattern baldness is the fact that prostate cancer is a hormone-dependent disease and most hair loss in men is caused by androgenic alopecia due to the hormones of androgens.  What are known risk factors for prostate cancer and male pattern baldness is aging of men and androgens, with androgens implicated in the development of both conditions. 

Results of the study

Of the 394 male participants, 194 men or 49.2% had cancer and 110 or 27.9% had a Gleason score of 7 or higher at biopsy.  The data analysis showed that the higher the grade of male pattern baldness as measured by the Norwood scale, the higher the risk of developing prostate cancer.  It was also found that higher-grade prostate cancer was associated with a higher grade or more severe type of baldness which was not found with the milder forms of baldness.

Male pattern baldness and prostate cancer may share the same manner of the development of the disease. Some of the proposed causes behind both prostate cancer and male pattern baldness are androgens, insulin-like growth factor 1 (IGF-1) and microRNAs.  It is also known that men with vertex baldness have a significantly higher association of free testosterone, DHT and a DHT/testosterone ratio.  In addition men with high levels of IGF-1 have been shown to have an increased risk of developing prostate cancer when compared to men with low IGF-1.  There was no association between male pattern baldness and prostate volume.

Findings from a larger study

Another study in 2016 and published in the American Journal of Epidemiology followed a sample of 4,316 men of which 107 deaths were attributable to prostate cancer, did make links between specific types of hair loss and those who developed the disease. The researchers explained that they found an increased risk of aggressive prostate cancer only in men with a very specific pattern of hair loss – baldness at the front and moderate hair-thinning on the crown of the head. Other types of hair loss patterns appeared unaffected. 

The scientists with the study hypothesized that androgens such as testosterone, are thought to underlie both male baldness and prostate cancer progression.  Depending on the pattern of male baldness appeared to determine the aggressiveness of prostate cancer. 

In conclusion

At this time, it is too early to definitively state that male pattern baldness can be considered an independent risk factor for prostate cancer.  It appears that male pattern baldness could be a strong independent risk factor for prostate cancer but both studies did state that further research is necessary before it can be validated as such.

At this time, men with any degree of baldness should not be additionally concerned about their individual risks of developing or dying from prostate cancer as these results should be interpreted in a cautious manner.  But men with concerns should discuss this with their physician about when and how frequently to undergo prostate cancer screening.