Androgenetic Alopecia: Predictive Factor for COVID-19 Severity - European Medical Journal

Androgenetic Alopecia: Predictive Factor for COVID-19 Severity

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Maria Rotaru,1,2 Gabriela Iancu,1,2 Ramona Farhat1

The authors have declared no conflicts of interest.


The patient in this case has given informed consent to publication of their images and case details.

EMJ Dermatology. ;9[1]:51-52. Abstract Review No. AR1.
Androgen receptor, androgenetic alopecia (AGA), COVID-19, transmembrane protease serine 2 (TMPRSS2).

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


Since December 2019, the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) from Wuhan, China, has been the aetiological agent of COVID-19 disease, an infectious disease that has evolved into a global pandemic.1 Androgenetic alopecia (AGA), the most common type of alopecia,2 is an androgen-dependent condition, the main androgen responsible for the follicular pathology being dihydrotestosterone.3


The authors reviewed nine articles studying the high rates of AGA in patients hospitalised with severe forms of COVID-19 that have been published in the last year. The multifaceted nature of this disease has been an incentive for many medical specialties to try to uncover its mechanisms, and dermatology is playing a part in this journey. The authors summarised the information they gathered on the topic and obtained the following results.


Recent studies suggest that males with AGA have a disproportionate risk relative to females of developing severe, symptomatic forms of COVID-19 through an androgen-mediated vulnerability to SARS-CoV-2.4-6 Sensitivity to androgen hormones is determined by genetic variants of the androgen receptor (AR). X-linked genetic polymorphisms that have been associated with androgenetic alopecia, benign prostatic hyperplasia, prostate cancer,7 and polycystic ovary syndrome8 may be responsible for an increase in host susceptibility, with AR being the only known promoter of transmembrane protease serine 2 (TMPRSS2). TMPRSS2 is an enzyme involved in SARS-CoV-2 infectivity by initiating the virus’ spike protein, a key step in viral replication and cell–virus fusion.5 In addition to theoretical molecular and epidemiological mechanisms, several studies have reported high rates of androgenetic alopecia in patients hospitalised with severe forms of COVID-19.2,4-6,9,10


The mechanism of regulation of TMPRSS2 by androgen hormones may explain the increased susceptibility of males to COVID-19. This pathophysiological process can also motivate the less symptomatic forms of children, given their reduced AR expression.5 The investigation of the potential association between androgens and the severity of COVID-19 disease is justified in view of evaluating androgen suppression therapy as a potential treatment for COVID-19 infection

Goren A et al. A preliminary observation: male pattern hair loss among hospitalized COVID-19 patients in Spain – a potential clue to the role of androgens in COVID-19 severity. J Cosmet Dermatol. 2020;19(7):1545-7. Lee J et al. Male balding is a major risk factor for severe COVID-19. J Am Acad Dermatol. 2020;83(5):e353-4. McCoy J et al. Androgen receptor genetic variant predicts COVID-19 disease severity: a prospective longitudinal study of hospitalized COVID-19 male patients. J Eur Acad Dermatol Venereol. 2021;35:e15-7. Mjaess GT et al. COVID-19 and the male susceptibility: the role of ACE2, TMPRSS2 and the androgen receptor. Prog Urol. 2020;30(10):484-7. Moravvej H et al. Androgenetic alopecia and COVID-19: a review of the hypothetical role of androgens. Dermatol Ther. 2021;34(4):e15004. Wambier CG et al. Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: the “Gabrin sign.” J Am Acad Dermatol. 2020;83(2): 680-2. Thatiparthi A et al. A response to “Male balding is a major risk factor for severe COVID-19.” J Am Acad Dermatol. 2021;84(2):e87-8. Sajid MI et al. SARS-CoV-2 & androgenic alopecia: exploring links! Int J Dermatol. 2021;60(5):e195-7. Wambier CG, Goren A. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is likely to be androgen mediated. J Am Acad Dermatol. 2020;83(1):308-9. Wambier CG et al. Androgenetic alopecia in COVID-19: compared to age-matched epidemiologic studies and hospital outcomes with or without the Gabrin sign. J Am Acad Dermatol. 2020;83(6):e453-4.

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