College Survey Shows Higher Prevalence of AGA Associated With Males, Rosacea

The China-based study disseminated a survey to over 9000 college freshmen from 2 universities in the country, revealing an overall prevalence of 5.3/1000.

Among college-aged patients, the prevalence of androgenetic alopecia (AGA) varies between genders and has significant associations with a certain skin condition, says a new study in PLoS One.

The China-based study disseminated a survey—with questions covering demographics, disease history, living habits, and comorbidities—to over 9000 college freshmen from 2 universities in the country, revealing an overall prevalence of 5.3/1000.

Compared with females, male students were significantly more likely to have AGA, with prevalences of 0.25% and 0.79%, respectively. According to the researchers, the finding is in line with previous studies, which have also shown higher prevalence of AGA among males. In addition to having a lower AGA prevalence, females with AGA experienced less hair loss than males with the condition.

“Much evidence has proven that females may have a different pathophysiology from male,’ wrote the researchers. “The findings of Sawaya and Price suggested that the level of 5a-reductase–andadronen receptors in frontal follicles was lower in women than men. Female patients usually presented with normal androgens levels, which suggested other multifactorial androgen-independent mechanism.”

Although several previous studies have indicated that body mass index has associations with AGA prevalence, the researchers of the current study found no such association based on their survey results. They also found no associations between AGA and factors such as annual household income, parents’ education level, living habits, or lifestyle.

Using a mixed logistic model, the researchers found that rosacea was significantly associated with AGA, with an odds ratio of 3.22.

“To our surprise, our study suggested that only rosacea, other than acne vulgaris, was significantly associated with higher prevalence of AGA,” wrote the researchers, who explained that previous research has shown both rosacea and acne vulgaris to be the most common comorbidities of AGA. “A similar result was revealed by another study conducted among middle-aged AGA patients (men aged 40-69 years), which claimed no associations between AGA and acne vulgaris. Our results also implied that rosacea was connected with AGA in a mechanism independent of hyperandrogenism.”

Notably, the researchers found that having AGA did not appear to significantly impact quality of life. Results of the study showed that compared with students without alopecia, students with AGA did not have a higher burden of disease. There also were no significant differences in symptoms of anxiety, depression, or quality of sleep between patients with and without AGA.

This finding, say the researchers, could be due to these patients being in the early stage of disease, without apparent hair loss.

Although the researchers included queries on comorbidities that included endocrine disorders, hematological diseases, and cardiovascular diseases, the freshmen included in the study rarely reported such comorbidities. As a result, the group was unable to draw conclusions on the association between AGA and these comorbidities.


He F, Shen M, Zhao Z, et al. Epidemiology and disease burden of androgenetic alopecia in college freshmen in China: a population-based study. PLoS One. Published online February 15, 2022. doi:10.1371/journal.pone.0263912

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