What is the relationship between Baldness, Baldness Drugs, and COVID-19?
by Alan J Bauman MD ABHRS
Personally, I was surprised when this letter to Dermatologic Therapy entitled “What does androgenetic alopecia have to do with COVID‐19? An insight into a potential new therapy” came across my desk this past week. This group of prominent researchers and physicians have identified a possible connection between Androgen Receptors, Androgenetic Alopecia (Male Pattern Baldness) and SARS-CoV-2 / COVID-19.
Androgens like dihydrotestosterone (DHT) and your hair follicles’ sensitivity to them are the primary triggers and mechanisms of male pattern baldness or androgenetic alopecia. Androgenetic Alopecia AGA or male pattern hair loss MPHL is a chronic and progressive condition that starts anytime after puberty and gets worse with time if left untreated. We know that your hair follicles sensitivity to DHT or androgen sensitivity is inherited can be diagnosed via genetic testing and is largely responsible for the progressive disruption of hair follicle function. The miniaturization of hair follicles starts typically at the hairline and crown/vertex areas and progresses across the entire top of the scalp, sparing the sides and back of the scalp, which are for the most part immune to the effects of DHT. FDA-approved treatment with finasteride lowers DHT production in the body and has a powerful effect on arresting (5 out of 6 chance), and often reversing (roughly 2 out of 3 chance) the progression of male pattern hair loss or AGA.
So why the interest in COVID-19 and Androgens? I wondered that myself. But here’s what Dr Andy Goren (Applied Biology, Inc.) and his team of researchers described…
They noted that there is an unexplained disparity in severe cases of COVID-19 in adult females compared to adult males (42% and 58% respectively), and also extremely low severe infection rates in children. They note that the reasons for these significant differences have yet to be identified.
In their publication, they highlight the following explanations, specifically highlighting several possible connections between COVID-19 with androgen receptor (AR) activity or expression from the clinical literature:
1) There is a link between ARDS (acute respiratory distress syndrome), production of certain protective pulmonary surfactant proteins, androgen receptor expression, and dihydrotestosterone or DHT. In rabbits, DHT inhibited pulmonary surfactant production, and this was reversed by anti-androgen drug therapy.
2) The entry of the SARS-CoV-2 virus into the host cell, like others in the coronavirus family (SARS-CoV-1, MERS-CoV-1) via type II pneumocytes in the human lung, is related to the priming of its viral spike surface protein by transmembrane protease serine 2 (TMPRSS2) located on the surface of the host cell.
In type II pneumocytes, TMPRSS2 expression has been linked to an AR-regulated gene promoter. In addition, angiotensin covering enzyme 2 (ACE2), the attachment molecule to the viral spike protein, has been shown to have reduced activity with a decrease of androgen hormones possibly due to the decreased expression of ACE2.
[ABOVE: TMPRSS2 gene transcription promoter site requires an activated androgen receptor, with androgens such as testosterone. Dihydrotestosterone (DHT) a potent androgen receptor activator and is intracellularly produced in particular cells of tissues such as prostate, hair, and liver that express 5‐alpha‐reductases, the targeted enzyme for drugs such as dutasteride and finasteride (5‐alpha‐reductase inhibitors).]
What does this all mean? This has several implications regarding possible investigations and therapeutic interventions to clarify the role of the AR on the severity of COVID-19 infection:
- Epidemiology of COVID-19 patients predisposed to lower or higher AR expression (i.e., males suffering from MPHL/AGA, benign prostatic hyperplasia BPH, or women w/ polycystic ovarian syndrome PCOS.
- Analyzing ethnic variations in AR expression may predict ethnic mortality differences.
- AR activation can be reduced by several classes of drugs AR receptor-antagonists, androgen synthesis inhibitors, and antigonadotropins. (e.g., the FDA-app’d 5-alpha reductase inhibitor finasteride demonstrated a reduction of AR in multiple tissues)
Stay tuned for more updates on this page as they become available.
Brown University and Dr. Andy Goren from Applied Biology, Inc. seem to be the leaders on these investigative pathways.
Applied Biology in Collaboration with Brown Researchers Announce the Discovery of a Possible Association Between the Genetic Cause of Hair Loss and Severity of COVID-19 Infection
JOINT RESEARCH EFFORT POINTS TO POSSIBLE GENETIC VARIATION THAT PRE-DISPOSES COVID-19 PATIENTS TO DEVELOP SEVERE SYMPTOMS
Applied Biology to Launch COVID-19 Drug Discovery Platform based on Breakthrough Discovery Made in Collaboration with Brown University Researchers
DRUG DISCOVERY PLATFORM TO RAPIDLY PREDICT BLOCKING OF COVID-19 PNEUMOCYTE CELLULAR ENTRY
If you or someone you know has hair loss or eyebrow or eyelash concerns, click to start either a long-distance phone consultation OR an in-person, in-office consultation with Dr. Bauman. You can also Ask Dr. Bauman a Question or simply call Bauman Medical Group toll-free 844-GET-HAIR or +1-561-394-0024.