“It’s genetic.”

“All the men in my family lose their hair.”

“It’s inevitable. There’s nothing I can do.”

Poor body image typically brings to mind young women but fretting over one’s physical appearance is an equal opportunity activity. It doesn’t discriminate. People of all body shapes and sizes ethnicities and genders will find fault with aspects of their physical body that other people probably don’t even notice. But knowing just about everyone experiences this in some way or another doesn’t make it any easier to deal with. And it’s not just our bodies we fight with in the mirror. What about our hair?

Women may experience hair loss due to various medical conditions but rarely do they get teased and chided by their friends. If hair loss in men wasn’t a big deal TV and radio wouldn’t be flooded with commercials for products intended to stimulate regrowth of hair or disguise the extent of the loss. And yes there is a genetic component to male pattern baldness (MPB). But what if MPB was like so many other conditions that plague us today and make us think of the phrase “Genetics load the gun but diet and lifestyle pull the trigger?” In other words maybe having a genetic propensity for MPB makes someone more likely to experience it but it doesn’t necessarily “program” them to lose their hair or make it unavoidable that they will.

Considering the undeniable role of chronic hyperinsulinemia in driving a host of “idiopathic” conditions perhaps insulin is contributing to male hair loss as well. According to Dr. Loren Cordain Dr. Micheal Eades and Dr. Mary Dan Eades who were among the earliest proponents of Paleo-style diets (they authored The Paleo Diet and Protein Power Lifeplan respectively):

“Male balding clearly has a genetic component. However it is well established that male pattern balding also is an androgen-dependent trait that occurs from elevated androgenesis after puberty. Consequently any environmental factor or factors that would elevate serum androgen levels would promote increased balding particularly in genetically susceptible individuals. High-glycemic-load carbohydrates by inducing hyperinsulinemia along with a concomitant elevation of serum androgens and reduction in SHBG represent a likely environmental agent that may in part underlie the promotion of male vertex balding.”

 (Cordain L Eades MR Eades MD 2003)

So there’s a plausible mechanism by which chronically elevated insulin might be a factor in male pattern baldness. Maybe not the main factor but possibly a contributor. It’s important to have a plausible mechanism because it would be easy to say that this is merely a correlation: many men experience alopecia and many men are hyperinsulinemic. So they might both be very common but that doesn’t necessarily mean one is causing the other.  

In a study of 50 male subjects (age 18-30 BMI < 27) with early-onset androgenetic alopecia (AGA) stage ≥ 3 (Hamilton-Norwood scale) compared to 40 age and weight-matched controls the men with alopecia had higher HOMA-IR and fasting insulin resistance indices. Interestingly the researchers observed “Given the criteria for metabolic syndrome no significant differences were observed between the two groups.” However recall that criteria for metabolic syndrome do not include any measurements of insulin. They include measurements of glucose blood pressure triglycerides HDL and abdominal circumference. So it’s not surprising that the two groups weren’t different with regard to metabolic syndrome as a whole. It was only when insulin measurements were included that the disparity was visible. (Fasting insulin is arguably the most important test many doctors don’t run.)

Another case/control study comparing cohorts of young men with early-onset AGA and unaffected controls showed that the men with AGA were significantly higher than the controls with regard to fasting glucose insulin HOMA-IR triglycerides blood pressure and more. Unfortunately these were not weight-matched controls. The waist circumference body weight and BMI were all significantly different between the groups (higher in the men with alopecia) so we can’t say whether that may have confounded the findings but we could also just as easily hypothesize that the elevated insulin metrics in the affected men were driving the higher body weight and waist circumference.

If we needed more evidence that there’s at the very least a correlation between male pattern baldness and insulin resistance another study found HOMA-IR to be significantly higher in cases of men with early onset androgenetic alopecia than in controls. The authors of this one recognize the implications of this finding: they recommend that young men with AGA be screened for insulin resistance and cardiovascular disease writing “Epidemiological studies have associated androgenetic alopecia (AGA) with severe young-age coronary artery disease and hypertension and linked it to insulin resistance.” Of course it would be wiser to simply make fasting insulin a standard part of routine bloodwork right along with fasting glucose which would then provide the HOMA-IR as well. Men shouldn’t have to wait until they lose their hair before they’re told they’re at risk for the very serious complications of metabolic syndrome. 

Insulin resistance might contribute to other forms of hair loss besides male pattern baldness. Alopecia areata has an autoimmune component to it but it’s possible that—just as in AGA—chronically elevated insulin may be one of the triggers. In a small study comparing insulin metrics between alopecia areata (AA) patients and unaffected controls the AA group had higher insulin [12.5 ± 7.01 vs. 8.3 ± 3.9 µIU/mL p = 0.001] c-peptide [2.7 ± 1.07 vs. 2. ± 0.6 ng/mL p = 0.007] and HOMA-IR [2.8 ± 1.6 vs. 1.9 ± 0.9 p = .004] than the controls. Those fasting insulin levels and HOMA-IR numbers should make anyone familiar with these sit up and take notice. While laboratory reference ranges vary widely doctors savvy with metabolic syndrome and insulin resistance prefer to see fasting insulin in the single digits and HOMA-IR at 2.8 is knocking on the door of “significant insulin resistance.”

In the interest of giving a balanced view we should note that one study concluded “Patients with metabolic syndrome with or without AGA were significantly more insulin resistant compared with patients with AGA with no metabolic syndrome and with healthy subjects and therefore no true association exists between AGA and insulin resistance.” Basically a man can have hair loss without being hyperinsulinemic. Well what a surprise! As mentioned above there’s a large genetic component to this issue; insulin resistance might simply increase the propensity.

Bottom line: consider early-onset androgenetic alopecia a possible indicator of insulin abnormalities and increased likelihood of metabolic syndrome.