Notes_15.internally consistent results?

Discloses conflict of interest?

Probable CoI detail

Probable CoI source

Probable CoI author email

Alfonso, M, H Richter-Appelt, A Tosti, MS Viera, and M García. ‘The Psychosocial Impact of Hair Loss among Men: A Multinational European Study.’ Current Medical Research & Opinion 21, no. 11 (2005): 1829–36.

To assess the psychosocial impact of hair loss among men

Representative telephone household interviews from major European cities

Cross sectional survey via telephone

Aimed to amass sample size of 1500, 300 from each countried "stratified accoridng to regions" (pg. 1830). 729, well justified sample size

Nonbiased representative sample

Men from households in 5 european countries randomly rang on telephone from Gallup databases or from 'random digit dialing' (pg. 1830)

No - community sample

Not mentioned/ appears all who were approached took part.

None

Non validated measures 1) demographics 2) psych impact when participants realised they were losing thier hair 2) general effect of hair loss on image & personal attractiveness 4) effect of hair loss on romantic relationships 5) time dedicated to different aspects of personal care & 6) use of and results of treatments

Generally yes - questionnaire included at end of survey. Unclear how random digit dialing works for sample recruitment in UK & Germany.

Summar statistics computed.

Undisclosed - perhaps not as conducted by a market research company Gallup SPain

Not really - most participants aren''t pursuing treatment and substantial proportions do no see hair loss as negative, but nonetheless treatment recommendation advice is promoted among GPs in the implications.Some measures (single-items) of distress offer differing conclusions to others in study

No, but this is acknowledged in the methods.

Merck funding

76% of particiapnts “had never used any treatment for hair loss” (pg. 1833)

Yes - Of the men with hair loss (n = 729) , 51% agreed with the statement that they ‘really did not mind’ their hair loss, just 7% reported being dissatisfied with their personal appearance and 39% stated they would not be more satisfied if they had more hair. the following proportions indicated disagreement with the following statements (although the exact % are not reported for disagreement, these can be calculated based on the number of ‘don’t know’ (reported as <4% for most items) & agreement responses): hair is an important feature of image (24%), hair contributes an important part of personal attractiveness (25%), hair loss could affect self-esteem (34%), hair loss makes men look older (37%), hair loss can make you feel insecure (43%), men with hair are much more sexy (58%). 43% of men agreed that hair loss “makes men look more experienced” (pg. 1832) and 28% agreed that “bald people have a better sense of humour” (10% did not answer leaving 62% disagreeing).
When recalling how they felt when first realising they were going bald, most participants did not have a fear of losing an important part of personal attractiveness (53%), nor a fear of becoming bald (54%), nor a concern about getting older (59%), nor did they believe there would be negative effects on social life (84%), or experience feelings of depression (85%).
Of the single participants (n = 232): 37% agreed their participant thought their hair loss was sexy, 65% reported their hair loss did not matter to their partner, 77% did not feel they would be more desirable to their partner if they had more hair and 79% reported that their partner did not want them to take measures to solve their hair loss problems. 58% of these participants disagreed that ‘hair loss reduces self confidence in my personal attractiveness’, 64% that ‘people with hair can flirt with more attractive people’, 84% that ‘hair loss makes it more difficult to start a conversation with people who attract me’, 75% that ‘other people pay less attention to me when I go flirting because of my hair loss’ and 76% that ‘I try to hide hair loss when meeting a new person’. Finally, 77% agreed that ‘there are people who can be attracted by bald men’ (pg. 1832).

"inherited disorder mediated by androgens"

Yes, overemphasizes benefits of treatments, downplays costs, argues drs need to "proactively question" patients on 'treatment's experiences seeking alternatives (meaning Merck / FDA approved ones not other 'treatments') argues further research needed to explore pathways to treatment etc. Yes, whole paper is about promoting pharma treatments especially (and not alternatives treatments and not accepting balding): "Conclusions: The results of this survey indicate a gap between the need for treatment of hair loss and initiation of such treatment among men in five European countries. Further research is needed into the factors affecting men’s willingness to seek treatment for hair loss"

Bade, Dr Rahul. ‘Impact of Androgenic Alopecia on the Quality of Life in Male Subjects: Results of an Observational Study from Tertiary Care Hospital’. Journal of Medical Science And Clinical Research, 2 October 2016. https://doi.org/10.18535/jmscr/v4i10.05.

To evaluate psychological impact and quality of life of androgenic alopecia in male patients

Recruited through dermatology outpatient
department of a tertiary care centre of Mumbai

"A prospective observational study" (pg. 12901)> Further details unclear, sounds like a cross-sectional design otherwise.

Hairdex and DQoL - better than most?

t-tests

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research7

Journal appears not to require disclosures

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

The first author, Bade, of the research (Bade et al., 2016) was a dermatologists providing baldness services at the time according to his dermatologist profile on Practo.com which states he has 10 years’ experience (Bade, n.d.). It appears the Journal of Medical Science and Clinical Research did not require disclosures.

Bade, R. (n.d.). Dr. Rahul Buvasaheb Bade—Dermatologist. Www.Practo.Com. https://www.practo.com/aurangabad/doctor/rahul-buvasaheb-bade-dermatologist
Bade, R., Bhosie, D., Bhagat, A., Shaikh, H., Sayyed, A., & Shaikh, A. (2016). Impact of Androgenic Alopecia on the Quality of Life in Male Subjects: Results of an Observational Study from Tertiary Care Hospital. Journal of Medical Science and Clinical Research, 4(10), 12900–1207. https://doi.org/10.18535/jmscr/v4i10.05

Bade, R. (n.d.). Dr. Rahul Buvasaheb Bade—Dermatologist. Www.Practo.Com. https://www.practo.com/aurangabad/doctor/rahul-buvasaheb-bade-dermatologist

10.18535/jmscr/v4i10.05

?Hard to tell - see notes. Need to understand the scores on the Hairdex and DQoL to fully make sense of their findings.

"Hair loss is a common problem and associated with cosmetic and psychological distress....androgentic alopecia is the most common cause....""treating patients of androgenetic alopecia" (pg. 12900)

Not in discussion but in introduction: "in many cases the results of treatment are unsatisfactory while on the other hand, people have high expectations, hence counselling is very important in these cases.Today, quality of life is being increasingly considered as a part of outcome measure while treating patients of androgenetic alopecia" (pg. 12900)

Budd, D, D Himmelberger, T Rhodes, T E Cash, and C J Girman. ‘The Effects of Hair Loss in European Men: A Survey in Four Countries.’ European Journal of Dermatology : EJD 10, no. 2 (2000): 122–27.

To assess the effects of hair loss on men in the general population of various European countries

A representative sample of households in 4
European countries (France, Germany, Italy and the United Kingdom. Randomly selected samples of men 18 to 40 years of age were surveyed in each
country.) Respondents were categorized into one of the four groups based on their self-reported
degree of hair loss: "a full head of hair", "a little hair loss", "some hair loss" or "moderate
hair loss", and finally, "a good bit of hair loss", "a lot of hair loss" or "bald".

Nonbiased representative sample

Men from households in 4 european countries

No - community sample

questionable - needs a closer look (not psychometrically tested?)

1) Hair appearance satisfaction - validated measures [8] of satisfaction with their hair appearance (on top of their head, frontal hairline, and overall), 2) degree of bother due to hair loss, 3) extent of concern about aging, and 4) perceived noticeability to others [13]. A "hair loss distress" domain score was calculated as the sum of responses to questions regarding bother and concern about looking older due to hair loss, whereas a domain score for thinning/shedding included three questions pertaining to shedding while grooming [7]. 5) general physical health (the SF-12 questionnaire) 6-9) three additional questions about mental health.

Unclear how participants details were contacted "A personal interviewer idewntified participants" but otherwise okay.

Some data not reported Differences among men with various degrees of hair loss were assessed using general
linear models. Some data presented in full text tables that are paywalled.

Acknwoledged in results certain measures not reported (pg. 6): "The general health measures, SF-12 physical (PCS-12) [16] and mental (MCS-12)
domains and the MHI-5 [17], were not related to self-reported hair loss and were not
significantly different from published norms for men in the United States between the
ages of 18 and 34 [16-17]."

Merck funding

Not assessed

? Also full tables and figures not included in full text which isn't available via institutional access.

"Androgenetic alopecia, or male pattern hair loss (MPHL), is a common condition" (pg. 122);.

Yes and 'awareness of treatments' actually assessed: "Additionally, data were collected about men's awareness of hair loss products and remedies, such as surgery, drug therapy, wigs, and hair styling"

Camacho, F M, and Ml García-Hernández. ‘Psychological Features of Androgenetic Alopecia.’ Journal of the European Academy of Dermatology and Venereology : JEADV 16, no. 5 (2002): 476–80.

To assess psychological features of androgenetic alopecia

Cross sectional survey and retrospective analysis of patient medical files (?)

Biased convenience

Dermatology clinic patients

None validated

"(a) Did he/she attend alone or with an accompanying person? (b) Did he/she enter the examination room alone or with an accompanying person? (c) Did he/she use a hairstyle that covered the alopecia? (d) Did he/she accept to have a trichogram performed? (e) Did he/she inform us that he/she was under psychiatric treatment for depression? (f ) Had he/she attended a hair centre before? (g) Had he/she received pseudotreatment in a hair centre? (h) Had he/she received implants in a hair centre? (i) Does he/she attend check-up appointments as scheduled? (j) Did he/she telephone to the centre between appointments? (k) Did he/she follow the treatment scheduled at the first consultation? (l) Was he/she considered a drop-out?"

Unclear what the treatment was, what the 'control visit' was, what the patient records were or what the observations were

% reported. Notes 12% male subjects lost to follow up

Very concerning methodological assessment. ? unable to determine much from the results given the assessment of aggression/anxiety seems o be based on very arbitary behaviours observed by the clinican "As we pointed out in the section on anxiety, the three patients with MAGA that we considered to be anxious and aggressive were the three who would not allow a trichogram: " (479)Reported effects of balding reflected considerable preoccupation, moderate stress or distress, and copious coping efforts. These effects were especially salient among men with more extensive balding and among younger men, single men, and those with an earlier hair-loss onset. Relative to controls, balding men had less body-image satisfaction yet were comparable on other personality indexes. Personality correlates of the psychological responses to hair loss were identified.

Brief paper but no limitations discussed

None found

Journal appears not to require disclosures

? unable to determine based on poor methodolgy

Undefined - just MAGA or AGA. Discusses diagnosis, treatment etc.

Not really - Is not explicit in advocacting cosmtic or medical treatments per se but does sugest their clinic treatment was effective and prescribed to the participants.

Cash, T F. ‘The Psychological Effects of Androgenetic Alopecia in Men.’ Journal of the American Academy of Dermatology 26, no. 6 (1992): 926–31.

This investigation examined the psychosocial impact and personalities of balding and nonbalding men

Thirty-one barber shops and hair salons in metropoli-
tan South Hampton Roads, Virginia, referred male
clientele to participate in the research for a nominal fee.

Non biased convenience

Participants selected via hair dressers on basis of hair loss, study described in general terms and hair dressers' attitudes disguised about the study.

No - selected via hair dressers, study described in general terms and hair dressers' attitudes disguised about the study.

yes for the psychological measures. "All measures possessed satisfactory reliability for this sample. "

1-4)The Hair Loss Effects Questionnaire (HLEQ) listed 70 possible effects of MPB, including emotional, cognitive, and behavioral events. MPB subjects indicated how their hair loss affected them on a 5-point rating of each item. On the basis of rational and statistical procedures, four composite HLEQ subscales were derived: (1) Negative Socioemotional Events (20 items; e.g., feeling self-conscious, being teased); (2) Positive Soeioemotional Events (15 items; e.g., feeling self-confident); (3) Cognitive Preoccupation (12 items; e.g., thinking about hair loss, noticing bald men); and (4) Behavioral Coping (14 items; e.g., seeking reassurance, doing things to conceal hair loss or improve appearance).Standardized measures were included to assess 5) body- image satisfaction, 9-u 6) social serf-esteem, 12 7) social anxi- ety, t3 8) public self-consciousness, J3 9) sexual self-confidence, l° and 10) locus of control.14 Locus of control refers to a person's belief system about his extent of control over events in his life.

M and SDs of scores sadly not reported. comparisons of the low-hair-
loss and high-hair-loss subjects on the HLEQ were conducted by t-tests.ANOVAs

compared the no-hair-loss (controls), low-hair-loss,

and high-hair-loss groups on the measures of per-
sonality and well-being.

1 sentence: "causality cannot be inferred". No other limitations acknowledged so will indicate no.

Upjohn funding

Not assessed

Yes-"Relative to controls, balding men had less body-image satisfaction yet were comparable on other personality indexes" (pg. 926). Appears (though not clearly reported) no differences were found on "social self-esteem, 12 social anxiety, t3 public self-consciousness, J3 sexua lself-confidence, l°and locus of control.1".Just 1 was signfiicant (body image)

It is never defined. Referred to as androgentic alopecia, MPB, balding and hair loss variously.

Referred to but not explicitly recommended: "medical treatments of persons with such body-image vulnerabilities have been discussed by Pruzinsky and Cash. 17 Contrary to prevalent assumptions that only women have body-image problems, 4, 18 the present findings implicate MPB as contributing to men's body-image concerns. Still, the psychological effects of androgen'eric alopecia on women are likely to be even more deleterious than those observed among men, a hypothesis I recently investigated.* One im- portant implication of the present results is that per- sons seeking remedies for androgenetic alopecia are often anticipating or experiencing losses beyond the loss of hair per se. An empathic understanding of these patients' concerns is essential to effective management" (pg. 930)

Cash, T F, V H Price, and R C Savin. ‘Psychological Effects of Androgenetic Alopecia on Women: Comparisons with Balding Men and with Female Control Subjects.’ Journal of the American Academy of Dermatology 29, no. 4 (1993): 568–75.

To determine the psychosocial impact of androgenetic alopecia in women and men.

The female control subjects (Fe) were 56 women
without androgenetic alopecia, who sought treatment for
cutaneous conditions that were notpublicly visible (espe-
cially not on the head or face) and were not sexually
transmitted diseases. The majority had nevi (15), sebor-
rheic keratoses (12), warts (9), skin tags (4), or cysts (3).
Other conditions represented were tinea pedis, keloids, li-
poma, eczema, psoriasis, dermatitis, and fungal infec-
tions. FC patients were comparable to the FAA group in
age (mean 37.2 years), race (82% white), and marital
status (54% unmarried).

Three groups of patients (N =212) were paid volun-
teers, selected from each of two dermatology centers in San Francisco and New Haven. They were consecutive referrals or private patients who met the study's diagnostic and treatment criteria.

Biased convenience

Dermatology clinic patients and paid volunteers for study diagnosed with male AGA

Yes - all dermatology clinic patients and paid volunteers for study diagnosed with male AGA

??? where did the hair loss specific questionnaires come from? Reliability/validity.

1) Social desirability - The 13- item Social Desirability Scale'' provides a validity index, assessing the influence of defensive response sets.
2) Body self relations including hair satisfaction - The 69-item Multidimensional Body-Self Relations Questionnaire (MBSRQ)?' 8 assesses multiple facets of body-image attitudes-including the Appearance Evaluation scale to measure feelings of attractiveness and satisfaction with one's overall appearance, the specific Hair Satisfaction scale, and the Appearance Orientation scale to assess the extent of psychological investment in appearance.
3) Social self esteem - The 16-item Texas Social Behavior Inventory? assesses social self-esteem.
4) Locus of control - The 24-item Levenson Locus of Control Scale (LaC) 10measures internality (belief in self-deter- mined control over life events), chance externality (belief that life events are largely controlled by fate, chance, or circumstances), and powerful others externality (belief that powerful people and institutions control one's life).
5) Self consciousness - The 13-item Self-Consciousness Scale! I, 12 assesses the intensity of self-as-object experiences in social contexts (i.e., public self-consciousness) and social anxiety. Two multiple-item indices (a total of 10 items) assess subjects' life satisfactionl' and psychosocial well-being.f
6) Illness condition stressfulness - The 15- item Impact of Event Scalel4, 15 measures the past-week stressfulness of the condition for which the patient was consulting the physician.
7) Hair loss information The Hair Loss Information Questionnaire (HLIQ), adapted from previous re- search.? contains items (including Ludwig and Norwood- Hamilton charts) for self-description of various aspects of reactions to past, recent, and future hair loss.
8) Hair loss effects - The Hair Loss Effects Questionnaire (HLEQ)2 assesses the psychosocial effects that patients attribute to their hair loss. Each of 69 effects is rated on a 5-point scale (from - 2 ="much less" to 0 ="no change" to +2 ="much more"). Itern analyses of the HLEQ revealed three multiple-item subscales: (1) Adverse Psychosocial Effects (i.e., cognitive, emotional, and social events), (2) Positive Events, and (3) Behavioral Coping.

A 2 (FAA vs MAA) X 2 (past vs cur-
rent effects) analysis of variance (ANOVA) re-
vealed that women reported more adverse past and

current effects than did men

1 sentence: "causality cannot be inferred". No other limitations acknowledged so will indicate no.

Upjohn funding

Some-30% not distressed as past negative effects, 21% reported no negative effects currently, 5% reported no past emotional distress and 11% no current emotional distress

"Androgenetic alopecia in women is a hereditary hair-loss pattern of diffuse central thinning" (pg. 568)

Argues that physicains should take hair loss more seriously (and presumably do more inc. treatments & psychotherapy) because of the psychological consequences of hair loss. "Physicians should recognize that androgenetic alopecia goes well beyond the mere physical aspects of hair loss and growth. As has been observed for other appearance-altering conditions, we found that patients' psychological reactions to hair loss were less related to clinicians' ratings than to patients' own perceptions of their extent of hair loss. Even in patients with slight hair loss, that loss is imbued with considerable emotional meaningthat the physicians should not ignore. The losses at stake and gains to be had pertain not only to hair but, from the patient's perspective, are also felt in the quality of life. In addition to medical or surgical treatments and nonsurgical hair replacements, psychotherapeutic assistance maybe valuable in the managementof some patients' body-image difficulties" (pg. 574)

Cash, TF. ‘Attitudes, Behaviors, and Expectations of Men Seeking Medical Treatment for Male Pattern Hair Loss: Results of a Multinational Survey.’ Current Medical Research & Opinion 25, no. 7 (2009): 1811–20.

To assess attitudes, behaviours, and expectations of men seeking medical treatment for male pattern hair loss

Emails sent to male consumers within age range on a market research company database

604 - Yes some justification, 236,561 approached, 21,501 agreed to participate (8.9%), and 604 participated (these were the first to agree to participate). "The sample size of 604 participants gave a maximum margin of error of 3.3% across all six countries at a
90% confidence interval (4.0% at a 95% confidence
interval). In addition to the presentation of descriptive
statistics, inferential statistical analyses were performed
using F-tests or median tests for group comparisons of
continuous variables, chi-square tests for categorical
data, and regression analysis for the multivariate prediction of continuous variables. Similar to the methodology described by Alfonso et al. in their multinational
survey of men with MPHL10, analysis of results in this
survey involved pooled data from all six countries to
maximize statistical reliability" (pg. 1814)

Biased representative sample

Men who had left their email with Harris Interactive database of consumers

Biased as only sought treatment-seeking men with MPHL (from a consumer database) how these men were determined is unclear but probably from the screening questions. Nonetheless it is clear in the aims and discussion that this was the sample: "The research objectives were to characterize more fully the concerns and selftreating efforts of men who seek medical treatment for
MPHL," (pg. 1812). In addition only men who were treatment orientated were recruited: "However, much of what is known about men’s experiences associated with MPHL derives from broad community samples rather than from clinically relevant cohorts who are treatment-motivated.,,,In this online international survey, men who selfidentified as having MPHL and were treatmentmotivated" (pg. 1817)

Lagre non responders rate 90%+ no explanation given

Non validated but cross translation validation of items 1) Demographics 2) Men’s concerns about their MPHL and its impact
on treatment attitudes, i3) Obstacles and motivations to seeing a doctor
about MPHL, and 4)( Expectations and experiences of men seeing a doctor about MPHL,

Yes study says questionnaire available via appendix

Undisclosed - perhaps not as conducted by a market research company Harris Research Interactive

Mostly - but assumes treatment is helpful which might not be the case, assume reluctance to get treatment is doctors fault rather a rational decision.

Yes - appears so

Merck funding

A little - 4% not concerned at all (though sample is biased)

"Androgenetic alopecia in men, or male pattern hair loss (MPHL)...is a condition....[that] characteristically presents as a progressive loss of scalp hair on the frontal, temporal, and vertex regions and increases in prevalence with age" (pg. 1818). Referred to as a condition throughout (pg. 181*) and as MPHL.

Yes but doesn't mention ineffectiveness, side effects or costs (even when assessing for 'treatment awareness') costs are downplayed.E.g., - this actually shows 38-67% of those taking minoxidil or finasterid do not percieve these to be succesful."In the European community-based surveybyAlfonso et al., self-perceived treatment success with approved therapies was relatively high (62% for finasteride and 43% for minoxidil)10." (pg. 181). Yes "Few busy physicians can afford lengthy discussions
with every patient with androgenetic hair loss, yet our
data indicate that, however uncomfortable, motivated
patients initiate the MPHL discussion about 90% of the
time and that these patients desire specific treatment
recommendations. It should be appreciated that an
individualized consideration of the patient’s concerns,
self-treating efforts, and expectations is paramount for
productive counseling and management of men seeking
medical treatment for MPHL. In this regard, a brief,
structured patient questionnaire may be an efficient
and effective clinical tool to clarify relevant issues and
reveal areas for further evaluation and communication" (pg. 1819)

Danyal, M, S I A Shah, and M S U Hassan. ‘Impact of Androgenetic Alopecia on the Psychological Health of Young Men’. Pakistan Journal of Medical and Health Sciences 12, no. 1 (2018): 406–10.

To investigate the psychological impact of different severity of hair loss among young men in the local population

they had a control group which was presumably those with minimal hair loss

"Non-random convenience sampling technique was employed and men between 20 to 30 years of age showing some degree of hair loss were approached" (pg. 407)

no power analysis

Non biased convenience

Likely recruited from authors' institution: Lahore Medical College. Participants who had transplants or "those using hair accessories" (pg. 406) excluded.

Unclear where they were recruited from. Participants who had transplants or hair accessories excluded.

Good

1. Hamilton Anxiety Rating Scale (HAM-A), 2) Rosenberg Self-
Esteem Scale (RSES) and 3) Zung Self-Rating Depression scale (SDS)

One-way ANOVA and post-hoc Bonferroni correction
were applied to observe differences between each
group’s mean scores. A p-value of <0.05 was
assigned for statistical significance.

None found

Not assessed

Somewhat- assessed 3 outcomes, 2 didn't differ to norms for balding men, just 1 did (anxiety) and only for a subgroup of balding men and even this this was moderate impact. Anxiety was higher for baldning compared to non balding men. Self esteem was lower compared to nonbalding men (though still within normal range; (assuming modifcation hasn't change response scale, unclear).. Depressionwithin normal range Anxiety for one group (men who had mild-moderate baldness though not for men with greater baldness n = 3) were significantly hgiher than nonbalding but noentheless this was only mdoerate anxiety.

"common condition known to affect between one-third
to half all men by the age of 50 years1. The
pathophysiology of androgenetic alopecia..." (pg. 406)

"Psychosocial measures need to be installed to
facilitate affected men in overcoming such deficits. Cosmetic treatments may also be used as a
remedy for the psychological concern arising due to hair loss." (pg. 406)

DeMuro-Mercon, C, T Rhodes, C J Girman, and L Vatten. ‘Male-Pattern Hair Loss in Norwegian Men: A Community-Based Study.’ Dermatology (Basel, Switzerland) 200, no. 3 (2000): 219–22.

This study sought to characterize the prevalence and self-perceived psychosocial impact of hair loss on community men not seeking treatment for their hair loss

Men without hair loss - not matched?

All members of the community
were invited to participate in the general health survey
and male participants, aged 20–50 years (n = 7,250),
regardless of their degree of hair loss, were asked to
complete a mail-based questionnaire.large-scale, population-based epidemiologic
study investigating the prevalence of self-reported degree
of hair loss and the psychosocial effects due to hair loss in
a community sample of over 4,000 Norwegian men.

Nonbiased representative sample

Purposive & representative sample

No - community sample

Poor the study does not report the findings from the standardised measures of mental health and health, only the findings from the nonvalidated concern about hair loss questions.

The questionnaire measured 1) satisfaction with hair appearance - the instrument included several questions regarding the subjects’ satisfaction with the appearance of their frontal hairline, the hair on top of their head, and their overall hair appearance, adapted from a previously validated instrument [5, 6]. These questions offered respondents a 5-point response scale that ranged from ‘I am very satisfied’ to ‘I am very dissatisfied’. 2) Hair Loss bother 3) Concern about getting older due to hair loss, 4) Noticeability of hair loss to others and included the 5) SF-12 general health status questionnaire 6) mental health survey (MHI-5).

Full questionnaire used not available and some items were constructed. Otherwise quite replicable.

Specific M and SD not reported for validate measures (though the M for one measure is represnted on a chart), mostly %s, inferrential test statistics missing. Two domain scores were calculated by summing responses to
individual questions comprising the domain. A hair thinning/shed-
ding domain was comprised of three questions regarding the degree
of thinning and shedding while grooming or bathing, while a hair loss
distress domain consisted of two questions regarding the degree of
bother and concern about getting older due to hair loss.

Merck funding

95% never used medication "Only 4.5% reported ever using medication for thier hair loss" (pg. 220)

Yes, 79% of men reported not being bothered, 67% were not concerned about growing older and 87% were not dissatisfeid with overall hair appearance.

"male-pattern hair loss" (pg. 219)

None advocated

Franzoi, Stephen L., Joan Anderson, and Stephen Frommelt. ‘Individual Differences in Men’s Perceptions of and Reactions to Thinning Hair’. The Journal of Social Psychology 130, no. 2 (1990): 209–18.

To assess hair loss’s relation to public self-consciousness.

They split the group based on their questionnaire scores in order to make comparisons between those high and low in self-consciousness, and/or high or low levels of hair loss.

casually selectedAt Milwaukee's General Mitchell International Airport, a male and female
researcher simultaneously approached men who were waiting for their
flights to depart and asked them if they would be willing to answer two
short questionnaires representing two separate studies being conducted at a
nearby university. One researcher carried a questionnaire labeled "Personal
Reaction Survey," and the other researcher carried a questionnaire labeled

"Physical Appearance Survey."

Non biased convenience

Convenience sample - men at airport showing signs of visible hair loss approached

Yes - used validated scale for self-consciousness but appearance scale was not validated.

1) Self consciousness - The Personal Reaction Questionnaire consisted of the public and private self-consciousness subscales of the Self-Consciousness Scale (Fenigstein et al., 1975), The public self-consciousness subscale measures the tendency to be aware of and concemed about public aspects of the self; the private self-consciousness subscale measures the tendency to fo- cus attention on priyate, nonvisible aspects of the self.
2) Demographics - along with items requesting the participants' age, weight, height, occupation, and marital status.
3) Hair Loss Distress - The Physical Appearance Questionnaire consisted of a series of questions and statements concerning hair loss. If a participant had any hair loss, he was asked how long he had noticed this condition, and he then responded to three hair-loss concern statements on a 4-point Likert scale: not at all like me (0); a little like me (1); somewhat like me (2); a lot like me (3). The state- ments were "I'm concerned about my hair loss," "I spend time thinking about my hair loss," and " I become sensitive when kidded about my hair loss." If he had a full head of hair, he responded to similarly worded state- ments in terms of future hair loss (e.g., "If I were losing my hair, I would be concerned about it.") For both balding and nonbalding men, responses to these three items were summed to form a hair-loss concern measure (Cron- bach's alpha = .87 for balding and .80 for nonbalding men). 4) Balding discrimination & stigma - The partici- pants were then asked to give their opinions, strongly disagree (1), disagree (2), agree (3), strongly agree (4), on the following three statements concern- ing possible negative consequences suffered by men with thinning hair: "Bald(ing) men are generally judged as less attractive," "Bald(ing) men are discriminated against on the job, " "Women are less likely to date bald(ing) men."
4) Self reported Attractiveness - They were then asked to rate their own attractiveness on a 10-point scale, from very unattractive (1) to very attractive (10).
5) Hair Loss Drug Use - Finally, they were asked whether, if faced with noticeable hair loss, they would consider using a prescription drug that is successful in stimulating hair growth approximately 40% of the time. The response format was defmitely yes (1), pos- sibly (2), unlikely (3), and defmitely not (4).

the men were placed into one of two groups based on
whether they had experienced any hair loss; 43% were nonbalding, and
57% were balding. In some of the analyses, they were categorized as either

high or low in public self-consciousness based on a median split of the sam-
ple (Mdn = 18), and an analysis of variance was conducted. In other analy-
ses, public self-consciousness scores were left in their interval form and par-
tial correlations were calculated between these scores and other VEiriables.

Because there was an age difference between men with thinning hair and
those with a full head of hair, all analyses controlled for age.

Distress isn't reported by all balding men, but self conscious balding men it is. This is acknowledged in the abstract.

None found

Journal appears not to require disclosures

Not assessed

Somewhat- 53% disagreed that men with thinning hair are less attractive, 59% disagreed that women are less likely to date balding men and 89% disagreed that baldning men are discriminated against on the job. 33% reported no concern about hair thinning. Finally 49% were unlikely or definitely wouldn't use a prescription drug for hair growth.

"Visible sign of the aging process" (pgf. 209)

None advocated

Ghimire, Rupak Bishwokarma. ‘Impact on Quality of Life in Patients Who Came with Androgenetic Alopecia for Hair Transplantion Surgery in a Clinic.’ JNMA; Journal of the Nepal Medical Association 56, no. 212 (2018): 763–65.

To assess the overall impact in quality of life in patients with AGA

patients
with androgenetic alopecia who came for hair transplantation surgery at Aavaran Skin Clinic Pvt
Ltd, Battisputali, Kathmandu between 15th July 2017 to 15th February 2018.

Fair as no statistical analsyis

Biased convenience

Yes hair transplant patients

Yes hair transplant patients

Good (I think - no reliability reported - need to find out where this has come from).

1) The DLQI questionnaire consisted of 10 questions regarding symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment as dimensions of life. Each answer was scored on a scale of 0–3 points. Scores were added to yield a total DLQI of 0–30 points; higher scores indicated greater impact on the patient’s QoL.

Very brief description but appears DLQI only included and patient sample described.

Limited - only reports percentage of patients who indicated some impact on quality of life.

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research8

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

Probable Conflict of Interest where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is. Specifically, the author, Ghimire, of the research (Ghimire, 2018) was a hair transplant surgeon according to his dermatological clinic employer: “[He is] one of [the] pioneers in hair transplant surgery in Nepal [who[ completed more than 1000 hair transplantation cases in more than 5 years of experience in Nepal” (Aavaran, n.d., para. 12). In J Nepal Med Assoc the author indicates he has no conflicts of interest.

Source: Aavaran. (n.d.). Best Skin and Hair Clinic in Nepal—Aavaran Skin and Hair Clinic. http://www.aavaranskin.com/about

Aavaran. (n.d.). Best Skin and Hair Clinic in Nepal—Aavaran Skin and Hair Clinic. http://www.aavaranskin.com/about

rupakghi@gmail.com

Yes - 52% responded 'none at all' when asked about hair loss's impact on their self consciousness (& 28% reported it had only a little); 97% responded 'none at all' when asked about hair loss's impact on difficulties with sexual life.

"Androgenetic alopecia (AGA) also known as male
pattern baldness, affects up to 50% of men worldwide.1
Medically, alopecia is viewed as a relatively mild
condition but those suffering from the condition feel a
major distress on life and how other people view them." (pg. 763)

None advocated

Girman, C J, T Rhodes, F R Lilly, S S Guo, R M Siervogel, D L Patrick, and W C Chumlea. ‘Effects of Self-Perceived Hair Loss in a Community Sample of Men.’ Dermatology (Basel, Switzerland) 197, no. 3 (1998): 223–29.

To assess self-perception and the impact of hair loss

Yes - men without hair loss in sample (30% reported no loss)

138 approx

Nonbiased representative sample

Purposive & representative sample. Houeholds in select zip codes from Dayton, Ohio with at least 1 male aged 18-65 were contacted to participate in research. 70% reported a little or at least some hair loss (presumably). Exact number of men with AGA not stated.

No - community sample

Yes - acknowledged and follow up survey conducted

Appears 2 distress measures deployed but the name, scoring and example items aren't included in manuscript.

No - some constructed items included but not specified in appendix how scored etc

Descriptives of distress measures unreported (M and SDs)

Merck funding

Not assessed

Some - 38% reported no bother about their hair loss, 40% were not concerned about getting older and 70% reported no dissatisfaction with overall hair appearance (among moderate& extensive hair loss groups together) and according to graphs.

"Androgentic alopecia....is characterised by the recession of the frontal hairline and overall thinning in the vertex area, and affects an estimated 29%...the prevalence...increases with age" (pg. 223)

None advocated

Gonul, Muzeyyen, Bengu Cevirgen Cemil, Havva Hilal Ayvaz, Eylem Cankurtaran, Can Ergin, and Mehmet Salih Gurel. ‘Comparison of Quality of Life in Patients with Androgenetic Alopecia and Alopecia Areata.’ Anais Brasileiros de Dermatologia 93, no. 5 (2018): 651–58.

To assess QoL in patients with AA or AGA

Clinical sample recruited through a dermatology clinic

Biased convenience

Dermatologyy clinic patient

Yes - dermatology

The validity and reliability of the Hairdex index have not been established in Turkey.

1) dermatology quality of life (TQL Turkish trasnalsation of DLQI?) “Hairdex scale and dermatology quality of life instrument in Turkish (TQL).scales”. TQL consists of 11 questions, each related to a dif- ferent aspect of skin disease (social, emotional, cognitive, sex life, daily activity, and symptoms) and QoL.7 Answers were scored from 0 to 4 according to the grading system. The maximum score was 44, and higher scores indicated lower quality of life. Gurel MS, Yanik M, Simsek Z, Kati M, Karaman A. Quality of life instrument for Turkish people with skin diseases. Int J Dermatol. 2005;44:933-8. tThis references note the Turkish DLQI is "based on a number of published works.1,3–6" one source is Finlay & Khan> Doesn't say how it is based on this however paper does report validity of instrument. Scores from sample are M - 13.28 (SD = 8.33)
2) Hairdex is an instrument developed to measure QoL in patients with disorders of the hair and scalp. The scale includes questions in five categories: a) emotions; b) functioning; c) symptoms; d) self-confidence; and e) stigmatization. Answers were graded from 0 to 4 by the subjects ac- cording to the frequency with which they occurred. Higher subscale scores for emotions, functions, symptoms, and stigmatization indicate more adverse effects on QoL, but a lower score on the self-confidence subscale suggests lower self-confidence or more adverse effect on QoL.8-11. Fischer et al. developed the Hairdex score as a tool for evaluation of disease-specific quality of life in patients with hair disorders. It consists of a 48-item questionnaire with hair-specific questions, and it allows assessing the effects of hair conditions in different categories such as functioning, symptoms, emotions, self-confidence, and stigmatization.8,18

Correlations and descriptive stats.

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research9

Four of the six authors of the research (Gonul et al., 2018) list their affiliation to a dermatology clinic. Currently this clinic offers baldness interventions (Dışkapı Yıldırım Beyazıt Training and Research Hospital, 2020). The authors declare they have no conflicts of interest in the journal: Anais Brasileiros de
Dermatologia.

Source: Dışkapı Yıldırım Beyazıt Training and Research Hospital. (2020, February 25). Dermatology Clinic. Diskapieah.Saglik.Gov.Tr. https://diskapieah.saglik.gov.tr/EN,427914/dermatology-clinic.html?_Dil=11

10.1590/abd1806-4841.20186131

dbcemil@yahoo.com

? unclear scale ranges and modifications for hairdex and TLQI

"Hair loss is a worldwide problem. Androgenetic alopecia (AGA) is a common hair loss disorder with a genetic predisposition that can occur in both sexes and at any age after puberty.1 AGA is biologically benign and is not a disease in the conventional sense....Although androgenetic alopecia is common and neither life-threatening nor painful, it is a stressful disorder with increased need for improvement in the patient’s quality of life. " (pg. 651)

None advocated

Gosselin, C. ‘Hair Loss, Personality and Attitudes’. Personality and Individual Differences 5, no. 3 (1984): 365–69.

To assess what association, if any, exists between hair loss and some personality variables.

Three groups were tested: those in the first group had had a hair weave fitted and were retaining
the weave as a viable solution to their hair problem; the second had worn the weave for a trial period
but had decided against its continued use; the third had had no form of treatment and seemed little
concerned about their hair loss.Group 3 (Unconcerned) comprised 51 control males who had not considered the hair weave
or any other treatment and seemed unconcerned or very little concerned about their partial baldness.

adult males who had attended one of a
number of clinics specializing in hair replacement in the form of a hair weave

Biased convenience

Personality measures were - hair loss not.

1) Personality - The first was a standard Eysenck Personality
Questionnaire.
2) Autonomy (Eysenck & Wilson, 1976).
3) Self-esteem scales (Eysenck & Wilson, 1976)
4) (self-rated opinions ranging from ‘much worse’ to ‘much better’) Hair loss attitudes/impact (on work, social, sexual, visual appearance and age),

Full constructed items included, sample adequately described.

t-tests to look for differences between the 3 different groups.

Tri Mil Trust / Institute of Trichologists funding

Yes - "It will be seen that, for each variable, life turned out rather better than was expected when hair loss began, and that
although some degree of adverse effect was experienced, it was in most cases significantly less than was expected. " (pg. 368). AUthor measured expectations about impact when first experiencing hair loss and then the reality on a 5 point scale where 5 = life got much better and 1 = life got much worse. Among the unconcerned hair loss group (most representative) across the 10 items scores average ranged from 1.98 - 3.08. Rounding up,3 of the 10 items men in this group indicated they expected or life got slightly worse (scores close to 2) and 7 of the items indicated life had no change (scores closer to 3).

"phenomenon of hair loss." (pg. 365). Also critiques association of hair loss with distress as this comes from biased sample research

None advocated

Gupta, Sanjeev, Ishan Goyal, and Aneet Mahendra. ‘Quality of Life Assessment in Patients with Androgenetic Alopecia.’ International Journal of Trichology 11, no. 4 (2019): 147–52.

To study the clinical profile of 200 male patients

conducted in the outpatient department of dermatology in a tertiary care center in North India.

"A prospective study" (pg. 148) & "Clinical profiles of 200 patients were studied, and QOL assessment was done using the DLQI and hair‑specific Skindex‑29 scales." (pg. 201). However otherwise appears to be cross sectional questionnaire

Biased convenience

Dermatologyy clinic patient

Yes - dermatology

GOOD

1) QOL in all patients was assessed using the Dermatology
Life Quality Index (DLQI) scale and The DLQI questionnaire was used to
know the hair and scalp problems for the past week. The
DLQI score consisted of maximum of 3 and minimum
of 0 values against a total of 30 score for each patient.2) the hair‐specific
Skindex‐29 scale. The Hairdex scale consisted of three subscales, i.e.,
emotion, function, and symptom. The pro forma consisted
of 29 questionnaires with a maximum score of 5 and
minimum score of 1 for each questionnaire. The total
minimum score was 29 and maximum score was 145 for
each patient.

descriptive stats

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research10

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

(Gupta et al., 2019) was a hair transplant surgeon at the time of the research according to his dermatologist profile on Practo.com stating he has 11 years’ experience providing services including baldness interventions (Dr. Sanjeev B. Gupta, n.d.). The authors declare no financial support, sponsorship, or conflict of interest in the journal: International
Journal of Trichology.

Source: Dr. Sanjeev B. Gupta. (n.d.). Dr. Sanjeev B. Gupta—Dermatologist. Retrieved 10 May 2021, from https://www.practo.com/pune/doctor/dr-sanjeev-b-gupta-dermatologist-cosmetologist

sanjeevguptadr@gmail.com

? DLQI and other validated measure scores. Although somewhat higher than other studies DLQI (M = 13.5) this was below the 50% quartile of the scale (scale range 0-30).

"Hair is one of the defining characteristics of
mammals. All through the ages, it has sociological
and psychological importance in making appearance
and personality of a person. The cultural origin of
humankind is reflected in different hair styles and
different hair‑shaving patterns. It also reflects the
person’s status and his distinct personality. Due to hair
hype by public and media advertisement, hair excess
or loss is socially and cosmetically unacceptable as in
hirsutism and alopecia. The genetically determined
progressive process that causes a gradual conversion of
terminal hair into vellus hair is known as androgenetic
alopecia (AGA), which is the most common type of
hair loss affecting over 70% of adult males and 50%
of women.[1] AGA is a benign condition and can have
significant psychological impact on a person and involves both hormonal and genetic factors....in patients with AGA due to continuous disease progression, QOL gets impaired" (pg. 147)

"Trichoquackery" is mentioned (pg. 150). Advocates medical practitioners address psychological impact of alopecia meaning both:"The medical practitioners can play a role in improvement of patients’ QOL, by recognizing and addressing the psychological impact of alopecia.
However, further research will be needed to know the QOL improvement with the newer behavioral PRP and LLLT therapies"

Han, Sung-Hyub, Ji-Won Byun, Won-Soo Lee, Hoon Kang, Yong-Chul Kye, Ki-Ho Kim, Do-Won Kim, et al. ‘Quality of Life Assessment in Male Patients with Androgenetic Alopecia: Result of a Prospective, Multicenter Study.’ Annals of Dermatology 24, no. 3 (2012): 311–18.

having MPA and to access its impact on QOL

Recruited from the dermatology depar-
tments of thirteen university hospitals in South Korea.They included patients who visited a hospital for
the treatment of alopecia and who visited a hospital for

the treatment of other diseases, but showed clinical hair

loss, which was sufficient enough to diagnose with alo-
pecia.

Biased convenience

Dermatologyy clinic patient

Yes - dermatology

However, a Skindex score has not been validated for use
in AGA. Despite the widely reported psychosocial
consequences of alopecia, each researcher used different
kinds of tools, such as the Skindex-16, the Skindex-29,
and the Dermatology Life Quality index and the brief
COPE. Among those tools, the Skindex scale was recently
used to measure the QoL of patients with hair loss7

1) Hair Specific Skindex-29. Assessment of the QoL using the Hair-Specific Skindex- 29. The Skindex-29 scale, which was originally developed by Chren et al.10, was modified to assess the QoL of patients with AGA. The words ‘skin’ and ‘skin condition’ on the Skindex-29 were changed to ‘scalp’ or ‘AGA’, respectively, and the Skindex-29 itself was renamed as the Hair Specific Skindex-29. This questionnaire consisted of three kinds of scales: a symptom scale (7 items), a function scale (12 items), and an emotion scale (10 items). Patients answered each question with a number ranging from 0 (never bothered) to 5 (always bothered). Answers to each item were transformed to a linear scale, ranging from 0 (never bothered) to 100 (always bothered). A scale score was the average score from the responded items and a global score was the mean of the sums of each scale. A high score indicates severely impaired QoL, and a low score reflects mild damage in the QoL.2) Assessment of clinical characteristics Patients were instructed to answer questions, such as previous experience in non-medical hair care and satisfac- tion ratings for the care, reasons for hospital visits, age, duration, and severity of AGA.

To investigate the relationship between age and
patient’s QoL, the patients were separated into three
groups: a group aged less than 30 years old, a group aged
between 30 and 50 years old, and a group aged over 50
years old. The duration of AGA was separated into three
groups: less than one year of alopecia, 1 to 5 years of
alopecia, and exceeding 5 years of alopecia. Did correlations and Multiple linear regression analyses were
conducted to determine the statistical predictors of QoL,
controlling for demographics and disease factors.

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research11

Journal appears not to require disclosures (does declare non-commercial funding in acknowledgements however)

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

The fourth author, Hoon Kang, of the research (Han et al., 2012) lists their affiliation to The Catholic University of Korea. On their webpage Kang is listed as providing “quick treatments” including “hair implants” (The Catholic University of Korea, n.d.: 5–6). The authors do not declare this, instead only acknowledging Korean Dermatological Association funding in the Journal Ann Dermatol.

Source: The Catholic University of Korea. (n.d.). Dermatology. https://www.cmcep.or.kr/page/en/department/A/1286/2

10.5021/ad.2012.24.3.311

?It's hard to know the significance of the skindex scores. On avaregae they look low to me suggesting not much distress.

"Medically, alopecia is viewed as a relatively mild dermatological condition." (pg. 311) and "The aim of this study was to investigate the clinical and
previous treatment factors, such as previous non-medical
hair care experiences, reasons for hospital visits, age,
duration, and severity of AGA, which can affect the QoL
of AGA patients."

"Physicians need
to offer relevant treatment not just for hair loss, but for
their emotional distress to AGA and functional consequences on their everyday lives" (pg. 317)

Karaman, Göksun Can, Ciğdem Dereboy, Ferhan Dereboy, and Esra Carman. ‘Androgenetic Alopecia: Does Its Presence Change Our Perceptions?’ International Journal of Dermatology 45, no. 5 (2006): 565–68.

To investigate the QoL of AGA patients

Recruited from workplaces - but information a bit vague

Unclear

Poor

1-8) eight questions for psychological evaluation (unspecified) & 9) list of 43 potentially stressful life events originally developed by Holmes and Holmes. In the present study each subject was given
the Turkish translation of this instrument and asked to insert
‘baldness’ into the most suitable space in the list, thereby
indicating the extent of distress caused by losing hair as compared
with other stressful events

Unclear how workplaces were found for participants, unclear number of participants. Constructed measure not reported.

T-test and chi squareThe relationship between desire for treatment and
demographical variables was assessed by means of a forward,
stepwise, logistic regression analysis.

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of the research12

Journal appears not to require disclosures

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

Multiple authors of the research (Karaman et al., 2006) list their affiliations to the dermatology department of Adnan Menderes University. It is unclear if this department offered any baldness interventions at the time. However, the first author, Göksun Karaman indicates she has privately offered baldness interventions since at least 2016 (Karaman, n.d.). It appears the journal: International Journal of Dermatology did not require disclosures.

Source: Karaman, G. (n.d.). Prof. Dr. Göksun Kahraman | Hakkımda. GöksunKaraman.Com. http://goksunkaraman.com/hakkimda/

10.1111/j.1365-4632.2005.02522.x

gkaraman@adu.edu.tr

Yes - 19% did not desire treatment. Most ppts thought that having their hair cut very short was a very appropriate approach to hair loss (although prevalence rates not reported). 62% (n = 154) of all the participants accepted AGA as a natural condition; however, they thought that a solution should be sought. 16% (n = 40) viewed it as a natural condition, 33% (n = 83) noted that hair loss was not noticed. Although results in the table and elsewhere are incomplete and sometimes only reported for both balding men (70%) and nonbalding men (30%) together, baldness was seen as impacting psychological wellbeing: positively (4%) or in no way (40%), family relationships positively (3%) or in no way (60%), occupational/academic life: positively (4%) or in no way (60%) and relations with opposite sex: positively (7%) or in no way (50%),

"Androgenetic alopecia (AGA), which is also known as malepattern baldness, is a specific type of hair loss mediated by
systemic androgens and genetic factors. Although AGA is not
considered a ‘disease’, it becomes a medical problem when the
hair loss is subjectively seen as excessive, premature, severely
progressive and distressing.1–4
The concept of health has a wider definition compared with
the past. The contemporary definition which emphasis well
being of the individual not only in a physical sense but also in
mental and social senses encompasses the psychological distress
created by physical limitations. Research on the psychological
results of AGA has been concentrated on the socio-cultural
meaning of hair loss, and individual as well as social variations in percepting and emotionally reacting to baldness." (pg. 565)

None advocated

Kranz, Dirk. ‘Young Men’s Coping with Androgenetic Alopecia: Acceptance Counts When Hair Gets Thinner’. Body Image 8, no. 4 (2011): 343–48.

To evaluate the effects of androgenetic alopecia on males with and without hair loss and to delineate the level of stress gained

German university students. Poster campaign and those with hair loss & were healthy participated in online or paper version of the same survye. Shampoo incentive (not related ot hair loss) was given.

Nonbiased convenience

Men with hair loss who answered a recruitment poster from author's university about the study

No - community sample

1) Self-esteem. The 10-item Rosenberg Self-Esteem Scale (SES; Rosenberg, 1965) was used to assess general self-esteem.Stage of hair loss. 2) Coping with hair loss. Based on Cash et al.’s (2005) work on coping with body image problems, six items were formulated to measure compensation, avoidance, and acceptance of balding. In particular, participants were asked how they dealt with their hair loss and rated the following statements on 5-point scales ranging from 1 (strongly disagree) to 5 (strongly agree). 3) Hair loss distress. Based on a literature review of hair loss dis- tress (see Introduction section), six items were formulated that referred to negative thoughts and feelings typically associated with hair loss (“looking old”, “becoming unattractive”, “having disadvan- tages”, “feeling embarrassed”, “feeling shy”, and “feeling insecure”). Items were rated on 5-point scales ranging from 1 (strongly dis- agree) to 5 (strongly agree).5) Medical consultation about hair loss. Finally, participants were asked if they had ever consulted a doctor about their hair loss. Of the 160 young men in the present study, 34 (21.3%) responded positively.

L’Oreal shampoo samples used as participant incentives

79% had not consulted a doctor ever. Only reported prevalence rates for "ever having consulted a doctor about hair loss" (pg. 344). FInding 21.3% had.

Yes - "compensation and especially avoidance seem to be dysfunctional responses to hair loss, whereas acceptance might have a functional value".

"Androgenetic alopecia cannot be considered a disease in the proper
sense. It has no impact on the state of an individual’s physical health
but may have an enormous impact on an individual’s mental health." (pg. 343) nonetheless does include some medicalizing language such as "condition", links ot hormones and genes too.

Advocates acceptance and psychological therapies and is cautious about cosmetic/medical (noting side effects of treatments: "Responsible practitioners and
dermatologists might be correct when hesitating to medically or
even surgically treat balding in young men. They should rather
encourage their patients to come to terms with their hair loss –
not least because of limited treatment options on the one side and
patient’s high expectations about treatment outcomes on the other
side." (pg. 347)

Liu, Fang, Yong Miao, Xingdong Li, Qian Qu, Yang Liu, Kaitao Li, Chuanbo Feng, and Zhiqi Hu. ‘The Relationship between Self‐esteem and Hair Transplantation Satisfaction in Male Androgenetic Alopecia Patients. Journal of Cosmetic Dermatolog’. Journal of Cosmetic Dermatology, 2019. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=cmedm&AN=30582267&site=ehost-live&custid=s4121186.

To explore young men’s coping with androgenetic alopecia

Yes all particiapnts had had hair transplants. A total of 1106 male AGA patients undergoing hair transplantation
were enrolled from January 1, 2014, to June 1, 2017, in the depart‐
ment of plastic surgery and cosmetology, Nan fang Hospital and
Kefayuan Hair Transplantation Hospital, Beijing, China.

Uncontrolled longitudinal study (i.e., treatment study without control group see: https://childhoodcancer.cochrane.org/non-randomised-controlled-study-nrs-designs). Pre and post surgery comparison (post = 9 months)

none - however large sample (1106).

Biased convenience

Hair Transplant Patient

Yes - all seeking transpants (but appropriate in the context of the RQ)

9 month follow up reported however, this isn't relevant to this SR which is interested in pre scores only (as this is a transplant evaluation).

Pre measures
1) Rosenberg Self‐Esteem Scale (RSES)
2) FACE-Q satisfaction indicators (satisfaction with appearance, visual age and expected visual age) The preoperative and 9‐month postoperative self‐esteem were evaluated by Rosenberg Self‐Esteem Scale (RSES), and preoperative satisfaction indicators (sat‐ isfaction with appearance, visual age and expected visual age) were assessed by Face‐Q scale. At the same time, postoperative satisfaction indicators (satisfaction with appearance, visual age, satisfaction with decision, psychological well‐being, and social function) were reevaluated as well.Face‐Q was a comprehensive set of scales used to measure the out‐ comes of esthetic procedures. This scale was independently scored with pre‐procedure and post‐procedure versions. The key parts of face‐Q scale were satisfaction with appearance, visual age, satis‐ faction with decision, psychological well‐being, and social function (Table 1). We used positive questionnaire language to set each item to relatively plain words, such as “I feel very happy to look in the mirror every morning (psychological well‐being).” Responses to the items were scored according to the Likert scale, with “strongly disa‐ gree” being given a score of 1, “disagree” scoring 2, “agree” scoring 3, and finally “strongly agree” scoring 4. The overall responses to items were then standardized to a Rasch transformed summary score of 0‐100. A higher score indicated a better patient satisfaction.
Post measure
1) FACE-Q satisfaction indicators (presumably although not specified): (satisfaction with appearance, visual age, satisfaction with decision, psychological well‐being, and social function) were re-evaluated as well.

Validated measures & clear sample information

Difference between preoperative and postoperative self‐esteem
score, satisfaction with appearance, visual age were tested using
paired T tests. ANOVA analysis was applied in three group of different
self‐esteem level to assess satisfaction with hair transplantation,

M and SDs were reported for pre and post.

Highly probable at least one (co)/author or (co)/author’s employer provided baldness interventions13

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

The third author, Xingdong Li, of the research (Liu et al., 2016) provided hair transplants as indicated by his stated affiliation to the “Kafuring Hair Transplant Hospital” and also as he is described, elsewhere, as the founder of a chain of 33 hair transplant hospitals in China (Barley Microneedle Hair Transplant Hospital, n.d.). The authors specifically note, however, that "None of the authors has a financial interest in any of the products or devices mentioned in this manuscript." (pg. 1441) in the journal: Journal of Cosmetic Dermatology.

Source: Barley Microneedle Hair Transplant Hospital. (n.d.). About Us. Barley Hair.Com. https://www.barleyhair.com/about-us/

Somewhat- Self esteem scores at pre (M = 30, SD = 6 out of 40) with higher scores indicating highest self esteem )and this barely changed after transplantion (by 1.56 mean diff), satisfaction with appearance was relatively low (M = 44 out of 100 maximum) and did increase signfiicantly post transplant (30 mean difference)

"As the most common form of baldness, AGA is characterized by
progressive, diffuse and symmetric hair loss.1 Although it is neither
a directly life‐threatening disease nor does it causes physical pain,
AGA is known to greatly influence individual's quality of life and psy‐
chological state.2,3 Due to these psychological effects, effective and
available treatments are sought for AGA patients." (pg. 1442)

"Cosmetic surgery is an effective way to improve patients’ appear‐
ance and psychological state. However, the psychological state can
be easily affected by multiple factors and has a significant impact on
the outcome of surgery" (pg. 1446)

Lulic, Zrinka, Shigeki Inui, Woo-Young Sim, Hoon Kang, Gwang Seong Choi, Woosung Hong, Toshiki Hatanaka, Timothy Wilson, and Michael Manyak. ‘Understanding Patient and Physician Perceptions of Male Androgenetic Alopecia Treatments in Asia-Pacific and Latin America.’ The Journal of Dermatology 44, no. 8 (2017): 892–902.

To investigate the impact of hair transplantation on patients’ self‐esteem and satisfaction with appearance.

Invita-
tions were sent to members of the public who had agreed with

a third party to receive invitations to complete online surveys.

Cross-sectional survey (qualitative)

835 patients

Biased convenience

Market research participants with hair loss & who had undergone hair loss treatment in last 6 months.

No - community sample.Invitations were sent to members of the public who had agreed with
a third party to receive invitations to complete online surveys. Lulic et al 2017

None

Market research questionnaire

Constructed item assessed not incldued in method or any appendix.

Descriptive statistics were used to analyze the data
collected in the questionnaires and patient case records.

Not reported

Yes - recall bias, not having a disgnosis

GlaxoSmithKline funding

Yes - Between 30-50% of participants in the study resisted. 30% disagreed that men with male AGA consider conssquences...to be very serious", 30% disagreed it had a "major impact on patience confidence" and 56% disagreed that AGA "impacts their life on a day to day basis" (pg. 895). Physicians resisted less.

Acknowledged as "relatively minor condition" (pg. 893) however extensive discussion of genetic and hormonal links and refers to it as needing "treatment"

Side effects of treatments & cost of treatment assessedin survey however these are still cursorary given the side effects aren't detailled or unpacked in the discussion/introduction. "The survey also highlights the need for physicians to spend
sufficient time with patients discussing male AGA, treatment
approaches and what patients wish to get out of treatment.
Patient involvement in treatment decisions is also important and
may be linked to patient satisfaction with treatment.
" (pg. 901)

Maffei, Cesare, Andrea Fossati, Fabio Rinaldi, and Elisabetta Riva. ‘Personality Disorders and Psychopathologic Symptoms in Patients with Androgenetic Alopecia’. Archives of Dermatology 130, no. 7 (1994): 868–872.

To explore patient and physician attitudes towards male androgenetic alopecia (AGA), satisfac-

Consecutive patients from their dermatology clinic in first half of 1992.

64 (&52 women)

Biased convenience

Dermatologyy clinic patient

Yes - dermatology patients

1) Personality Disorders Ques¬ tionnaire-Revised (PDQ-R), 2) Personality Disorders Ques¬ tionnaire-Revised (PDQ-R),..."was used to gather psychopathologic symptons, reactive to alopecia" (pg. 868)

"The x2 test (with Yates' correction) and the coefficient phi were used to measure the association between nominal dichotomous variables. An exploratoryfactor analysis based on the principal axes was used to identify the latent vari¬ ables subtended to the 13 personality disorders indicated by the PDQ-R. Only factors that passed the Kaiser crite¬ rion (eigenvalue >1.0) were extracted. The varimax or¬ thogonal rotation was used to rotate the factors obtained. Only the factor loadings that were above 0.40 were con¬ sideredsignificant. The factor score was calculated accord¬ ing to the Bartlett method. Hotelling's T2 was used to test the null hypothesis of identical mean vectors between the categories of nominal dichotomous variables for a multivariate set of continuous variables. Univariate protected t tests were performed to evaluate which of the dependent variables played a significant role in the final rejection of the null hypothesis. Two-way multivariate analysis, fol¬ lowed by univariate protected F tests, was used to evalu¬ ate both the main effects and the effect of the interaction of two nominal variables on a multivariate set of depen¬ dent continuous variables. The use of stepwise discrimi¬ nant analysis, a multivariate technique statistically more correct, buthighly sensitive to colinearity, to explore a sig¬ nificant multivariant analysis of omnibus test was pre¬ cluded by high correlations between the dependent vari¬ ables (mean r=.63) and research aims (we were interested in determining the significance of the relative contribu¬ tion of each dependent variable to the difference between the groups, rather than in carrying out a dimension reduc¬ tion analysis. In fact, all our dependentvariables belonged to only one dimension: the psychopathologic reaction to alopecia). Stepwisemultipleregression was used to test the hypothesis ofthe predictingrole playedby the personality profiles on the psychopathologic reaction to androgenetic alopecia. The minimum alpha level established for the sta¬ tistical tests was .05.
" (pg. 869)

Informed consent obtained, but no formal ethical approval appears to be.

Highly probable at least one (co)/author worked at a dermatologist centre offering hair loss interventions14

Journal appears not to require disclosures

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

The third author, Fabio Rinaldi, of the research (Maffei et al., 1994) provided baldness interventions according to his CV which states he has almost 40 years of experience of trichology-related outpatient and surgical experience (Rinaldi, n.d.). In addition, he is currently the head of research and development of Guilliana-SpA a pharmaceutical company that produces baldness interventions (Rinaldi, n.d.). It appears the journal: Arch Dermatol did not require disclosures.

Source: Rinaldi, F. (n.d.b). Home. Dottor Rinaldi. https://www.studiorinaldi.com/

10.1001/archderm.1994.01690070062009

maffei.cesare@unisr.it

N/A - Not particularly relevant to this design - just looking at personality profiles of AGA diagnosed treatment seeking patients

Hairloss not generally defined however "suffering from" (pg. 871) and "patients with AGA" (pg. 868)

Advocates pharma/medical hair loss treatment: "Consequently, an improvement in alopecia induced by medical treatment could reduce the psychopathologic reactive symptoms by restoring the body image and its inter¬personal correlates, at least partially, this way neutral¬ izing the negative personality effects" (pg. 871) Does acknowledge sample bias: "However, one should keep in mind that these sample subjects represent only a subpopulation of subjects suffering from androgenetic alopecia who actively sought medical consultation, and not the total population of subjects suffering from androgenetic alopecia" (pg. 871).

Molina-Leyva, Alejandro, Isabel Caparros-Del Moral, Pilar Gomez-Avivar, Mercedes Alcalde-Alonso, and Jose Juan Jimenez-Moleon. ‘Psychosocial Impairment as a Possible Cause of Sexual Dysfunction among Young Men with Mild Androgenetic Alopecia: A Cross-Sectional Crowdsourcing Web-Based Study.’ Acta Dermatovenerologica Croatica : ADC 24, no. 1 (2016): 42–48.

tion with currently available male AGA treatments and investigate the factors affecting treatment choice.

Men with AA (or Male Androgentic Alopecia MAGA) over 18 years of age with no physical or psychological disorders that used the sites invited to participate. None over 40 participated.

Cross-sectional online survey posted in popular Spanish alopecia forum (recuperarpelo.com)

Fair-good

Biased convenience

Hair loss forum user

Yes - men recruited through Spanish hair loss forum and 80% had consulted a dermatologist. This is acknowledged: "Regarding to the external validity of our sample, we want to emphasize that nearly 80% of the participants of our study had consulted at least one dermatologist regarding their MAGA. The fact that these individuals participated in an online community for alopecia suggests they are more concerned about the impact of alopecia on their everyday life" (pg. 46).

1) Sexual Functioning measure (MGH-SFQ), 2) Hair loss related quality of life (adapted Skindex-29) & 3) demographics

Descriptive & inferrential statistics. Appears robust, reports odds ratio etc.

Highly probable at least one (co)/author or (co)/author’s employer provided baldness interventions at the time of research15

Journal appears not to require disclosures

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

The third author, Dr Pilar Avivar, of the research (Molina-Leyva et al., 2016) provided baldness interventions according to her employee profile noting she has provided aesthetic interventions including baldness- / trichology- related ones since July 2015 (LinkedIn, n.d.). In addition, the first author is currently employed by a clinic that provides baldness services (Virgen de las Nieves University Hospital, n.d.). The journal: Acta Dermatovenerologica Croatica did not appear to require disclosures.

Source: Virgen de las Nieves University Hospital. (n.d.). Service Portfolio. HUVN.Es. https://www.huvn.es/asistencia_sanitaria/dermatologia/cartera_de_servicios#cmsIndex_10

alejandromolinaleyva@gmail.com

Most men did not report sexual dysfunction (those who did might have only reported mild dysfucntion but M & SD of this measure unreported).

Referred to as MAGA, not as a disease or condition (not really defined). Treatments mentioned.

"Primarily, though finasteride is the most effective and widespread treatment for MAGA to date, it
is associated with changes in sexual function (1,10-
12). Thus, identification of subjects with MAGA with
a high-risk profile of sexual dysfunction could have
important therapeutic implications." (pg. 47)

Sort of, presents evidence that finasteride's sexual dysfunction side effects isn't caused by finasteride but by pre existing psychological impairment: " Our results showed that psychosocial impairment was significantly associated with a decreased sexual desire and arousal, independently from the use of finasteride 1 mg (Figure 2). No other study to date in the field of sexual dysfunction and finasteride has considered the potential impact of psychological variables in this relationship. Could psychological impairment confound the relationship between finasteride and sexual dysfunction in men with MAGA? " (pg. 46). repeatedly states that dermatologists need to 'wake up' to this relationship but does not say in which direction or how. Potentially this study is carefully setting itself up to be used as a rebuttal for any claim that finasteride in AGA treatment causes sexual dysfunction OR it is a warning to dermatologists not to use finasteride that might worsen pre-existing sexual dyfunction in patients with AGA (unclear, but probably the former).

Mubki, Thamer F., Salman A. Bin Dayel, Abdullah H. AlHargan, Khaled M. AlGhamdi, and Abdullah I. AlKhalifah. ‘Quality of Life and Willingness-to-Pay in Patients with Androgenetic Alopecia’. Egyptian Journal of Dermatology and Venerology 39, no. 1 (2019): 31.

To explore personality disorders and psychopathologic symptoms in patients with androgenetic alopecia

Pateints diagnosed with AGA from dermatology clinics (all generally healthy, any with scalp disorders excluded)

Cross-sectional paper survey

Biased convenience

Dermatologyy clinic patient

Yes all recruited from dermatology clinic (this is understandable as difficult to access those with hair loss otherwise however these patients will be more predisposed to be distressed and to medicalize their AGA).

Yes and validity & reliability in current study also reported.

1) DLQI (Finlay & Khan 1994) Dermatological- quality of life (QoL) assessed (does not appear to be adapted to hair loss specifically which it needs to be)
2) Willingness-to-pay (WTP; "WTP was addressed by asking one question about the amount of money they would be willing to pay as a single payment to achieve a sustainable cure of AGA. Predefined categories: 200–1000 USD, 1001–5000 USD, 5001–10 000 USD. In theory, the more the patients are willing to pay, the more they are impaired in their QoL by the disease." (pg. 32)).
3) Demographics

"The relationships between DLQI scores and clinical and demographic variables wereanalyzedusingordinalmultiplelogisticregression. Averageinteritemcorrelation,itemtotalcorrelation,and Cronbach’salphawereusedtoassessreliability.APvalue less than 0.05 is considered statistically significant." (pg. 50).

Probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research16

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

All authors of the research (Mubki et al., 2019) list their affiliations to dermatology clinics that “diagnose[ patients] with AGA” (pg. 31). The third author also cowrote a paper urging dermatologists to promote their cosmetic interventions including hair transplants to the wider public: “The responses demonstrate that the Saudi Arabian public is not aware of the full scope and practice of dermatologic surgery, especially as it pertains to cosmetic procedures. Therefore, this lack of knowledge must be addressed” (AlHargan et al., 2017: 6). The authors declare no conflicts of interest in the journal: Egyptian Journal of
Dermatology and Venereology.

Source: AlHargan, A. H., Al-Hejin, N. R., & AlSufyani, M. A. (2017). Public perception of dermatologic surgery in Saudi Arabia: An online survey. Dermatology Online Journal, 23(5), 1–7.

10.4103/ejdv.ejdv_33_18

tfmubki@hotmail.com

Yes, WTP decreases with severer hair loss. Also severity did not relate to higher QOL impact: "In our population, QoL was not affected by the duration of the disease. This contradicts previous findings in the QoL study in Korean [10] and Chinese populations [32]. A possible explanation for that is patients may gradually adapt to their chronic disease, such as AGA, and as time passes, their QoL gradually improves" (pg. 33).

Referred to as AGA not defined but also uses medicalized language "Although this disorder is highly prevalent," (pg. 31)

No as recommends counselling, acknowledges treatment lack and notes psychological impact: " In diseases such as AGA with limited treatment options, it is important to recognize the psychological issues of patients and offer both medical treatment as well as psychological support." (pg. 33)

Passchier et al. (2006)

To explore the effect of psychosocial impairment due to hair loss in the sexual function of men with MAGA

Patients who had hair recesssion and were attending a dermatology clinic but not for hair loss were approached to particiate

Cross-sectional paper survey (Group 1) & quant interview (Group 2)

No, constructed for this & previous study - validity and reliability not reported.

Group 1: completed the 1) Hair Problem List [a standardized (20-item) question- naire, applied in our previous study, that measures psychological and social problems related to hair loss and associated help-seeking behaviour (Van der Donk, et dl., 1991)" , [Unclear how this is scored: "Questions are answered on a mod- ified Likert-type scale, with five response categories (coded 1-5) representing decreasing varying agreement with the problem statements, and the item scores are summed to obtain a total hair problem score" (pg. 227). Appears from results that lower scores indicate more hair loss related problems]. Group 1 completed the questionnaire twice (doesn't say when, presumably on the same day) to indicate their responses at the moment of hair loss discovery (past) and currently (present). Group 2 "a structured interview about 2) expe- riences and needs at the moment of discovery of hair loss. 3) A rating of un- pleasantness of the discovery was measured both on a verbal rating scale and 4) on a scale indicating their affect for which they were asked to select a number, given that O meant neutral and 10 meant very bad" (pg. 227).

Validated measures & sample described (except the location)

Frequency counts & paired t tests conducte.d

No % of only some items on the hair problem list given, not all.

Merck funding

Unreported - too brief

Yes, (have calculated scale range of this measure and it should be 0-100 with 100 being least problems). Thus some resistance to hair loss distress and acceptance of hair loss present arguably given scores could be much closer to 0 than 65 (indicating higher distress) and that scores did not seem to change drastically (from 65-66 from moment of discovery to present). Group 2 rated their hair loss as 4.4 (with 0=neutral and 10 = very bad) indicating for many/most hair loss wasn't very bad;. Men wanted to consult medical professionals more often than internet on their hair loss indicating they want unbiased advice. The authors themselves note that treatments should be available and does not advocate acceptance (medicalizing) but also caution this by noting hair loss info should come from unbiased, non-commerical sources (perhaps tryign to indicate Merck & propecia and Jan Passchier himself aren't commercial themselves): " For those who have problems, a prompt communi- cation between the man and a dermatologist should be encouraged after the discovery, as there are now effective treatment options available for hair loss and the earlier the treatment, the better. Secondly, our recent computer search using 'baldness' as the keyword indicated that most information on the Internet is given by advertisers of commercial hair treatments. Hence, it seems desirable to have valid, unbiased, and supportive information avail- able via this medium, as has been also mentioned by Pollock, Goulden, Sheehan-Dare, and Goodfield (2001)" (pg. 228)

"alopecia androgenetica (hereditary male hair loss)" (pg. 226) not defined throughout, treatments referred to but not much else

"Men like to consult the Internet
for information, but still often consider the medical professional as the first
choice for consultation. For those who have problems, a prompt communication between the man and a dermatologist should be encouraged after the
discovery, as there are now effective treatment options available for hair loss
and the earlier the treatment, the better." (pg. 228)

Yes. Group 2 also asked to rate their hair loss with 0 being neutral and 10 being very bad. Meaning p's not given option to state their hair loss makes them feel good.

Passchier, J., S. E. Rijpma, R. O. Dutrée-Meulenberg, F. Verhage, and E. Stolz. ‘Why Men with Hair Loss Go to the Doctor’. Psychological Reports 65, no. 1 (1989): 323–30.

To assess where dermatological quality of life and WTP relate to hair loss?

drawn from a database formed from a call-out in local paper to participate in minoxidil trial that occured 2 years prior to the study completion (these p's expressed interest in participating but were not eligible based on stage of hair recesssion / hair colour or replied too late).

Biased convenience

Prospective or current minoxidil user

Yes as all men expressed interest in minoxidil as a treatment (thus p's more likely to medicalize hair loss).

1) Demographics
2) tendency to consult GP for illness,
3) who would you consult (GP, dermatologist, hair dresser, chemist, pharmacist & hair institute),
4) Hair Problem List (" list identifies social and psychological problems attributed to baldness and cosmetic help-seeking behaviour" (pg. 325).

No, constructed items not included.

"Four groups were distinguished: (a) a GP only group consisting of those who had only consulted their GP, (b) an other group who had not consulted their GP but one (or more) professional(s) other than their GF', (c) a GP- and-other group who had consulted their GP and one (or more) other profes- sional(~) and (d) a no-consult group, i.e., those who had not consulted one of the above-mentioned professionals or bodies. A t test was applied to test group differences between the interval measures; the Mam-Whitney U test for ordinal variables and the xZ test for nominal variables. The latter test was not carried out when the number of cells with expected frequencies <5 was 20% or more. All tests were two- tailed because of the lack of directional hypotheses on the differences. Since the study was exploratory, a p of .05 was accepted" (pg. 325).

Vaguely reported, not as limitations but stated twice about sample bias.

Upjohn funding

Yes - majority of sample did not consult anyone on hair loss (133; 64%) and also agreed most often with the statement that hair loss could thought not be treated/ they do not give it much thoguht or it does not bother me (actual stats here not reported by authors). Yes - also all scores on hair loss problems were normal. Further, authors do accept that AA is not physically harmful: " So far, no reports are available on the motivation of patients who visit a general practitioner (GP) for complaints which are, at least at the physical level, not harmful" (pg. 323).

Androgentic alopecia refers to as "the disease" (pg. 2)

Not really- focus on treatment being normal for hair loss and focus on who is best to dispense this treatment (what is the threshiold for consultation and who would you trust most? is asked). Deceptive reported in abstract: " During the past two years, one-third consulted a profes- sional on account of hair loss. General practitioners were consulted by 60% and other professionals by about 75%." (pg. 323) which does not make clear that the 60% refers to the 1/3 rd of the sample only. GP referral should actually be 20% of the entire sample. "Two month after the treatment, patients didn't report any
side-effects, except for transient libido loss. Loss of libido
was reported by 9.4% (12 patients) of the subjects. This
was found to be transient and partial in all cases." (pg. 3)

Passchier, J., J. Van der Donk, ROGM Dutrée-Meulenberg, E. Stolz, and F. Verhage. ‘Psychological Characteristics of Men With Alopecia Androgenetica and Effects of Treatment With Topical Minoxidil An Exploratory Study’. International Journal of Dermatology 27 (1988): 441–446.

To assess the stress of discovery of hair loss.

P's recruited from local media reporting the trial. P's also screened for health issues (e.g., cardiograms). Randmozed into minxidil group (n = 46) and placebo group (n = 39).

RCT: questionnaire pre (one completed retrospectively 1-month prior to treatment) and 1 completed currently.RCT - placebo controlled, double-blind, randomized. Two questionnaires provided 6-months post trial started (one completed retrospectively 1-month prior to treatment) and 1 completed currently.

Biased convenience

Prospective or current minoxidil user

Yes - all wanted treatment with minoxidil

Yes except Hair Problem list

1) Hair Problem List
2) Social Anxiety & Assertiveness scale,
3) Self Esteem,
4) Psychological Maladjustent (Delft Questionnaire)
5) Dutch Personality Questionnaire

16/46 minoxidil p’s were judged to experience hair regrowth at time of study (6 months). These 16 were divided into one group (responders) and the rest were collapsed with placebos to complete another group (as non-responders: n = 69). DVs were compared across groups at pre & post treatment.

Upjohn funding

Yes - scores of sample (men with AA) do not differ or are not worse on all but 1 of the 10 outcomes compared to a normed sample (presumably who have less AA).Minoxidil only effective for 16/46 particiapnts. Among these only 1 out of the 5 outcomes (or 10 depending on whether personality counts as 7 outcomes or 1) imrpoved self-esteem. Thus minoxidil actually only works in 35% of the sample and only improved self-esteem for them, not psych maladjustment social comfort & social frequency, personality, or. hair loss problems

"Alopecia androgenetica is a common phenomenon" (pg. 441) but treatments referred to.

Not really howeverme studies did not make explicit recommendations however readers might be left with Passchier (1988) but one might think minoxidil was the way forward es 1) where minoxidil not advocated specifically but selective interpretation of results suggest it is useful including reporting non-significant results as if they are significant in their abstract (which is more often read than the body of the paper) (Abstract: “More psychological improvement, with regard to hair problems, social discomfort, and self-esteem occurred in the minoxidil group than in the placebo group.” (pg. 441) despite the results actually confirming 2 of the 3 benefits were nonsignificant (“the responders were more improved than the nonresponders with respect to self-esteem (t(83) = 1.87, p < 0.05), overall social discomfort (a trend: p < 0.10) and hair problems (NS)” (pg. 444)

Rahimi-Ardabili, Babak, Ramin Pourandarjani, Peiman Habibollahi, and Amir Mualeki. ‘Finasteride Induced Depression: A Prospective Study.’ BMC Clinical Pharmacology 6 (2006): 7.

To examine whether depressive symptoms or anxiety might be induced by finasteride administration.

Patients referred to the clinic

Uncontrolled longitudinal study (i.e., treatment study without control group see: https://childhoodcancer.cochrane.org/non-randomised-controlled-study-nrs-designs)

Baised convenience

Dermatologyy clinic patient

yes - referred to the clinic

Yes

1)Beck Depression Inventory (BDI), 2)Hospital Anxiety and Depression Scale (HADS).

used student's
paired t test for comparing the means before and after the
treatment. Mann-Whitney U test was used to compare the

scores of patients who reported any side effects with oth-
ers.

yes - inlcuded information to interpret the results in relation to clinical norms.

None found

Somewhat - most balding men were not (47%) or minimally (31%) depressed (BDI) and most were not (61%) or only mildly (29%) anxious(HADS-A). Study also shows finasteride increases HADS-D and BDI scores signfiicantly increased (after 2 months of use) but HADS-A did not (p = .061)

yes- described as a disease and people as patients

No - Not recommended, instead study is about side effects of finasteride

Russo, P M, E Fino, C Mancini, M Mazzetti, M Starace, and B M Piraccini. ‘HrQoL in Hair Loss-Affected Patients with Alopecia Areata, Androgenetic Alopecia and Telogen Effluvium: The Role of Personality Traits and Psychosocial Anxiety.’ Journal of the European Academy of Dermatology and Venereology : JEADV 33, no. 3 (2019): 608–11.

To identify the personality dimensions most predictive of the impact of disease on HrQoL for male and female patients with alopecia areata (AA), androgenetic alopecia (AGA) and telogen effluvium (TE)

23 (very small)

Biased convenience

Dermatologyy clinic patient

Yes - dermatology patients

(note scale ranges, scoring processes & validity unreported) however measures appear established.

1) DLQI; big five questionnaire BFQ subscales: 2) Extraversion (BFQ) 3) Conscientiousness (BFQ), 4) Emotion stability (BFQ), 5) Agreeableness (BFQ), 6) Openess (BFQ), 7) Emotional intelligence (trait emotional intelligence, TEI), 8) Social Phobia (SPI), 9) Social Interaction Anxiety (SIAS), 10) trait anxiety

Descriptives analysis reported for the male AGA group. Otherwise only gender differences reported by hair loss group. The relationship between the DVs and hair loss related quality of life was not anaysed for the male specific AGA group and so is not reported here.

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research17

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

Three of the authors of the research (Russo et al., 2019) list their affiliation to a dermatology clinic. Currently this clinic provides baldness interventions (S. Orsola-Malpighi Polyclinic, n.d.). The authors declare no conflicts of interest in the journal: Journal of the European Academy of Dermatology
and Venereology.

Source: S. Orsola-Malpighi Polyclinic. (n.d.). Dermatology [AOSP.bo.it]. http://www.aosp.bo.it/content/dermatologia-patrizi

edita.fino@unibo.it; michela.mazzetti@unibo.it

?Potentially, personality and hair loss quality of life etc may be normal/mild (though ranges of scales unreported).

Yes, refers to hair loss as illness/disease.

However has an ambigious conclusion with regard to psychological implication: "Although not a life-threatening condition, the psychosocial impact of hair loss, as evidenced by our results should be considered in clinical practice to reduce the burden of illness and enhance patients’ psychological well-being" (pg. 611)

Sawant, Neena, Siddhi Chikhalkar, Varun Mehta, Malvika Ravi, Bhushan Madke, and Uday Khopkar. ‘Androgenetic Alopecia: Quality-of-Life and Associated Lifestyle Patterns.’ International Journal of Trichology 2, no. 2 (2010): 81–85.

To compare the prevalence of psychiatric symptoms between two age groups of males with AGA

Convenience dermatology sample.Illness or pyschiatric conditions excluded.

Biased convenience

Appears validated measures used but full references not included

1) Lifestyle indices (eating habits, fitness, physical health & psychological health & addictions)
2) HAIRDEX (emotions, functions, symptons, self-assurance & stigmatization; (item examples, and numbers not reported, nor validity or scale authors reported).
3) Psychopathology (90-item scale) symptoms in last week & past day, stressful life events during period hair loss first noticed

T Tests between the participant sample divided into 2 groups (15-25 year olds Group A & 25-50 group B).

Highly probable that at least one (co)/author or (co)/author’s employer offered baldness interventions at the time of research18

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

Three of the authors of the research (Sawant et al., 2010) list their affiliation to a dermatology clinic. Currently this clinic provides baldness interventions (King Edward Memorial Hospital, n.d.). The authors declare no conflicts of interest in the International Journal of Trichology.

Source: King Edward Memorial Hospital. (n.d.). Department of Skin , STD & Leprosy. KEM.Edu. https://www.kem.edu/department-of-skin-std-leprosy/

10.4103/0974-7753.77510

drneenas@yahoo.com

HairDEX score ranges not reported difficult to say how high stress was. iven older gorup and younger hair loss group very similar indicates length 7& age of hair loss unrelated to distress. Visibility of hair loss also unrelated too.As acknowlegded: pg 85 " While AGA patients score higher on neuroticism as psychopathology, no significant psychopathological effects of AGA have been noted."

Yes AGA referred to as a disease, disordere and people affected as patients.

None advocated

Yes - reports sig findings when they're not.

Tabolli, Stefano, Francesca Sampogna, Cristina Pietro, Thomas Mannooranparampil, Marcella Ribuffo, and Damiano Abeni. ‘Health Status, Coping Strategies, and Alexithymia in Subjects with Androgenetic Alopecia.’ American Journal of Clinical Dermatology 14, no. 2 (2013): 139–45.

To assess the risk of anxiety/ depression in people with AGA

Yes - men without AGA (healthy hospital staff)

AGA ps were patients from a dermatology hospital (non-AGA ps were hospital staff)

202 men with AGA (approx) plus comparison groups

Biased convenience

Dermatologyy clinic patient

Yes - P's with AGA from dermatology clinic, comparison group were hospital staff.

Yes, all reliable measures with reliability reported.

1) physical & mental health,
2) psychological distress (GHQ-12 with scores above 4/12 considered GHQ-12 positive or psychologically distressed),
3) (situational coping from the COPE comprising 3 grouped sets of subscales, note, response scales not reported nor ranges however higher scores indicate more of that coping)" (pg. 140-141) Problem Focussed Coping (active coping, planning, instrumental support, religion etc.)
4) Active Emotional Coping (AEC: venting, positive reframing, humour, emotional support, acceptance etc.)
5) Avoidant Coping (AC; self-distraction, denial, behavioural disengagement, self-blame, substance use, etc.",
6) Alexithymia ("difficulty in identifying and describing feelings").

ANOVAs and multiple logistic regressioned

Giuliani SpA funding

Yes, most of the men with AGA did not differ on outcomes involving psychological coping & distress compared to men with full heads of hair. Plus differences that were there relatively minimal. Plus hair loss severity did not relate to distress.

Referred to as a condition "relatively mild dermatologic condition; however, affected individuals feel that alopecia is a serious condition with major consequences in their life" (pg. 140).

Authors recommend psychological support: "Physicians should be aware that the impact of AGA is not limited to symptoms, and should help people to deal with their emotional responses to alopecia, such as anger and worry, and their beliefs about the consequences of their condition, and how it will impact on their daily life" (pg. 140).

Tahir, Kehkshan, Shahbaz Aman, Muhammad Nadeem, and Atif Hasnain Kazmi. ‘Quality of Life in Patients with Androgenetic Alopecia’. Annals of King Edward Medical University 19, no. 2 (2013): 150–150.

To assess the mpact of quality of life in AGA patients

All patients attending thier clinic who had been diagnosed with AGA (screened for psychological disorders of physical health problems)

Biased convenience

Dermatologyy clinic patient

Yes - all attending a clinic for hair loss.

DLQI is reliabble

1) DLQI 2) Demographics

DLQI used and basic reporting of recruitment reported

ANOVAS and multiple logistic regressioned

Highly probable that at least one (co)/author or (co)/author’s employer provided baldness interventions at the time of research19

Journal appears not to require disclosures

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

The second author, Dr Shahbaz Aman, of the research (Tahir et al., 2013) is currently listed by a medical database (Ola Doc, n.d.) as having 28 years’ experience as a dermatologist and as providing baldness interventions. The journal: Annals of King Edward Medical University does not appear to require disclosures.

Source: Ola Doc. (n.d.). Prof. Dr. Shahbaz Aman—Dermatologist at Derma Laser Center (New Garden Town). OlaDoc.Com. https://oladoc.com/pakistan/lahore/dr/dermatologist/shahbaz-aman/1866

https://doi.org/10.21649/akemu.v19i2.500

drshahbazaman@yahoo.com

No, DLQI score is higher comapred to other studies (however these participants are all seeking help for thier hair loss).

Refers to hair loss as disease:

Advocates counselling & hair loss 'treatment' for distress, also refers to hair loss as disease: "Patients with high score may benefit from individual counseling and / or contact with psychologist. This negative impact on QoL can be reversed to some extent by medical treatment as shown by improvement in DLQI scores in patients with AGA after treatment with finasteride in a study conducted by Uchiyama et al.2" (pg. 154)

Tang, P H, H P Chia, L L Cheong, and D Koh. ‘A Community Study of Male Androgenetic Alopecia in Bishan, Singapore.’ Singapore Medical Journal 41, no. 5 (2000): 202–5.

To determine the prevalence of the condition in the community

254 men; 161 with AGA. Mentions low power at the end in limitations

Nonbiased representative sample

community sample

No -community samples of volunteers with and without AGA

(67% response rate).

None

Questions pertained to the personal
profile of the interviewee, the diagnosis and grade of
alopecia as assessed by the interviewer, the knowledge,
attitudes, beliefs as well as the help-seeking behaviour
of those affected.

All items constructed but not included in study.

yes - descriptive stats

yes - grade 1 alopecia and recognition of this. Low statistical power

Highly probable that at least one (co)/author or (co)/author’s employer provided baldness interventions at the time of research20

Journal appears not to require disclosures

Probable Conflict of Interest (where at least one author or author's employer commercially sold hair loss products meaning they may have financially profited from balding men reading this research believing baldness to be more psychologically distressing then it is):

Multiple authors of the research (Tang et al., 2000) list their affiliation to the National Skin Centre. Currently, this centre provides baldness interventions (National Skin Centre, n.d.). In the author(s)’ acknowledgements section of the journal: Singapore Medical Journals this probable conflict of interest is not acknowledged.

Source: National Skin Centre. (n.d.). Dermatologists. Nsc.Com. https://www.nsc.com.sg/patient-guide/our-doctors/pages/dermatologists.aspx

cofkohd@nus.edu.sg

81% "did not seek help" (pg. 204)

Yes - 81% "did not seek helpas they did not view it as a problem" (pg. 204). No other wellbeing results reported.

*Doesn't say disease per se but defines it in first instance as "common presenting complaint" (pg. 202) however does use medicalized language: "treatment", "condition"(pg. 202), "suffering from" & "clinically apparent" (pg. 203), however does state: "While the condition may be socially unacceptable to
some, it is not a disease in the medical sense of the word" (pg. 204)_

"While the condition may be socially unacceptable to
some, it is not a disease in the medical sense of the word" (pg. 204). Notes some treatment "have yet to be proven effective" but then points to effective help as finasteride or minoxidil: "These
persons are part of the larger population of people with
androgenetic alopecia who spend thousands of dollars
on such treatment, which have yet to be proven effective.
Such people would benefit from an educational
program for the public with suggestions on the
appropriate and effective help available (e.g. topical
minoxidil(16) or oral finasteride(17))." (pg. 205)

No - although does mention medical treatment and suggest that people should be educated about this. Also emphasises the actions of those who did seek treatment and doesn't really linger on the 81% who didn't.

Tas, Betul, Filiz Kulacaoglu, Hasan Belli, and Murat Altuntas. ‘The Tendency towards the Development of Psychosexual Disorders in Androgenetic Alopecia According to the Different Stages of Hair Loss: A Cross-Sectional Study.’ Anais Brasileiros de Dermatologia 93, no. 2 (2018): 185–90.

To evaluate the development of psychosexual disorders in those with AGA

Dermatology clinic AA patients, excluded any with psychological disorders.

Biased convenience

Dermatologyy clinic patient

P's with AGA from authors' dermatology clinic

Reliability in study unreported, but measures are previously validated.

1) self-perception (SP - SPS, score range 40-200 higher scores indicate higher satisfaction (cut off is 135)),
2) self-esteem (SE - RSES, range 0-30, higher scores indicate higher self-esteem <15 indicates abnormally low self-esteem),
3) sexual experiences (S-Exp, score range 5-30 with higher scores indicate more sexual dysfunction),
4) anxiety (ANX, BAI, scores ranged 0-63, 7+ indicate mild or more anxiety)
5) depression (DEP, BDI, scores range from 0-63 with scores higher than 11 indicating mild or severer depression)

T test for between gender analysis and ANOVAs for n-H scale hair loss severity group analysis.

None found

Yes men with AA using the dermatological clinic appeared to be psychologically healthy - Briefly, self perception was high (134/200), no depression, very mild anxiety, normal self esteem. Sexual dysfunction rated at mid point of scale for men.

"Hair loss (HL) is a frequent
complaint among adults, which mostly leads to cosmetic consequences, however, it can also cause significant psychological and
psychosocial impacts." (pg. 185)_

Advociates 'treatments' and psychotherapy.

Doesn't emphasize how normal the sample was (despite being dermatological clinic recruited).

van der Donk, J, J Passchier, R O Dutree-Meulenberg, E Stolz, and F Verhage. ‘Psychologic Characteristics of Men with Alopecia Androgenetica and Their Modification.’ International Journal of Dermatology 30, no. 1 (1991): 22–28.

To assess whether AGA men seeking treatment have unfavorable personality traits?

Yes - control group from hospital staff without dermatological conditions (currently or in the past, n = 1359).

Ps heard about minoxidil hospital trial from local news, of those interested those w/ hair loss & healthy selected. Ps completed questionnaire at start of study and recieved $5.

RCT Longitudinal study of a survey taken 1-month prior to the RCT and 6 months into the RCT. RCT (published elsewhere) - placebo controlled, double-blind, randomized and 6 month observation of hair growth after minoxidil/placebo treatment, hwoever this is reported in another publication).

168 men (pre) to 122 men (post)

Biased convenience

Prospective or current minoxidil user

Yes, all interested in minoxidil treatment

Yes all of the measures reported as reliable (except Hair Problems List where there is no mention of this)

1) Hair Problem List (20-item, "psychologic & social problems related to baldness and cosmetic help-seeking" responses on a 5 point Likert scale & should be summed, unclear on direction whether higher scores indicate more problems);
2) IOA (Inventory List on Association with Others comprising 2 scales overall social discomfort and overall social frequency)
3) self-esteem (Dutch translation of Rosenberg's scale),
4) personality (7 traits: inadequacy, social inadequacy, rigidity, injuredness, self-sufficiency, dominance & self-evaluation)
5) body dissatisfaction (using the Body-Cathexis List, Secord & Journard).

1) Personality indices compared to a norm group (independant samples t test), 2) Descriptives & Changes from pre - to post- of DVs measured (in paired samples T test) and 3) "Third, analysis of variance was done on post- treatment scores for the psychologic variables separately, and pretreatment scores were included as a co- variant." (pg. 23).

Many problems on list are rare, and men with AGA had better psychological functioning than men without.

Upjohn funding

j.passchier@erasmusmc.nl; j.passchier@vu.nl

Yes, men with hair loss psychologically better adjusted on some indicies than norms & many of the hair list problems were rare.

Undefined however does refer to minoxidil as a "medication...clinical trial...efficacy" (pg. 22)

None advocated -"Hair loss (HL) is a frequent complaint among adults, which mostly leads to cosmetic consequences, however, it can also cause significant psychological and psychosocial impacts." (pg. 27)

Yes, uses p cut off as .10, does not appear to use any Bonferroni corections either. Over emphasizes findings where most men didn't report hair problems. Also the psychological benefits seen in all of the post test group (including those that were on placebo), Study may even over emphasize treatment effects e.g., as noted: "Averaged across young and old subjects, subjective perception of regrowth of hair was not associated with a significant improvement in psychologic or social aspects and a decrease in specific hair problems." (pg. 26). It seems minoxidil didn't improve psychology of ps, though if the study was split into two groups (on age, some positive effects found: "Responders in the a35-year-old group showed more improvement on several measures of general psychologic impairment than nonre- sponders. A reverse trend was, however, found in the less than 35-year-old group where the nonresponders were more improved. The cognitive dissonance hy- pothesis requires confirmation with an epidemiologic study, which involves unselected population of men with alopecia androgenetica" (pg. 26)

Wang, Xia, Chunping Xiong, Li Zhang, Bin Yang, Rongfang Wei, Liqian Cui, and Xiangbin Xing. ‘Psychological Assessment in 355 Chinese College Students with Androgenetic Alopecia.’ Medicine 97, no. 31 (2018): e11315.

To assess the psychological state of college students with AGA

Yes 406 helath controls comparable in age, sex and educaiton to main group.

College students from 18 universities in Southern China with AGA approached & were asked if willing to "attend a psychomatic dermatology consultation" (pg. 1). 406 controls recriuited too.

355 (& 406 control)

Biased convenience

Dermatologyy clinic patient (initial consultation)

Yes - All participants taken from a psychosomatic dermatology consultaiton

1) Psychological distress ( 83 items with 0-4 (extremely); scoring: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism)
2) Global Severity Index (which is a mean score of all items "considered to be the best representation of an overall psychological distress dimension" (pg. 2)); SCL-90-R, Derogatis, 1994);

None found

?Unclear scale ranges to see responses.

Does not define it as a disease but uses medicalized language including genetic links "Male pattern baldness is a physiologic
process that was significantly associated with androgens and
occurred in genetically predisposed hair follicles.[3] Nyholt et al[4]
put forward that heredity is the major contributing factor to
AGA, and makes up 80% of the variance. AGA can occur in men
even with the normal levels of androgen, and has the clinical
manifestation of hair loss genetically related to the individual."

Not really, does advocate psychological therapy for hair loss distress. "These findings suggested that the
therapeutic approach for the psychological problems should be considered in the tailored treatment for AGA in the college students."

Wells, P A, Willmoth, T & Russel, R J H ‘Does Fortune Favor the Bald? Psychological Correlates of Hair Loss in Males.’ British Journal of Psychology 86, no. 3 (1995): 337.

To investigate the relationship between male hair loss and psychological distress

Ps "approached individually and asked if they were willing to fill in a questionnaire" (pg. ) unclear where recruited (presumably community sample)?

Non-biased convenience (likely)

Likely men with hair loss recruited form public location and asked to participate in a study

No - maybe community sample, doesn't actually state. Ps not informed about what the study would involve (believed it to be smoking vs non smoking).

Yes reliable

1) Self esteem, 2) depression, 3) psychoticism, 4) extraversion, 5) neuroticism 6) unattractiveness

No ethical approval mentoned, howeever participants were debriefed.

None found

Journal appears not to require disclosures

Not assessed

Yes - Of the 2 psychosocial outcomes (excluding personality) reported both dertrimentally associated with baldness. However one had scores for all well within the nromal range (<10 < clincal cut off of 17) and the other (self esteem) did not have published norms avalilabel but nonetheless group differences appeared minimal (bald groups: M = 41.4, SD = 9.9 vs nonbald group: 44.1, SD = 8.9).

Not defined refered to as "hair loss" and "hirsuteness" also referenced (pg. 337).

No treatments advocated/ no implications

Not really, does say presence of hair transplant clinics is evidence of psychological burden of hair loss.

Yamazaki, Masashi, Takashi Miyakura, Masaki Uchiyama, Ayako Hobo, Ryokichi Irisawa, and Ryoji Tsuboi. ‘Oral Finasteride Improved the Quality of Life of Androgenetic Alopecia Patients.’ The Journal of Dermatology 38, no. 8 (2011): 773–77.

To ascertain whether treatment by oral finasteride can improve the quality of life (QOL) of AGA men

Original sample was 46 however 17 "dropped out of treatment & 2 cases... lacked suffieint VAS & DLQI data" (pg. 774).

Uncontrolled longitudinal study (i.e., treatment study without control group see: https://childhoodcancer.cochrane.org/non-randomised-controlled-study-nrs-designs) Longitudinal study (first visit to hospital; pre) and then 6-months after treatment (post)

27 (11 vs 16 for group comparisons)

Biased convenience

Prospective or current minoxidil user

Yes all attended hospital & had been medicated for 6-months for finasteride.

Validated measures used but no relaibility reporte din study

1) Dermatology Life Quality Index (Finlay & Khan; an ascending score indicates lower QOL.
2) WHO-QOL-26 assesses quality of life with higher scores indicating higher quality of life.
3) Hair Satisfaction VAS (0% totally dissatisfied to 100% totally satisfied),
4) State-Trait Anxiety Inventory (STAI; 20 items, 1-4 points, higher scores indicate more state & trait anxiety).

None found

Journal appears not to require disclosures

Yes - 1) Except for hair loss satisfaction (score was low indiciating high dissatisfaction (VAS) (M = 21.4, SD = 13.7 out of 100% which is totally satisfied), other resullts indicate low distress/ normal scores relative to normed samples: Specifically the DLQI score was low (M = 5.74, SD = 6.14). WHO-QOL, state & trait anxiety were equivalent scores to normed samples.

"Androgenetic alopecia (AGA) is characterized by
patterned hair loss, occurs after adolescence and
advances with aging....Although AGA is not involved
in systemic diseases," (pg. 773). Does note that participants are patients (as they are visiting hospital) and note other dermatological diseases.

Whilst somewhat ambigious this doesn't mention side effects and still suggests finasteride is useful. not harmful. "The present study suggests that oral finasteride
improves the QOL of patients but does not necessarily alleviate their anxieties. The guidelines for the treatment of AGA should take account of the patients’
QOL." (pg. 777)

Finasteride's effectiveness is quesitonable both objectively and according to patients'. "These possibilities suggest that we should take account of the patients' wishes carefully when deciding whether or not to discontinue the adminsitration of finasteride, even when the finasteride seems to be ineffective...the present study suggests tha oral finasteride improves the QOL of patients but does not necessarily alleviate their anxieties. The guideliens for the treatments of AGA should take account of the patients' QOL" (pg. 776-777).

Notes regarding probable conflicts of interest: 7 The first author, Bade, of the research (Bade et al., 2016) was a dermatologists providing baldness services at the time according to his dermatologist profile on Practo.com which states he has 10 years’ experience (Bade, n.d.). It appears the Journal of Medical Science and Clinical Research did not require disclosures.
8 The author, Ghimire, of the research (Ghimire, 2018) was a hair transplant surgeon according to his dermatological clinic employer: “[He is] one of [the] pioneers in hair transplant surgery in Nepal [who[ completed more than 1000 hair transplantation cases in more than 5 years of experience in Nepal” (Aavaran, n.d.: 12). In J Nepal Med Assoc the author indicates he has no conflicts of interest.
9 Four of the six authors of the research (Gonul et al., 2018) list their affiliation to a dermatology clinic. Currently this clinic offers baldness interventions (Dışkapı Yıldırım Beyazıt Training and Research Hospital, 2020). The authors declare they have no conflicts of interest in the journal: Anais Brasileiros de Dermatologia.
10 (Gupta et al., 2019) was a hair transplant surgeon at the time of the research according to his dermatologist profile on Practo.com stating he has 11 years’ experience providing services including baldness interventions (Dr. Sanjeev B. Gupta, n.d.). The authors declare no financial support, sponsorship, or conflict of interest in the journal: International Journal of Trichology.
11 The fourth author, Hoon Kang, of the research (Han et al., 2012) lists their affiliation to The Catholic University of Korea. On their webpage Kang is listed as providing “quick treatments” including “hair implants” (The Catholic University of Korea, n.d.: 5–6). The authors do not declare this, instead only acknowledging Korean Dermatological Association funding in the Journal Ann Dermatol.
12 Multiple authors of the research (Karaman et al., 2006) list their affiliations to the dermatology department of Adnan Menderes University. It is unclear if this department offered any baldness interventions at the time. However, the first author, Göksun Karaman indicates she has privately offered baldness interventions since at least 2016 (Karaman, n.d.). It appears the journal: International Journal of Dermatology did not require disclosures.
13 The third author, Xingdong Li, of the research (Liu et al., 2016) provided hair transplants as indicated by his stated affiliation to the “Kafuring Hair Transplant Hospital” and also as he is described, elsewhere, as the founder of a chain of 33 hair transplant hospitals in China (Barley Microneedle Hair Transplant Hospital, n.d.). The authors specifically note, however, that "None of the authors has a financial interest in any of the products or devices mentioned in this manuscript." (pg. 1441) in the journal: Journal of Cosmetic Dermatology.
14 The third author, Fabio Rinaldi, of the research (Maffei et al., 1994) provided baldness interventions according to his CV which states he has almost 40 years of experience of trichology-related outpatient and surgical experience (Rinaldi, n.d.). In addition, he is currently the head of research and development of Guilliana-SpA a pharmaceutical company that produces baldness interventions (Rinaldi, n.d.). It appears the journal: Arch Dermatol did not require disclosures.
15 The third author, Dr Pilar Avivar, of the research (Molina-Leyva et al., 2016) provided baldness interventions according to her employee profile noting she has provided aesthetic interventions including baldness- / trichology- related ones since July 2015 (LinkedIn, n.d.). In addition, the first author is currently employed by a clinic that provides baldness services (Virgen de las Nieves University Hospital, n.d.). The journal: Acta Dermatovenerologica Croatica did not appear to require disclosures.
16 All authors of the research (Mubki et al., 2019) list their affiliations to dermatology clinics that “diagnose[ patients] with AGA” (pg. 31). The third author also cowrote a paper urging dermatologists to promote their cosmetic interventions including hair transplants to the wider public: “The responses demonstrate that the Saudi Arabian public is not aware of the full scope and practice of dermatologic surgery, especially as it pertains to cosmetic procedures. Therefore, this lack of knowledge must be addressed” (AlHargan et al., 2017: 6). The authors declare no conflicts of interest in the journal: Egyptian Journal of Dermatology and Venereology.
17 Three of the authors of the research (Russo et al., 2019) list their affiliation to a dermatology clinic. Currently this clinic provides baldness interventions (S. Orsola-Malpighi Polyclinic, n.d.). The authors declare no conflicts of interest in the journal: Journal of the European Academy of Dermatology and Venereology.
18 Three of the authors of the research (Sawant et al., 2010) list their affiliation to a dermatology clinic. Currently this clinic provides baldness interventions (King Edward Memorial Hospital, n.d.). The authors declare no conflicts of interest in the International Journal of Trichology.
19 The second author, Dr Shahbaz Aman, of the research (Tahir et al., 2013) is currently listed by a medical database (Ola Doc, n.d.) as having 28 years’ experience as a dermatologist and as providing baldness interventions. The journal: Annals of King Edward Medical University does not appear to require disclosures.
20 Multiple authors of the research (Tang et al., 2000) list their affiliation to the National Skin Centre. Currently, this centre provides baldness interventions (National Skin Centre, n.d.). In the author(s)’ acknowledgements section of the journal: Singapore Medical Journals this probable conflict of interest is not acknowledged.

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