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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 10  |  Issue : 6  |  Page : 284-285  

New-onset androgenic alopecia following human chorionic gonadotropic diet and testosterone pellet implantation


Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA

Date of Web Publication1-Feb-2019

Correspondence Address:
Mr. Jacob Griggs
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Suite 2175, Miami 33136, Florida
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_75_18

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   Abstract 


A diet involving human chorionic gonadotropic (hCG) injections combined with extreme caloric restriction is sometimes undertaken by people desiring rapid weight loss. We report a patient with new-onset androgenic alopecia following hCG diet combined with the implantation of testosterone pellets.

Keywords: Androgenic alopecia, hair loss, human chorionic gonadotropic diet, testosterone, testosterone pellet


How to cite this article:
Griggs J, Almohanna H, Ahmed A, Tosti A. New-onset androgenic alopecia following human chorionic gonadotropic diet and testosterone pellet implantation. Int J Trichol 2018;10:284-5

How to cite this URL:
Griggs J, Almohanna H, Ahmed A, Tosti A. New-onset androgenic alopecia following human chorionic gonadotropic diet and testosterone pellet implantation. Int J Trichol [serial online] 2018 [cited 2019 Aug 21];10:284-5. Available from: http://www.ijtrichology.com/text.asp?2018/10/6/284/251427




   Introduction Top


Androgens have a clear role in the pathogenesis of androgenic alopecia in men with genetic susceptibility; however, the effect of an iatrogenic increase of androgen levels by human chorionic gonadotropic (hCG) supplementation or testosterone pellet implant is less clear. There are many anecdotal reports from men linking testosterone supplementation to hair loss, and androgenic alopecia is considered a potential side effect of testosterone therapy, yet there are surprisingly few cases published in the literature.


   Case Report Top


A man in the fourth decade of life with a family history of mild androgenic alopecia in his father first noticed sudden hair loss in 2016, 1 year after starting the hCG diet for weight loss followed by testosterone hormone pellet implantation intended for gain of muscle mass. The patient denied losing weight from the diet. Physical examination showed Norwood Hamilton Stage III male-pattern hair loss [Figure 1].
Figure 1: Trichoscopy exhibited hair shaft diameter variability, supporting the diagnosis of androgenic alopecia

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   Discussion Top


Supplementation of hCG is sometimes abused in an effort to lose weight or for the purposes of performance enhancement in athletes; however, there is no scientific basis supporting the effectiveness of hCG use for weight loss.[1] The use of hCG in combination with caloric restriction has been previously reported to cause telogen effluvium after treatment cessation.[2] While the telogen effluvium may be caused by weight loss associated with the caloric restriction, another proposed hypothesis is the induction of a “pseudopregnancy” state by hCG, thereby causing telogen effluvium after the cessation of hCG therapy similar to that experienced by postpartum women. Administration of hCG is known to increase intratesticular testosterone levels, which highly correlates with serum testosterone levels after hCG administration.[3] The ability of hCG to modulate testosterone provides an intuitive mechanism for how hCG may contribute to androgenic alopecia.

Testosterone pellets are inserted subcutaneously and are typically used to treat male hypogonadism. They involve a slow-rising and sustained increase in testosterone levels.[4] Our patient was using the testosterone pellet to gain muscle mass, a common reason for testosterone abuse.[5] Androgenic alopecia is considered a potential side effect of testosterone pellets; however, its incidence is unknown, as literature on the matter is lacking.[6] In fact, in a retrospective chart review that tracked the adverse events of 273 patients treated with testosterone pellets followed over 3 years, no patients reported hair loss.[7]

Testosterone therapy by other modalities has been shown to cause androgenic alopecia. One case reports the onset of androgenic alopecia in a female patient after approximately 18 months of connubial exposure to her husband's topical testosterone gel.[8] A prospective interventional study of female-to-male transsexuals demonstrated androgenic alopecia caused by long-term testosterone therapy via intramuscular, transdermal, or oral route.[9] Treatment targeting androgens using 5α-reductase inhibitor finasteride was shown to improve androgenic alopecia in female-to-male transsexuals.[10]

Androgens are clearly implicated in the development of androgenic alopecia. As evidenced by the patient we report, the combination of hCG and testosterone pellet administration can precipitate androgenic alopecia in a genetically susceptible individual. Potential users of either treatment should be aware of this important cosmetic complication.

Acknowledgment

The authors would like to thank the staff of the dermatology department at the University of Miami Hospital for their support.

Financial support and sponsorship

Nil.

Conflicts of interest

Dr. Antonella Tosti is a consultant for P&G, DS Laboratories, and Monat; and a principal investigator for Incyte, Lilly, Aclaris, and Nutrafol.



 
   References Top

1.
Lijesen GK, Theeuwen I, Assendelft WJ, Van Der Wal G. The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the simeons therapy: A criteria-based meta-analysis. Br J Clin Pharmacol 1995;40:237-43.  Back to cited text no. 1
    
2.
Goette DK, Odum RB. Letter: Profuse hair loss. Arch Dermatol 1975;111:930.  Back to cited text no. 2
    
3.
Roth MY, Page ST, Lin K, Anawalt BD, Matsumoto AM, Snyder CN, et al. Dose-dependent increase in intratesticular testosterone by very low-dose human chorionic gonadotropin in normal men with experimental gonadotropin deficiency. J Clin Endocrinol Metab 2010;95:3806-13.  Back to cited text no. 3
    
4.
McCullough AR, Khera M, Goldstein I, Hellstrom WJ, Morgentaler A, Levine LA, et al. A multi-institutional observational study of testosterone levels after testosterone pellet (Testopel(®)) insertion. J Sex Med 2012;9:594-601.  Back to cited text no. 4
    
5.
Westerman ME, Charchenko CM, Ziegelmann MJ, Bailey GC, Nippoldt TB, Trost L. Heavy testosterone use among bodybuilders: An uncommon cohort of illicit substance users. Mayo Clin Proc 2016;91:175-82.  Back to cited text no. 5
    
6.
McCullough A. A review of testosterone pellets in the treatment of hypogonadism. Curr Sex Health Rep 2014;6:265-9.  Back to cited text no. 6
    
7.
Pastuszak AW, Mittakanti H, Liu JS, Gomez L, Lipshultz LI, Khera M. Pharmacokinetic evaluation and dosing of subcutaneous testosterone pellets. J Androl 2012;33:927-37.  Back to cited text no. 7
    
8.
Lattouf C, Miteva M, Tosti A. Connubial androgenetic alopecia. Arch Dermatol 2011;147:1329-30.  Back to cited text no. 8
    
9.
Wierckx K, Van de Peer F, Verhaeghe E, Dedecker D, Van Caenegem E, Toye K, et al. Short- and long-term clinical skin effects of testosterone treatment in trans men. J Sex Med 2014;11:222-9.  Back to cited text no. 9
    
10.
Moreno-Arrones OM, Becerra A, Vano-Galvan S. Therapeutic experience with oral finasteride for androgenetic alopecia in female-to-male transgender patients. Clin Exp Dermatol 2017;42:743-8.  Back to cited text no. 10
    


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