Assessment of quality of life and self‐esteem in male patients with androgenetic alopecia before and after hair transplantation

Patients with androgenetic alopecia experience a significant decrease in self‐esteem and quality of life. There are several methods by which these factors may be improved.


| INTRODUC TI ON
Androgenetic alopecia (AGA) is a generally dermatological condition which is more common among males. 1 AGA is characterized by symmetric diffused hair thinning and hair loss, 2 and it is estimated 3 that frequency of AGA in men 40 years and older is almost 50%.
Although it is neither a lethal condition nor will it causes physical pain 4,5 ; however, the unpleasant psychological effect of alopecia on affected individuals is considerable which is underestimated. 6 Currently, available information suggests that AGA may be associated with a significant impact on an individual's quality of life, often including extremely severe psychological distresses. 4 Adverse effects which were reported include weakened self-esteem, appearance unattractiveness, depression, emotional problems, and anxiety.
Besides, preoccupation with hair loss, and psychosocial separations was reported. 5 These hair loss-associated unfavorable effects provide robust motivation for individuals with AGA to find effective treatment for this condition.
AGA may be treated either surgically or with finasteride or minoxidil. Finasteride, an FDA-approved type 2 5 α-reductase inhibitor, and minoxidil reduce, and reverse hair loss and, in certain situations, promote hair re-growth, and survival. [7][8][9] Using finasteride drug is based on the role of androgen in AGA pathogenesis. Finasteride, via reductase enzyme suppression, inhibits the conversion of testosterone to dihydroxytestosterone 10 Clinical trial studies showed the efficiency of finasteride and men who use this drug had significantly less hair loss. 11,12 Besides, the mechanism of the action of minoxidil is not completely clear; however, it was shown 13 to increase the proliferation index of epidermal cells and survival time. Similar to finasteride, minoxidil-based therapies confirmed considerable improvement in hair count numbers and reversing hair loss in clinical trial studies. 8,13,14 Despite this, a number of patients are dissatisfied with pharmacological therapy and prefer surgical treatment and hair transplantation surgery has become a regular and well-liked treatment. Despite its increasing popularity, the effect of this surgery on psychological aspects of youth, patient's quality of life, and social success are unclear. Therefore, we aimed to determine whether hair restoration surgery improves self-esteem and quality of life in recipients.
In our research, the Rosenberg Self-Esteem Scale (RSES) was utilized to measure the improvement in participants' self-esteem. This measure had been extensively accepted in clinical settings and proven as a trustworthy and valid tool for assessing the self-esteem of individuals. In addition, we used the "Dermatology Life Quality Index (DLQI)" scale, which was previously validated as an adequate and valid instrument for assessing the quality of life.

| Questionnaires
Prior to hair transplantation, each patient was given a quality of life  Table 1. Table 1: main characteristics of the questionnaires.

| Statistical analysis
Using SPSS23.0 statistical analysis software, investigations were undertaken. The Kolmogrov-Smirnoff test was used to examine whether or not the numerical findings were typical. We intended

| RE SULTS
The average age of the 35 AGA patients was 60 years, with the youngest patient being 25. Patients had a mean age of 39.88 years.
Patients, he was 51.42 percent married and 48.58 percent single.
As an average educational qualification, the patient has a Bachelor of Science degree. Table 2  Quantitative comparison of preoperative and postoperative hair transplants is shown in Table 2. Table 3 displays the impact of marital status on life satisfaction and self-esteem. There were no statistically significant differences between marital status and self-esteem and quality of life. Table 3: The effect of marital status on quality of life and self-esteem. Table 4 provides information on the effect of education on quality of life and self-esteem. A statistically significant correlation was discovered between education level and quality of life.
The mean quality of life ratings for those without a bachelor's degree changed by 0.82 points, those with a bachelor's degree by 2.21 points, and those with an upper bachelor's degree by 3.6 points.

| DISCUSS ION
The present research indicated that the psychosocial features of AGA patients improve considerably postoperatively compared preoperatively. According to our findings, there was a statistically significant difference between the self-esteem and quality of life of individuals with AGA before and after hair restoration operation. Also statistically significant link between educational achievement and quality of life was found. Given the significance of hair psychologically, it is not unexpected that hair loss might have a negative impact on a person's psychological features. 1 Few studies have attempted to quantify the psychological impacts of hair loss to date. [15][16][17][18][19] These studies suggest that AGA patients of both sexes have worse self-esteem, worse quality of life, and more psychological issues. Self-esteem is closely related to happiness with one's looks, and many patients anticipate cosmetic surgery to boost their self-esteem. 20,21 Recent research has shown that cosmetic surgery boosts confidence and enhances physical attractiveness in addition to raising self-esteem. [21][22][23] Our findings align with those of these investigations. Yin et al. 22

| CON CLUS ION
In our research, the DLQI score, which measures life quality, and the RSES score, which measures self-esteem, both increased as a result of improving physical appearance, emotional state, and social standing after hair transplant surgery. To confirm our findings, a further experiment with a bigger sample size is required.

ACK N OWLED G M ENTS
We thank the Tehran Medical College, Tehran, Iran (Grant number: 96-24) for financial support.

CO N FLI C T O F I NTER E S T S TATEM ENT
The authors declare no conflict of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.