الفهرس 
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Abstract
AGA is the most common cause of hair loss that occurs after puberty. It affects approximately 50% of men at the ages 40-50 years. AGA results from a combination of hereditary and acquired factors and hormones. DHT binds to the follicle’s androgen-sensitive receptors and causing shortening the anagen phase of hair growth and miniaturization of the follicle. Finasteride is an effective drug for treatment of AGA that can be used orally or locally. The drug decreases loss of hair by inhibiting 5αR enzyme activity.
The pull test is usually negative in AGA, except in active periods when there can be a moderate telogen hair shedding in a pattern distribution. AGA can be also diagnosed by trichoscopy.
BPH is the nonmalignant enlargement of the prostate gland. It affects more than half of men aged older than 50 years and nearly 90% of men over 80 years. On a population level, there are many risk factors for BPH and LUTS. BPH is a progressive clinical disease of ageing men. Men with inherited forms of BPH tend to have larger prostates and younger age at onset than men with sporadic BPH. Testosterone promotes prostate growth by increasing the ratio of cellular proliferation to death. DHT binds to AR which causes a cascade of intracellular events that leads to gene expression, the production of growth and signaling factors that regulate cell division and proliferation in the prostate.
In BPH evaluation, it was demonstrated that there was a high correlation between diagnoses using medical history, serum PSA, digital rectal examination and IPSS score and those based on a full battery of tests including ultrasonography and uroflowmetry. BPH was defined by: prostate volume greater than 30 mL by TRUS, peak urinary flow rate less than 15 mL/s and PSA less than 10 ng/ ml.
Both AGA and BPH are androgen-dependent diseases in which testosterone and DHT are involved and in which the enzyme 5α-R plays a key role. In the scalp, the DHT responsible for follicular miniaturization is largely produced by the action of 5α-R2 on testosterone. In the prostate, DHT derived from the action on testosterone of both isoenzymes (5α-R1 & 5α-R2) is implicated in the growth and development of the prostate gland.
Nevertheless, the activity of 5α-R and number of androgenic receptors are considered to be higher in patients with BPH than in control subjects. Scalp biopsy specimens of patients with AGA have shown increased DHT concentrations and 5α-R activity.
The present study was done to evaluate the relationship between AGA and urinary symptoms associated with prostate growth in patient with BPH.
The study included fifty males were complaining of early onset AGA and fifty normal males as control. They were selected from those attending the Dermatology and Andrology clinic, Benha University Hospital in the period from September 2012 to June 2013. Any male with any medical problem that may affect the results of the study was excluded.
All patients (n= 50) and controls (n= 50) were subjected to thorough personal history taking, fulfillment of IPSS questionnaire, IIEF questionnaire. Serum samples were collected to determine the level of total testosterone, DHT and total PSA. AGA was evaluated by trichoscopy. The prostate volume was measured by TRUS. Urinary flowmetry was used to determine the maximum flow rate, the urination time, and volume.
All results of the current study were statistically analyzed. The patients and control groups did not significantly differ in mean age, testosterone level and DHT level. Patients with early onset AGA were found to have a larger prostate, higher PSA level, higher IIEF and lower Q max value in comparison with individuals without AGA (control group).
Patients were divided into two groups according to hair thickness, patients with very thin hair (<0.03) (n=26) and patients with mild to moderate hair thickness (>0.03) (n=24). There was a significant difference between both groups as regards age, DHT level, testosterone level and Qmax.
Patients were divided into two groups according prostatic volume. Patients with normal prostate volume (<30 ml) (n=14) and those with enlarged prostate (>30 ml) (n=36). There was a significant difference between both groups as regards age, hair thickness, DHT level, testosterone level, PSA level, Qmax, prostatic symptoms and erectile function.
Patients were divided into two groups according erectile function by using of IIEF. Patients with mild ED (n= 22) and those with moderate to severe ED (n=28). There was significant difference between both groups as regard age.
There was positive correlation between DHT level and age of patients and a negative correlation between testosterone level and age of patients. There was positive correlation between testosterone level and erectile function of patients. There was negative correlation between prostate volume and testosterone level of patients and a negative correlation between prostate volume and Qmax of patients.
In conclusion, early onset AGA may be a marker of urinary symptoms and enlarged prostatic volume in older age. There is a link between AGA and BPH on the level of pathogenesis, hormonal profile, prostatic symptoms and erectile function.