American Journal of Clinical and Experimental Medicine

2016; 4(4): 98-102

http://www.sciencepublishinggroup.com/j/ajcem
doi: 10.11648/j.ajcem.20160404.12
ISSN: 2330-8125 (Print); ISSN: 2330-8133 (Online)

The Level of Copper in Hair Androgenic Alopecia

Wiwiek Amriyana Saputri1, Farida Tabri1, Nurelly Noro Waspodo1, Burhanuddin Bahar2,
Agussalim Bukhari3, Nursiah La Nafie4
1
Department of Dermatovenereology, Medical Faculty, Hasanuddin University, Makassar, Indonesia
2
Biostatistic, Medical Faculty, Hasanuddin University, Makassar, Indonesia
3
Department of Clinical Nutritional, Medical Faculty, Hasanuddin University, Makassar, Indonesia
4
Department of Chemical, Mathematics and Sciences Faculty, Hasanuddin University, Makassar, Indonesia

Email address:
wiwiekamriyana@yahoo.com (W. A. Saputri)

To cite this article:

Wiwiek Amriyana Saputri, Farida Tabri, Nurelly Noro Waspodo, Burhanuddin Bahar, Agussalim Bukhari, Nursiah La Nafie. The Level of
Copper in Hair Androgenic Alopecia. American Journal of Clinical and Experimental Medicine. Vol. 4, No. 4, 2016, pp. 98-102.
doi: 10.11648/j.ajcem.20160404.12

Received: May 20, 2016; Accepted: May 31, 2016; Published: June 17, 2016

Abstract: Androgenic alopecia is characterized by progressive loss of hair from the scalp. This research aimed to determine
the hair and blood copper levels in men with androgenic alopecia. The research was conducted in the Department of
Dermatovenereology of Dr. Wahidin Sudirohusodo Hospital, Makassar and the Center for Health Laboratory, Makassar, using
the observational research method. The samples comprised 21 the males with androgenic alopecia and 11 control samples
without androgenic alopecia. The hair and blood of the samples were analyzed using the atomic absorption spectrophotometer
receipts. The research results indicated resources that the hair copper level in the androgenic alopecia group Showed a
difference compared to the hair copper levels in the control group, though the difference was significant (p <0.05). On the
other hand, the blood copper levels in androgenic alopecia group had no difference compared to that in the control group. The
hair copper levels had no correlation with the blood copper levels. The age had a significant correlation with the androgenic
alopecia, in that, the alopecia incidence would increase of as the age increased (p <0.05). However, the levels of both the hair
and blood coppers had no correlation with the age. Neither, did the levels of both copper hair and blood have a correlation with
the degree of androgenic alopecia (Hamilton grade).

Keywords: Androgenic Alopecia, Copper, Hair Loss

1. Preliminary
Androgenic alopecia is a form of hair loss is most often in world and is more common in older women, 6-12% in men
men, but can also occur in women, involving the loss of real aged 20-30 years and increased by 40-45% over the age of 70
hair, pigmented terminal hair on the head, which responds to years. [2] There are variations in terms of race. The reason of
circulating androgens. Other names are male pattern variation in terms of race is not yet clear, but it is likely due
baldness, the common hair loss, male pattern alopecia, to genetic factors as differences in appearance regardless of
androgen-dependent alopecia, androgenic alopecia, or the location. [2, 3]
baldness. [1] Androgenic alopecia is common and not life-threatening
Although there are no precise statistics, the incidence of and is not painful but it is troublesome diseases. In the
Caucasians recorded close to 100%, other opinions cultural orientation in industrialized countries, relationships
mentioned most in both men and women over 40 years bald with aging has a negative connotation and is often the
showed androgenic alopecia. [1] Prevalence of androgenic cause of androgenic alopecia which is characterized by
alopecia (AGA) increases with age. Androgenic alopecia in psychological distress and reduced quality of life for men and
women is estimated at about 21 million women around the women. The patient feels ashamed, a feeling of being old,
99 Wiwiek Amriyana Saputri et al.: The Level of Copper in Hair Androgenic Alopecia

and a loss of confidence. [4] 2. Materials and Methods

The psychological impact of this condition affects the
attractiveness of personal and social life. A study conducted 2.1. Location and Time Research
in both sexes has confirmed that the AGA is a stressful The study was conducted at the Health Sciences
condition which affects the function of individual Dermatology, Department of Dermatovenereology Dr.
psychological. Although in many developing countries Wahidin Sudirohusodo Hospital and other hospitals.
androgenic alopecia when not accompanied by abnormal Examination conducted at the Center for Health Laboratory
health status, is seen as a cosmetic problem, especially in Makassar conducted in February-March 2016.
males, but the psychological impact is not diminished. This is
seen as a cosmetic issue perhaps because compared to many 2.2. Design and Research Variables
other issues are more pressing (e.g. socioeconomic). [3]
Previous research by Amirnia et al (2013), who This study design was observational study to determine
hypothesized that decreased levels of copper and zinc causes levels of copper hair and blood on androgenic alopecia than
hair loss in these patients. The concentration of elements of the control. The research variables consist of: the
hair is also important. Besides the existing article, the independent variable (copper content), the dependent
hypothesis that the elements copper and zinc deficiency on variable (androgenic alopecia), variable between (hair
the hair can cause the occurrence of androgenic alopecia. follicles), and the control variables (gender and age).
There is no significant difference in the levels of zinc, iron, 2.3. Population and Sample
and copper serum between patients with alopecia and normal
people. He reported only universalis alopecia with urinary The study population was all androgenic alopecia patients
copper levels were significantly lower. [5] who visited the clinic Cosmetic Dermatology Division of
The hair follicle is a unique structure that has an department of dermatovenereology, Wahidin Sudirohusodo
incredible ability with the potential for regeneration. It is hospital in Makassar aged 20-60 years. Samples are
very important for epidermal homeostasis and affordable throughout the population who meet the inclusion
reepithelialization after damage to human skin. Like the criteria, willing to participate in the study by signing an
others, the organ system that is more active and quick to informed consent. Selection of research sample conducted in
breed, hair follicles can be easily distracted in a normal consecutive sampling is appropriate sampling the patient's
growth cycle by the effects of local and systemic. As an arrival.
example of the influence of Dihydrotestosterone (DHT), a
molecule derived from the action of the enzyme 5-alpha 2.4. Method of Collecting Data
reductase (type 1 and 2) on testosterone. DHT among others This research was conducted with the stages of activities
cause damage to the hair follicle that leads to an as follows: 1) Preparation, 2) Explanation and signing
inflammatory reaction to the scalp and hair follicle informed consent, 3) Mechanical execution, 4) examination
miniaturization development. This may be a receptor to assess patients androgenic alopecia using criteria
pathway abnormalities that arise. The receptor problem is Norwood-Hamilton, 5) examination to assess the levels of
probably in the fact that many subjects using chemical copper hair and serum androgenic alopecia patients by using
elements that reduce levels of DHT to occur alopecia, this Atomic Absorption Spectrometry (AAS), 6) procedure of
may indicate involvement / disorder biochemical specimen collection.
components in addition to testosterone and its derivatives in
the pathogenesis of alopecia. [1] 2.5. Data Analysis Technique
Until now, the location of androgen action on hair follicles
is not yet clear, but new research shows that the papillary To know the difference between the levels of copper hair
dermis as a hair growth. Is currently thought that the in androgenic alopecia and control, we used independent t-
differences between men and women with androgenic test test when the data were normally distributed copper
alopecia is associated with differences in the effect of levels; if not normal to use the Mann Whitney U test. To
androgens. Previously, androgenic alopecia in women is determine the relationship (correlation) between the copper
believed to be associated with increased levels of DHT which content of the hair with androgenic alopecia. Limit of
has the same mechanism in men, but the current study significance used was α = 5%. The results of the analysis are
showed that unlike in men, women with AGA marked collected in the form of a narrative, incorporating tables or
increase in the amount of testosterone production. [2] graphs.
There are still very few studies evaluating the androgenic
alopecia and hair copper levels and some research results are 3. Results
still at odds about the copper content of the hair on the
androgenic alopecia is the reason we investigate further. We have conducted an observational study to evaluate
Therefore, this study aimed to evaluate the hair and blood the hair and blood copper levels in men with androgenic
copper levels in men with androgenic alopecia. alopecia. The study was conducted at the Health Sciences
Dermatology, department of Dermatovenereology, Dr.
 American Journal of Clinical and Experimental Medicine 2016; 4(4): 98-102 100

Wahidin Sudirohusodo hospital. Examination conducted at levels not found differences between the groups
the Center for Health Laboratory Makassar conducted in androgenic alopecia (49.36) and the controls (49.90)
February-March 2016. Samples taken in the form of hair (Appendix, Table 1).
on the head portion of the occipital and blood taken from Copper hair is not associated with blood copper, groups,
V. The median cubital for patients suffering from and age (p> 0.05), as well as with unrelated blood copper
androgenic alopecia and who do not suffer from with copper hair, and age groups (p> 0.05). However, age
androgenic alopecia. significantly associated with androgenic alopecia (p
The number of samples in this study were 33 people <0.05), the older age increases the incidence of alopecia
consisting of 22 men suffering from androgenic alopecia (Appendix, Table 2).
and 11 men who did not androgenic alopecia. In the age The relationship between copper hair, blood copper and
group suffering from androgenic alopecia between 20-60 degrees of androgenic alopecia (Hamilton grade) obtained a
years old on average at the age of 39 years, while the copper content of copper hair and blood is not related to the
average control at the age of 30 years. Hair copper levels degree of androgenic alopecia (Hamilton grade) obtained p>
between androgenic alopecia i.e. (276.05) and control 0.05 (Appendix, Table 3).
(151.09) but not significantly different. On blood copper
Table 1. Characteristics of Sample.

variable Group N mean The standard deviation of ± The p-value

Case 22 39.22 7.71 0.86
Age
Control 11 30.36 7.08
Case 22 276.05 677.35 0.55
Hair Cu (g / g)
Control 11 151.09 315.02
Case 22 49.36 18.27 0.69
Cu Blood (mg / L)
Control 11 49.90 29.45

Table 2. Relationship Between Group androgenic alopecia, hair Copper, Copper Blood and Age.

variable n r Hair Cu (p-value) r Cu Blood (P-value) R Group (P-value) r Age (P-value)

Cu Hair 33 0.05 0.77 -0.10 0.56 0.15 0.41
Cu Blood 33 0.51 0.77 0.12 0.94 -0.78 0.66
Group 33 -0.10 0.56 0.01 0.94 -0.49 0,003
Age 33 0.14 0.41 -0.08 0.66 -0.49 0,003

Table 3. Relationship between Hair Copper, Copper Blood and degree of androgenic alopecia (Hamilton Grade).

variable N Hamilton Grade (P-value)

Cu Hair 22 0.59
Cu Blood 22 0.94

* Spearman's rho

of this disease may be a reference to precaution and step

4. Discussion therapy. Different hypotheses such as the lack of some of the
This study shows the differences between the levels of elements in the blood and hair have been investigated. [6]
androgenic alopecia hair copper and control but not The mean value of the hair copper content between
significant (p> 0.05). There were no differences in blood androgenic alopecia i.e. (276.05) and control (151.09) but no
copper levels between androgenic alopecia and control. Hair significance differences among them. However, there is no
copper levels are not related to blood copper levels. Age has significant different between the mean blood copper of the
a significant relationship with androgenic alopecia, alopecia androgenic alopecia patients and controls. These results are
where the incidence increases with age (p <0.05). Hair and consistent with research which was conducted by Ozturka et
blood copper levels are not related to age. Hair and blood al (2014), in Turkey that produced a mean value of hair
copper levels are also not related to the degree of alopecia copper levels differ between patients with androgenic
(Hamilton grade). alopecia than the control and serum copper levels were not
This study chose the hair and blood copper levels different between the two groups. [7] The research that
associated with androgenic alopecia, although androgenic conducted in Iran by Amirnia et al (2013), which get the
alopecia can occur genetically. Regarding the possible causes hairs on the copper content of androgenic alopecia lower than
of androgenic alopecia diverse hypotheses have been the control with p <0.005. [6] The research that conducted by
introduced, but the main cause of this disease has not been Kil et al (2013), who analyzed the concentrations of copper
discussed in any of the hypotheses. Finding possible causes and zinc in the hair loss results obtained serum copper not
differ significantly between groups androgenic alopecia than
101 Wiwiek Amriyana Saputri et al.: The Level of Copper in Hair Androgenic Alopecia

controls (p = 0.975). [8] levels in various types of alopecia except androgenic alopecia
The hair copper is not associated with blood copper, have been reported and the results are still being debated.
groups, and age (p> 0.05), as well as with unrelated blood The results were varied in levels of copper and zinc in many
copper with copper hair, and age groups (p> 0.05). Research studies can be explained because the foundation of the
conducted by Amirnia et al (2013), in androgenic alopecia sample size, methodology and variations in population. [7]
patients aged 17 to 62 years found that hair copper levels Zinc and copper is absorbed in the small intestine through
lower than controls age 15 to 38 years. This study did not a special pathway ZNT (zinc transporter), as well by divalent
show the relationship of age with a copper content of hair. [6] cationic transporter. Therefore, we can assume that if both
Research by Kil et al (2013), did not show any significant excessive levels may affect serum concentrations of
correlation between copper and age. [8] competing with the way in which this can lead to inaccurate
This study show that age significantly associated with results. Therefore, the concentration of serum copper showed
androgenic alopecia (p <0.05), the older age increases the no significant difference is the amount and the ratio of
incidence of alopecia. Androgenic alopecia is a form of hair patients in the control group. This is due to the absence of a
loss that usually occurs in adulthood. Onset based on history direct relationship between the concentration of serum
begins at puberty. [9] According to the age, the incidence of copper and hair loss where it is in line with other studies that
androgenic alopecia at the age of 30 years is around 30% and further studies are needed. [8]
is increasing at age of 50 approximately 50%, and 80% at age Hair copper levels were significantly higher in patients
of 70 years. [10, 11] than controls. Although copper has no direct role in the
The copper hair and blood levels are not related to the formation of hair, but its role in the formation of blood
degree of androgenic alopecia (Hamilton grade) obtained p> vessels has been demonstrated. But at the very high levels of
0.05. Direct relationship explanation between copper content copper acts as an oxidant, it can interfere with various
of hair, blood copper and degrees of alopecia has not been biochemical reactions important for the formation of hair
explained. Based on the severity of alopecia is judged by the through the product of oxidative process. [1]
presence of hair thinning that occurs at a young age, a family From these results, we get the difference of different hair
history of androgenic alopecia, and the pattern or distribution copper levels were higher in androgenic alopecia than the
of thinning / hair loss then the classification of the Hamilton- control, although the number of samples slightly. Limitations
Norwood for men with androgenic alopecia is divided into of our study because only a group of men with androgenic
mild (grade 1 and 2), moderate (degree 3a to 4) and weight alopecia with a little number of samples studied.
(degree 4a to 7). [12]
In this study, we get the results of different hair copper but 5. Conclusions and Recommendations
not significantly in androgenic alopecia patients than in
controls. Various biochemical functions depend on copper The researchers concluded that there is a difference between
such as immune activity, protein synthesis and hormone the levels of androgenic alopecia hair copper and control but
action. So that copper has a major role in the physiology and not significant. There were no differences in blood copper
biochemistry, and his involvement in the health of levels. between androgenic alopecia and control. Hair copper
individuals. However, the function of copper to the hair levels are not related to blood copper levels. Age has a
follicle is unknown. Only one study of hair copper levels in significant relationship with androgenic alopecia, alopecia
patients with male androgenic alopecia. Zinc levels in where the incidence increases with age. Hair and blood copper
patients with male androgenic alopecia. They showed that the levels are not related to age. Hair and blood copper levels are
levels of zinc in the male androgenic alopecia was also not related to the degree of androgenic alopecia (Hamilton
significantly lower in men with normal hair. The authors grade). Researchers suggest that further research with a larger
reported that the levels of zinc may play a role in number of samples to prove the relationship between copper
etiopathogenesis male androgenic alopecia and its treatment. hair and blood to do research androgenic alopecia and
Research by Ozturka et al (2014), who reported that zinc and androgenic alopecia copper levels in women.
copper hair with lower levels of androgenic alopecia in males
than in controls. The result is different probably due to
genetic and environmental reasons. No significant References
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urine. Until now, no study has compared the levels of copper [1] Iyanda. (2012). Serum Elements Status of Androgenetic
Alopecia Subjects Exposed to Cigarette Smoke or Alcohol.
and zinc in serum and urine of male androgenic alopecia. [7] JETEAS. 3.702 to 707.
On the other hand Skalnaya study (2014), which showed a
much lesser extent on the content of copper and zinc in the [2] Schweiger et al. (2010). Update on The Pathogenesis,
hair of the head occipital frontal area than in women with Genetics and Medical Treatments of Patterned Hair Loss.
JDD, 9.1412-9.
androgenic alopecia. Comparison of level in serum and hair
have two different uses. The serum level tend to show the [3] Iyanda AA. Serum Elements Status of Androgenetic Alopecia
current status of the body, and the hair level showed that long Subjects Exposed to Cigarette Smoke or Alcohol. JETEAS.
a time limit and can be measured in years. [13] Micronutrient 2012; 3(4):702-7.
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[4] Randall. (2010). Molecular Basis of Androgenetic Alopecia. [9] Gonzalez et al. (2010). Androgenetic Alopecia in The
United Kingdom, Springer. Paediatric Population: A Retrospective Review of 57 Patients.
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[5] Dastgheib et al. (2014). Comparison of Zn, Cu, and Fe
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Normal Group. Derm Resc Pract, 1-5. Pathogenesis and Therapy. Expert Review, 1-12.
[6] Amirnia et al. (2013). Assessment of Zinc and Copper [11] Boldrin. (2010). Androgenic alopecia: Exploring Causes,
Contents in the Hair and Serum and Also superoxide Psychological Effects, with Western and Chinese Medicine
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[7] Ozturka et al. (2014). BMI and Levels of Zinc, Copper in Hair
Serum and Urine of Patients With Turkish Male Androgenetic [13] Skalnaya. (2014). Copper Deficiency A New Reason of
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Concentrations in Hair Loss. Ann Dermatol, 25.405-409.