Dear Editor,
I have read with great interest recently published article entitled with “The association of urolithiasis and androgenetic alopecia” by Resorlu et al. in your journal. This is the first article as regards to the association of urolithiasis and male type alopecia in literature. They determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old.
Studies have shown that urolithiasis 2–3 times more common in males than females. Both clinical and experimental studies have reported that the main cause of male predilection stems from testosterone inducing stone formation.Citation1–3 However, in literature, the relation between serum testosterone and urolithiasis are controversial. While in some studies urolithiasis is associated with higher serum testosterone levels, we have shown opposite relation.Citation4,Citation5 Androgenetic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life. AGA is caused by a progressive reduction in the diameter, length, and pigmentation of the hair. Testosterone may play an important role in the pathophysiology of AGA.Citation6
The study is well-designed cross-sectional cohort study, but opens to several criticisms. Authors have discussed the relation between urolithiasis and alopecia in detail in the discussion section. As men age, there is a progressive and small decline in sex hormones, and related increases in luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin.Citation7 Although alopecia and urolithiasis have been attributed to testosterone, serum testosterone levels, the active metabolite of testosterone and testosterone binding globulin level have not been measured. This is the most important limitation of the study, which is open the criticism. Increased reactive oxygen species (ROS) and decreased antioxidant capacity are also associated with aging and proposed risk factors for urolithiasis.Citation8 There is no information about the serum levels of ROS and antioxidant capacity and relation between urolithiasis and AGA.
In conclusion, if this study were included some laboratory tests, such as serum testosterone levels, serum ROS and antioxidant capacity, as well as urinary crystal formation, it would be better. This study combined with these laboratory parameters may lead to comprehensive prospective studies showing the relation alopecia and urolithiasis.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Alper Otunctemur, Emre Can Polat and Emin Ozbek
Department of Urology, Okmeydani Training and
Research Hospital, Istanbul, Turkey
Levent Ozcan
Department of Urology, Derince Training and
Research Hospital, Kocaeli, Turkey
Received 12 November 2015; accepted 22 November 2015
References
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- Otunctemur A, Ozbek E, Cakir SS, et al. Urolithiasis is associated with low serum testosterone levels in men. Arch Ital Urol Androl. 2015;87:83–86.
- Piraccini BM, Alessandrini A. Androgenetic alopecia. G Ital Dermatol Venereol. 2014;149:15–24.
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- Chariyavilaskul P, Poungpairoj P, Chaisawadi S, et al. In vitro anti-lithogenic activity of lime powder regimen (LPR) and the effect of LPR on urinary risk factors for kidney stone formation in healthy volunteers. Urolithiasis 2015;43:125–134.