Prevalence of metabolic syndrome in patients with androgenetic alopecia: an analysis of current evidence

Background Androgenetic alopecia (AGA) is the most common non-scarring alopecia, and its prevalence increases with age. Previous meta-analyses of AGA and metabolic syndrome (MetS) have focused mainly on associations and risk estimates. We quantified the prevalence of MetS and its components among patients with AGA. Methods PubMed, Embase, Web of Science, the Cochrane Library, CNKI, VIP, and WanFang Data were searched from inception to July 2026 for cross-sectional and cohort studies. Prevalence estimates were pooled using logit-transformed random-effects models with restricted maximum likelihood estimation. We report 95% confidence intervals (CIs), I², τ², and 95% prediction intervals (PIs) when estimable. Examined subgroups included region, sex, AGA severity, MetS definition, and study quality. Sensitivity analyses assessed robustness. Egger’s test was performed to assess outcomes derived from ≥10 studies. Results Twenty-eight studies were included. MetS prevalence was 23.7% (12 studies; 3,623 participants; 95% CI, 15.5%–34.5%; I² = 95.4%; 95% PI, 3.7%–71.7%). Prevalence estimates for abdominal obesity, hypertension or elevated blood pressure, diabetes mellitus, dyslipidemia, hypertriglyceridemia, elevated low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol were 36.0%, 30.7%, 13.3%, 24.5%, 23.6%, 30.0%, and 28.8%, respectively. Heterogeneity was substantial across outcomes; the elevated low-density lipoprotein cholesterol estimate was based on only two studies. MetS prevalence was 19.7%, 30.8%, and 44.2% in mild, moderate, and severe AGA, respectively, although grading systems varied. In leave-one-out analyses, the pooled MetS estimate ranged from 21.1% to 25.9%; other outcomes with at least seven studies were also broadly unchanged; however, heterogeneity persisted. Evidence from female patients was limited (4 studies, 765 participants). Conclusion MetS and several metabolic abnormalities are common among patients with AGA, although estimates vary substantially across studies. Early assessment may support comprehensive health management in this population.