毛囊和相关腺体是雄激素的靶点

F.J.G. Ebling
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引用次数: 53

摘要

除头皮外,头发的生长和皮脂的分泌一般都受雄激素的主要影响。然而,毛囊及其相关腺体的反应在不同部位和个体之间差异很大。在面部、躯干和四肢上,睾酮最重要的作用是增加毛囊的活动周期,即毛囊的生长期,尽管它也会增加毛发的生长速度、厚度、髓质程度和色素沉着。这些作用包括高水平的激素及其在靶器官转化为5α-二氢睾酮。相比之下,即使没有5α-还原酶,下耻骨三角也发育繁茂。在皮脂腺中,细胞复制和脂质合成似乎不受相同的控制,因为它们对抑制剂的反应不同。皮脂腺对雄激素的反应涉及垂体因子靶部位的相互作用,其中生长激素、催乳素和促黑素细胞激素都是假定的候选者。最重要的科学和临床问题是,在任何特定情况下,毛囊或皮脂腺的反应程度是由可用雄激素水平决定的,还是由目标器官的敏感性决定的。虽然确实有些多毛症或痤疮患者的血浆雄激素水平高于正常水平或SHBG水平低于正常水平,但很大一部分患者在所有方面都是正常的。此外,四肢毛发生长率或前额皮脂排泄率似乎与血浆雄激素或SHBG负相关,尽管它们都被证明与循环5α-二氢睾酮相关。结论必须是,尽管男性型毛发生长和高皮脂腺分泌可能是由或至少伴随着高水平的游离睾酮引起的,但关键因素更可能是外周反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
8 Hair follicles and associated glands as androgen targets

The growth of hair, except that on the scalp, and the secretion of sebum are, in general, under the major influence of androgens. However, the responses of the hair follicles and their associated glands vary greatly between sites and between individuals.

On the face, trunk and extremities the most important role of testosterone is to increase the period of activity, the anagen phase, of the hair follicle, though it also increases the rate of growth, thickness, extent of medullation and pigmentation of the hair. These effects involve high levels of hormone and its conversion to 5α-dihydrotestosterone in the target organ. In contrast, the lower pubic triangle develops luxuriantly even in absence of 5α-reductase.

In the sebaceous glands, cell replication and lipid synthesis do not seem to be identically controlled, since they respond differently to inhibitors. The response of the sebaceous glands to androgens involves the interaction at the target site of pituitary factors, for which growth hormone, prolactin, and melanocyte stimulating hormone are all putative candidates.

The most important scientific and clinical question is whether, in any particular circumstances, the degree of response of the hair follicles or sebaceous glands is determined by the level of available androgen or by the sensitivity of the target organ. While it is true that some patients with hirsutism or acne have above normal levels of plasma androgens or below normal levels of SHBG, a substantial proportion are normal in all respects. Moreover, the rates of hair growth on the extremities or of sebum excretion on the forehead do not seem to be correlated either positively with plasma androgens or negatively with SHBG, though they each have been shown to be correlated with circulating 5α-dihydrotestosterone. The conclusion must be that, although male-type hair growth and high sebaceous secretion may be caused by, or at least accompanied by, high levels of free testosterone, the critical factor is more likely to be the peripheral response.

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