PSYCHOLOGICAL IMPACT AND AWARENESS OF ANDROGENETIC

ALOPECIA AMONG FILIPINO MALE PATIENTS AGED 18 TO 65 SEEN AT

THE OUTPATIENT DEPARTMENT OF THE OSPITAL NG MAYNILA

MEDICAL CENTER, DEPARTMENT OF DERMATOLOGY

Fenny Leets Santoso, MD1

Benedicto dL Carpio, MD, FPDS2

Eileen Regalado-Morales, MD, FPDS2

Armelia Lapitan-Torres, MD, FPDS2

Department of Dermatology

Ospital ng Maynila Medical Center

1
Ospital ng Maynila Medical Center, Department of Dermatology, Resident
2
Ospital ng Maynila Medical Center, Department of Dermatology, Consultant

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ABSTRACT
Background Androgenetic alopecia is the most common type of hair loss. Although
losing hair  is not life-threatening, it can lead to psychological distress.
Objective To investigate the psychological impact using Hospital Anxiety and Depression
Scale (HADS) and the awareness among Filipino male patients aged 18 to 65 with
androgenetic alopecia.
Methods A cross-sectional study was conducted at the OMMC Dermatology. Psychological
impact was assessed using HADS. Age, education, duration of disease, previous investigation
experience, previous experience in treating this condition, and satisfaction ratings for the
treatment were likewise obtained.
Results 145 Filipino male patients with androgenetic alopecia were included in the study.
The risks of anxiety and depression were not statistically associated with severity of AGA
(P>0.05). The risk of depression was highest among those with severe AGA. 57% had
previous investigation experience and 21% had previous experience in treating the condition,
however only 1 or 0.7% was satisfied with the treatment. Age, education, duration of disease,
level of awareness and treatment satisfaction and the severity of AGA in Filipino male
patients were not statistically associated with anxiety (P>0.05), however, age, education and
Hamilton Norwood Classification were statistically associated with depression (P<0.05).
Conclusion Three factors have been found to influence psychological well-being and self-
image in AGA patients: age of 50 years and above, lower education level, and a moderate to
severe grade of disease according to the Hamilton-Norwood classification. It is hoped that
optimal management focusing on these factors can be used to solve one of the mankind’s
psychologically debilitating hair diseases.

Keywords androgenetic alopecia, male pattern hair loss, psychodermatology

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Introduction

Hair protects the scalp against sun exposure, helps maintain the body heat, and facilitates

social interaction1. Androgenetic alopecia (AGA) or pattern hair loss is the most common

type of hair loss. It is androgen-dependent and characterized by a progressive decline in the

duration of anagen – an increase in the duration of telogen and miniaturization of scalp hair

follicles. Androgenetic alopecia in male or Male Pattern Hair Loss (MPHL) is symmetric and

progressive hair loss with some pattern variations. Hamilton and Norwood classified the

patterns of male AGA based upon frontoparietal and frontal recession as well as vertex

thinning. The most common pattern of male AGA starts on the temples and progresses to

affect the vertex area1, 2.

In Asians, AGA is a common disorder of hair loss, most especially among the male

population. The age of onset is between the thirties and forties, but the hair loss starts

immediately after puberty and continues progressively3. The AGA incidence in Asian men

and women is up to 73% of the general population4.

Although losing hair is not life-threatening, it can lead to psychological, mental, and

emotional distress. As a result, it has been reported that mild hair loss has an impact on

poorer quality of life. A study by Ng, et al highlighted several AGA-related negative

psychological impacts such as anxiety, depression, low self-esteem and feelings of

unattractiveness5.

Most patients with AGA are not aware of their hair loss until they are diagnosed with AGA

by their physicians. Some consider AGA as a normal aging process which might lead to

unimportance in the treatment of hair loss. The lack of awareness regarding this disease

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process leads to delayed treatment. However, significant awareness will bring patients to seek

consultation from medical health providers or to try different kinds of treatment, especially

when faced with psychological pressure and negative social perception about their

appearance6.

The aim of this study is to investigate the psychological impacts on patients with AGA and

their awareness of their hair condition. Factors that could influence these impacts will also be

investigated.

Study design and methods

Study design

This study was a single-center, cross-sectional, descriptive study. The study was conducted at

the Outpatient Department of the Ospital ng Maynila Medical Center, Department of

Dermatology.

Subjects

One hundred and forty-five patients satisfying the inclusion/exclusion criteria were sampled

among patients visiting the Outpatient Department of the Ospital ng Maynila Medical Center,

Department of Dermatology based on 80% standard normal variation, 5% absolute error or

precision, and based on the prevalence rate of AGA in Asian men ranging from 31-73%,

proportion population of 57% will be used in this study6. Sample size calculation for cross

sectional studies/surveys-qualitative variable was used in this study 7. The inclusion included

male patients of 18 to 65 years old who visited the hospital for any treatment of skin disease,

but showed clinical hair loss, which was sufficient enough to be diagnosed with androgenetic

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alopecia, and patients must understand and complete the questionnaires in English or

Filipino. The exclusion criteria included patients who were on medications that could cause

alopecia, patients with other types of alopecia, and patients who had already been included in

this study on their previous consults.

Sample Size7

Z 1−α / 2 p(1− p)
2

n=
d2

n= sample size

Z1-α/2= standard normal variation (80%) =1.28

P= proportion in population = (0.57)6

D= absolute error or precision = 5%

Methods of assessment and measurements

Severity of androgenetic alopecia

Two senior residents of dermatology were assigned to assess the severity of AGA using

Hamilton-Norwood Classification. There are seven grades of androgenetic alopecia which

will be further classified as: mild (Grade I and II), moderate (Grade IIA, III, IIIA and IV) and

severe (Grade IVA, V, VA, VI and VII)8.

Clinical Characteristics

Patients were instructed to fill up a questionnaire about the following characteristics: age,

education, duration of disease, previous investigation experience, previous experience in

treating this condition, and satisfaction ratings for the treatment. To compare the patient’s

psychological impact of varying age characteristics, the patients were separated into three

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groups: a group aged less than 30 years old, a group aged between 30 and 50 years old, and a

group aged over 50 years old. To compare the patient’s psychological impact of varying

education level, the patients were separated into three groups: elementary, secondary, and

college. To compare the duration of disease and patient’s psychological impact, the patients

were separated into three groups: less than five years of AGA, 5 to 10 years of AGA, and

exceeding 10 years of AGA. To compare patient’s psychological impact and level of

awareness, the patients were separated into: patients with awareness of AGA and patients

without awareness of AGA. To compare the patient’s psychological impact of varying

previous treatment satisfaction, the patients were separated into patients with high satisfaction

of their previous treatment and low satisfaction of their previous treatment. Additional

questions were administered to the following groups: patients who had done research

regarding the disease would mention the source (e.g. advertisement, friends, doctor, etc),

patients who had been using previous treatments (e.g., medical treatment, herbal shampoo,

etc), and patients who had low satisfaction with their previous treatment (e.g., high costs, low

subjective effects).

The Psychological Impact was assessed using Hospital Anxiety and Depression Scale

(HADS)9,10 and Hospital Anxiety and Depression Scale-Pilipino Translation (HADS-

P)11,12,13,14.

The HADS is a self-rating scale developed to assess psychological distress in non-psychiatric

patients. The HADS was developed by Zigmoid and Snaith in 1983. HADS and its Filipino

translation (HADS-P) was utilized in this study. The copyright was given by GL Assessment

for this study. This questionnaire includes two types of subscales: an anxiety scale (7 items)

and a depression scale (7 items). Each item was answered by the patient on a four-point (0-3)

response category, so the scores ranged from 0 to 21 for anxiety and 0 to 21 for depression. A

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score of 0 to 11 for either subscale was regarded as being in normal range/ no risk of anxiety

and depression, and a score of 11 and above indicating ‘risk’ of anxiety and depression11.

Statistical analysis

Descriptive analyses of demographic and psychological impact and awareness of

androgenetic alopecia among Filipino male patients aged 18 to 65 was done using frequency

and percentage for categorical variables. For continuous variables, mean and standard

deviation, and range were described. Relationship between demographic characteristics,

duration of disease, level of awareness and severity of AGA in Filipino male patients with

anxiety and depression were determined using chi square test and analysis of variance. A

level of significance was set at alpha less than 0.05.

ETHICAL CONSIDERATION

This study was conducted following international and national guidelines on research for

human participants such as the Declaration of Helsinki, International Conference on

Harmonization-Good Clinical Practice, the National Ethical Guidelines for Health and

Health-Related Research (NEGHHRR) and the Data Privacy Act of 2012 and its

Implementing Rules and Regulations and underwent ethical evaluation and approval from the

Institutional Review Board of the Manila Central University, Filemon D. Tanchoco Sr.

Medical Foundation, Inc. EDSA, Caloocan City 1400.

INFORMED CONSENT

Patients with AGA based on Hamilton-Norwood classification were selected according to the

inclusion and exclusion criteria of the study. Each subject was asked to sign an informed

consent prior to commencement of the study at the Ospital ng Maynila Medical Center-

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Department of Dermatology. The subject was informed regarding the study purpose, its

expected length, confidentiality, and any possible risks and benefits involved in participating

in the study. Written informed consent was secured from the subject and if he cannot read, it

was signed by a witness to testify that the study had been fully explained and understood by

the participant. All informed consents obtained from the study will be kept and locked in the

filing cabinet in the personal possession of the primary investigator.

RESULTS

Demographic characteristics

There were 145 Filipino male patients aged 18 to 65 with androgenetic alopecia seen at the

Outpatient Department of the Ospital ng Maynila Medical Center, Department of

Dermatology included in the study. The mean age was 39.69 (12.6) years and ranged from 20

to 65 years. More than half of the patients had a duration of condition below 5 years. 60%

were able to finish tertiary education. There were forty-seven percent patients who had

moderate Hamilton Norwood Classification, 35% with mild classification, and 18.6% with

severe classification.

Table I. Baseline demographic and clinical characteristics of Filipino

male patients aged 18 to 65 with androgenetic alopecia
Demographic and Clinical Characteristics No. %
Age, years 39.69 12.6
<30 years 40 27.6
30-50 years 73 50.3
>50 years 32 22.1
Education
Elementary 10 6.9
Secondary 47 32.4
Tertiary 88 60.7
Duration of condition
< 5 years 81 55.9
5-10 years 34 23.4

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 >10 years 30 20.7
Hamilton Norwood Classification
Mild (Grade I, II) 50 34.5
Moderate (Grade IIA, III, IIIA and IV) 68 46.9
Severe (Grade IVA, V, VA, VI and VII) 27 18.6

Risk of anxiety and depression using the Hospital Anxiety and Depression Scale

Score of 0 to 11 for either subscale was regarded as being in normal range/ no risk of anxiety

and depression, and a score of 11 and above indicating ‘risk’ of anxiety and depression. In

our study, the mean score of anxiety was 5.74 (3.2) and depression was 5.67 (3.165). Using

chi square test, the risk of anxiety and depression was not statistically associated with

severity of AGA with p-value of 0.654 and 0.086, respectively. However, the risk of

depression was highest with 18.5% among those with severe AGA as compare to those with

moderate and mild AGA with 4.4% and 4% risk of depression only. Those with mild AGA

had 8% risk of anxiety.

Table II. Risk of Anxiety and Depression using the Hospital Anxiety and Depression
Scale in Filipino male patients
Hamilton- Risk of Anxiety (>11) Risk of Depression (>11)
Norwood p-value p-value
Classification No. % No. %

Mild 4 8.0% 2 4.0%

Moderate 4 5.9% 0.654 3 4.4% 0.086
Severe 2 7.4% 5 18.5%

The level of awareness and treatment management of androgenetic alopecia

Fifty-seven patients or 39.3% had previous investigation experience and 18.6% used internet

as source of information. Twenty-one patients or 14.5% had previous experience in the

treatment of this condition – however, only 1 patient or 0.7%, was satisfied with the

treatment. The most common reason for non-satisfaction with the treatment was its

ineffectiveness, as cited by 7.6% of patients.

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 Table III. Level of awareness and treatment management of androgenetic alopecia
among Filipino male patients aged 18 to 65
Awareness and treatment management No. %
Previous Investigation Experience 57 39.3
Source
Advertisement 7 4.8
Friends 7 4.8
Internet 27 18.6
Internet, Advertisement 2 1.4
Others: Textbook 1 0.7
Seek consult to doctor 13 9.0
Previous experience in treating this condition 21 14.5
Treatment
Hair shampoo 3 2.1
Herbal therapy 6 4.1
Medical treatment 9 6.2
Medical treatment, Hair shampoo 2 1.4
Medical treatment, Hair transplant 1 0.7
Satisfaction for the treatment 1 0.7
Reason
Low effects 11 7.6
Required long-term treatment 8 5.5
High costs 6 4.1

Association of demographic characteristic, duration of disease, level of awareness and

severity of AGA in Filipino male patients with anxiety and depression

Using ANOVA, Table IV shows that age, education, duration of disease, level of awareness

and treatment satisfaction and severity of AGA in Filipino male patients were not statistically

associated with anxiety with p-value not less than 0.05. However, age, education and

Hamilton Norwood Classification were statistically associated with depression with p-value

of 0.008, 0.002, and 0.020, respectively. The mean HADS depression score was highest

among patients whose age are above 50 years old and lowest in patients who are less than 30

years old. Those who finished tertiary education had a lower depression score of 4.95 (3.19)

compared to the ones with secondary education, having a mean score of 6.98 (2.7). Those

with moderate and severe Hamilton Norwood Classification had higher depression scores as

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compared to ones with mild classification. The duration of disease, level of awareness,

treatment satisfaction and severity of AGA in Filipino male patients were not statistically

associated with depression.

Table IV. Association of demographic characteristic, duration of disease, level of awareness and
severity of AGA in Filipino male patients with anxiety and depression
Anxiety p- Depression
Factors p-value
Mean SD value Mean SD

Age group 0.165 0.008

<30 years 6.55 3.250 4.55 3.381
30-50 years 5.40 3.183 5.77 2.904
>50 years 5.53 2.940 6.84 3.081
Education 0.002
Bachelor 5.47 3.216 4.95 3.194
0.238
Elementary 5.20 3.676 5.8 3.12
Secondary 6.38 2.931 6.98 2.723
Duration of condition 0.441 0.077
<5 5.58 2.806 5.27 3.446
5-10 6.35 4.148 5.62 2.796
>10 5.50 2.825 6.8 2.511
Hamilton-Norwood classification 0.087 0.020
Mild 6.42 3.488 4.66 3.166
Moderate 5.15 3.029 6.21 3.258
Severe 6.00 2.675 6.19 2.497
Previous investigation 0.140 0.92
experience
No 5.43 3.054 5.65 3.259
Yes 6.23 3.306 5.7 3.041
Satisfaction for the treatment 0.362 0.562
No 6.59 3.034 5 3.177
Yes 7.00 6

DISCUSSION

Androgenetic alopecia or pattern hair loss is the most common type of hair loss 4. Although
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the Asian prevalence of AGA is lower than that of Caucasians, AGA is also a common

disorder in Asia. According to epidemiologic data from China, India, Korea, Taiwan and

Thailand, it is estimated that 41–73% of Asians develop pattern hair loss at some point in

their lives6. The age of onset of male AGA is highly variable. Different results have been

reported regarding the prevalence of AGA, depending on ethnic groups 5,15. In this study, the

age ranges from 20 to 65 years old, with variable duration of the condition, which is

consistent with the other study where an individual can develop pattern hair loss at some

point in their lives6.

A study done by Ng, et.al was noted that the association between AGA and psychological

disorders was well documented. AGA leads to anxiety and depression, patient’s perception

on their disease severity determines the severity of the psychological impact 5. Our study

shows that the risk of anxiety and depression were documented, however it was not

statistically associated with severity of AGA. Risk of anxiety and depression can be seen in

any androgenetic alopecia grade. The risk of depression is highest with 18.5% among those

with severe AGA as compare to those with moderate and mild AGA with 4.4% and 4% risk

of depression only.

In this study, it was found that age, education, duration of disease, level of awareness and

treatment satisfaction and severity of AGA in Filipino male patients were not statistically

associated with anxiety, however, age, education and severity of AGA were statistically

associated with depression. Our study found that the mean HADS depression score was

highest in patients over 50 years old and lowest in patients less than 30 years old, which was

in line with a study by Sawant et al 5. However, in most studies, a greater degree of

psychological impact was seen among younger patients. The finding in our study can be

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explained that among younger patients, the affected areas are much less severe and are thus

not readily visible.

In our study, those with tertiary education had lower depression score as compared with

secondary education. This is in contrast with a study by Ng, et.al. in which they observed that

those who received secondary and tertiary education were remarkably more dissatisfied with

their hair condition. The condition in their finding could be due to their increased awareness

and self-consciousness about image and the need for high degree of social interaction in these

group of patients5. A possible explanation for the finding in our study is that higher education

will have more understanding and acceptance about their condition.

Those with moderate and severe Hamilton Norwood Classification had higher depression

scores as compared to those with mild classification. This is in agreement with a study done

by Ng, et.al. which remarked that the association between AGA and psychological disorders

was well documented. The study explained that patients with a more severe grade of AGA

according to the Hamilton Norwood Classification had a higher risk of depression, and they

were psychologically disturbed by their severe hair condition. It explained that those with

severe baldness generally appear older and less attractive, thus associated with a poor self-

image and low self-respect5, which leads to the risk of depression5.

Patients who sought treatment for their hair likely have significant awareness about the

condition or they had already tried to obtain information and tried different kinds of treatment

available in the market. However, the available treatment in the market might be unproven.

The patients must know that a safe and effective treatment is available and they must

understand the expected outcome of each form of therapy. Knowledge about AGA may help

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the misunderstandings and psychological impact about its occurrence, and indirectly

influence the patients to seek treatment for their condition6. A study reported by Cash et al.

and Zhuang et al. discovered that patients who were actively seeking dermatologic treatment

were substantially more distressed and anxious compared to nontreatment-seeking group 5.

This is not in line with our study. In this study, more than half of the subjects had previous

investigation experience, but only 14.5% had previous experience in treating this condition.

This result is not statistically corelated with anxiety and depression. However, since more

than half of the subjects had concern about their condition, this could be a good signal that

they had actively sought for treatment. Due to the few treatment options, which give low

effects, with a high cost and long-term treatments, patients usually would not initiate the

medication. Our study found that only 14.5% of the subjects had previous treatment

experience with only 0.7% of them expressed satisfaction with their treatment. The most

common reason for non-satisfaction with their treatment was its low effectivity, which was

expressed by 7.6% of our subjects.

Therefore, to prevent the risk of anxiety and depression in AGA patients, proactive

management which covers both the disease process as well as psychological support must be

given to the patient. Adequate and comprehensive disease and treatment explanation, prompt

referral to a hair specialist, as well as encouragement to start treatment as early as possible

are among several proactive management options. The internet is the most common source of

information available to patients. Hence, sound and expert-written medical articles by hair

specialists need to be made available online.

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Limitations to this study include restricted applicability to other variants of alopecia as well

as lack of control for presence of other concomitant anxiety and/or depression in our

participants.

CONCLUSION

The health of one’s hair is inextricably linked with one’s self-image. Androgenetic alopecia,

being one of the most common hair diseases, has been correlated with levels of anxiety and

depression. Three factors have been found to influence psychological well-being and self-

image in AGA patients: age of 50 years and above, lower education level, and a moderate to

severe grade of disease according to the Hamilton-Norwood classification. It is hoped that

with the elucidation of these factors, an optimal management focusing on these factors can be

used to promote a targeted approach in solving one of the mankind’s psychologically

debilitating hair diseases.

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REFERENCES

1. Bolognia, JL, Jorizzo JJ, Schaffer JV, Callen JP, Cerroni L, Heymann WR et

al. Dermatology, 3rd edition. London: Elsevier, 2012:1093-7

2. Wolff, K, Goldsmith L, Katz S, Gilchrest B, Paller AS, Leffell D. Fitzpatrick's

Dermatology in general medicine, 8th edition. New York: McGraw-Hill, 2011:980-7

3. Tanaka Y, Aso T, Ono J, Hosoi R, Kaneko T. Androgenetic alopecia treatment in

asian. J Clin Aesthet Dermatol. 2018;11(7):32–5.

4. Lee, WS, Lee HJ. Characteristics of androgenetic alopecia in Asians. Ann Dermatol

[serial online]. 2012 Aug; 24(3):243-52. DOI: 10.5021/ad.2012.24.3.243

5. Ng, KF, Norazirah MN, Mazlin MB, Adawiyah J, Shamsul AS. Psychological impact,

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6. Lee, WS, Lee HJ, Choi GS, Cheong WK, Chow SK, Gabriel MT et al. Guidelines for

management of androgenetic alopecia based on BASP classification–the asian

consensus committee guideline. Journal of European Academy of Dermatology and

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7. Charan, J, Biswas T. How to calculate sample size for different study designs in

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8. Gupta, M, Mysore V. Classifications of patterned hair loss: a review. J Cutan Aesthet

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9. Stern, AF. The hospital anxiety and depression scale. Occupational Medicine [series

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10. Sengar, SS, Maheshwari G, Jain P, Anis S. Analysis of anxiety and depression in five

hundred patients in a tertiary care hospital with common hair disorders using HADS

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 scale. International Journal of Medical Science and Clinical Invention [series online].

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11. Guzman, MLR. A validation of the hospital anxiety and depression scale (HADS) in

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12. Montelibano, AAM. Comparison of the risk of depression and anxiety between

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Appendix 1. IRB Approval

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Appendix 2. Hospital Anxiety and Depression Scale Copyright

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Appendix 3. Informed consent Form Adult (English version) ICF version 2_5 July 2019

Study Title: Psychological Impact and Awareness of Androgenetic Alopecia Among

Filipino Male Patients Aged 18 to 65 seen at the Outpatient Department of the Ospital ng

Maynila Medical Center, Department of Dermatology

Study Site: Ospital ng Maynila Medical Center, Department of Dermatology OPD

Principal Investigator: Fenny Leets Santoso, MD Contact Number: 5246061 loc

133

Co-investigators: Benedict dL Carpio, MD

Eilleen R. Morales, MD

Armelia Andrea L. Torres, MD

Sponsor: There is no financial support from any pharmaceutical nor funding companies.

Introduction

Good day! I am Dr. Fenny Leets Santoso, Dermatology Resident of the Department of

Dermatology, Ospital ng Maynila Medical Center. My co-investigators and I are doing a

study on psychological problem (anxiety, depression) and awareness in patients with male

pattern hair loss. We invite you to be part of this study. This consent form may contain words

that you do not understand. Please ask me to stop as we go through the information and I will

take time to explain.

Purpose of the Research

People nowadays are concerned about their hair because it has an important role in their

physical appearance. The purpose of this study is to investigate the risk of anxiety and

depression in male patients with male pattern hair loss and their perception and concern of

their hair condition. We want to learn more about this problem in order to improve our

examination and treatment for this disease.

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Type of Research Intervention

This study will involve your participation to fill up questionnaires.

Participation Selection

You are invited to take part in this research if you comply with all of the following

conditions: (1) 18 to 65 years of age, (2) with male pattern baldness (3) understand English or

Filipino. However, if you are taking medicine that can cause hair loss or you have other types

of hair loss, you will be excluded.

Voluntary Participation

Your participation in this research is entirely voluntary. It is your choice whether to

participate or not. If you choose not to participate, all the services you receive at this clinic

will continue and nothing will change.

Procedures

We are asking you to help us learn more about the psychological impact of male pattern hair

loss. We are inviting you to take part in this research project. If you accept, you will be

examined by a Dermatology Resident and the Resident will tell you what type of male pattern

hair loss you have. Second, you will be asked to fill out a questionnaire which will be

provided and collected by the investigator, Dr. Fenny Santoso. You may answer the

questionnaire by yourself, or it can be asked to you verbally and you may answer it verbally,

so that the investigator will write the answer down for you. If you do not wish to answer any

question in this questionnaire, you may skip and move on to the next question. All

information that you will provide will be kept confidential. Your name will be coded

questionnaire to protect your identity. Your questionnaire will be identified by code that the

Investigator will assign. No one else except the investigator will have access to your

questionnaire.

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Duration

This study will involve your participation to fill out the questionnaire that will take about

fifteen minutes.

Risks

In the questionnaire, there may be some questions regarding your personal information that

you may feel uncomfortable to answer. You may opt to skip a question answer that you may

feel uncomfortable to answer or may decide not to take part in the study if you do not wish to

do so, and that is also fine. You do not have to give us any reason for not responding to any

questions or withdrawal from the study.

Benefit

This study may help to bring benefits to society as the result of finding relationship between

psychological problem and male pattern hair loss.

Reimbursements

You will not be provided any incentive to take part in this study.

Confidentiality

All participants will be assigned with substitute codes for information that identifies the

participants. The data will be stored in a locked file cabinet and password protected laptop

with limited access only by the Primary Investigator. Only the primary investigator will

collect, code, and maintain the data. All paper documents that may contain participant

identifiers and data regarding the patient will be properly disposed as soon as they are no

longer needed.

Sharing the Results

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Confidential_Androgenetic Alopecia Psychological Impact
The knowledge that we get from this research will be shared through publications and

conferences.

Right to Refuse or Withdraw

You do not have to take part in this study if you do not wish to do so, and choosing to

participate will not affect your treatment. You may stop participating in the survey any time

that you wish.

If you have questions or concerns after the survey or you would like to receive a copy of the

final aggregate results of this study, please contact:

Fenny Leets Santoso, MD

Primary Investigator

Department of Dermatology

Ospital ng Maynila Medical Center

Telephone number: 09396394390

This study was reviewed and approved by the Institutional Review Board of Manila Central

University-FDTMF IRB. You may contact

MA. ROSARIO E. BONAGUA, MD

Chair, MCU-FDTMF IRB

MCU-Filemon D. Tanchoco, Sr. Medical Foundation

Samson Road, EDSA, Caloocan City

Telephone Nos.: 364-1071 to 77 local 183

Thank you very much for your cooperation.

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Confidential_Androgenetic Alopecia Psychological Impact
Certificate of consent:

I have read and understood the information sheet given to me. I have had the opportunity to

ask questions about it and any questions that I have asked have been answered to my

satisfaction. I consent voluntarily to participate in this research.

Print name of Patient: _______________

Signature of Patient: ________________

Date: __________________

If illiterate

I have witnessed the accurate reading of the consent form of the potential participant, and the

individual has had the opportunity to ask questions. I confirm that the individual has given

consent freely

And

Print Name of Witness ___________

Signature of Witness ____________ Thumb Print of Participant

Date: ________________________

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Appendix 4. Informed consent Form Adult (Tagalog version) - ICF version 2_5 July

2019

Pamagat ng pananaliksik: Psychological Impact and Awareness of Androgenetic

Alopecia Among Filipino Male Patients Aged 18 to 65 seen at the Outpatient Department

of the Ospital ng Maynila Medical Center, Department of Dermatology

Lugar ng pananaliksik: Ospital ng Maynila Medical Center, Department of Dermatology

OPD

Pangunahing imbestigador: Fenny Leets Santoso, MD Contact Number: 5246061 loc

133

Co-imbestigador: Benedict dL Carpio, MD

Eilleen R. Morales, MD

Armelia Andrea L. Torres, MD

Sponsor: Walang suporta sa pananalapi mula sa anumang mga parmasyutiko o mga

kumpanya ng pagpopondo.

Panimula

Ako si Dra. Fenny Santoso, isang Residente ng Dermatolohiya sa Department of

Dermatology, Ospital ng Maynila Medical Center. Ako at ang aking mga co-imbestigador ay

gumagawa ng isang pananaliksik sa sikolohikal (pagkabalisa, depresyon, at kamalayan) sa

mga pasyente na may pagkawala ng buhok sa mga kalalakihan. Inaanyayahan kitang maging

bahagi ng pananaliksik na ito. Ang form ng pahintulot na ito ay maaaring maglaman ng mga

salita na hindi mo mauunawaan. Mangyaring hilingin sa akin na huminto habang dumadaan

kami sa impormasyon at magbibigay ako ng oras upang ipaliwanag.

Layunin ng Pananaliksik

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Sa ngayon ang mga tao ay nag-aalala tungkol sa kanilang buhok dahil may mahalagang papel

ito sa kanilang pisikal na hitsura. Ang layunin ng pananaliksik na ito ay upang siyasatin ang

panganib ng pagkabalisa at depresyon sa mga lalaking pasyente na may pagkawala ng buhok

at ang kanilang pang-unawa at pagmamalasakit sa kalagayan ng kanilang buhok. Gusto

naming matuto nang higit patungkol sa problemang ito upang mapabuti ang aming pagsusuri

at paggamot sa sakit na ito.

Uri ng Pamamagitan ng Pananaliksik

Ang pagsusuring ito ay patungkol sa pagsagot ng mga katanungan.

Pagpipilian sa Paglahok

Inaanyayahan kang makilahok sa pananaliksik na ito kung ikaw ay mayrooon ng lahat ng

mga sumusunod na kondisyon: (1) 18 taon hanggang 65 taong gulang, (2) lalaking may

“pattern baldness” (3) nakakkaunawa ng Ingles o Tagalog. Gayunpaman, kung ikaw ay

umiinom ng gamot na maaaring maging sanhi ng pagkawala ng buhok o mayroon kang iba

pang mga uri ng pagkawala ng buhok, ikaw ay hindi kasama.

Boluntaryong paglahok

Ang pagsali sa pananaliksik na ito ay kusang- loob at boluntaryo. Kung pinili mong hindi

lumahok, ang lahat ng mga serbisyo na iyong natatanggap sa klinika na ito ay magpapatuloy

at walang magbabago.

Pamamaraan

Hinihiling namin sa iyo na tulungan kaming matuto nang higit pa tungkol sa sikolohikal na

epekto ng pagkawala ng buhok ng lalaki sa pattern. Inaanyayahan ka naming makilahok sa

proyektong ito. Kung tatanggapin mo, ikaw ay susuriin ng Residente ng Dermatolohiya at

sasabihin sa iyo ng Resident kung anong uri ng male pattern na pagkawala ng buhok ang

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Confidential_Androgenetic Alopecia Psychological Impact
mayroon ka. Pangalawa, hihilingin ka na punan ang isang questionnaire na ibibigay at

kukuhanin ng imbestigador na si Dr. Fenny Santoso. Maari mo itong sagutan mag-isa o kaya

ay maaari mong hililingin na sagutan ito para saiyo ng imebestigator habang ikaw ay

nagsasalita. Kung hindi mo nais na sagutin ang anuman sa mga katanungan na ito, maaari

mong laktawan at magpatuloy sa susunod na tanong. Ang lahat ng impormasyong iyong

ibibigay, ay mananatiling kompidensyal. Ang iyong pangalan ay hindi isusulat sa form ng

mga katanungan. Ito ay makikilala o malalaman lamang sa pamamagitan ng code na itatalaga

ng Imbestigador. Walang sinuman maliban ang investigator ay magkakaroon ng access sa

iyong questionnaire.

Tagal

Ang iyong pagsagot sa mga katanungan kung ikaw ay makikilahok sa pagsasaliksik na ito ay

tatagal ng labing – limang minute.

Mga panganib

Maaaring may ilang mga katanungan tungkol sa iyong personal na impormasyon na hindi ka

komportableng sagutin. Nasa sa iyo kung sasagutan mo o hindi ang mga katanungan o kung

nais mo o hindi na makilahok sa pananaliksik na ito. Hindi mo kailangang bigyan kami ng

anumang dahilan para hindi tumugon sa anumang mga tanong.

Benepisyo

Ang pag-aaral na ito ay maaaring makatulong upang magdala ng mga benepisyo sa lipunan

bilang resulta ng paghahanap ng relasyon sa pagitan ng sikolohikal na problema at pagkawala

ng buhok ng lalaki.

Mga Pagbabayad

Walang ano mang bayad o insentibo ang ibibigay sa iyo sa paglahok sa pananaliksik na ito.

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Confidential_Androgenetic Alopecia Psychological Impact
Kumpidensyal

Ang lahat ng mga kalahok ay bibigyan ng mga “substitute codes” para sa impormasyong

magpapakilala sa kanila. Ang data ay maiimbak sa isang naka-lock na file cabinet at laptop

na “password-protected” na may limitadong pag-access lamang ng Imbestigator. Tanging ang

pangunahing imbestigador ang mangongolekta, magkko-code, at magtatabi ng data. Ang

lahat ng mga dokumento ng papel na maaaring maglaman ng mga impormasyon patungkol sa

mga kalahok ay maayos napupunitin at itatapon sa lalong madaling panahon kapat ito ay

hindi na kailangan.

Pagbabahagi ng Mga Resulta

Ang kaalaman na makukuha namin mula sa pananaliksik na ito ay ibabahagi sa pamamagitan

ng mga pahayagan at kumperensya.

Karapatan na tumanggi o hindi lumahok

Hindi mo kailangang makilahok sa pag-aaral na ito kung hindi mo nais na gawin ito, at ang

pagpili na lumahok ay hindi makakaapekto sa i paggamot sa iyo. Maaari kang tumigil sa

pagsali sa survey anumang oras na nais mo.

Kung mayroon kang mga katanungan o alalahanin pagkatapos ng survey o nais mong

makatanggap ng isang kopya ng pangwakas na pinagsama-samang mga resulta sa pag-aaral

na ito, mangyaring makipag-ugnayan kay:

Fenny Leets Santoso, MD

Pangunahing imbestigador
Department of Dermatology
Ospital ng Maynila Medical Center
Numero ng telepono: 09396394390
Ang pag-aaral na ito ay sinuri at inaprubahan ng Institutional Review Board ng Manila

Central University-FDTMF IRB. Maaari kang makipag-ugnay

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Confidential_Androgenetic Alopecia Psychological Impact
MA. ROSARIO E. BONAGUA, MD
Chair, MCU-FDTMF IRB
MCU-Filemon D. Tanchoco, Sr. Medical Foundation
Samson Road, EDSA, Caloocan City
Numero ng telepono: 364-1071 to 77 local 183

Maraming salamat po sa inyong kooperasyon.

Sertipiko ng pahintulot:

Aking binasa at naintindihan Mabuti ang mga impormasyon na ibinigay sa akin. Ako ay may

Karapatan na magtanong patungkol ditto at kung may mga katanungan na tinanong sa aking

na nasagot sa aking kasiyahan. Kusang-loob akong lumahok sa pananaliksik na ito.

I-print ang pangalan ng Pasyente: _____________________

Lagda ng Pasyente: ___________

Petsa: ______________________

Kung mangmang

Nasaksihan ko ang tamang pagbabasa ng form ng pahintulot ng potensyal na kalahok, at ang

indibidwal ay nagkaroon ng pagkakataon na magtanong. Kinukumpirma ko na ang bawat

indibidwal ay binigyan ng pahintulot..

AT
I-print ang Pangalan ng saksi _________________

Lagda ng Saksi ____________

Petsa: ____________________ Thumb Print ng Kalahok

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Confidential_Androgenetic Alopecia Psychological Impact
Appendix 5. HAMILTON-NORWOOD CLASSIFICATION8

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Confidential_Androgenetic Alopecia Psychological Impact
Appendix 6. Hospital Anxiety and Depression Scale (English Version)

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Confidential_Androgenetic Alopecia Psychological Impact
Appendix 7. Hospital Anxiety and Depression Scale (Tagalog Version)

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Confidential_Androgenetic Alopecia Psychological Impact
Appendix 8. MALE PATTERN HAIR LOSS SURVEY (English Version)
Initial Name : ______________
Date of Collection : MM / DD / YY
Age : ______

Education
o Elementary
o Secondary
o Bachelor

How long have you been suffering with this condition?

o < 5 years
o 5 - 10 years
o > 10 years

Have you ever done some research about this condition?

o YES
o NO
If YES, mention what kind of research.
o Internet
o Friends
o Advertisement
o Seek consult to the doctor
o Others: ___________________

Has this condition been treated before?

o YES
o NO
If YES, mention what kind of treatment.
o Medical treatment (Minoxidil, Finasteride)
o Light Therapy
o Hair transplant

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Confidential_Androgenetic Alopecia Psychological Impact
 o Hair shampoo
o Herbal therapy
o Wigs or hair pieces
o Others: __________________

Were you satisfied with the medication?

o YES
o NO
IF NO, mention why.
o Low effects
o High costs
o Required long-term treatment
o Others: __________________

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Confidential_Androgenetic Alopecia Psychological Impact
Appendix 9. MALE PATTERN HAIR LOSS SURVEY (Tagalog Version)
Paunang Pangalan : ______________
Petsa ng Koleksyon : MM / DD / YY
Edad : ____

Edukasyon
o Elementary
o Secondary
o College

Gaano katagal na kayo ay nagdurusa sa kondisyong ito?

o < 5 taon
o 5 - 10 taon
o > 10 taon

Nakagawa ka na ba ng pananaliksik tungkol sa kondisyong ito?

o Oo
o Hindi
Kung Oo, banggitin kung anong uri ng pananaliksik.
o Internet
o Kaibigan
o Patalastas sa TV, Radyo, Diyaryo, Billboard
o Kumunsulta sa doktor
o At iba pa: _____________________

Naipagamot mo na ba ito dati?

o Oo
o Hindi
Kung Oo, banggitin kung anong uri ng gamotan.
o Gamutan na ginawa ng doktor (Minoxidil, Finasteride)
o Magaan na terapi
o Pagpapatransplant ng buhok

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Confidential_Androgenetic Alopecia Psychological Impact
 o Shampoo
o Herbal na gamot
o Peluka o hibla ng buhok
o At iba pa: ______________________

Napunan ba ang sakit mo ng gamot na ito?

o Oo
o Hindi
Kung Hindi, banggitin kung bakit.
o Mahina ang epekto
o Magastos
o Pangmatagalan gamutan
o At iba pa: _______________________

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