Abstract
BACKGROUND: Androgenetic alopecia (AGA) is a prevalent chronic condition with health burden, yet its association with psychological well-being remains inconsistent. This study systematically examines differences in psychological well-being between AGA patients and non-AGA controls, focusing on symptoms of anxiety, symptoms of depression, stress, and other psychological issues. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted across 7 databases (CNKI, Wanfang, PubMed, Web of Science, Cochrane, EMBASE, EBSCO series) from their inception to June 30, 2025. A total of 13 studies were included, comprising 2,737 AGA patients and 17,382 controls. Study quality was assessed using the Agency for Healthcare Research and Quality (AHRQ) tool for cross-sectional studies and Newcastle-Ottawa Scale (NOS) for case-control studies. Effect sizes were pooled using a random-effects model, supplemented by sensitivity analysis and publication bias assessment to ensure the robustness of the results. RESULTS: Compared to non-AGA controls, AGA patients demonstrated significantly higher levels of generalized anxiety symptoms (pooled SMD = -0.50, 95% CI [-0.99, 0.00], p = 0.05), social anxiety symptoms (pooled SMD = -0.50, 95% CI [-0.84,-0.16], p = 0.004), depression symptoms (pooled SMD = -0.38, 95% CI [-0.65,-0.12], p = 0.004), and perceived stress (pooled SMD = -1.09, 95% CI [-1.43,-0.74], p < 0.001). However, no significant difference was observed in general distress (pooled SMD = -0.01, 95% CI [-0.39,0.37], p = 0.97). Qualitatively, AGA patients also exhibited reduced self-esteem, life satisfaction, and emotional intelligence dimensions, along with greater body image dissatisfaction, somatization, interpersonal sensitivity, and psychoticism. CONCLUSION: AGA patients experience increased levels of symptoms of anxiety, symptoms of depression, stress, body image dissatisfaction, somatization, interpersonal sensitivity, and psychoticism, as well as decreased self-esteem, life satisfaction, emotional intelligence, self-actualization, problem-solving ability, optimism, and happiness. In the future, clinical treatment should focus on patient psychological well-being through assessments and timely interventions, and further research should be conducted to provide precise clinical guidance. SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD420250655604].