Metabolic dysfunction-associated steatotic liver disease is associated with androgenetic alopecia in adults with stronger effects in women and unhealthy lifestyles.

Androgenetic alopecia (AGA), the most prevalent hair loss type, significantly affects life quality. While androgen excess has been linked to metabolic dysfunction-associated steatotic liver disease (MASLD), their direct association remains underexplored. The cross-sectional investigation enrolled 7,993 adults (35-70 years old) from the FACS cohort (49.1% male, mean age 48.6 ± 9.63). Participants with extreme caloric intake, AGA-relevant comorbidities such as anemia, thyroid disorders, cancer, and pregnancy, or confounding conditions were excluded. MASLD was defined using the Fatty Liver Index (FLI) and adult cardiometabolic criteria. Multivariate logistic regression assessed the connection between MASLD and AGA, adjusting for key literature-based confounders. AGA was present in 6,004 participants. MASLD was linked to 31% elevated odds of AGA (OR = 1.31;95%CI:1.13-1.52;p < 0.001), with a stronger effect in females (OR = 1.62;95%CI:1.30-2.03;p < 0.001). Elevated risk was also observed among those with high carbohydrate intake (OR = 1.45), low physical activity (OR = 1.48), and no lipid-lowering therapy (OR = 1.30). No significant association was found in individuals with healthier lifestyle profiles. The MASLD-AGA relationship remained independent of calorie, lipid, protein, and fiber intake, insulin resistance, and inflammatory status. MASLD is significantly associated with AGA, particularly in women and individuals with specific lifestyle patterns. These findings highlight the importance of metabolic evaluation in AGA patients.