Finasteride 5 Mgr vs 1 Mgr in Androgenic Alopecia. !
Finasteride 5 Mgr vs 1 Mgr en Alopecia Androgénica. !
EDITORIAL ENGLISH
===================
Hello friends of the DERMAGIC network, again with you with a hot topic: FINASTERIDE 5 VS FINASTERIDE 1 IN ANDROGENIC ALOPECIA. The first job I found on this drug dates back to 1.993 and others 1.994 where FINASTERIDE was spoken of as a promising drug in some PATHOLOGIES such as acne, hirsutism, prostate cancer and bening prostatic hyperplasia (BHP).
===================
Hello friends of the DERMAGIC network, again with you with a hot topic: FINASTERIDE 5 VS FINASTERIDE 1 IN ANDROGENIC ALOPECIA. The first job I found on this drug dates back to 1.993 and others 1.994 where FINASTERIDE was spoken of as a promising drug in some PATHOLOGIES such as acne, hirsutism, prostate cancer and bening prostatic hyperplasia (BHP).
It was later discovered that FINASTERIDE was and is useful in ANDROGENIC
ALOPECIA But by that date there was only the presentation of 5 MGRS, and
many people started using it 2 TIMES per week, or dividing the original
pill in 4 PARTS, to take 1/4 of pill daily. For this reason the laboratory
bring to the market the presentation of 1 MGR for its exclusive use in The
ANGROGENIC ALOPECIA.
There are studies where patients were given FINASTERIDE 5 MGRS DAY FOR 2
YEARS WITHOUT COLLATERAL EFFECTS, BUT EVEN, in the first report of 1.993
it was shown that daily doses of 80 MGRS / day of FINASTERIDE for 3 months
did not produce EFFECTS SECONDARY, but in later studies it was verified
that at doses of 1 mgrs FINASTERIDE, as Every drug has its adverse effects
mainly ERECTILE DYSFUNCTION, changes in mood, decrease in semen volume and
in some cases gynecomastia, and adenomas.
Among cases of female alopecia, finasteride was significantly more
concurrent with fetal damage and uterine disorder. In addition, analysis
of the drug-gene network indicated that finasteride could profoundly alter
the pathways related to sex hormone signaling and oocyte maturation.
Since it was known in the scientific world THAT FINASTERIDE produced Hair
growth, the FINASTERIDE 5 mgrs began to be used as before mentioned
Because FINATERIDE 1 MGR had not been released. The dose: 10 MGRS WEEKLY
in 2 doses, Tuesday and Thursday with GOOD RESULT.
Once FINASTERIDE 1 MGR was on the market, the laboratory began an
CAMPAIGN saying that the dose had to be A 1 MGR day for 7 days a week,
which would be 7 MGR in total, versus 10 MGR In the 2 weekly shots of
FINASTERIDE 5 MGRS.
The TRUTH is that FINASTERIDE 5 MGRS 2 TIMES WEEKLY is as good or equal
to FINASTERIDE 1 MGR DAILY, and The cost is much smaller, more secure,
less risk. A box of 30 tabs lasts 15 Weeks, (3 months and 3 weeks).
Perhaps one of the advantages that can be attributed to this scheme is
that Your body "rests" on the drug because you only take it twice a week
in relation to FINASTERIDE 1 MGR daily of which your body does not rest,
always has the medicine "inside".
I went on the scientific side and used the product FINASTERIDE 5 MGRS in
patients with androgenic alopecia with the aforementioned scheme 5 MGR 2
times Weekly and at the 4th month observe remarkable improvement of
patients, see the photos of the Attach.
But undoubtedly it is you who will decide which therapy suits you based
on adverse effects FINASTERIDE 1 MGRS or FINASTERIDE 5 MGRS,
SERENOA REPENS
or DUTASTERIDE, drug that will be reason of a future Review as I said earlier.
Recently POSTFINASTERIDE SYNDROME (PFS) is a term coined to characterize
a constellation of reported undesirable side effects after stopping
finasteride treatment. Symptoms included decreased libido, erectile
dysfunction, sexual anhedonia, decreased sperm count, gynecomastia, skin
changes, cognitive impairment, fatigue, anxiety, depression, and suicidal
ideation.
To conclude, FINASTERIDE has been used lately in the treatment of
SUPPURATIVE HYDRADENITIS (HS) in both men and women with good results. It
is also proposed to use as a hormonal agent in the treatment of
acne.
In these 50 references you will know FINASTERIDE, its uses and some of
its adverse effects.
Greetings to all.
Dr, José Lapenta.
EDITORIAL ESPAÑOL
===================
Hola amigos de la red DERMAGIC, de nuevo con ustedes con un tema bien
caliente: FINASTERIDE 5 VS FINASTERIDE 1 EN ALOPECIA ANDROGENICA. El
primer trabajo que encontre sobre esta droga data del año 1.993 y otros
mas de 1.994 donde se hablaba del FINASTERIDE COMO UNA DROGA promisoria
en algunas PATOLOGIAS COMO acne, hirsutismo, cancer de prostata e
hiperplasia prostatica benigna (BHP).
Posteriormente se descubrio que el FINASTERIDE era y es util en la
ALOPECIA ANDROGENCIA
pero para esa fecha solo existia la presentacion de 5 MGRS, y mucha gente la comenzo a usar 2 VECES por semana, o picaba la pastilla original en 4 PARTES, para tomar 1/ 4 de pastilla diaria. Esto motivo al laboratior a sacar al mercado la presentacion de 1 mgr para su uso exclusivo en
la ALOPECIA ANGROGENICA.
pero para esa fecha solo existia la presentacion de 5 MGRS, y mucha gente la comenzo a usar 2 VECES por semana, o picaba la pastilla original en 4 PARTES, para tomar 1/ 4 de pastilla diaria. Esto motivo al laboratior a sacar al mercado la presentacion de 1 mgr para su uso exclusivo en
la ALOPECIA ANGROGENICA.
EXISTEN estudios donde a pacientes se les dio FINASTERIDE 5 MGRS DIA POR
2 AÑOS SIN EFECTOS COLATERALES, MAS AUN,, en el primer reporte de 1.993 se
DEMOSTRO que dosis diarias de 80 MGRS /dia de finasteride por 3 meses NO
OCASIONABAN EFECTOS SECUNDARIOS, pero en estudios posteriores se comprobo
que a dosis de 1 mgrs el FINASTERIDE, como todo medicamento tiene sus
efectos secuandarios principalmente LA DISFUNCION ERECTIL, cambios en el
humor, disminucion del volumen del semen y en algunos casos ginecomastia,
y adenomas.
Entre los casos de alopecia femenina, EL FINASTERIDE fue
significativamente más concurrente con el daño al feto y el trastorno del
útero. Además, el análisis de la red de fármacos-genes indicó que el
finasteride podría alterar profundamente las vías relacionadas con la
señalización de las hormonas sexuales y la maduración de los
ovocitos.
Desde que se conocio en el mundo cientifico QUE EL FINASTERIDE producia
crecimiento del cabello, comenzo a usarse el FINASTERIDE 5 mgrs como antes
les mencione porque el FINATERIDE 1 MGR no habia salido al mercado. La
dosis: 10 MGRS SEMANALES en 2 dosis, martes y jueves con BUEN
RESULTADO.
Una vez salido al mercado el FINASTERIDE 1 MGR, el laboratorio comenzo
una CAMPAÑA diciendo que la dosis tenia que ser un 1 MGR dia por 7 dias a
la semana, que serian 7 MGR en total, versus los 10 MGR en las 2 tomas
semanales del FINASTERIDE 5 MGRS.
La VERDAD es que FINASTERIDE 5 MGRS 2 VECES SEMANAL es tan bueno o igual
al FINASTERIDE 1 MGR DIARIO, y el costo es muchisimo menor, mas seguro,
menos riesgos. Una caja de 30 tab dura 15 semanas, (3 meses y 3 semanas).
Quiza una de las ventajas que puede atribuirsele a este esquema es que tu
organismo ¨descansa¨ de la droga pues solo la tomas 2 veces semanal en
relacion al FINASTERIDE 1 MGR diario del cual tu organismo no descansa,
siempre tiene la medicina ¨adentro¨.
Yo me fui por el lado cientifico y utilize el producto FINASTERIDE 5 MGRS
en pacientes con alopecia androgenica con el esquema antes dicho 5 MGR 2
veces semanal y al 4to mes observe mejoria notable de los pacientes, vean
las fotos del attach.
Pero indudablemente usted es quien decidira cual terapia le conviene en
base a efectos secuandarios
FINASTERIDE 1 MGRS o FINASTERIDE 5 MGRS, SERENOA REPENS o DUTASTERIDE, droga que sera obeto de una futura revision como dije anteriormente.
FINASTERIDE 1 MGRS o FINASTERIDE 5 MGRS, SERENOA REPENS o DUTASTERIDE, droga que sera obeto de una futura revision como dije anteriormente.
Recientemente se ha acuñado el termino POST FINSTERIDE SINDROME para un
conjunto de sintomas que se presentan luego de descontinuae el medicamento.
Los síntomas incluyeron disminución de la libido, disfunción eréctil,
perdida del disfrute o deseo por la relacion sexual, disminución del
recuento de espermatozoides, ginecomastia, cambios en la piel, deterioro
cognitivo, fatiga, ansiedad, depresión e ideación suicida.
Para finalizar el FINASTERIDE a sido utilizado ultimamente en el
tratamiento de la HIDRADENITIS SUPURATIVA tanto en hombres como mujeres con
buen resultado. Tambien se propone su uso como agente hormonal en el
tratamiento del acne.
En estas 50 referencias conoceras el FINASTERIDE , sus usos y algunos
de sus efectos adversos.
Saludos a todos !
Dr. Jose Lapenta..
========================================================================
==================================================================
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
==================================================================
1.) Five-year follow-up of patients with benign prostatic hyperplasia treated with
finasteride.
2.) Therapeutic effects of finasteride in benign prostatic hyperplasia: a randomized
double-blind controlled trial.
3.) The effect of finasteride on prostate volume, urinary flow rate and symptom score in
men with benign prostatic hyperplasia.
4.) [5-alpha-reductase inhibitors].
5.) Benign prostatic hyperplasia.
6.) The potential for hormonal prevention trials.
7.) 5 alpha-reductase inhibition by finasteride (Proscar) in epithelium and stroma of human
benign prostatic hyperplasia.
8.) Pharmacological treatment of benign prostatic hyperplasia with finasteride: a clinical
review.
9.) Medical therapy for benign prostatic hyperplasia: A review of the literature.
10.) Pretreatment with finasteride decreases perioperative bleeding associated with
transurethral resection of the prostate.
11.) Urinary retention in patients with BPH treated with finasteride or placebo over 4
years. Characterization of patients and ultimate outcomes.The PLESS Study Group.
12.) Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign
prostatic hyperplasia.
13.) Chronic treatment with finasteride daily does not affect spermatogenesis or semen
production in young men.
14.) Management of androgenetic alopecia.
15.) Finasteride in the treatment of men with frontal male pattern hair loss.
16.) Androgenetic alopecia in men: the scale of the problem and prospects for treatment.
17.) [Androgenetic alopecia, hirsutism and hypertrichosis].
18.) Medical treatments for balding in men.
19.) Understanding and managing common baldness.
20.) Finasteride: a review of its use in male pattern hair loss.
21.) Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male
Pattern Hair Loss Study Group.
22.) Genetic analysis of male pattern baldness and the 5alpha-reductase genes.
23.) Effect of finasteride on human testicular steroidogenesis.
24.) [Finasteride: a new drug for the treatment of male hirsutism and androgenetic
alopecia]?
25.) The 5 alpha-reductase system and its inhibitors. Recent development and its
perspective in treating androgen-dependent skin disorders.
26.) Finasteride: a clinical review.
27.) The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and
dihydrotestosterone concentrations in patients with male pattern baldness.
28.) Finasteride: the first 5 alpha-reductase inhibitor.
29.) Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia.
30.) Reversible painful gynaecomastia induced by low dose finasteride (1 mg/day).
31.) Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts
in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men
and postmenopausal women.
32.) Improvement in androgenetic alopecia in 53-76-year-old men using oral finasteride.
33.) New topical antiandrogenic formulations can stimulate hair growth in human bald
scalp grafted onto mice.
34.) Current management of androgenetic alopecia in men.
35.) Immunohistochemical localization of types 1 and 2 5alpha-reductase in human scalp.
36.) The psychosocial consequences of androgenetic alopecia: a review of the research
literature.
37.) Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in
men with male pattern hair loss.
38.) The effects of finasteride on scalp skin and serum androgen levels in men with
androgenetic alopecia.
39.) Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review.
40.) Interventions for Female Pattern Hair Loss.
41.) Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases.
42.) Finasteride in Hidradenitis Suppurativa: A "Male" Therapy for a Predominantly "Female" Disease.
43.) Hidradenitis suppurativa treated with finasteride.
44.) The use of hormonal agents in the treatment of acne.
45.) Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia.
46.) Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome.
47.) Post-Finasteride Adverse Effects in Male Androgenic Alopecia: A Case Report of Vitiligo.
48.) Side Effects Related to 5 α-Reductase Inhibitor Treatment of Hair Loss in Women: A Review.
49.) 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss.
50.) Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know?
=============================================================
=============================================================
1.) Five-year follow-up of patients with benign prostatic hyperplasia treated with
finasteride.
=============================================================
Eur Urol 1995;27(4):267-73
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
==================================================================
1.) Five-year follow-up of patients with benign prostatic hyperplasia treated with
finasteride.
2.) Therapeutic effects of finasteride in benign prostatic hyperplasia: a randomized
double-blind controlled trial.
3.) The effect of finasteride on prostate volume, urinary flow rate and symptom score in
men with benign prostatic hyperplasia.
4.) [5-alpha-reductase inhibitors].
5.) Benign prostatic hyperplasia.
6.) The potential for hormonal prevention trials.
7.) 5 alpha-reductase inhibition by finasteride (Proscar) in epithelium and stroma of human
benign prostatic hyperplasia.
8.) Pharmacological treatment of benign prostatic hyperplasia with finasteride: a clinical
review.
9.) Medical therapy for benign prostatic hyperplasia: A review of the literature.
10.) Pretreatment with finasteride decreases perioperative bleeding associated with
transurethral resection of the prostate.
11.) Urinary retention in patients with BPH treated with finasteride or placebo over 4
years. Characterization of patients and ultimate outcomes.The PLESS Study Group.
12.) Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign
prostatic hyperplasia.
13.) Chronic treatment with finasteride daily does not affect spermatogenesis or semen
production in young men.
14.) Management of androgenetic alopecia.
15.) Finasteride in the treatment of men with frontal male pattern hair loss.
16.) Androgenetic alopecia in men: the scale of the problem and prospects for treatment.
17.) [Androgenetic alopecia, hirsutism and hypertrichosis].
18.) Medical treatments for balding in men.
19.) Understanding and managing common baldness.
20.) Finasteride: a review of its use in male pattern hair loss.
21.) Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male
Pattern Hair Loss Study Group.
22.) Genetic analysis of male pattern baldness and the 5alpha-reductase genes.
23.) Effect of finasteride on human testicular steroidogenesis.
24.) [Finasteride: a new drug for the treatment of male hirsutism and androgenetic
alopecia]?
25.) The 5 alpha-reductase system and its inhibitors. Recent development and its
perspective in treating androgen-dependent skin disorders.
26.) Finasteride: a clinical review.
27.) The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and
dihydrotestosterone concentrations in patients with male pattern baldness.
28.) Finasteride: the first 5 alpha-reductase inhibitor.
29.) Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia.
30.) Reversible painful gynaecomastia induced by low dose finasteride (1 mg/day).
31.) Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts
in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men
and postmenopausal women.
32.) Improvement in androgenetic alopecia in 53-76-year-old men using oral finasteride.
33.) New topical antiandrogenic formulations can stimulate hair growth in human bald
scalp grafted onto mice.
34.) Current management of androgenetic alopecia in men.
35.) Immunohistochemical localization of types 1 and 2 5alpha-reductase in human scalp.
36.) The psychosocial consequences of androgenetic alopecia: a review of the research
literature.
37.) Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in
men with male pattern hair loss.
38.) The effects of finasteride on scalp skin and serum androgen levels in men with
androgenetic alopecia.
39.) Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review.
40.) Interventions for Female Pattern Hair Loss.
41.) Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases.
42.) Finasteride in Hidradenitis Suppurativa: A "Male" Therapy for a Predominantly "Female" Disease.
43.) Hidradenitis suppurativa treated with finasteride.
44.) The use of hormonal agents in the treatment of acne.
45.) Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia.
46.) Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome.
47.) Post-Finasteride Adverse Effects in Male Androgenic Alopecia: A Case Report of Vitiligo.
48.) Side Effects Related to 5 α-Reductase Inhibitor Treatment of Hair Loss in Women: A Review.
49.) 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss.
50.) Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know?
=============================================================
=============================================================
1.) Five-year follow-up of patients with benign prostatic hyperplasia treated with
finasteride.
=============================================================
Eur Urol 1995;27(4):267-73
Geller J
Mercy Hospital and Medical Center, San Diego, CA 92103-2180,
USA.
In 18 of 55 original patients who completed 5 years of treatment with
finasteride,
significant reductions in prostate size were noted at 1 year and sustained thereafter.
Symptom scores in these same patients were significantly improved or stable over the 5
years while maximal urinary flow rates were unchanged. Data from 15 of 18 other
patients who dropped out of the study before 5 years showed changes in prostate size,
symptom score and flow rates that were similar to those noted in patients treated for 5
years. No side effects were noted in this study except for sexual dysfunction, which
occurred in less than 5% of the patients. With few exceptions, finasteride appears to
arrest the process of BPH over a 5 year period as indicated by sustained reductions in
prostate size accompanied by either symptomatic improvement or stability in all other
patients.
significant reductions in prostate size were noted at 1 year and sustained thereafter.
Symptom scores in these same patients were significantly improved or stable over the 5
years while maximal urinary flow rates were unchanged. Data from 15 of 18 other
patients who dropped out of the study before 5 years showed changes in prostate size,
symptom score and flow rates that were similar to those noted in patients treated for 5
years. No side effects were noted in this study except for sexual dysfunction, which
occurred in less than 5% of the patients. With few exceptions, finasteride appears to
arrest the process of BPH over a 5 year period as indicated by sustained reductions in
prostate size accompanied by either symptomatic improvement or stability in all other
patients.
=============================================================
2.) Therapeutic effects of finasteride in benign prostatic hyperplasia: a randomized
double-blind controlled trial.
=============================================================
J Formos Med Assoc 1995 Jan-Feb;94(1-2):37-41
2.) Therapeutic effects of finasteride in benign prostatic hyperplasia: a randomized
double-blind controlled trial.
=============================================================
J Formos Med Assoc 1995 Jan-Feb;94(1-2):37-41
Yu HJ, Chiu TY, Lai MK
Department of Urology, National Taiwan University Hospital, Taipei,
R.O.C.
The clinical effects of finasteride, a 5 alpha-reductase inhibitor, in
patients with benign
prostatic hyperplasia (BPH) were evaluated in a double-blind, placebo-controlled study.
Forty-six patients with symptomatic BPH were randomly assigned to 2 groups, the
finasteride group and the placebo group. The finasteride group received 5 mg of
finasteride daily for 6 months. Prostate volume, urinary flow, urinary symptoms, serum
prostate-specific antigen (PSA) and adverse events were determined before and after
treatment. After 6 months of treatment the patients treated with 5 mg of finasteride per
day had a 30% decrease in their total urinary symptom score, a 14% decrease in prostate
volume and a 0.9 ng/dL decrease of PSA. Their maximal urinary flow rate increased by
1.42 mL per second and the mean urinary flow rate increased by 0.64 mL per second.
The patients given placebo showed no significant changes in their prostate volume, serum
PSA and maximal and mean urinary flow rate. However, the symptom scores in the
placebo group also decreased significantly. When compared with the placebo group,
those in the finasteride group had significantly lower prostate volume, serum PSA,
maximal urinary flow rate and urinary symptoms, but not mean urinary flow rate. The
frequency of adverse events was low in both the finasteride and placebo groups. These
results show that finasteride may be an effective and safe alternative for the treatment of
patients with BPH.
prostatic hyperplasia (BPH) were evaluated in a double-blind, placebo-controlled study.
Forty-six patients with symptomatic BPH were randomly assigned to 2 groups, the
finasteride group and the placebo group. The finasteride group received 5 mg of
finasteride daily for 6 months. Prostate volume, urinary flow, urinary symptoms, serum
prostate-specific antigen (PSA) and adverse events were determined before and after
treatment. After 6 months of treatment the patients treated with 5 mg of finasteride per
day had a 30% decrease in their total urinary symptom score, a 14% decrease in prostate
volume and a 0.9 ng/dL decrease of PSA. Their maximal urinary flow rate increased by
1.42 mL per second and the mean urinary flow rate increased by 0.64 mL per second.
The patients given placebo showed no significant changes in their prostate volume, serum
PSA and maximal and mean urinary flow rate. However, the symptom scores in the
placebo group also decreased significantly. When compared with the placebo group,
those in the finasteride group had significantly lower prostate volume, serum PSA,
maximal urinary flow rate and urinary symptoms, but not mean urinary flow rate. The
frequency of adverse events was low in both the finasteride and placebo groups. These
results show that finasteride may be an effective and safe alternative for the treatment of
patients with BPH.
=============================================================
3.) The effect of finasteride on prostate volume, urinary flow rate and symptom score in
men with benign prostatic hyperplasia.
=============================================================
Aust N Z J Surg 1995 Jan;65(1):35-9
3.) The effect of finasteride on prostate volume, urinary flow rate and symptom score in
men with benign prostatic hyperplasia.
=============================================================
Aust N Z J Surg 1995 Jan;65(1):35-9
Nacey JN, Meffan PJ, Delahunt B
Department of Surgery, Wellington School of Medicine, New
Zealand.
This study was designed to determine the efficacy of the 5
alpha-reductase inhibitor
finasteride (Proscar, MK-906) in men with reduced urinary flow rates and symptoms of
urinary outflow obstruction secondary to benign prostatic hyperplasia. Forty-five men
were randomized to one of three groups receiving either placebo, 1 mg/day or 5 mg/day
finasteride for the first 12 months of the study period. At the end of this period all men
received 5 mg/day finasteride for a further 2 years. Efficacy was determined by
measurement of prostate volume, maximum urinary flow rate, and symptom score using a
modified Boyarsky assessment. Prostate volume reduced by 20 and 27%, respectively,
for those on 1 and 5 mg after the first year. At 3 years the volume had reduced by 43%.
This reduction in prostate volume was associated with an improvement in maximum
urinary flow rate by 50% (1 mg), and 35% (5 mg) at 1 year, and 36% at 3 years. The
total, obstructive and non-obstructive symptom scores decreased (improved) for patients
on 1 and 5 mg finasteride, with the total score reducing by 33% from baseline at year 3.
The results demonstrate that finasteride causes a modest but significant clinical
improvement in men with urinary outflow obstruction secondary to benign prostatic
hyperplasia.
finasteride (Proscar, MK-906) in men with reduced urinary flow rates and symptoms of
urinary outflow obstruction secondary to benign prostatic hyperplasia. Forty-five men
were randomized to one of three groups receiving either placebo, 1 mg/day or 5 mg/day
finasteride for the first 12 months of the study period. At the end of this period all men
received 5 mg/day finasteride for a further 2 years. Efficacy was determined by
measurement of prostate volume, maximum urinary flow rate, and symptom score using a
modified Boyarsky assessment. Prostate volume reduced by 20 and 27%, respectively,
for those on 1 and 5 mg after the first year. At 3 years the volume had reduced by 43%.
This reduction in prostate volume was associated with an improvement in maximum
urinary flow rate by 50% (1 mg), and 35% (5 mg) at 1 year, and 36% at 3 years. The
total, obstructive and non-obstructive symptom scores decreased (improved) for patients
on 1 and 5 mg finasteride, with the total score reducing by 33% from baseline at year 3.
The results demonstrate that finasteride causes a modest but significant clinical
improvement in men with urinary outflow obstruction secondary to benign prostatic
hyperplasia.
=============================================================
4.) [5-alpha-reductase inhibitors].
=============================================================
Acta Urol Belg 1994 Dec;62(4):23-31
4.) [5-alpha-reductase inhibitors].
=============================================================
Acta Urol Belg 1994 Dec;62(4):23-31
De Jaegher K, Kozyreff P, Claes H
A reflection is made, on the one hand, on the lack of correlation between
the intensity of
micturition problems and the volume of the prostate and, on the other hand, on the
different therapeutic approaches of irritative or obstructive voiding problems, and finally
on the insufficiently convincing activity of Finasteride.
micturition problems and the volume of the prostate and, on the other hand, on the
different therapeutic approaches of irritative or obstructive voiding problems, and finally
on the insufficiently convincing activity of Finasteride.
=============================================================
5.) Benign prostatic hyperplasia.
=============================================================
Endocrinol Metab Clin North Am 1994 Dec;23(4):795-807
Jonler M, Riehmann M, Brinkmann R, Bruskewitz RC
5.) Benign prostatic hyperplasia.
=============================================================
Endocrinol Metab Clin North Am 1994 Dec;23(4):795-807
Jonler M, Riehmann M, Brinkmann R, Bruskewitz RC
Division of Urology, University of Wisconsin, Madison.
Benign prostatic hyperplasia (BPH) is the most common cause of bladder
outlet
obstruction and voiding symptoms in elderly men. The pathogenesis is not fully determined
but a combination of androgens and age are needed for development of BPH. Symptoms
of BPH are divided into obstructive and irritative symptoms but large interpersonal
variability is found and no specific BPH symptom exists. Treatment modalities include
surgery (TURP, TUIP, open prostatectomy, laser ablation, balloon dilatation,
hyperthermia and thermotherapy, and urethral stents) and medical therapy. TURP is the
gold standard treatment and TUIP is a safe and effective alternative to TURP in patients
with smaller prostates. Laser ablation, hyperthermia and thermotherapy, and urethral
stents are at the present time under investigation. Balloon dilatation is FDA-approved but
not often used because of low efficacy and poor long-term results. Medical treatment
includes alpha-blocker or finasteride treatment and is indicated in patients with moderate
to severe symptoms of BPH without a strong indication for surgery.
obstruction and voiding symptoms in elderly men. The pathogenesis is not fully determined
but a combination of androgens and age are needed for development of BPH. Symptoms
of BPH are divided into obstructive and irritative symptoms but large interpersonal
variability is found and no specific BPH symptom exists. Treatment modalities include
surgery (TURP, TUIP, open prostatectomy, laser ablation, balloon dilatation,
hyperthermia and thermotherapy, and urethral stents) and medical therapy. TURP is the
gold standard treatment and TUIP is a safe and effective alternative to TURP in patients
with smaller prostates. Laser ablation, hyperthermia and thermotherapy, and urethral
stents are at the present time under investigation. Balloon dilatation is FDA-approved but
not often used because of low efficacy and poor long-term results. Medical treatment
includes alpha-blocker or finasteride treatment and is indicated in patients with moderate
to severe symptoms of BPH without a strong indication for surgery.
=============================================================
6.) The potential for hormonal prevention trials.
=============================================================
Cancer 1994 Nov 1;74(9 Suppl):2726-33
6.) The potential for hormonal prevention trials.
=============================================================
Cancer 1994 Nov 1;74(9 Suppl):2726-33
Ford LG, Brawley OW, Perlman JA, Nayfield SG, Johnson KA, Kramer
BS
Detection and Community Oncology Program, National Cancer Institute,
Bethesda,
Maryland 20892.
Maryland 20892.
Breast and prostate cancer are significant causes of morbidity and
mortality and are very
similar in etiology, epidemiology, and modalities of treatment. Investigational strategies in
the prevention of these malignancies also have strong parallels. The National Cancer
Institute is sponsoring several large scale clinical trials involving hormonal manipulation and
cancer prevention. In the Breast Cancer Prevention Trial, 16,000 women at high risk for
breast cancer are being randomized to receive the antiestrogen agent tamoxifen or
placebo for 5 years in an effort to determine if breast cancer development can be
inhibited. In a similar trial, the Prostate Cancer Prevention Trial, 18,000 men older than
55 years of age will be randomized to receive finasteride, a 5-alpha-reductase inhibitor,
or placebo to determine if inhibition of dihydrotestosterone synthesis in the prostate over a
prolonged period will lead to a decreased incidence of prostate cancer. Both clinical trials
offer the possibility of demonstrating that a hormonal intervention can decrease an
individual's risk of developing breast or prostate cancer. They also have the potential of
providing critical information about cancer risk, etiology, screening, and genetics, as well
as quantifying the risks and benefits of specific preventive interventions.
similar in etiology, epidemiology, and modalities of treatment. Investigational strategies in
the prevention of these malignancies also have strong parallels. The National Cancer
Institute is sponsoring several large scale clinical trials involving hormonal manipulation and
cancer prevention. In the Breast Cancer Prevention Trial, 16,000 women at high risk for
breast cancer are being randomized to receive the antiestrogen agent tamoxifen or
placebo for 5 years in an effort to determine if breast cancer development can be
inhibited. In a similar trial, the Prostate Cancer Prevention Trial, 18,000 men older than
55 years of age will be randomized to receive finasteride, a 5-alpha-reductase inhibitor,
or placebo to determine if inhibition of dihydrotestosterone synthesis in the prostate over a
prolonged period will lead to a decreased incidence of prostate cancer. Both clinical trials
offer the possibility of demonstrating that a hormonal intervention can decrease an
individual's risk of developing breast or prostate cancer. They also have the potential of
providing critical information about cancer risk, etiology, screening, and genetics, as well
as quantifying the risks and benefits of specific preventive interventions.
=============================================================
7.) 5 alpha-reductase inhibition by finasteride (Proscar) in epithelium and stroma of human
benign prostatic hyperplasia.
=============================================================
Steroids 1994 Nov;59(11):616-20
7.) 5 alpha-reductase inhibition by finasteride (Proscar) in epithelium and stroma of human
benign prostatic hyperplasia.
=============================================================
Steroids 1994 Nov;59(11):616-20
Weisser H, Tunn S, Debus M, Krieg M
Institute of Clinical Chemistry and Laboratory Medicine, University
Clinic Bergmannsheil,
Bochum, Germany.
Bochum, Germany.
Finasteride is a specific 5 alpha-reductase inhibitor that has been shown
to reduce the size
of human benign prostatic hyperplasia (BPH) by inhibiting the intraprostatic conversion of
testosterone to 5 alpha-dihydrotestosterone. The aim of the present in vitro study was to
describe in more detail the inhibitory effect of finasteride on 5 alpha-reductase in
epithelium and stroma of human BPH. 5 alpha-Reductase activity in epithelium and
stroma was inhibited dose-dependently by finasteride. The mean IC50 (50% inhibitory
concentration) values, determined in the presence of various testosterone concentrations,
were generally 2- to 4-fold lower in epithelium than in stroma. With finasteride
concentrations greater than 5 nM, competitive inhibition of 5 alpha-reductase occurred
both in epithelium and stroma. The mean inhibition constant Ki[nM +/- SEM] was 7 +/- 3
and 31 +/- 3 in epithelium and stroma, respectively. In the presence of finasteride
concentrations < or = 5 nM, the epithelial 5 alpha-reductase seems to be inhibited in an
uncompetitive manner, whereas such low finasteride concentrations cause either no
inhibition (1-2 nM) or competitive inhibition (5 nM) in stroma. Our present study provides
evidence that the inhibitory effect of finasteride on 5 alpha-reductase is much stronger in
epithelium than in stroma. Therefore, it is conceivable that the global size-reduction of
BPH under finasteride treatment is primarily due to the regression of BPH epithelium.
of human benign prostatic hyperplasia (BPH) by inhibiting the intraprostatic conversion of
testosterone to 5 alpha-dihydrotestosterone. The aim of the present in vitro study was to
describe in more detail the inhibitory effect of finasteride on 5 alpha-reductase in
epithelium and stroma of human BPH. 5 alpha-Reductase activity in epithelium and
stroma was inhibited dose-dependently by finasteride. The mean IC50 (50% inhibitory
concentration) values, determined in the presence of various testosterone concentrations,
were generally 2- to 4-fold lower in epithelium than in stroma. With finasteride
concentrations greater than 5 nM, competitive inhibition of 5 alpha-reductase occurred
both in epithelium and stroma. The mean inhibition constant Ki[nM +/- SEM] was 7 +/- 3
and 31 +/- 3 in epithelium and stroma, respectively. In the presence of finasteride
concentrations < or = 5 nM, the epithelial 5 alpha-reductase seems to be inhibited in an
uncompetitive manner, whereas such low finasteride concentrations cause either no
inhibition (1-2 nM) or competitive inhibition (5 nM) in stroma. Our present study provides
evidence that the inhibitory effect of finasteride on 5 alpha-reductase is much stronger in
epithelium than in stroma. Therefore, it is conceivable that the global size-reduction of
BPH under finasteride treatment is primarily due to the regression of BPH epithelium.
=============================================================
8.) Pharmacological treatment of benign prostatic hyperplasia with finasteride: a clinical
review.
=============================================================
Arch Esp Urol 1994 Nov;47(9):883-7; discussion 887-8
Ekman P
8.) Pharmacological treatment of benign prostatic hyperplasia with finasteride: a clinical
review.
=============================================================
Arch Esp Urol 1994 Nov;47(9):883-7; discussion 887-8
Ekman P
Department of Urology, Karolinska Hospital, Stockholm,
Sweden.
Finasteride acts by blocking the conversion of testosterone to 5
alpha-dihydrotestosterone, the active androgen metabolite in the human prostate. In large,
double-blind, placebo-controlled phase III studies recruiting over 1600 patients, it was
shown that the administration of Finasteride, either 5 or 1 mg a day, reduced the size of
the prostate by a mean of 22%, following 6 months of therapy. Despite this reduction in
prostate size, urinary flow rate only improved by a mean of 1.7 ml per second and
symptom score improved only marginally, but statistically significantly different from
placebo. Long-term results in small series of patients have indicated a further
improvement beyond 1 year. After 3 years flow was improved by 60%. The future role
for Finasteride therapy is emerging, but it appears as if patients with mild to moderate
symptoms would be a group who could benefit the most. Whether or not Finasteride can
stop the long-term natural course of benign prostatic hyperplasia has still to be
demonstrated.
alpha-dihydrotestosterone, the active androgen metabolite in the human prostate. In large,
double-blind, placebo-controlled phase III studies recruiting over 1600 patients, it was
shown that the administration of Finasteride, either 5 or 1 mg a day, reduced the size of
the prostate by a mean of 22%, following 6 months of therapy. Despite this reduction in
prostate size, urinary flow rate only improved by a mean of 1.7 ml per second and
symptom score improved only marginally, but statistically significantly different from
placebo. Long-term results in small series of patients have indicated a further
improvement beyond 1 year. After 3 years flow was improved by 60%. The future role
for Finasteride therapy is emerging, but it appears as if patients with mild to moderate
symptoms would be a group who could benefit the most. Whether or not Finasteride can
stop the long-term natural course of benign prostatic hyperplasia has still to be
demonstrated.
=============================================================
9.) Medical therapy for benign prostatic hyperplasia: A review of the literature.
=============================================================
Eur Urol 2000 Jul;38(1):2-19
9.) Medical therapy for benign prostatic hyperplasia: A review of the literature.
=============================================================
Eur Urol 2000 Jul;38(1):2-19
Clifford GM, Farmer RD
Public Health and Primary Care Research Unit, European Institute of
Health and Medical
Sciences, University of Surrey, Surrey Research Park, UK.
Sciences, University of Surrey, Surrey Research Park, UK.
[Medline record in process]
OBJECTIVE: To review the existing evidence regarding the efficacy and
safety of
medical therapy for lower urinary tract symptoms (LUTS) indicative of benign prostatic
hyperplasia (BPH). To assess randomised controlled trials investigating the six
alpha-adrenergic receptor antagonists (alpha-blockers), prazosin, alfuzosin, indoramin,
terazosin, doxazosin, and tamsulosin, that benefit patients by relaxing prostatic smooth
muscle, and the anti-androgen, finasteride, that mediates its more long-term benefits by
reducing prostate size. RESULTS: This review suggests that both classes of drug offer
significant improvement in criteria used to evaluate symptomatic BPH and can be effective
whilst being acceptably safe. Furthermore, the therapeutic efficacy of all contemporary
alpha-blockers appear similar, both in terms of symptom relief and urodynamic
improvements. Randomised controlled trials have additionally demonstrated that
finasteride therapy can provide improvement in terms of quality of life indices, prostate
volume, and risks of progressing to acute urinary retention or prostatic surgery. While
alpha-blockers have a rapid onset of action, likely to produce a therapeutic result within
weeks, regardless of whether prostatic enlargement or bladder outlet obstruction is
present, finasteride appears to be effective for more long-term therapy for up to 4 years,
but only in alleviating symptoms when they are associated with a significantly large
prostate. Neither finasteride nor the alpha(1a)-receptor-selective blocker, tamsulosin, are
associated with the lowering of blood pressure and incidence of cardiovascular side
effects that are apparent with other less selective alpha-blocker therapies such as
dizziness and postural hypertension. They are, however, both associated with an
increased risk of sexual dysfunction, albeit less than those associated with surgical
intervention. Whereas tamsulosin is associated only with ejaculatory dysfunction,
finasteride is additionally linked to decreased libido and impotence.
medical therapy for lower urinary tract symptoms (LUTS) indicative of benign prostatic
hyperplasia (BPH). To assess randomised controlled trials investigating the six
alpha-adrenergic receptor antagonists (alpha-blockers), prazosin, alfuzosin, indoramin,
terazosin, doxazosin, and tamsulosin, that benefit patients by relaxing prostatic smooth
muscle, and the anti-androgen, finasteride, that mediates its more long-term benefits by
reducing prostate size. RESULTS: This review suggests that both classes of drug offer
significant improvement in criteria used to evaluate symptomatic BPH and can be effective
whilst being acceptably safe. Furthermore, the therapeutic efficacy of all contemporary
alpha-blockers appear similar, both in terms of symptom relief and urodynamic
improvements. Randomised controlled trials have additionally demonstrated that
finasteride therapy can provide improvement in terms of quality of life indices, prostate
volume, and risks of progressing to acute urinary retention or prostatic surgery. While
alpha-blockers have a rapid onset of action, likely to produce a therapeutic result within
weeks, regardless of whether prostatic enlargement or bladder outlet obstruction is
present, finasteride appears to be effective for more long-term therapy for up to 4 years,
but only in alleviating symptoms when they are associated with a significantly large
prostate. Neither finasteride nor the alpha(1a)-receptor-selective blocker, tamsulosin, are
associated with the lowering of blood pressure and incidence of cardiovascular side
effects that are apparent with other less selective alpha-blocker therapies such as
dizziness and postural hypertension. They are, however, both associated with an
increased risk of sexual dysfunction, albeit less than those associated with surgical
intervention. Whereas tamsulosin is associated only with ejaculatory dysfunction,
finasteride is additionally linked to decreased libido and impotence.
=============================================================
10.) Pretreatment with finasteride decreases perioperative bleeding associated with
transurethral resection of the prostate.
=============================================================
Urology 2000 May;55(5):684-9
10.) Pretreatment with finasteride decreases perioperative bleeding associated with
transurethral resection of the prostate.
=============================================================
Urology 2000 May;55(5):684-9
Hagerty JA, Ginsberg PC, Harmon JD, Harkaway RC
Department of Surgery, Division of Urology, Albert Einstein Medical
Center and
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
OBJECTIVES: The efficacy of finasteride in the treatment of gross
hematuria associated
with benign prostatic hyperplasia is well established. We evaluated a regimen of
pretreatment with finasteride in decreasing perioperative bleeding associated with
transurethral resection of the prostate (TURP). METHODS: A prospective analysis
compared 25 patients pretreated with finasteride for 2 to 4 months before TURP with 50
patients without pretreatment. Patients in each group were further separated by the
amount of prostate tissue resected. Patients were then followed up for perioperative
bleeding, defined as a perioperative blood transfusion requirement or a return visit to the
emergency room with gross hematuria or clot retention. RESULTS: None of the patients
with less than 30 g of prostate tissue resected experienced perioperative bleeding. In
patients with 30 g or more resected, several episodes of bleeding occurred. In the
patients pretreated with finasteride, 1 (8.3%) of 12 experienced perioperative bleeding; in
the control group, 7 (36.8%) of 19 had an episode of bleeding. CONCLUSIONS: In
patients with large prostate glands undergoing TURP, pretreatment with finasteride
appears useful in reducing perioperative bleeding.
with benign prostatic hyperplasia is well established. We evaluated a regimen of
pretreatment with finasteride in decreasing perioperative bleeding associated with
transurethral resection of the prostate (TURP). METHODS: A prospective analysis
compared 25 patients pretreated with finasteride for 2 to 4 months before TURP with 50
patients without pretreatment. Patients in each group were further separated by the
amount of prostate tissue resected. Patients were then followed up for perioperative
bleeding, defined as a perioperative blood transfusion requirement or a return visit to the
emergency room with gross hematuria or clot retention. RESULTS: None of the patients
with less than 30 g of prostate tissue resected experienced perioperative bleeding. In
patients with 30 g or more resected, several episodes of bleeding occurred. In the
patients pretreated with finasteride, 1 (8.3%) of 12 experienced perioperative bleeding; in
the control group, 7 (36.8%) of 19 had an episode of bleeding. CONCLUSIONS: In
patients with large prostate glands undergoing TURP, pretreatment with finasteride
appears useful in reducing perioperative bleeding.
=============================================================
11.) Urinary retention in patients with BPH treated with finasteride or placebo over 4
years. Characterization of patients and ultimate outcomes.The PLESS Study Group.
=============================================================
Eur Urol 2000 May;37(5):528-36
11.) Urinary retention in patients with BPH treated with finasteride or placebo over 4
years. Characterization of patients and ultimate outcomes.The PLESS Study Group.
=============================================================
Eur Urol 2000 May;37(5):528-36
Roehrborn CG, Bruskewitz R, Nickel GC, Glickman S, Cox C, Anderson R,
Kandzari
S, Herlihy R, Kornitzer G, Brown BT, Holtgrewe HL, Taylor A, Wang D, Waldstreicher
J
S, Herlihy R, Kornitzer G, Brown BT, Holtgrewe HL, Taylor A, Wang D, Waldstreicher
J
The University of Texas Southwestern Medical Center, Dallas, TX
07525-9110, USA.
claus.roehrborn@email.swmed.edu
claus.roehrborn@email.swmed.edu
OBJECTIVES: Knowledge regarding the incidence and prevalence of acute
urinary
retention and the ultimate outcome is very limited. The purpose of the present analysis
was to document the natural history and outcomes of acute urinary retention (AUR)
further specified as being either precipitated or spontaneous, and to evaluate the potential
benefit of finasteride therapy. MATERIALS AND METHODS: Three thousand and
forty men with moderate to severe symptoms of BPH and enlarged prostate glands by
digital rectal examination were enrolled into the 4-year placebo-controlled PLESS trial
and were evaluated for occurrences of AUR and BPH-related surgery. Men in the study
were seen every 4 months; discontinued patients were followed up 6 months after
discontinuation and again at the end of the 4-year trial. Complete 4-year data on
outcomes (occurrence of AUR or BPH-related surgery) was available for 92% of the
enrolled subjects in each treatment group. An endpoint committee, blinded to treatment
group and center, reviewed and categorized all study-related documentation relating to
retention and surgery. RESULTS: Over the 4-year period, 99 of 1,503 placebo-treated
patients (6.6%) experienced one or more episodes of AUR in comparison with 42 or
1,513 finasteride-treated patients (2.8%; p<0. 001). Approximately half of the episodes
of retention were spontaneous and clearly BPH-related, while the other episodes were
precipitated by another factor (PAUR). After spontaneous AUR, subsequent surgery was
performed in 39 of 52 (75%) placebo-treated patients versus 8 of 20 (40%)
finasteride-treated patients (p = 0. 01). BPH-related surgery was less common in men
who had a prior episode of PAUR (26% in the placebo group and 14% in the finasteride
group). CONCLUSION: There is a continual risk of spontaneous and precipitated acute
urinary retention in men with moderate to severe lower urinary tract symptoms and an
enlarged prostate gland. Fewer patients who developed precipitated AUR than
spontaneous AUR go on to need subsequent BPH-related surgery. Significantly fewer
finasteride-than placebo-treated patients developed AUR, and among those men, fewer
ultimately needed BPH-related surgery.
retention and the ultimate outcome is very limited. The purpose of the present analysis
was to document the natural history and outcomes of acute urinary retention (AUR)
further specified as being either precipitated or spontaneous, and to evaluate the potential
benefit of finasteride therapy. MATERIALS AND METHODS: Three thousand and
forty men with moderate to severe symptoms of BPH and enlarged prostate glands by
digital rectal examination were enrolled into the 4-year placebo-controlled PLESS trial
and were evaluated for occurrences of AUR and BPH-related surgery. Men in the study
were seen every 4 months; discontinued patients were followed up 6 months after
discontinuation and again at the end of the 4-year trial. Complete 4-year data on
outcomes (occurrence of AUR or BPH-related surgery) was available for 92% of the
enrolled subjects in each treatment group. An endpoint committee, blinded to treatment
group and center, reviewed and categorized all study-related documentation relating to
retention and surgery. RESULTS: Over the 4-year period, 99 of 1,503 placebo-treated
patients (6.6%) experienced one or more episodes of AUR in comparison with 42 or
1,513 finasteride-treated patients (2.8%; p<0. 001). Approximately half of the episodes
of retention were spontaneous and clearly BPH-related, while the other episodes were
precipitated by another factor (PAUR). After spontaneous AUR, subsequent surgery was
performed in 39 of 52 (75%) placebo-treated patients versus 8 of 20 (40%)
finasteride-treated patients (p = 0. 01). BPH-related surgery was less common in men
who had a prior episode of PAUR (26% in the placebo group and 14% in the finasteride
group). CONCLUSION: There is a continual risk of spontaneous and precipitated acute
urinary retention in men with moderate to severe lower urinary tract symptoms and an
enlarged prostate gland. Fewer patients who developed precipitated AUR than
spontaneous AUR go on to need subsequent BPH-related surgery. Significantly fewer
finasteride-than placebo-treated patients developed AUR, and among those men, fewer
ultimately needed BPH-related surgery.
=============================================================
12.) Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign
prostatic hyperplasia.
=============================================================
Eur Urol 2000 Apr;37(4):367-80
12.) Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign
prostatic hyperplasia.
=============================================================
Eur Urol 2000 Apr;37(4):367-80
Bartsch G, Rittmaster RS, Klocker H
Department of Urology, University of Innsbruck, Austria.
georg.bartsch@uibk.ac.at
OBJECTIVE:The development of the human benign prostatic hyperplasia
clearly requires
a combination of testicular androgens and aging. Although the role of androgens as the
causative factor for human benign prostatic hyperplasia is debated, they undoubtedly have
at least a permissive role. The principal prostatic androgen is dihydrotestosterone (DHT).
Although not elevated in human benign prostatic hyperplasia, DHT levels in the prostate
remain at a normal level with aging, despite a decrease in the plasma testosterone.
RESULTS: DHT is generated by reduction of testosterone. Two isoenzymes of
5alpha-reductase have been discovered. Type 1 is present in most tissues of the body
where 5alpha-reductase is expressed and is the dominant form in sebaceous glands.
Type2 5alpha-reductase is the dominant isoenzyme in genital tissues, including the
prostate. Finasteride is a 5alpha-reductase inhibitor that has been used for the treatment
of benign prostatic hyperplasia and male-pattern baldness. At doses used clinically, its
major effect is through suppression of type 2 5alpha-reductase, because it has a much
lower affinity for the type 1 isoenzyme. Finasteride suppresses DHT by about 70% in
serum and by as much as 85-90% in the prostate. The remaining DHT in the prostate is
likely to be the result of type 1 5alpha-reductase. Suppression of both 5alpha-reductase
isoenzymes with GI198745 result in greater and more consistent suppression of serum
dihydrotestosterone than that observed with a selective inhibitor of type 2
5alpha-reductase. Physiological and clinical studies comparing dual 5alpha-reductase
inhibitors, such as GI198745, with selective type 2, such as finasteride, will be needed to
determine the clinical relevance of type 1 5alpha-reductase within the prostate. Two large
international multicenter, phase III trials have been published documenting the safety and
efficacy of finasteride in the treatment of human benign prostatic hyperplasia. Combining
these two studies, randomized, controlled data are available for 12 months.
Noncontrolled extension of these data from a subset of patients, who elected to continue
drug treatment for 3, 4 or 5 years, are also available. Long-term medical therapy with
finasteride can reduce clinically significant endpoints such as acute urinary retention or
surgery. According to the meta-analysis of six randomised clinical trial with finasteride,
finasteride is most effective in men with large prostates. A more effective dual inhibitor of
type 1 and 2 human 5alpha-reductase may lower circulating DHT to a greater extent than
finasteride and show advantages in the treatment of human benign prostatic hyperplasia
and other disease states that depend on DHT. CONCLUSION: Clinical evaluation of
potent dual 5alpha-reductase inhibitors may help define the relative roles of human type 1
and 2 5alpha-reductase in the pathophysiology of benign prostatic hyperplasia and other
androgen-dependent diseases.
a combination of testicular androgens and aging. Although the role of androgens as the
causative factor for human benign prostatic hyperplasia is debated, they undoubtedly have
at least a permissive role. The principal prostatic androgen is dihydrotestosterone (DHT).
Although not elevated in human benign prostatic hyperplasia, DHT levels in the prostate
remain at a normal level with aging, despite a decrease in the plasma testosterone.
RESULTS: DHT is generated by reduction of testosterone. Two isoenzymes of
5alpha-reductase have been discovered. Type 1 is present in most tissues of the body
where 5alpha-reductase is expressed and is the dominant form in sebaceous glands.
Type2 5alpha-reductase is the dominant isoenzyme in genital tissues, including the
prostate. Finasteride is a 5alpha-reductase inhibitor that has been used for the treatment
of benign prostatic hyperplasia and male-pattern baldness. At doses used clinically, its
major effect is through suppression of type 2 5alpha-reductase, because it has a much
lower affinity for the type 1 isoenzyme. Finasteride suppresses DHT by about 70% in
serum and by as much as 85-90% in the prostate. The remaining DHT in the prostate is
likely to be the result of type 1 5alpha-reductase. Suppression of both 5alpha-reductase
isoenzymes with GI198745 result in greater and more consistent suppression of serum
dihydrotestosterone than that observed with a selective inhibitor of type 2
5alpha-reductase. Physiological and clinical studies comparing dual 5alpha-reductase
inhibitors, such as GI198745, with selective type 2, such as finasteride, will be needed to
determine the clinical relevance of type 1 5alpha-reductase within the prostate. Two large
international multicenter, phase III trials have been published documenting the safety and
efficacy of finasteride in the treatment of human benign prostatic hyperplasia. Combining
these two studies, randomized, controlled data are available for 12 months.
Noncontrolled extension of these data from a subset of patients, who elected to continue
drug treatment for 3, 4 or 5 years, are also available. Long-term medical therapy with
finasteride can reduce clinically significant endpoints such as acute urinary retention or
surgery. According to the meta-analysis of six randomised clinical trial with finasteride,
finasteride is most effective in men with large prostates. A more effective dual inhibitor of
type 1 and 2 human 5alpha-reductase may lower circulating DHT to a greater extent than
finasteride and show advantages in the treatment of human benign prostatic hyperplasia
and other disease states that depend on DHT. CONCLUSION: Clinical evaluation of
potent dual 5alpha-reductase inhibitors may help define the relative roles of human type 1
and 2 5alpha-reductase in the pathophysiology of benign prostatic hyperplasia and other
androgen-dependent diseases.
=============================================================
13.) Chronic treatment with finasteride daily does not affect spermatogenesis or semen
production in young men.
=============================================================
J Urol 1999 Oct;162(4):1295-300 Related Articles, Books, LinkOut
13.) Chronic treatment with finasteride daily does not affect spermatogenesis or semen
production in young men.
=============================================================
J Urol 1999 Oct;162(4):1295-300 Related Articles, Books, LinkOut
Overstreet JW, Fuh VL, Gould J, Howards SS, Lieber MM, Hellstrom W,
Shapiro S,
Carroll P, Corfman RS, Petrou S, Lewis R, Toth P, Shown T, Roy J, Jarow JP, Bonilla
J, Jacobsen CA, Wang DZ, Kaufman KD
Carroll P, Corfman RS, Petrou S, Lewis R, Toth P, Shown T, Roy J, Jarow JP, Bonilla
J, Jacobsen CA, Wang DZ, Kaufman KD
Department of Obstetrics and Gynecology, University of California, Davis,
USA.
PURPOSE: Finasteride, an oral type 2, 5alpha-reductase inhibitor, is used
in 1 mg. daily
doses for the treatment of male pattern hair loss. A dose of 5 mg. finasteride daily reduces
ejaculate volume by approximately 25%, and reduces prostate volume by approximately
20% and serum prostate specific antigen (PSA) by approximately 50% in men with
benign prostatic hyperplasia. To our knowledge no data exist on the effect of 1 mg.
finasteride daily on ejaculate volume or other semen parameters, or on the prostate in
young men. Therefore, we studied the potential effect and reversibility of effect of 1 mg.
finasteride daily on spermatogenesis, semen production, the prostate and serum PSA in
young men. MATERIALS AND METHODS: In this double-blind, placebo controlled
multicenter study 181 men 19 to 41 years old were randomized to receive 1 mg.
finasteride or placebo for 48 weeks followed by a 60-week off-drug period. Of the 181
men 79 were included in a subset for the collection and analysis of sequential semen
samples. RESULTS: There were no significant effects of 1 mg. finasteride on sperm
concentration, total sperm per ejaculate, sperm motility or morphology. Ejaculate volume
in subjects on finasteride decreased 0.3 ml. (-11%) compared to a decrease of 0.2 ml.
(-8%) for placebo, with a median between treatment group difference of -0.03 ml. (1%,
90% confidence interval -10.4 to 13.1, p = 0.915). There were significant but small
decreases in prostate volume (-2.6%) and serum PSA (-0.2 ng./ml.) in the finasteride
group, which reversed on discontinuation of the drug. CONCLUSIONS: Treatment with
1 mg. finasteride daily for 48 weeks did not affect spermatogenesis or semen production
in young men. The effects of 1 mg. finasteride daily on prostate volume and serum PSA in
young men without benign prostatic hyperplasia were small and reversible on
discontinuation of the drug.
doses for the treatment of male pattern hair loss. A dose of 5 mg. finasteride daily reduces
ejaculate volume by approximately 25%, and reduces prostate volume by approximately
20% and serum prostate specific antigen (PSA) by approximately 50% in men with
benign prostatic hyperplasia. To our knowledge no data exist on the effect of 1 mg.
finasteride daily on ejaculate volume or other semen parameters, or on the prostate in
young men. Therefore, we studied the potential effect and reversibility of effect of 1 mg.
finasteride daily on spermatogenesis, semen production, the prostate and serum PSA in
young men. MATERIALS AND METHODS: In this double-blind, placebo controlled
multicenter study 181 men 19 to 41 years old were randomized to receive 1 mg.
finasteride or placebo for 48 weeks followed by a 60-week off-drug period. Of the 181
men 79 were included in a subset for the collection and analysis of sequential semen
samples. RESULTS: There were no significant effects of 1 mg. finasteride on sperm
concentration, total sperm per ejaculate, sperm motility or morphology. Ejaculate volume
in subjects on finasteride decreased 0.3 ml. (-11%) compared to a decrease of 0.2 ml.
(-8%) for placebo, with a median between treatment group difference of -0.03 ml. (1%,
90% confidence interval -10.4 to 13.1, p = 0.915). There were significant but small
decreases in prostate volume (-2.6%) and serum PSA (-0.2 ng./ml.) in the finasteride
group, which reversed on discontinuation of the drug. CONCLUSIONS: Treatment with
1 mg. finasteride daily for 48 weeks did not affect spermatogenesis or semen production
in young men. The effects of 1 mg. finasteride daily on prostate volume and serum PSA in
young men without benign prostatic hyperplasia were small and reversible on
discontinuation of the drug.
=============================================================
14.) Management of androgenetic alopecia.
=============================================================
J Eur Acad Dermatol Venereol 1999 May;12(3):205-14 Related Articles, Books,
LinkOut
14.) Management of androgenetic alopecia.
=============================================================
J Eur Acad Dermatol Venereol 1999 May;12(3):205-14 Related Articles, Books,
LinkOut
Tosti A, Camacho-Martinez F, Dawber R
Department of Dermatology, University of Bologna, Italy.
tosti@almadns.unibo.it
BACKGROUND: Androgenetic alopecia (AGA) is the most frequent cause of
hair loss
affecting up to 50% of men and 40% of women by the age of 50. METHODS: This
paper outlines the current status of diagnosis and offers guidelines for optimal management
of AGA in both men and women. RESULTS: The diagnosis of AGA can usually be
confirmed by medical history and physical examination alone. A trichogram can be useful
to assess the progression of the hair loss. A scalp biospy is diagnostic but usually not
required. In women with signs of hyperandrogenism, investigation for ovarian (polycystic
ovarian disease) or adrenal (late-onset congenital adrenal hyperplasia) disorders is
required. Mild to moderate AGA in men can be treated with oral finasteride or topical
minoxidil. Oral finasteride at the dosage of 1 mg/day produced clinical improvement in up
to 66% of patients treated for 2 years. The drug is effective for both frontal and vertex
hair thinning. Medical treatment with finasteride or minoxidil should be continued
indefinitely since interruption of therapy leads to hair loss with return to pretreatment
status. Mild to moderate AGA in women can be treated with oral antiandrogens
(cyproterone acetate, spironolactone) and/or topical minoxidil with good results in many
cases. Hair systems and surgery may be considered for selected cases of severe AGA
both in men and in women. CONCLUSIONS: Patients with AGA should be informed
about the pathogenesis of the condition. If used correctly, available medical treatments
arrest progression of the disease and reverse miniaturization in most patients with mild to
moderate AGA.
affecting up to 50% of men and 40% of women by the age of 50. METHODS: This
paper outlines the current status of diagnosis and offers guidelines for optimal management
of AGA in both men and women. RESULTS: The diagnosis of AGA can usually be
confirmed by medical history and physical examination alone. A trichogram can be useful
to assess the progression of the hair loss. A scalp biospy is diagnostic but usually not
required. In women with signs of hyperandrogenism, investigation for ovarian (polycystic
ovarian disease) or adrenal (late-onset congenital adrenal hyperplasia) disorders is
required. Mild to moderate AGA in men can be treated with oral finasteride or topical
minoxidil. Oral finasteride at the dosage of 1 mg/day produced clinical improvement in up
to 66% of patients treated for 2 years. The drug is effective for both frontal and vertex
hair thinning. Medical treatment with finasteride or minoxidil should be continued
indefinitely since interruption of therapy leads to hair loss with return to pretreatment
status. Mild to moderate AGA in women can be treated with oral antiandrogens
(cyproterone acetate, spironolactone) and/or topical minoxidil with good results in many
cases. Hair systems and surgery may be considered for selected cases of severe AGA
both in men and in women. CONCLUSIONS: Patients with AGA should be informed
about the pathogenesis of the condition. If used correctly, available medical treatments
arrest progression of the disease and reverse miniaturization in most patients with mild to
moderate AGA.
=============================================================
15.) Finasteride in the treatment of men with frontal male pattern hair loss.
=============================================================
J Am Acad Dermatol 1999 Jun;40(6 Pt 1):930-7 Related Articles, Books, LinkOut
15.) Finasteride in the treatment of men with frontal male pattern hair loss.
=============================================================
J Am Acad Dermatol 1999 Jun;40(6 Pt 1):930-7 Related Articles, Books, LinkOut
Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, Kraus S,
Baldwin H,
Shalita A, Draelos Z, Markou M, Thiboutot D, Rapaport M, Kang S, Kelly T, Pariser D,
Webster G, Hordinsky M, Rietschel R, Katz HI, Terranella L, Best S, Round E,
Waldstreicher J
Shalita A, Draelos Z, Markou M, Thiboutot D, Rapaport M, Kang S, Kelly T, Pariser D,
Webster G, Hordinsky M, Rietschel R, Katz HI, Terranella L, Best S, Round E,
Waldstreicher J
University of Pennsylvania School of Medicine, Philadelphia,
USA.
BACKGROUND: Finasteride, a specific inhibitor of type II
5alpha-reductase, decreases
serum and scalp dihydrotestosterone and has been shown to be effective in men with
vertex male pattern hair loss. OBJECTIVE: This study evaluated the efficacy of
finasteride 1 mg/day in men with frontal (anterior/mid) scalp hair thinning. METHODS:
This was a 1-year, double-blind, placebo-controlled study followed by a 1-year open
extension. Efficacy was assessed by hair counts (1 cm2 circular area), patient and
investigator assessments, and global photographic review. RESULTS: There was a
significant increase in hair count in the frontal scalp of finasteride-treated patients (P <
.001), as well as significant improvements in patient, investigator, and global photographic
assessments. Efficacy was maintained or improved throughout the second year of the
study. Finasteride was generally well tolerated. CONCLUSION: In men with hair loss in
the anterior/mid area of the scalp, finasteride 1 mg/day slowed hair loss and increased hair
growth.
serum and scalp dihydrotestosterone and has been shown to be effective in men with
vertex male pattern hair loss. OBJECTIVE: This study evaluated the efficacy of
finasteride 1 mg/day in men with frontal (anterior/mid) scalp hair thinning. METHODS:
This was a 1-year, double-blind, placebo-controlled study followed by a 1-year open
extension. Efficacy was assessed by hair counts (1 cm2 circular area), patient and
investigator assessments, and global photographic review. RESULTS: There was a
significant increase in hair count in the frontal scalp of finasteride-treated patients (P <
.001), as well as significant improvements in patient, investigator, and global photographic
assessments. Efficacy was maintained or improved throughout the second year of the
study. Finasteride was generally well tolerated. CONCLUSION: In men with hair loss in
the anterior/mid area of the scalp, finasteride 1 mg/day slowed hair loss and increased hair
growth.
=============================================================
16.) Androgenetic alopecia in men: the scale of the problem and prospects for treatment.
=============================================================
Int J Clin Pract 1999 Jan-Feb;53(1):50-3 Related Articles, Books, LinkOut
16.) Androgenetic alopecia in men: the scale of the problem and prospects for treatment.
=============================================================
Int J Clin Pract 1999 Jan-Feb;53(1):50-3 Related Articles, Books, LinkOut
Rushton DH
School of Pharmacy and Biomedical Sciences, University of Portsmouth,
Hants.
While the precise incidence of androgenetic alopecia is unknown, it is
universally
acknowledged to be the most common hair problem in men. Balding is generally
associated with ageing; consequently, the desire to prolong a youthful appearance
inevitably leads to demands for effective treatments. Further, changing attitudes in modern
society have resulted in people becoming concerned about their appearance and less
tolerant about conditions that might be alleviated by medical intervention. The importance
of hair loss upon quality of life has been underestimated by the medical profession.
Clinicians failing to accept hair loss as an important medical problem ignore the real
distress suffered by a significant proportion of those affected. New options for treatment
that selectively target the metabolic pathways involved in the balding process are showing
promise. The first generation of such drugs, Propecia, is now available in some countries
and other molecules are currently under development.
acknowledged to be the most common hair problem in men. Balding is generally
associated with ageing; consequently, the desire to prolong a youthful appearance
inevitably leads to demands for effective treatments. Further, changing attitudes in modern
society have resulted in people becoming concerned about their appearance and less
tolerant about conditions that might be alleviated by medical intervention. The importance
of hair loss upon quality of life has been underestimated by the medical profession.
Clinicians failing to accept hair loss as an important medical problem ignore the real
distress suffered by a significant proportion of those affected. New options for treatment
that selectively target the metabolic pathways involved in the balding process are showing
promise. The first generation of such drugs, Propecia, is now available in some countries
and other molecules are currently under development.
=============================================================
17.) [Androgenetic alopecia, hirsutism and hypertrichosis].
=============================================================
Ther Umsch 1999 Apr;56(4):219-24 Related Articles, Books, LinkOut
17.) [Androgenetic alopecia, hirsutism and hypertrichosis].
=============================================================
Ther Umsch 1999 Apr;56(4):219-24 Related Articles, Books, LinkOut
Trueb RM, Wyss M, Itin PH
Dermatologische Klinik, Universitatsspital Zurich.
Having too much hair on the face or the body and not enough on the scalp
respectively, is
generally not a mirror of a life-threatening disease. However, the emotional impact of such
cosmetic problems may be remarkable in the individual case. Currently rational treatment
options are becoming increasingly available to correct such hair problems. This review
highlights the new therapeutic achievements in the treatment of both androgenetic alopecia
and hirsutism. Oral treatment of male patterned hair loss with finasteride in men is
emphasized, and the use of antiandrogens in women is discussed. In addition, the mode of
action and clinical results of topical minoxidil treatment find mention. The second part of
the review deals with hirsutism and hypertrichosis. The diagnostic steps and investigations
are briefly reviewed, and the advances in laser treatment of hirsutism and hypertrichosis
are presented.
generally not a mirror of a life-threatening disease. However, the emotional impact of such
cosmetic problems may be remarkable in the individual case. Currently rational treatment
options are becoming increasingly available to correct such hair problems. This review
highlights the new therapeutic achievements in the treatment of both androgenetic alopecia
and hirsutism. Oral treatment of male patterned hair loss with finasteride in men is
emphasized, and the use of antiandrogens in women is discussed. In addition, the mode of
action and clinical results of topical minoxidil treatment find mention. The second part of
the review deals with hirsutism and hypertrichosis. The diagnostic steps and investigations
are briefly reviewed, and the advances in laser treatment of hirsutism and hypertrichosis
are presented.
=============================================================
18.) Medical treatments for balding in men.
=============================================================
Am Fam Physician 1999 Apr 15;59(8):2189-94, 2196 Related Articles, Books,
LinkOut
18.) Medical treatments for balding in men.
=============================================================
Am Fam Physician 1999 Apr 15;59(8):2189-94, 2196 Related Articles, Books,
LinkOut
Scow DT, Nolte RS, Shaughnessy AF
Harrisburg Family Practice Residency, PA 17105-8700, USA.
Two drugs are available for the treatment of balding in men. Minoxidil, a
topical product,
is available without a prescription in two strengths. Finasteride is a prescription drug taken
orally once daily. Both agents are modestly effective in maintaining (and sometimes
regrowing) hair that is lost as a result of androgenic alopecia. The vertex of the scalp is the
area that is most likely to respond to treatment, with little or no hair regrowth occurring on
the anterior scalp or at the hairline. Side effects of these medications are minimal, making
them suitable treatments for this benign but psychologically disruptive condition.
is available without a prescription in two strengths. Finasteride is a prescription drug taken
orally once daily. Both agents are modestly effective in maintaining (and sometimes
regrowing) hair that is lost as a result of androgenic alopecia. The vertex of the scalp is the
area that is most likely to respond to treatment, with little or no hair regrowth occurring on
the anterior scalp or at the hairline. Side effects of these medications are minimal, making
them suitable treatments for this benign but psychologically disruptive condition.
=============================================================
19.) Understanding and managing common baldness.
=============================================================
Aust Fam Physician 1999 Mar;28(3):248-50, 252-3
19.) Understanding and managing common baldness.
=============================================================
Aust Fam Physician 1999 Mar;28(3):248-50, 252-3
Tran D, Sinclair RD
Department of Dermatology, St Vincent's Hospital, Melbourne.
BACKGROUND: Society places importance on physical attributes especially
the
appearance of our hair. Common baldness or androgenetic alopecia is a normal
physiological process of hair loss in genetically predisposed individuals. Premature or
accelerated hair loss can engender considerable negative thoughts and anxiety associated
with feelings of diminished attractiveness. OBJECTIVE: To enable general practitioners to
recognise the various treatment options available, therefore offering patients reasonable
hope and informed choices. DISCUSSION: Common baldness can be prevented by
currently available mediums and regrowth may be achieved in a significant percentage of
cases. Correct use of these agents requires an understanding of the pathogenesis of
androgenetic alopecia, its natural history and the time course of response to treatment.
appearance of our hair. Common baldness or androgenetic alopecia is a normal
physiological process of hair loss in genetically predisposed individuals. Premature or
accelerated hair loss can engender considerable negative thoughts and anxiety associated
with feelings of diminished attractiveness. OBJECTIVE: To enable general practitioners to
recognise the various treatment options available, therefore offering patients reasonable
hope and informed choices. DISCUSSION: Common baldness can be prevented by
currently available mediums and regrowth may be achieved in a significant percentage of
cases. Correct use of these agents requires an understanding of the pathogenesis of
androgenetic alopecia, its natural history and the time course of response to treatment.
=============================================================
20.) Finasteride: a review of its use in male pattern hair loss.
=============================================================
Drugs 1999 Jan;57(1):111-26 Related Articles, Books, LinkOut
20.) Finasteride: a review of its use in male pattern hair loss.
=============================================================
Drugs 1999 Jan;57(1):111-26 Related Articles, Books, LinkOut
McClellan KJ, Markham A
Adis International Limited, Mairangi Bay, Auckland, New Zealand.
demail@adis.co.nz
The 5alpha-reductase inhibitor finasteride blocks the conversion of
testosterone to
dihydrotestosterone (DHT), the androgen responsible for male pattern hair loss
(androgenetic alopecia) in genetically predisposed men. Results of phase III clinical
studies in 1879 men have shown that oral finasteride 1 mg/day promotes hair growth and
prevents further hair loss in a significant proportion of men with male pattern hair loss.
Evidence suggests that the improvement in hair count reported after 1 year is maintained
during 2 years' treatment. In men with vertex hair loss, global photographs showed
improvement in hair growth in 48% of finasteride recipients at 1 year and in 66% at 2
years compared with 7% of placebo recipients at each time point. Furthermore, hair
counts in these men showed that 83% of finasteride versus 28% of placebo recipients had
no further hair loss compared with baseline after 2 years. The clinical efficacy of oral
finasteride has not yet been compared with that of topical minoxidil, the only other drug
used clinically in patients with male pattern hair loss. Therapeutic dosages of finasteride
are generally well tolerated. In phase III studies, 7.7% of patients receiving finasteride 1
mg/day compared with 7.0% of those receiving placebo reported treatment-related
adverse events. The overall incidence of sexual function disorders, comprising decreased
libido, ejaculation disorder and erectile dysfunction, was significantly greater in finasteride
than placebo recipients (3.8 vs 2.1%). All sexual adverse events were reversed on
discontinuation of therapy and many resolved in patients who continued therapy. No other
drug-related events were reported with an incidence > or =1% in patients receiving
finasteride. Most events were of mild to moderate severity. Oral finasteride is
contraindicated in pregnant women because of the risk of hypospadias in male fetuses.
CONCLUSIONS: Oral finasteride promotes scalp hair growth and prevents further hair
loss in a significant proportion of men with male pattern hair loss. With its generally good
tolerability profile, finasteride is a new approach to the management of this condition, for
which treatment options are few. Its role relative to topical minoxidil has yet to be
determined.
dihydrotestosterone (DHT), the androgen responsible for male pattern hair loss
(androgenetic alopecia) in genetically predisposed men. Results of phase III clinical
studies in 1879 men have shown that oral finasteride 1 mg/day promotes hair growth and
prevents further hair loss in a significant proportion of men with male pattern hair loss.
Evidence suggests that the improvement in hair count reported after 1 year is maintained
during 2 years' treatment. In men with vertex hair loss, global photographs showed
improvement in hair growth in 48% of finasteride recipients at 1 year and in 66% at 2
years compared with 7% of placebo recipients at each time point. Furthermore, hair
counts in these men showed that 83% of finasteride versus 28% of placebo recipients had
no further hair loss compared with baseline after 2 years. The clinical efficacy of oral
finasteride has not yet been compared with that of topical minoxidil, the only other drug
used clinically in patients with male pattern hair loss. Therapeutic dosages of finasteride
are generally well tolerated. In phase III studies, 7.7% of patients receiving finasteride 1
mg/day compared with 7.0% of those receiving placebo reported treatment-related
adverse events. The overall incidence of sexual function disorders, comprising decreased
libido, ejaculation disorder and erectile dysfunction, was significantly greater in finasteride
than placebo recipients (3.8 vs 2.1%). All sexual adverse events were reversed on
discontinuation of therapy and many resolved in patients who continued therapy. No other
drug-related events were reported with an incidence > or =1% in patients receiving
finasteride. Most events were of mild to moderate severity. Oral finasteride is
contraindicated in pregnant women because of the risk of hypospadias in male fetuses.
CONCLUSIONS: Oral finasteride promotes scalp hair growth and prevents further hair
loss in a significant proportion of men with male pattern hair loss. With its generally good
tolerability profile, finasteride is a new approach to the management of this condition, for
which treatment options are few. Its role relative to topical minoxidil has yet to be
determined.
=============================================================
21.) Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male
Pattern Hair Loss Study Group.
=============================================================
J Am Acad Dermatol 1998 Oct;39(4 Pt 1):578-89
21.) Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male
Pattern Hair Loss Study Group.
=============================================================
J Am Acad Dermatol 1998 Oct;39(4 Pt 1):578-89
Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price
VH, Van
Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ
Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ
Department of Clinical Research, Merck Research Laboratories, Rahway, NJ
07065,
USA.
USA.
BACKGROUND: Androgenetic alopecia (male pattern hair loss) is caused
by
androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone
(DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II
5alpha-reductase, decreases serum and scalp DHT by inhibiting conversion of
testosterone to DHT. OBJECTIVE: Our purpose was to determine whether finasteride
treatment leads to clinical improvement in men with male pattern hair loss. METHODS: In
two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received
oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies
for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator
assessments, and review of photographs by an expert panel. RESULTS: Finasteride
treatment improved scalp hair by all evaluation techniques at 1 and 2 years (P < .001 vs
placebo, all comparisons). Clinically significant increases in hair count (baseline = 876
hairs), measured in a 1-inch diameter circular area (5.1 cm2) of balding vertex scalp,
were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years,
respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients'
self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair
growth, and improved appearance of hair. These improvements were corroborated by
investigator assessments and assessments of photographs. Adverse effects were minimal.
CONCLUSION: In men with male pattern hair loss, finasteride 1 mg/d slowed the
progression of hair loss and increased hair growth in clinical trials over 2 years.
androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone
(DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II
5alpha-reductase, decreases serum and scalp DHT by inhibiting conversion of
testosterone to DHT. OBJECTIVE: Our purpose was to determine whether finasteride
treatment leads to clinical improvement in men with male pattern hair loss. METHODS: In
two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received
oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies
for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator
assessments, and review of photographs by an expert panel. RESULTS: Finasteride
treatment improved scalp hair by all evaluation techniques at 1 and 2 years (P < .001 vs
placebo, all comparisons). Clinically significant increases in hair count (baseline = 876
hairs), measured in a 1-inch diameter circular area (5.1 cm2) of balding vertex scalp,
were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years,
respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients'
self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair
growth, and improved appearance of hair. These improvements were corroborated by
investigator assessments and assessments of photographs. Adverse effects were minimal.
CONCLUSION: In men with male pattern hair loss, finasteride 1 mg/d slowed the
progression of hair loss and increased hair growth in clinical trials over 2 years.
=============================================================
22.) Genetic analysis of male pattern baldness and the 5alpha-reductase genes.
=============================================================
J Invest Dermatol 1998 Jun;110(6):849-53 Related Articles, Books, LinkOut
22.) Genetic analysis of male pattern baldness and the 5alpha-reductase genes.
=============================================================
J Invest Dermatol 1998 Jun;110(6):849-53 Related Articles, Books, LinkOut
Ellis JA, Stebbing M, Harrap SB
Department of Physiology, The University of Melbourne, Parkville,
Victoria, Australia.
Genetic predisposition and androgen dependence are important
characteristics of the
common patterned loss of scalp hair known as male pattern baldness. The involvement of
the 5alpha-reductase enzyme in male pattern baldness has been postulated due to its role
in the metabolism of testosterone to dihydrotestosterone. There are two known isozymes
of 5alpha-reductase. Type I has been predominantly localized to the skin and scalp. Type
II, also present on the scalp, is the target of finasteride, a promising treatment for male
pattern baldness. We conducted genetic association studies of the 5alpha-reductase
enzyme genes (SRD5A1 on chromosome 5 and SRD5A2 on chromosome 2) using
dimorphic intragenic restriction fragment length polymorphisms. >From a population
survey of 828 healthy families comprising 3000 individuals, we identified 58 young bald
men (aged 18-30 y) and 114 older nonbald men (aged 50-70 y) for a case control
comparison. No significant differences were found between cases and controls in allele,
genotype, or haplotype frequencies for restriction fragment length polymorphisms of either
gene. These findings suggest that the genes encoding the two 5alpha-reductase
isoenzymes are not associated with male pattern baldness. Finally, no clear inheritance
pattern of male pattern baldness was observed. The relatively strong concordance for
baldness between fathers and sons in this study was not consistent with a simple
Mendelian autosomal dominant inheritance. A polygenic etiology should be considered.
common patterned loss of scalp hair known as male pattern baldness. The involvement of
the 5alpha-reductase enzyme in male pattern baldness has been postulated due to its role
in the metabolism of testosterone to dihydrotestosterone. There are two known isozymes
of 5alpha-reductase. Type I has been predominantly localized to the skin and scalp. Type
II, also present on the scalp, is the target of finasteride, a promising treatment for male
pattern baldness. We conducted genetic association studies of the 5alpha-reductase
enzyme genes (SRD5A1 on chromosome 5 and SRD5A2 on chromosome 2) using
dimorphic intragenic restriction fragment length polymorphisms. >From a population
survey of 828 healthy families comprising 3000 individuals, we identified 58 young bald
men (aged 18-30 y) and 114 older nonbald men (aged 50-70 y) for a case control
comparison. No significant differences were found between cases and controls in allele,
genotype, or haplotype frequencies for restriction fragment length polymorphisms of either
gene. These findings suggest that the genes encoding the two 5alpha-reductase
isoenzymes are not associated with male pattern baldness. Finally, no clear inheritance
pattern of male pattern baldness was observed. The relatively strong concordance for
baldness between fathers and sons in this study was not consistent with a simple
Mendelian autosomal dominant inheritance. A polygenic etiology should be considered.
=============================================================
23.) Effect of finasteride on human testicular steroidogenesis.
=============================================================
J Androl 1996 Sep-Oct;17(5):516-21 Related Articles, Books
23.) Effect of finasteride on human testicular steroidogenesis.
=============================================================
J Androl 1996 Sep-Oct;17(5):516-21 Related Articles, Books
Castro-Magana M, Angulo M, Fuentes B, Canas A, Sarrantonio M, Arguello R,
Vitollo
P
P
Department of Pediatrics, Winthrop-University Hospital, Mineola, New York
11501,
USA.
USA.
We studied the testicular function and some androgen-mediated events in
22 males
(16-30 years of age) with male pattern baldness that was treated with finasteride (10 mg
once daily) for 2 years. Patients were evaluated every 3 months. Prostatic volume was
determined in six subjects by endorectal ultrasound scans. Serum gonadotropin,
prostate-specific antigen (PSA), and sex hormone levels were determined basally and
periodically during the treatment period. Fourteen subjects underwent gonadal stimulation
with human chorionic gonadotropin (hCG), and the gonadotropin response to
gonadotropin releasing hormone (GnRH) was determined in eight subjects, prior to and
after 2 years of therapy. Finasteride treatment resulted in an improvement in the male
pattern baldness and prostatic shrinkage that was associated with an increase in serum
testosterone levels (17.2 +/- 2.5 vs. 26.3 +/- 1.7 nmol/L) and a decrease in
dihydrotestosterone (DHT) levels (1.45 +/- 0.41 vs. 0.38 +/- 0.10 nmol/L), causing a
marked increase in that testosterone/DHT ratio. A significant increase in the serum levels
of androstenedione (3.67 +/- 0.49 vs. 7.05 +/- 0.70 nmol/L) and estradiol (132 +/- 44
vs. 187 +/- 26 pmol/L) was also noted, whereas androstanediol glucoronide (33.3 +/-
6.4 vs. 10.7 +/- 4.5 pmol) and PSA (1.6 +/- 0.6 vs. 0.4 +/- 0.1 ng/ml) were significantly
decreased. No changes in basal or stimulated levels of gonadotropin were observed.
There was a significant increase in the testosterone response to hCG during finasteride
therapy (delta: 16.7 vs. 35.5 nmol/L) that could be explained, at least in part, by the
reduction of testosterone metabolism resulting from the blockage induced by finasteride.
The decrease in the androstenedione to testosterone and estrone to estradiol ratios
observed after hCG treatment, however, strongly suggests increased activity of the
17-ketosteroid reductase enzyme and an improvement of the testicular capacity for
testosterone production.
(16-30 years of age) with male pattern baldness that was treated with finasteride (10 mg
once daily) for 2 years. Patients were evaluated every 3 months. Prostatic volume was
determined in six subjects by endorectal ultrasound scans. Serum gonadotropin,
prostate-specific antigen (PSA), and sex hormone levels were determined basally and
periodically during the treatment period. Fourteen subjects underwent gonadal stimulation
with human chorionic gonadotropin (hCG), and the gonadotropin response to
gonadotropin releasing hormone (GnRH) was determined in eight subjects, prior to and
after 2 years of therapy. Finasteride treatment resulted in an improvement in the male
pattern baldness and prostatic shrinkage that was associated with an increase in serum
testosterone levels (17.2 +/- 2.5 vs. 26.3 +/- 1.7 nmol/L) and a decrease in
dihydrotestosterone (DHT) levels (1.45 +/- 0.41 vs. 0.38 +/- 0.10 nmol/L), causing a
marked increase in that testosterone/DHT ratio. A significant increase in the serum levels
of androstenedione (3.67 +/- 0.49 vs. 7.05 +/- 0.70 nmol/L) and estradiol (132 +/- 44
vs. 187 +/- 26 pmol/L) was also noted, whereas androstanediol glucoronide (33.3 +/-
6.4 vs. 10.7 +/- 4.5 pmol) and PSA (1.6 +/- 0.6 vs. 0.4 +/- 0.1 ng/ml) were significantly
decreased. No changes in basal or stimulated levels of gonadotropin were observed.
There was a significant increase in the testosterone response to hCG during finasteride
therapy (delta: 16.7 vs. 35.5 nmol/L) that could be explained, at least in part, by the
reduction of testosterone metabolism resulting from the blockage induced by finasteride.
The decrease in the androstenedione to testosterone and estrone to estradiol ratios
observed after hCG treatment, however, strongly suggests increased activity of the
17-ketosteroid reductase enzyme and an improvement of the testicular capacity for
testosterone production.
=============================================================
24.) [Finasteride: a new drug for the treatment of male hirsutism and androgenetic
alopecia]?
=============================================================
Clin Ter 1996 Jun;147(6):305-15 Related Articles, Books, LinkOut
24.) [Finasteride: a new drug for the treatment of male hirsutism and androgenetic
alopecia]?
=============================================================
Clin Ter 1996 Jun;147(6):305-15 Related Articles, Books, LinkOut
[Article in Italian]
Spinucci G, Pasquali R
Dipartimento di Medicina interna e Gastroenterologia, Policlinico S.
Orsola-Malpighi,
Bologna.
Bologna.
Finasteride is a drug which inhibits the transformation of testosterone
into its active
metabolite, dihydrotestosterone, in the target organs, i.e. the skin, the scalp, the liver and
the prostate. In the pathogenic mechanism of hirsutism and androgenetic alopecia, and
important role is presumably played by alterations of the mechanisms which transform
testosterone into dihydrotestosterone. In some conditions an increase in
dihydrotestosterone has been demonstrated, due to increased activity of the enzyme 5
alpha-reductase. The effect of finasteride develops above all at the level of type II 5
alpha-reductase. Recent studies have evaluated the effect of finasteride in patients of both
sexes with hirsutism and androgenetic alopecia. In women with various forms of
hyperandrogenism, the use of the drug at the doses commonly used for the treatment of
benign prostatic hyperplasia seems to have induced a significant reduction in the degree of
hirsutism. Furthermore, both in animals and men with alopecia, the drug seems to have led
to an increase in the number and an improvement in the shape of the follicles in the anagen
phase, and a simultaneous decrease of dehydrotestosterone at the level of the scalp. This
study represents a review of the main results obtained over the last two years and reports
the prospects which the use of finasteride may have in this context.
metabolite, dihydrotestosterone, in the target organs, i.e. the skin, the scalp, the liver and
the prostate. In the pathogenic mechanism of hirsutism and androgenetic alopecia, and
important role is presumably played by alterations of the mechanisms which transform
testosterone into dihydrotestosterone. In some conditions an increase in
dihydrotestosterone has been demonstrated, due to increased activity of the enzyme 5
alpha-reductase. The effect of finasteride develops above all at the level of type II 5
alpha-reductase. Recent studies have evaluated the effect of finasteride in patients of both
sexes with hirsutism and androgenetic alopecia. In women with various forms of
hyperandrogenism, the use of the drug at the doses commonly used for the treatment of
benign prostatic hyperplasia seems to have induced a significant reduction in the degree of
hirsutism. Furthermore, both in animals and men with alopecia, the drug seems to have led
to an increase in the number and an improvement in the shape of the follicles in the anagen
phase, and a simultaneous decrease of dehydrotestosterone at the level of the scalp. This
study represents a review of the main results obtained over the last two years and reports
the prospects which the use of finasteride may have in this context.
=============================================================
25.) The 5 alpha-reductase system and its inhibitors. Recent development and its
perspective in treating androgen-dependent skin disorders.
=============================================================
Dermatology 1996;193(3):177-84 Related Articles, Books, LinkOut
25.) The 5 alpha-reductase system and its inhibitors. Recent development and its
perspective in treating androgen-dependent skin disorders.
=============================================================
Dermatology 1996;193(3):177-84 Related Articles, Books, LinkOut
Chen W, Zouboulis CC, Orfanos CE
Department of Dermatology, University Medical Center Benjamin Franklin,
Free
University of Berlin, Germany.
University of Berlin, Germany.
5 alpha-Reductase, the enzyme system that metabolizes testosterone
into
dihydrotestosterone, occurs in two isoforms. The type 1 isozyme is composed of 259
amino acids, has an optimal pH of 6-9 and represents the 'cutaneous type'; it is located
mainly in sebocytes but also in epidermal and follicular keratinocytes, dermal papilla cells
and sweat glands as well as in fibroblasts from genital and non-genital skin. The type 2
isozyme is composed of 254 amino acids, has an optimal pH of about 5.5 and is located
mainly in the epididymis, seminal vesicles, prostate and fetal genital skin as well as in the
inner root sheath of the hair follicle and in fibroblasts from normal adult genital skin. The
genes encoding type 1 and type 2 isozymes are found in chromosomes 5p and 2p,
respectively, and each consists of 5 exons and 4 introns. During the last decade, several
steroid analogues and non-steroid agents have been developed to interfere with 5
alpha-reductase activity. Finasteride, which has a higher affinity for the type 2 isozyme, is
the first 5 alpha-reductase antagonist clinically introduced for treatment of benign prostate
hyperplasia. The clinical evaluation of finasteride or other 5 alpha-reductase inhibitors in
the field of dermatology has been very limited; in particular, those that selectively bind to
type 1 isozyme (e.g. MK-386, LY191704) may be regarded as candidates for treatment
of androgen-dependent skin disorders such as seborrhoea, acne, hirsutism and/or
androgenetic alopecia.
dihydrotestosterone, occurs in two isoforms. The type 1 isozyme is composed of 259
amino acids, has an optimal pH of 6-9 and represents the 'cutaneous type'; it is located
mainly in sebocytes but also in epidermal and follicular keratinocytes, dermal papilla cells
and sweat glands as well as in fibroblasts from genital and non-genital skin. The type 2
isozyme is composed of 254 amino acids, has an optimal pH of about 5.5 and is located
mainly in the epididymis, seminal vesicles, prostate and fetal genital skin as well as in the
inner root sheath of the hair follicle and in fibroblasts from normal adult genital skin. The
genes encoding type 1 and type 2 isozymes are found in chromosomes 5p and 2p,
respectively, and each consists of 5 exons and 4 introns. During the last decade, several
steroid analogues and non-steroid agents have been developed to interfere with 5
alpha-reductase activity. Finasteride, which has a higher affinity for the type 2 isozyme, is
the first 5 alpha-reductase antagonist clinically introduced for treatment of benign prostate
hyperplasia. The clinical evaluation of finasteride or other 5 alpha-reductase inhibitors in
the field of dermatology has been very limited; in particular, those that selectively bind to
type 1 isozyme (e.g. MK-386, LY191704) may be regarded as candidates for treatment
of androgen-dependent skin disorders such as seborrhoea, acne, hirsutism and/or
androgenetic alopecia.
=============================================================
26.) Finasteride: a clinical review.
=============================================================
Biomed Pharmacother 1995;49(7-8):319-24 Related Articles, Books
26.) Finasteride: a clinical review.
=============================================================
Biomed Pharmacother 1995;49(7-8):319-24 Related Articles, Books
Gormley GJ
Merck Research Laboratories, Rahway, NJ 07065-0914, USA.
Finasteride is the first of a new class of 5 alpha-reductase inhibitors
which allows selective
androgen deprivation affecting dihydrotestosterone (DHT) levels in target organs such as
the prostate and scalp hair without effecting circulating levels of testosterone thus
preserving the desired androgen mediated effects on muscle strength, bone density and
sexual function. Finasteride has been demonstrated to produce significant effects in men
with an enlarged prostate gland. The long-term data now emerging suggests that
progression of benign prostatic hyperplasia (BPH) may be arrested providing additional
long term benefits. Experimental uses in prostate cancer prevention and male pattern
baldness offer new and exciting possibilities for this class of compounds.
androgen deprivation affecting dihydrotestosterone (DHT) levels in target organs such as
the prostate and scalp hair without effecting circulating levels of testosterone thus
preserving the desired androgen mediated effects on muscle strength, bone density and
sexual function. Finasteride has been demonstrated to produce significant effects in men
with an enlarged prostate gland. The long-term data now emerging suggests that
progression of benign prostatic hyperplasia (BPH) may be arrested providing additional
long term benefits. Experimental uses in prostate cancer prevention and male pattern
baldness offer new and exciting possibilities for this class of compounds.
=============================================================
27.) The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and
dihydrotestosterone concentrations in patients with male pattern baldness.
=============================================================
J Clin Endocrinol Metab 1994 Sep;79(3):703-6 Related Articles, Books, LinkOut
27.) The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and
dihydrotestosterone concentrations in patients with male pattern baldness.
=============================================================
J Clin Endocrinol Metab 1994 Sep;79(3):703-6 Related Articles, Books, LinkOut
Dallob AL, Sadick NS, Unger W, Lipert S, Geissler LA, Gregoire SL, Nguyen
HH,
Moore EC, Tanaka WK
Moore EC, Tanaka WK
Merck Research Laboratories, Rahway, New Jersey 07065.
The effects of the 5 alpha-reductase inhibitor, finasteride, on scalp
skin testosterone (T)
and dihydrotestosterone (DHT) levels were studied in patients with male pattern baldness.
In a double blind study, male patients undergoing hair transplantation were treated with
oral finasteride (5 mg/day) or placebo for 28 days. Scalp skin biopsies were obtained
before and after treatment for measurement of T and DHT by high pressure liquid
chromatography-RIA. In 10 male subjects studied at baseline, mean (+/- SEM) DHT
levels were significantly higher in bald (7.37 +/- 1.24 pmol/g) compared to hair-containing
(4.20 +/- 0.65 pmol/g) scalp, whereas there was no difference in mean T levels at
baseline. In bald scalp from 8 patients treated with finasteride, the mean DHT
concentration decreased from 6.40 +/- 1.07 pmol/g at baseline to 3.62 +/- 0.38 pmol/g
on day 28. Scalp T levels increased in 6 of 8 subjects treated with finasteride. Finasteride
decreased the mean serum DHT concentration from 1.36 +/- 0.18 nmol/L (n = 8) at
baseline to 0.46 +/- 0.10 nmol/L on day 28 and had no effect on serum T. There were no
significant changes in scalp or serum T or DHT in placebo-treated patients. In this study,
male subjects treated with 5 mg/day finasteride for 4 weeks had significantly decreased
concentrations of DHT in bald scalp, resulting in a mean level similar to the baseline levels
found in hair-containing scalp.
and dihydrotestosterone (DHT) levels were studied in patients with male pattern baldness.
In a double blind study, male patients undergoing hair transplantation were treated with
oral finasteride (5 mg/day) or placebo for 28 days. Scalp skin biopsies were obtained
before and after treatment for measurement of T and DHT by high pressure liquid
chromatography-RIA. In 10 male subjects studied at baseline, mean (+/- SEM) DHT
levels were significantly higher in bald (7.37 +/- 1.24 pmol/g) compared to hair-containing
(4.20 +/- 0.65 pmol/g) scalp, whereas there was no difference in mean T levels at
baseline. In bald scalp from 8 patients treated with finasteride, the mean DHT
concentration decreased from 6.40 +/- 1.07 pmol/g at baseline to 3.62 +/- 0.38 pmol/g
on day 28. Scalp T levels increased in 6 of 8 subjects treated with finasteride. Finasteride
decreased the mean serum DHT concentration from 1.36 +/- 0.18 nmol/L (n = 8) at
baseline to 0.46 +/- 0.10 nmol/L on day 28 and had no effect on serum T. There were no
significant changes in scalp or serum T or DHT in placebo-treated patients. In this study,
male subjects treated with 5 mg/day finasteride for 4 weeks had significantly decreased
concentrations of DHT in bald scalp, resulting in a mean level similar to the baseline levels
found in hair-containing scalp.
=============================================================
28.) Finasteride: the first 5 alpha-reductase inhibitor.
=============================================================
Pharmacotherapy 1993 Jul-Aug;13(4):309-25; discussion 325-9 Related Articles,
Books
28.) Finasteride: the first 5 alpha-reductase inhibitor.
=============================================================
Pharmacotherapy 1993 Jul-Aug;13(4):309-25; discussion 325-9 Related Articles,
Books
Sudduth SL, Koronkowski MJ
Program on Aging, School of Pharmacy, University of North Carolina,
Chapel Hill
27599-7360.
27599-7360.
Finasteride is a synthetic 4-azasteroid that is a specific competitive
inhibitor of 5
alpha-reductase, an intracellular enzyme that converts testosterone to dihydrotestosterone
(DHT). It has no binding affinity for androgen receptor sites and itself possesses no
androgenic, antiandrogenic, or other steroid hormone-related properties. It is well
absorbed after oral administration, with absolute bioavailability in humans of 63% (range
34-108%). The mean time to maximum concentration is 1-2 hours, and it is
approximately 90% plasma protein bound. The elimination half-life averages 6-8 hours.
The agent is metabolized to a series of five metabolites, of which two are active and
possess less than 20% of the 5 alpha-reductase activity of finasteride. Little is known
about potential drug interactions, although they appear to be minimal and not clinically
relevant. The drug is indicated for the treatment of symptomatic benign prostatic
hyperplasia. Its efficacy in regression of prostate gland enlargement is rapid and
predictable, although correlation with subsequent improvement in urinary flow and
symptoms is highly variable. Dosages of 0.5-100 mg/day regress prostate enlargement;
the recommended dosage is 5 mg once/day. Finasteride may hold promise for other
DHT-mediated disorders such as acne, facial hirsutism, frontal lobe alopecia, and
prostate cancer, but its use in these conditions remains investigational. The frequency of
adverse drug events is low, with the most common side effects being impotence,
decreased libido, and decreased volume of ejaculate. No reports of intentional overdose
have been reported, and dosages of up to 80 mg/day for 3 months have been taken
without adverse effect.
alpha-reductase, an intracellular enzyme that converts testosterone to dihydrotestosterone
(DHT). It has no binding affinity for androgen receptor sites and itself possesses no
androgenic, antiandrogenic, or other steroid hormone-related properties. It is well
absorbed after oral administration, with absolute bioavailability in humans of 63% (range
34-108%). The mean time to maximum concentration is 1-2 hours, and it is
approximately 90% plasma protein bound. The elimination half-life averages 6-8 hours.
The agent is metabolized to a series of five metabolites, of which two are active and
possess less than 20% of the 5 alpha-reductase activity of finasteride. Little is known
about potential drug interactions, although they appear to be minimal and not clinically
relevant. The drug is indicated for the treatment of symptomatic benign prostatic
hyperplasia. Its efficacy in regression of prostate gland enlargement is rapid and
predictable, although correlation with subsequent improvement in urinary flow and
symptoms is highly variable. Dosages of 0.5-100 mg/day regress prostate enlargement;
the recommended dosage is 5 mg once/day. Finasteride may hold promise for other
DHT-mediated disorders such as acne, facial hirsutism, frontal lobe alopecia, and
prostate cancer, but its use in these conditions remains investigational. The frequency of
adverse drug events is low, with the most common side effects being impotence,
decreased libido, and decreased volume of ejaculate. No reports of intentional overdose
have been reported, and dosages of up to 80 mg/day for 3 months have been taken
without adverse effect.
=============================================================
29.) Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia.
=============================================================
Arch Pathol Lab Med 2000 Apr;124(4):625-7 Related Articles, Books, LinkOut
29.) Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia.
=============================================================
Arch Pathol Lab Med 2000 Apr;124(4):625-7 Related Articles, Books, LinkOut
Zimmerman RL, Fogt F, Cronin D, Lynch R
Departments of Pathology & Laboratory Medicine, Presbyterian Medical
Center,
University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
Finasteride has been associated with the development of gynecomastia.
Although
cytoplasmic vacuolization has been noted in prostatic epithelium in men taking this drug,
we found no documentation of the cytologic changes in finasteride-associated
gynecomastia. We present the case of a 53-year-old man who developed unilateral
gynecomastia following finasteride therapy for alopecia. A fine-needle aspiration biopsy of
the mass was diagnosed as adenocarcinoma on the basis of nuclear atypia and particularly
because of cytoplasmic vacuolization. Subsequent excisional biopsy revealed benign
gynecomastia with no evidence of malignant change. The ductal epithelium did exhibit
cytoplasmic vacuolization similar to that described in the prostate following finasteride
therapy. We believe this is the first reported case documenting the cytologic changes seen
in gynecomastia secondary to finasteride therapy. Cytoplasmic vacuolization in this setting
should not be considered evidence of malignancy in men with gynecomastia. As with
gynecomastia in general, extreme caution should be used before rendering a cytologic
diagnosis of malignancy.
cytoplasmic vacuolization has been noted in prostatic epithelium in men taking this drug,
we found no documentation of the cytologic changes in finasteride-associated
gynecomastia. We present the case of a 53-year-old man who developed unilateral
gynecomastia following finasteride therapy for alopecia. A fine-needle aspiration biopsy of
the mass was diagnosed as adenocarcinoma on the basis of nuclear atypia and particularly
because of cytoplasmic vacuolization. Subsequent excisional biopsy revealed benign
gynecomastia with no evidence of malignant change. The ductal epithelium did exhibit
cytoplasmic vacuolization similar to that described in the prostate following finasteride
therapy. We believe this is the first reported case documenting the cytologic changes seen
in gynecomastia secondary to finasteride therapy. Cytoplasmic vacuolization in this setting
should not be considered evidence of malignancy in men with gynecomastia. As with
gynecomastia in general, extreme caution should be used before rendering a cytologic
diagnosis of malignancy.
=============================================================
30.) Reversible painful gynaecomastia induced by low dose finasteride (1 mg/day).
=============================================================
Australas J Dermatol 2000 Feb;41(1):55 Related Articles, Books, LinkOut
30.) Reversible painful gynaecomastia induced by low dose finasteride (1 mg/day).
=============================================================
Australas J Dermatol 2000 Feb;41(1):55 Related Articles, Books, LinkOut
Wade MS, Sinclair RD
Publication Types:
Letter
=============================================================
Letter
=============================================================
=============================================================
31.) Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts
in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men
and postmenopausal women.
=============================================================
J Investig Dermatol Symp Proc 1999 Dec;4(3):282-4 Related Articles, Books, LinkOut
31.) Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts
in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men
and postmenopausal women.
=============================================================
J Investig Dermatol Symp Proc 1999 Dec;4(3):282-4 Related Articles, Books, LinkOut
Whiting DA, Waldstreicher J, Sanchez M, Kaufman KD
Baylor Hair Research and Treatment Center, Baylor University Medical
Center, Dallas,
Texas 75246, USA.
Texas 75246, USA.
Hair regrowth was evaluated by histologic analysis in men and women
treated for
androgenetic alopecia, by counting follicles in horizontal sections of scalp biopsies. Serial
4mm punch biopsies were taken at baseline and after 12mo of treatment from the
transitional area of hair thinning between normal hair and vertex balding in men, and in an
area of frontal/parietal thinning in women. Horizontal sections of reticular and papillary
dermis were read by one observer, blinded to patient, treatment, and time. All terminal
hair bulbs, terminal anagen and telogen hairs, and vellus and vellus-like miniaturized hairs
were counted. Twenty-six men aged 18-41y, comprising 14 on finasteride 1 mg daily and
12 on placebo, and 94 postmenopausal women, aged 41-60y, comprising 44 on
finasteride 1 mg daily and 50 on placebo, were evaluated. In the male study, the terminal
hairs increased from a mean baseline count of 15.5-20.9 after 12mo of finasteride, versus
17.3-18.3 in the placebo patients. The miniaturized hairs decreased from 26.7 to 23.6
with finasteride versus 21.3-20.3 with placebo. The terminal-to-vellus ratio increased
more in the finasteride than in the placebo patients, suggesting some reversal of the
miniaturization process with finasteride. In the female study, no significant differences in
follicular counts were found between the finasteride and placebo groups after 12mo of
treatment. Follicular counts in horizontal sections provide an informative adjunct to
noninvasive measures used in hair growth studies. Finasteride appears to be capable of
reversing hair miniaturization in androgenetic alopecia in young to middle-aged men, but
not in postmenopausal women.
androgenetic alopecia, by counting follicles in horizontal sections of scalp biopsies. Serial
4mm punch biopsies were taken at baseline and after 12mo of treatment from the
transitional area of hair thinning between normal hair and vertex balding in men, and in an
area of frontal/parietal thinning in women. Horizontal sections of reticular and papillary
dermis were read by one observer, blinded to patient, treatment, and time. All terminal
hair bulbs, terminal anagen and telogen hairs, and vellus and vellus-like miniaturized hairs
were counted. Twenty-six men aged 18-41y, comprising 14 on finasteride 1 mg daily and
12 on placebo, and 94 postmenopausal women, aged 41-60y, comprising 44 on
finasteride 1 mg daily and 50 on placebo, were evaluated. In the male study, the terminal
hairs increased from a mean baseline count of 15.5-20.9 after 12mo of finasteride, versus
17.3-18.3 in the placebo patients. The miniaturized hairs decreased from 26.7 to 23.6
with finasteride versus 21.3-20.3 with placebo. The terminal-to-vellus ratio increased
more in the finasteride than in the placebo patients, suggesting some reversal of the
miniaturization process with finasteride. In the female study, no significant differences in
follicular counts were found between the finasteride and placebo groups after 12mo of
treatment. Follicular counts in horizontal sections provide an informative adjunct to
noninvasive measures used in hair growth studies. Finasteride appears to be capable of
reversing hair miniaturization in androgenetic alopecia in young to middle-aged men, but
not in postmenopausal women.
=============================================================
32.) Improvement in androgenetic alopecia in 53-76-year-old men using oral finasteride.
=============================================================
Int J Dermatol 1999 Dec;38(12):928-30 Related Articles, Books, LinkOut
32.) Improvement in androgenetic alopecia in 53-76-year-old men using oral finasteride.
=============================================================
Int J Dermatol 1999 Dec;38(12):928-30 Related Articles, Books, LinkOut
Brenner S, Matz H
Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv,
Israel.
Twenty-eight men with AGA, aged 53-76 years (mean, 65 years), were
selected to
participate in this trial from a double blind, placebo controlled, multicenter study of
subjects with moderate symptoms of BPH. Patients received either finasteride 5 mg or
placebo daily for 24 months. Hair counts were performed at entry to the study and at 6,
12, 18, and 24 months. Hair counts were made directly on the scalp in a circular target
area 1 in in diameter, located in the center of a template. The template was applied in
such a way that its counting window fell on the most balding scalp area, which remained
the same for each patient.11 At each hair counting session, patients were asked about
side-effects and questioned about their sex life. Time trend and differences between
groups were examined using a one-way (treatment) MANOVA with repeated measures
(baseline, 6, 12, 18, and 24 months). Additional two-tailed t-tests were performed to
compare the two groups at each point of time. P < 0.05 was considered to be significant.
participate in this trial from a double blind, placebo controlled, multicenter study of
subjects with moderate symptoms of BPH. Patients received either finasteride 5 mg or
placebo daily for 24 months. Hair counts were performed at entry to the study and at 6,
12, 18, and 24 months. Hair counts were made directly on the scalp in a circular target
area 1 in in diameter, located in the center of a template. The template was applied in
such a way that its counting window fell on the most balding scalp area, which remained
the same for each patient.11 At each hair counting session, patients were asked about
side-effects and questioned about their sex life. Time trend and differences between
groups were examined using a one-way (treatment) MANOVA with repeated measures
(baseline, 6, 12, 18, and 24 months). Additional two-tailed t-tests were performed to
compare the two groups at each point of time. P < 0.05 was considered to be significant.
=============================================================
33.) New topical antiandrogenic formulations can stimulate hair growth in human bald
scalp grafted onto mice.
=============================================================
Int J Pharm 2000 Jan 20;194(1):125-34 Related Articles, Books, LinkOut
33.) New topical antiandrogenic formulations can stimulate hair growth in human bald
scalp grafted onto mice.
=============================================================
Int J Pharm 2000 Jan 20;194(1):125-34 Related Articles, Books, LinkOut
Sintov A, Serafimovich S, Gilhar A
Ben-Gurion University of the Negev, The Institutes for Applied Research,
PO Box 653,
Beer-Sheva, Israel. asintov@bgumail.bgu.ac.il
Beer-Sheva, Israel. asintov@bgumail.bgu.ac.il
The purpose of this study was to test the ability of topical formulations
of finasteride and
flutamide to re-enlarge hair follicles in male-pattern baldness. This was evaluated by an
experimental model of human scalp skin graft transplanted onto SCID mice. A
comparison was made between formulations containing finasteride and flutamide, and a
vehicle formulation in terms of the mean hairs per graft, length, diameter of the shafts, and
structures of the growth stages of the hair. Flutamide and finasteride had a significantly
higher effect (P<0.05) than the placebo in all the tested parameters, but flutamide
demonstrated more hair per graft and longer hair shafts than finasteride (P<0.05). The
number of hairs per graft for flutamide and finasteride groups were 1.22+/-0. 47 and
0.88+/-0.95 hairs/0.5 mm2 graft, respectively, versus 0. 35+/-0.6 hairs/graft for
vehicle-treated graft. Similarly, hair lengths for flutamide and finasteride were 5.82+/-0.50
and 4.50+/-0. 32 mm, respectively, versus 2.83+/-0.18 mm for the vehicle-treated grafts.
An in vitro diffusion study of flutamide gel using hairless mouse skin demonstrated the
beneficial effect of the vehicle composition in comparison with a hydroalcoholic solution
or a gel containing no penetration enhancer. It is therefore suggested that this topical
composition containing flutamide or finasteride may effectively result in regression of
male-pattern baldness.
flutamide to re-enlarge hair follicles in male-pattern baldness. This was evaluated by an
experimental model of human scalp skin graft transplanted onto SCID mice. A
comparison was made between formulations containing finasteride and flutamide, and a
vehicle formulation in terms of the mean hairs per graft, length, diameter of the shafts, and
structures of the growth stages of the hair. Flutamide and finasteride had a significantly
higher effect (P<0.05) than the placebo in all the tested parameters, but flutamide
demonstrated more hair per graft and longer hair shafts than finasteride (P<0.05). The
number of hairs per graft for flutamide and finasteride groups were 1.22+/-0. 47 and
0.88+/-0.95 hairs/0.5 mm2 graft, respectively, versus 0. 35+/-0.6 hairs/graft for
vehicle-treated graft. Similarly, hair lengths for flutamide and finasteride were 5.82+/-0.50
and 4.50+/-0. 32 mm, respectively, versus 2.83+/-0.18 mm for the vehicle-treated grafts.
An in vitro diffusion study of flutamide gel using hairless mouse skin demonstrated the
beneficial effect of the vehicle composition in comparison with a hydroalcoholic solution
or a gel containing no penetration enhancer. It is therefore suggested that this topical
composition containing flutamide or finasteride may effectively result in regression of
male-pattern baldness.
=============================================================
34.) Current management of androgenetic alopecia in men.
=============================================================
Eur J Dermatol 1999 Dec;9(8):606-9 Related Articles, Books, LinkOut
34.) Current management of androgenetic alopecia in men.
=============================================================
Eur J Dermatol 1999 Dec;9(8):606-9 Related Articles, Books, LinkOut
Wolff H, Kunte C
Klinik fur Dermatologie und Allergologie,
Ludwig-Maximilians-Universitat,
Frauenlobstrasse 9-11, D-80337, Munchen, Germany. hans.wolff@lrz.uni-muenchen.de
Frauenlobstrasse 9-11, D-80337, Munchen, Germany. hans.wolff@lrz.uni-muenchen.de
Androgenetic alopecia (AGA) is a common dermatological condition
affecting both men
and women. Until recently there has been little interest in AGA as a clinical condition,
largely due to the lack of any genuinely effective treatment for it. A number of "remedies"
exist, such as vitamin supplements, which are not generally harmful but which have no
proven efficacy in promoting hair growth or preventing further hair loss. Hair systems and
surgery provide camouflage for the symptoms but do not effect a cure. By far the most
promising approaches to the treatment of AGA are drug therapies, such as minoxidil and
finasteride. Finasteride, an inhibitor of the type II 5alpha-reductase that converts
testosterone to dihydrotestosterone, has been shown to prevent further hair loss, and
promotes new hair growth in the majority of the men taking part in clinical trials. Tailored
drug approaches like this offer the greatest hope for the successful future treatment of
alopecia.
and women. Until recently there has been little interest in AGA as a clinical condition,
largely due to the lack of any genuinely effective treatment for it. A number of "remedies"
exist, such as vitamin supplements, which are not generally harmful but which have no
proven efficacy in promoting hair growth or preventing further hair loss. Hair systems and
surgery provide camouflage for the symptoms but do not effect a cure. By far the most
promising approaches to the treatment of AGA are drug therapies, such as minoxidil and
finasteride. Finasteride, an inhibitor of the type II 5alpha-reductase that converts
testosterone to dihydrotestosterone, has been shown to prevent further hair loss, and
promotes new hair growth in the majority of the men taking part in clinical trials. Tailored
drug approaches like this offer the greatest hope for the successful future treatment of
alopecia.
=============================================================
35.) Immunohistochemical localization of types 1 and 2 5alpha-reductase in human scalp.
=============================================================
Br J Dermatol 1999 Sep;141(3):481-91 Related Articles, Books, LinkOut
35.) Immunohistochemical localization of types 1 and 2 5alpha-reductase in human scalp.
=============================================================
Br J Dermatol 1999 Sep;141(3):481-91 Related Articles, Books, LinkOut
Bayne EK, Flanagan J, Einstein M, Ayala J, Chang B, Azzolina B, Whiting
DA, Mumford
RA, Thiboutot D, Singer II, Harris G
RA, Thiboutot D, Singer II, Harris G
Merck Research Laboratories, PO Box 2000, Rahway, NJ 07065, USA.
ellen_bayne@merck.com
ellen_bayne@merck.com
The predominant form of 5alpha-reductase (5aR) in human scalp is 5aR1.
None the less,
clinical studies have shown that finasteride, a selective inhibitor of 5aR2, decreases scalp
dihydrotestosterone and promotes hair growth in men with androgenetic alopecia.
Immunolocalization studies were thus carried out to examine 5aR isozyme distribution
within scalp and, in particular, to determine whether 5aR2 might be associated with hair
follicles. 5aR2 was localized using both a rabbit polyclonal and a mouse monoclonal
antibody. 5aR1 was detected with a mouse monoclonal antibody. The specificity of these
reagents was demonstrated both by immunofluorescence and Western blot analyses of
COS cells overexpressing human 5aR1 or 5aR2. When cryosections of scalp from men
with androgenetic alopecia were stained with antibody against 5aR2, using
immunoperoxidase avidin-biotin complex methodology, immunostaining was observed in
the inner layer of the outer root sheath and, in more proximal regions of the follicle, in the
inner root sheath. Staining was also prominent in the infundibular region of the follicle, with
less intense staining extending throughout the granular layer of the epidermis. Some
staining was also seen in sebaceous ducts. Similar results were obtained with both the
polyclonal and monoclonal 5aR2 antibodies. In contrast, in scalp cryosections stained
with antibody to 5aR1, no immunostaining was observed within hair follicles. Intense
staining for the type 1 isozyme was, however, detected within sebaceous glands. Our
immunolocalization data suggest that the results seen in clinical trials of men with male
pattern hair loss treated with finasteride may be due, at least in part, to local inhibition of
5aR2 within the hair follicle.
clinical studies have shown that finasteride, a selective inhibitor of 5aR2, decreases scalp
dihydrotestosterone and promotes hair growth in men with androgenetic alopecia.
Immunolocalization studies were thus carried out to examine 5aR isozyme distribution
within scalp and, in particular, to determine whether 5aR2 might be associated with hair
follicles. 5aR2 was localized using both a rabbit polyclonal and a mouse monoclonal
antibody. 5aR1 was detected with a mouse monoclonal antibody. The specificity of these
reagents was demonstrated both by immunofluorescence and Western blot analyses of
COS cells overexpressing human 5aR1 or 5aR2. When cryosections of scalp from men
with androgenetic alopecia were stained with antibody against 5aR2, using
immunoperoxidase avidin-biotin complex methodology, immunostaining was observed in
the inner layer of the outer root sheath and, in more proximal regions of the follicle, in the
inner root sheath. Staining was also prominent in the infundibular region of the follicle, with
less intense staining extending throughout the granular layer of the epidermis. Some
staining was also seen in sebaceous ducts. Similar results were obtained with both the
polyclonal and monoclonal 5aR2 antibodies. In contrast, in scalp cryosections stained
with antibody to 5aR1, no immunostaining was observed within hair follicles. Intense
staining for the type 1 isozyme was, however, detected within sebaceous glands. Our
immunolocalization data suggest that the results seen in clinical trials of men with male
pattern hair loss treated with finasteride may be due, at least in part, to local inhibition of
5aR2 within the hair follicle.
=============================================================
36.) The psychosocial consequences of androgenetic alopecia: a review of the research
literature.
=============================================================
Br J Dermatol 1999 Sep;141(3):398-405 Related Articles, Books, LinkOut
36.) The psychosocial consequences of androgenetic alopecia: a review of the research
literature.
=============================================================
Br J Dermatol 1999 Sep;141(3):398-405 Related Articles, Books, LinkOut
Cash TF
Department of Psychology, Old Dominion University, Norfolk, VA
23529-0267, USA.
Androgenetic alopecia is a common dermatological condition, with
potentially adverse
psychosocial sequelae. The present review critically examines scientific evidence
concerning the effects of androgenetic hair loss on social processes and psychological
functioning, as well as the psychosocial outcomes of medical treatments. Research
confirms a negative but modest effect of visible hair loss on social perceptions. More
importantly, androgenetic alopecia is typically experienced as a moderately stressful
condition that diminishes body image satisfaction. Deleterious effects on self-esteem and
certain facets of psychological adjustment are more apparent among women than men
and among treatment-seeking patients. Various 'risk factors' vis-a-vis the psychological
adversity of androgenetic alopecia are identified. Medical treatments, i.e. minoxidil and
finasteride, appear to have some psychological efficacy. A conceptual model is delineated
to explain the psychological effects of hair loss and its treatment. Directions for needed
research are discussed. Strategies are presented for the clinical management of
psychological issues among these patients.
psychosocial sequelae. The present review critically examines scientific evidence
concerning the effects of androgenetic hair loss on social processes and psychological
functioning, as well as the psychosocial outcomes of medical treatments. Research
confirms a negative but modest effect of visible hair loss on social perceptions. More
importantly, androgenetic alopecia is typically experienced as a moderately stressful
condition that diminishes body image satisfaction. Deleterious effects on self-esteem and
certain facets of psychological adjustment are more apparent among women than men
and among treatment-seeking patients. Various 'risk factors' vis-a-vis the psychological
adversity of androgenetic alopecia are identified. Medical treatments, i.e. minoxidil and
finasteride, appear to have some psychological efficacy. A conceptual model is delineated
to explain the psychological effects of hair loss and its treatment. Directions for needed
research are discussed. Strategies are presented for the clinical management of
psychological issues among these patients.
=============================================================
37.) Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in
men with male pattern hair loss.
=============================================================
J Am Acad Dermatol 1999 Oct;41(4):555-63 Related Articles, Books, LinkOut
37.) Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in
men with male pattern hair loss.
=============================================================
J Am Acad Dermatol 1999 Oct;41(4):555-63 Related Articles, Books, LinkOut
Roberts JL, Fiedler V, Imperato-McGinley J, Whiting D, Olsen E, Shupack
J, Stough D,
DeVillez R, Rietschel R, Savin R, Bergfeld W, Swinehart J, Funicella T, Hordinsky M,
Lowe N, Katz I, Lucky A, Drake L, Price VH, Weiss D, Whitmore E, Millikan L, Muller
S, Gencheff C, et al
DeVillez R, Rietschel R, Savin R, Bergfeld W, Swinehart J, Funicella T, Hordinsky M,
Lowe N, Katz I, Lucky A, Drake L, Price VH, Weiss D, Whitmore E, Millikan L, Muller
S, Gencheff C, et al
Northwest Cutaneous Research Specialists, Portland, Oregan,
USA.
BACKGROUND: Androgenetic alopecia is a common condition of adult
men.
Finasteride, a type 2 5alpha-reductase inhibitor, decreases the formation of
dihydrotestosterone from testosterone. OBJECTIVE: Two separate clinical studies were
conducted to establish the optimal dose of finasteride in men with this condition.
METHODS: Men from 18 to 36 years of age with moderate vertex male pattern hair loss
received finasteride 5, 1, 0.2, or 0.01 mg/day or placebo based on random assignment.
Efficacy was determined by scalp hair counts, patient self-assessment, investigator
assessment, and assessment of clinical photographs. Safety was assessed by clinical and
laboratory measurements and by analysis of adverse experiences. RESULTS: Efficacy
was demonstrated for all end points for finasteride at doses of 0.2 mg/day or higher, with
1 and 5 mg demonstrating similar efficacy that was superior to lower doses. Efficacy of
the 0.01 mg dose was similar to placebo. No significant safety issues were identified in the
trials. CONCLUSION: Finasteride 1 mg/day is the optimal dose for the treatment of men
with male pattern hair loss and was subsequently identified for further clinical
development.
Finasteride, a type 2 5alpha-reductase inhibitor, decreases the formation of
dihydrotestosterone from testosterone. OBJECTIVE: Two separate clinical studies were
conducted to establish the optimal dose of finasteride in men with this condition.
METHODS: Men from 18 to 36 years of age with moderate vertex male pattern hair loss
received finasteride 5, 1, 0.2, or 0.01 mg/day or placebo based on random assignment.
Efficacy was determined by scalp hair counts, patient self-assessment, investigator
assessment, and assessment of clinical photographs. Safety was assessed by clinical and
laboratory measurements and by analysis of adverse experiences. RESULTS: Efficacy
was demonstrated for all end points for finasteride at doses of 0.2 mg/day or higher, with
1 and 5 mg demonstrating similar efficacy that was superior to lower doses. Efficacy of
the 0.01 mg dose was similar to placebo. No significant safety issues were identified in the
trials. CONCLUSION: Finasteride 1 mg/day is the optimal dose for the treatment of men
with male pattern hair loss and was subsequently identified for further clinical
development.
=============================================================
38.) The effects of finasteride on scalp skin and serum androgen levels in men with
androgenetic alopecia.
=============================================================
J Am Acad Dermatol 1999 Oct;41(4):550-4 Related Articles, Books, LinkOut
38.) The effects of finasteride on scalp skin and serum androgen levels in men with
androgenetic alopecia.
=============================================================
J Am Acad Dermatol 1999 Oct;41(4):550-4 Related Articles, Books, LinkOut
Drake L, Hordinsky M, Fiedler V, Swinehart J, Unger WP, Cotterill PC,
Thiboutot DM,
Lowe N, Jacobson C, Whiting D, Stieglitz S, Kraus SJ, Griffin EI, Weiss D, Carrington
P, Gencheff C, Cole GW, Pariser DM, Epstein ES, Tanaka W, Dallob A, Vandormael
K, Geissler L, Waldstreicher J
Lowe N, Jacobson C, Whiting D, Stieglitz S, Kraus SJ, Griffin EI, Weiss D, Carrington
P, Gencheff C, Cole GW, Pariser DM, Epstein ES, Tanaka W, Dallob A, Vandormael
K, Geissler L, Waldstreicher J
University of Oklahoma Health Sciences, Oklahoma City, USA.
BACKGROUND: Data suggest that androgenetic alopecia is a process
dependent on
dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2
5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair
growth in men with androgenetic alopecia. OBJECTIVE: We attempted to determine the
effect of finasteride on scalp skin and serum androgens. METHODS: Men with
androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving
0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days. RESULTS: Scalp
skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56.
5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride,
respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%,
71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups,
respectively. CONCLUSION: In this study, doses of finasteride as low as 0.2 mg per
day maximally decreased both scalp skin and serum DHT levels. These data support the
rationale used to conduct clinical trials in men with male pattern hair loss at doses of
finasteride between 0.2 and 5 mg.
dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2
5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair
growth in men with androgenetic alopecia. OBJECTIVE: We attempted to determine the
effect of finasteride on scalp skin and serum androgens. METHODS: Men with
androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving
0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days. RESULTS: Scalp
skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56.
5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride,
respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%,
71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups,
respectively. CONCLUSION: In this study, doses of finasteride as low as 0.2 mg per
day maximally decreased both scalp skin and serum DHT levels. These data support the
rationale used to conduct clinical trials in men with male pattern hair loss at doses of
finasteride between 0.2 and 5 mg.
=============================================
39.) Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review.
==============================================
J Clin Aesthet Dermatol. 2016 Jul;9(7):56-62. Epub 2016 Jul 1.
Hirshburg JM1, Kelsey PA2, Therrien CA2, Gavino AC1, Reichenberg JS1.
Author information
1Dell Medical School, University of Texas at Austin, Austin, Texas;
2University of Texas Medical Branch, Galveston, Texa.
Abstract
Finasteride and dutasteride, both 5-alpha reductase inhibitors, are considered first-line treatment for androgenetic hair loss in men and used increasingly in women. In each case, patients are expected to take the medications indefinitely despite the lack of research regarding long-term adverse effects. Concerns regarding the adverse effects of these medications has led the United States National Institutes of Health to add a link for post-finasteride syndrome to its Genetic and Rare Disease Information Center. Herein, the authors report the results of a literature search reviewing adverse events of 5-alpha reductase inhibitors as they relate to prostate cancer, psychological effects, sexual health, and use in women. Several large studies found no increase in incidence of prostate cancer, a possible increase of high-grade cancer when detected, and no change in survival rate with 5-alpha reductase inhibitor use. Currently, there is no direct link between 5-alpha reductase inhibitor use and depression; however, several small studies have led to depression being listed as a side effect on the medication packaging. Sexual effects including erectile dysfunction and decreased libido and ejaculate were reported in as many as 3.4 to 15.8 percent of men. To date, there are very few studies evaluating 5-alpha reductase inhibitor use in women. Risks include birth defects in male fetuses if used in pregnancy, decreased libido, headache, gastrointestinal discomfort, and isolated reports of changes in menstruation, acne, and dizziness. Overall, 5-alpha reductase inhibitors were well-tolerated in both men and women, but not without risk, highlighting the importance of patient education prior to treatment.
=========================================================
40.) Interventions for Female Pattern Hair Loss.
========================================================
JAMA Dermatol. 2017 Jan 18. doi: 10.1001/jamadermatol.2016.5790. [Epub ahead of print]
van Zuuren EJ1, Fedorowicz Z2.
Author information
1Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.
2Bahrain Branch of Cochrane, Awali, Bahrain.
Abstract
Clinical Question:
Which interventions are effective and safe for treating female pattern hair loss (FPHL)?
Bottom Line:
There was low- to moderate-quality evidence that topical minoxidil (2% and 5%) was associated with improvements in FPHL. There was low-quality evidence that finasteride was no more effective than placebo. There were inconsistent results from studies that laser devices were effective, but total hair count increased compared with baseline (moderate- to low-quality evidence). Most treatments were not associated with higher adverse event rates than placebo.
=======================================================
41.) Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases.
======================================================
Oncotarget. 2016 Dec 13;7(50):82074-82084. doi: 10.18632/oncotarget.12617.
Wu M1, Yu Q1, Li Q1.
Author information
1Department of Plastic and Reconstruction Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
Alopecia is a dermatological condition with limited therapeutic options. Only two drugs, finasteride and minoxidil, are approved by FDA for alopecia treatment. However, little is known about the differences in adverse effects between these two drugs. We examined the clinical reports submitted to the FDA Adverse Event Reporting System (FAERS) from 2004 to 2014. For both female and males, finasteride was found to be more associated with reproductive toxicity as compared to minoxidil. Among male alopecia cases, finasteride was significantly more concurrent with several forms of sexual dysfunction. Among female alopecia cases, finasteride was significantly more concurrent with harm to fetus and disorder of uterus. In addition, drug-gene network analysis indicated that finasteride could profoundly disturb pathways related to sex hormone signaling and oocyte maturation. These findings could provide clues for subsequent toxicological research. Taken together, this analysis suggested that finasteride could be more liable to various reproductive adverse effects. Some of these adverse effects have yet to be warned in FDA-approved drug label. This information can help improve the treatment regimen of alopecia and post-marketing regulation of drug products.
=====================================
42.) Finasteride in Hidradenitis Suppurativa: A "Male" Therapy for a Predominantly "Female" Disease.
======================================
J Clin Aesthet Dermatol. 2016 Jun;9(6):44-50. Epub 2016 Jun 1.
Khandalavala BN1, Do MV1.
Author information
1University of Nebraska Medical Center, Omaha, Nebraska.
Abstract
OBJECTIVE:
Hidradenitis suppurativa is associated with obesity and metabolic syndrome, and a hormonal component has been implicated. Finasteride is an anti-androgenic agent used for benign prostatic hypertrophy, androgenic alopecia, and, in females, hirsutism. Finasteride is an inhibitor of type II5 alpha-reductase that reduces dihydrotestosterone levels and appears to alter end-organ sensitivity of the folliculopilosebaceous unit. The objective is to review the use of finasteride for hidradenitis suppurativa.
DESIGN:
Review of the literature.
SETTING:
Clinical treatment of patients with hidradenitis suppurativa. Measurement/participants: Five publications described the use for hidradenitis suppurativa. Four global case reports cited 13 individual patients, four male and nine female. Females included three adolescent patients and a child aged seven with precocious puberty. In the United States, finasteride in obese male adults was mentioned to be helpful.
RESULTS:
Oral finasteride, as monotherapy or additional therapy was utilized for advanced hidradenitis suppurativa. The outcomes were largely favorable, with complete resolution in three patients. A latency period was evident in a majority. Limited, or continuous use for up to six years, was detailed. Response to reintroduction was successful. A benign safety profile with excellent tolerability was described. Teratogenicity of finasteride was addressed and contraception advocated in female patients. Sexual adverse effects were not ascertained.
CONCLUSION:
In hidradenitis suppurativa, finasteride could be considered in adults of both sexes as well as in select female children and adolescents, particularly those with concurrent metabolic and hormonal alterations present. Finasteride provides another highly effective, durable, relatively safe, and inexpensive option in the treatment of hidradenitis suppurativa.
======================================================
43.) Hidradenitis suppurativa treated with finasteride.
======================================================
Joseph MA1, Jayaseelan E, Ganapathi B, Stephen J.
Author information
1Department of Dermatology, St. John's Medical College Hospital, Bangalore, India. maryjoseph1@rediffmail.com
Abstract
BACKGROUND:
Hidradenitis suppurativa (HS) is a distressing condition for which no satisfactory treatment is available. Studies on hormonal mechanisms responsible for HS point towards altered end-organ sensitivity, probably related to the enzyme 5a reductase that converts testosterone to dihydrotestosterone. Finasteride, an inhibitor of type II 5a reductase, has been reported to be effective in recalcitrant HS.
AIM:
To study the effectiveness and tolerability of finasteride in patients with HS in a preliminary trial.
METHODS:
Seven patients (five women and two men) with HS that was not responding well to antibiotics were treated with finasteride at a dose of 5 mg/day as monotherapy. Clinical response was assessed at regular intervals. Patients were followed up for periods varying from 8 months to 2 years.
RESULTS:
Six patients improved significantly and three of them had complete healing of lesions. Two patients who were followed up for more than 1 year experienced remissions lasting 8-18 months. The drug was generally well tolerated; however, two women complained of breast enlargement.
CONCLUSION:
The results of this preliminary study suggest that finasteride is an effective therapeutic option in HS.
======================================================
44.) The use of hormonal agents in the treatment of acne.
=======================================================
Semin Cutan Med Surg. 2016 Jun;35(2):68-73. doi: 10.12788/j.sder.2016.027.
Hassoun LA1, Chahal DS2, Sivamani RK3, Larsen LN4.
Author information
1School of Medicine, University of California-Davis, Sacramento, California, USA.
2School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
3Department of Dermatology, University of California-Davis, Sacramento, California, USA.
4Department of Dermatology, University of California-Davis, Sacramento, California, USA. lnlarsen@ucdavis.edu.
Abstract
Hormones and androgens play an important role in the pathogenesis of acne. Multiple hormonal modulators are now available for the treatment of acne. The efficacies and side effects of currently available hormonal agents are reviewed here including the use of oral contraceptives, spironolactone, flutamide, cyproterone acetate, finasteride, and cortexolone 17α-propionate. Hormonal therapies are an efficacious treatment option for acne among females. With the growing need to reduce antibiotic exposures, hormonal therapies should be more widely studied and incorporated into acne treatment strategies.
=================================================
45.) Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia.
=================================================
Clin Epidemiol. 2017 Feb 10;9:83-91. doi: 10.2147/CLEP.S124674. eCollection 2017.
Hagberg KW1, Divan HA2, Fang SC2, Nickel JC3, Jick SS1.
Author information
1Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington.
2New England Research Institutes, Inc., Watertown, MA, USA.
3Kingston General Hospital, Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND:
Clinical trial results suggest that 5-alpha reductase inhibitors (5ARIs) for the treatment of benign prostatic hyperplasia (BPH) may increase the risk of gynecomastia and male breast cancer, but epidemiological studies have been limited.
PATIENTS AND METHODS:
We conducted a cohort study with nested case-control analyses using the UK Clinical Practice Research Datalink. We identified men diagnosed with BPH who were free from Klinefelter syndrome, prostate, genital or urinary cancer, prostatectomy or orchiectomy, or evidence of gynecomastia or breast cancer. Patients entered the cohort at age ≥40 years and at least 3 years after the start of their electronic medical record. We classified exposure as 5ARIs (alone or in combination with alpha blockers [ABs]), AB only, or unexposed to 5ARIs and ABs. Cases were men who had a first-time diagnosis of gynecomastia or breast cancer. Incidence rates and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in the gynecomastia analysis and crude and adjusted odds ratios (ORs) with 95% CIs in both analyses were calculated.
RESULTS:
Compared to no exposure, gynecomastia risk was elevated for users of 5ARIs (alone or in combination with ABs) in both the cohort (IRR=3.55, 95% CI 3.05-4.14) and case-control analyses (OR=3.31, 95% CI 2.66-4.10), whereas the risk was null for users of AB only. The increased risk of gynecomastia with the use of 5ARIs persisted regardless of the number of prescriptions, exposure timing, and presence or absence of concomitant prescriptions for drugs known to be associated with gynecomastia. The risk was higher for dutasteride than for finasteride. 5ARI users did not have an increased risk of breast cancer compared to unexposed men (OR=1.52, 95% CI 0.61-3.80).
CONCLUSION:
In men with BPH, 5ARIs significantly increased the risk of gynecomastia, but not breast cancer, compared to AB use and no exposure.
=================================================
46.) Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome.
=================================================
Skin Appendage Disord. 2017 Jan;2(3-4):120-129. doi: 10.1159/000450617. Epub 2016 Sep 23.
Fertig R1, Shapiro J2, Bergfeld W3, Tosti A1.
Author information
1Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Fla, USA.
2The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, N.Y., USA.
3Departments of Dermatopathology Fellowship, Cleveland Clinic, Cleveland, Ohio, USA; Departments of Pathology, Dermatopathology Fellowship, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
Postfinasteride syndrome (PFS) is a term recently coined to characterize a constellation of reported undesirable side effects described in postmarketing reports and small uncontrolled studies that developed during or after stopping finasteride treatment, and persisted after drug discontinuation. Symptoms included decreased libido, erectile dysfunction, sexual anhedonia, decreased sperm count, gynecomastia, skin changes, cognitive impairment, fatigue, anxiety, depression, and suicidal ideation. The aim of this study is to review the existing medical literature for evidence-based research of permanent sexual dysfunction and mood changes during treatment with 5-alpha-reductase inhibitors including finasteride and dutasteride.
================================================
47.) Post-Finasteride Adverse Effects in Male Androgenic Alopecia: A Case Report of Vitiligo.
================================================
Skin Pharmacol Physiol. 2017 Feb 22;30(1):42-45. doi: 10.1159/000455972. [Epub ahead of print]
Motofei IG1, Rowland DL, Georgescu SR, Tampa M, Paunica S, Constantin VD, Balalau C, Manea M, Baleanu BC, Sinescu I.
Author information
1Department of Surgery/Dermatology, Carol Davila University, Bucharest, Romania.
Abstract
Finasteride has proved to be relatively safe and effective in the therapeutic management of male androgenic alopecia. However, literature data report several endocrine imbalances inducing various adverse effects, which often persist after treatment cessation in the form of post-finasteride syndrome. Here we present the case of a 52-year-old man receiving finasteride (1 mg/day) who developed an uncommon adverse effect represented by generalized vitiligo 2 months after finasteride discontinuation. Associated adverse effects encountered were represented by mild sexual dysfunction (as determined by the International Index of Erectile Function, IIEF) and moderate depressive symptoms (according to DSM-V criteria), all of these manifestations aggregating within/as a possible post-finasteride syndrome. Further studies should develop and compare several therapeutic approaches, taking into account not only compounds that decrease the circulating dihydrotestosterone level but also those that could block the dihydrotestosterone receptors (if possible, compounds with selective tropism towards the skin). In addition, the possibility of predicting adverse effects of finasteride (according to hand preference and sexual orientation) should be taken into account.
39.) Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review.
==============================================
J Clin Aesthet Dermatol. 2016 Jul;9(7):56-62. Epub 2016 Jul 1.
Hirshburg JM1, Kelsey PA2, Therrien CA2, Gavino AC1, Reichenberg JS1.
Author information
1Dell Medical School, University of Texas at Austin, Austin, Texas;
2University of Texas Medical Branch, Galveston, Texa.
Abstract
Finasteride and dutasteride, both 5-alpha reductase inhibitors, are considered first-line treatment for androgenetic hair loss in men and used increasingly in women. In each case, patients are expected to take the medications indefinitely despite the lack of research regarding long-term adverse effects. Concerns regarding the adverse effects of these medications has led the United States National Institutes of Health to add a link for post-finasteride syndrome to its Genetic and Rare Disease Information Center. Herein, the authors report the results of a literature search reviewing adverse events of 5-alpha reductase inhibitors as they relate to prostate cancer, psychological effects, sexual health, and use in women. Several large studies found no increase in incidence of prostate cancer, a possible increase of high-grade cancer when detected, and no change in survival rate with 5-alpha reductase inhibitor use. Currently, there is no direct link between 5-alpha reductase inhibitor use and depression; however, several small studies have led to depression being listed as a side effect on the medication packaging. Sexual effects including erectile dysfunction and decreased libido and ejaculate were reported in as many as 3.4 to 15.8 percent of men. To date, there are very few studies evaluating 5-alpha reductase inhibitor use in women. Risks include birth defects in male fetuses if used in pregnancy, decreased libido, headache, gastrointestinal discomfort, and isolated reports of changes in menstruation, acne, and dizziness. Overall, 5-alpha reductase inhibitors were well-tolerated in both men and women, but not without risk, highlighting the importance of patient education prior to treatment.
=========================================================
40.) Interventions for Female Pattern Hair Loss.
========================================================
JAMA Dermatol. 2017 Jan 18. doi: 10.1001/jamadermatol.2016.5790. [Epub ahead of print]
van Zuuren EJ1, Fedorowicz Z2.
Author information
1Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.
2Bahrain Branch of Cochrane, Awali, Bahrain.
Abstract
Clinical Question:
Which interventions are effective and safe for treating female pattern hair loss (FPHL)?
Bottom Line:
There was low- to moderate-quality evidence that topical minoxidil (2% and 5%) was associated with improvements in FPHL. There was low-quality evidence that finasteride was no more effective than placebo. There were inconsistent results from studies that laser devices were effective, but total hair count increased compared with baseline (moderate- to low-quality evidence). Most treatments were not associated with higher adverse event rates than placebo.
=======================================================
41.) Differences in reproductive toxicology between alopecia drugs: an analysis on adverse events among female and male cases.
======================================================
Oncotarget. 2016 Dec 13;7(50):82074-82084. doi: 10.18632/oncotarget.12617.
Wu M1, Yu Q1, Li Q1.
Author information
1Department of Plastic and Reconstruction Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
Alopecia is a dermatological condition with limited therapeutic options. Only two drugs, finasteride and minoxidil, are approved by FDA for alopecia treatment. However, little is known about the differences in adverse effects between these two drugs. We examined the clinical reports submitted to the FDA Adverse Event Reporting System (FAERS) from 2004 to 2014. For both female and males, finasteride was found to be more associated with reproductive toxicity as compared to minoxidil. Among male alopecia cases, finasteride was significantly more concurrent with several forms of sexual dysfunction. Among female alopecia cases, finasteride was significantly more concurrent with harm to fetus and disorder of uterus. In addition, drug-gene network analysis indicated that finasteride could profoundly disturb pathways related to sex hormone signaling and oocyte maturation. These findings could provide clues for subsequent toxicological research. Taken together, this analysis suggested that finasteride could be more liable to various reproductive adverse effects. Some of these adverse effects have yet to be warned in FDA-approved drug label. This information can help improve the treatment regimen of alopecia and post-marketing regulation of drug products.
=====================================
42.) Finasteride in Hidradenitis Suppurativa: A "Male" Therapy for a Predominantly "Female" Disease.
======================================
J Clin Aesthet Dermatol. 2016 Jun;9(6):44-50. Epub 2016 Jun 1.
Khandalavala BN1, Do MV1.
Author information
1University of Nebraska Medical Center, Omaha, Nebraska.
Abstract
OBJECTIVE:
Hidradenitis suppurativa is associated with obesity and metabolic syndrome, and a hormonal component has been implicated. Finasteride is an anti-androgenic agent used for benign prostatic hypertrophy, androgenic alopecia, and, in females, hirsutism. Finasteride is an inhibitor of type II5 alpha-reductase that reduces dihydrotestosterone levels and appears to alter end-organ sensitivity of the folliculopilosebaceous unit. The objective is to review the use of finasteride for hidradenitis suppurativa.
DESIGN:
Review of the literature.
SETTING:
Clinical treatment of patients with hidradenitis suppurativa. Measurement/participants: Five publications described the use for hidradenitis suppurativa. Four global case reports cited 13 individual patients, four male and nine female. Females included three adolescent patients and a child aged seven with precocious puberty. In the United States, finasteride in obese male adults was mentioned to be helpful.
RESULTS:
Oral finasteride, as monotherapy or additional therapy was utilized for advanced hidradenitis suppurativa. The outcomes were largely favorable, with complete resolution in three patients. A latency period was evident in a majority. Limited, or continuous use for up to six years, was detailed. Response to reintroduction was successful. A benign safety profile with excellent tolerability was described. Teratogenicity of finasteride was addressed and contraception advocated in female patients. Sexual adverse effects were not ascertained.
CONCLUSION:
In hidradenitis suppurativa, finasteride could be considered in adults of both sexes as well as in select female children and adolescents, particularly those with concurrent metabolic and hormonal alterations present. Finasteride provides another highly effective, durable, relatively safe, and inexpensive option in the treatment of hidradenitis suppurativa.
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43.) Hidradenitis suppurativa treated with finasteride.
======================================================
Joseph MA1, Jayaseelan E, Ganapathi B, Stephen J.
Author information
1Department of Dermatology, St. John's Medical College Hospital, Bangalore, India. maryjoseph1@rediffmail.com
Abstract
BACKGROUND:
Hidradenitis suppurativa (HS) is a distressing condition for which no satisfactory treatment is available. Studies on hormonal mechanisms responsible for HS point towards altered end-organ sensitivity, probably related to the enzyme 5a reductase that converts testosterone to dihydrotestosterone. Finasteride, an inhibitor of type II 5a reductase, has been reported to be effective in recalcitrant HS.
AIM:
To study the effectiveness and tolerability of finasteride in patients with HS in a preliminary trial.
METHODS:
Seven patients (five women and two men) with HS that was not responding well to antibiotics were treated with finasteride at a dose of 5 mg/day as monotherapy. Clinical response was assessed at regular intervals. Patients were followed up for periods varying from 8 months to 2 years.
RESULTS:
Six patients improved significantly and three of them had complete healing of lesions. Two patients who were followed up for more than 1 year experienced remissions lasting 8-18 months. The drug was generally well tolerated; however, two women complained of breast enlargement.
CONCLUSION:
The results of this preliminary study suggest that finasteride is an effective therapeutic option in HS.
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44.) The use of hormonal agents in the treatment of acne.
=======================================================
Semin Cutan Med Surg. 2016 Jun;35(2):68-73. doi: 10.12788/j.sder.2016.027.
Hassoun LA1, Chahal DS2, Sivamani RK3, Larsen LN4.
Author information
1School of Medicine, University of California-Davis, Sacramento, California, USA.
2School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
3Department of Dermatology, University of California-Davis, Sacramento, California, USA.
4Department of Dermatology, University of California-Davis, Sacramento, California, USA. lnlarsen@ucdavis.edu.
Abstract
Hormones and androgens play an important role in the pathogenesis of acne. Multiple hormonal modulators are now available for the treatment of acne. The efficacies and side effects of currently available hormonal agents are reviewed here including the use of oral contraceptives, spironolactone, flutamide, cyproterone acetate, finasteride, and cortexolone 17α-propionate. Hormonal therapies are an efficacious treatment option for acne among females. With the growing need to reduce antibiotic exposures, hormonal therapies should be more widely studied and incorporated into acne treatment strategies.
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45.) Risk of gynecomastia and breast cancer associated with the use of 5-alpha reductase inhibitors for benign prostatic hyperplasia.
=================================================
Clin Epidemiol. 2017 Feb 10;9:83-91. doi: 10.2147/CLEP.S124674. eCollection 2017.
Hagberg KW1, Divan HA2, Fang SC2, Nickel JC3, Jick SS1.
Author information
1Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington.
2New England Research Institutes, Inc., Watertown, MA, USA.
3Kingston General Hospital, Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND:
Clinical trial results suggest that 5-alpha reductase inhibitors (5ARIs) for the treatment of benign prostatic hyperplasia (BPH) may increase the risk of gynecomastia and male breast cancer, but epidemiological studies have been limited.
PATIENTS AND METHODS:
We conducted a cohort study with nested case-control analyses using the UK Clinical Practice Research Datalink. We identified men diagnosed with BPH who were free from Klinefelter syndrome, prostate, genital or urinary cancer, prostatectomy or orchiectomy, or evidence of gynecomastia or breast cancer. Patients entered the cohort at age ≥40 years and at least 3 years after the start of their electronic medical record. We classified exposure as 5ARIs (alone or in combination with alpha blockers [ABs]), AB only, or unexposed to 5ARIs and ABs. Cases were men who had a first-time diagnosis of gynecomastia or breast cancer. Incidence rates and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in the gynecomastia analysis and crude and adjusted odds ratios (ORs) with 95% CIs in both analyses were calculated.
RESULTS:
Compared to no exposure, gynecomastia risk was elevated for users of 5ARIs (alone or in combination with ABs) in both the cohort (IRR=3.55, 95% CI 3.05-4.14) and case-control analyses (OR=3.31, 95% CI 2.66-4.10), whereas the risk was null for users of AB only. The increased risk of gynecomastia with the use of 5ARIs persisted regardless of the number of prescriptions, exposure timing, and presence or absence of concomitant prescriptions for drugs known to be associated with gynecomastia. The risk was higher for dutasteride than for finasteride. 5ARI users did not have an increased risk of breast cancer compared to unexposed men (OR=1.52, 95% CI 0.61-3.80).
CONCLUSION:
In men with BPH, 5ARIs significantly increased the risk of gynecomastia, but not breast cancer, compared to AB use and no exposure.
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46.) Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome.
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Skin Appendage Disord. 2017 Jan;2(3-4):120-129. doi: 10.1159/000450617. Epub 2016 Sep 23.
Fertig R1, Shapiro J2, Bergfeld W3, Tosti A1.
Author information
1Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Fla, USA.
2The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, N.Y., USA.
3Departments of Dermatopathology Fellowship, Cleveland Clinic, Cleveland, Ohio, USA; Departments of Pathology, Dermatopathology Fellowship, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
Postfinasteride syndrome (PFS) is a term recently coined to characterize a constellation of reported undesirable side effects described in postmarketing reports and small uncontrolled studies that developed during or after stopping finasteride treatment, and persisted after drug discontinuation. Symptoms included decreased libido, erectile dysfunction, sexual anhedonia, decreased sperm count, gynecomastia, skin changes, cognitive impairment, fatigue, anxiety, depression, and suicidal ideation. The aim of this study is to review the existing medical literature for evidence-based research of permanent sexual dysfunction and mood changes during treatment with 5-alpha-reductase inhibitors including finasteride and dutasteride.
================================================
47.) Post-Finasteride Adverse Effects in Male Androgenic Alopecia: A Case Report of Vitiligo.
================================================
Skin Pharmacol Physiol. 2017 Feb 22;30(1):42-45. doi: 10.1159/000455972. [Epub ahead of print]
Motofei IG1, Rowland DL, Georgescu SR, Tampa M, Paunica S, Constantin VD, Balalau C, Manea M, Baleanu BC, Sinescu I.
Author information
1Department of Surgery/Dermatology, Carol Davila University, Bucharest, Romania.
Abstract
Finasteride has proved to be relatively safe and effective in the therapeutic management of male androgenic alopecia. However, literature data report several endocrine imbalances inducing various adverse effects, which often persist after treatment cessation in the form of post-finasteride syndrome. Here we present the case of a 52-year-old man receiving finasteride (1 mg/day) who developed an uncommon adverse effect represented by generalized vitiligo 2 months after finasteride discontinuation. Associated adverse effects encountered were represented by mild sexual dysfunction (as determined by the International Index of Erectile Function, IIEF) and moderate depressive symptoms (according to DSM-V criteria), all of these manifestations aggregating within/as a possible post-finasteride syndrome. Further studies should develop and compare several therapeutic approaches, taking into account not only compounds that decrease the circulating dihydrotestosterone level but also those that could block the dihydrotestosterone receptors (if possible, compounds with selective tropism towards the skin). In addition, the possibility of predicting adverse effects of finasteride (according to hand preference and sexual orientation) should be taken into account.
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48.) Side Effects Related to 5 α-Reductase Inhibitor Treatment of Hair Loss in Women: A Review.
=================================================
J Drugs Dermatol. 2016 Apr;15(4):414-9.
Seale LR, Eglini AN, McMichael AJ.
Abstract
5 α-reductase inhibitors such as finasteride and dutasteride have been studied for the treatment of hair loss in men, with finasteride being the only Food and Drug Administration-approved treatment. Increasingly, in recent years, off-label use of these drugs has been employed in the treatment of female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA) in women. Side effects with 5 α-reductase inhibitors can include changes in sexual function, and recent publications have characterized an increasing prevalence of these in men. A review of 20 peer-reviewed articles found that very few side effects, or adverse events, related to sexual function have been reported in studies in which dutasteride or finasteride has been used to treat hair loss in women. Future publications should investigate not only the efficacy of these drugs in treating FPHL and FFA, but the side effect profile in patients as well.
==================================================
49.) 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss.
=================================================
J Eur Acad Dermatol Venereol. 2011 Feb;25(2):211-4. doi: 10.1111/j.1468-3083.2010.03758.x. Epub 2010 Jun 21.
Yeon JH1, Jung JY, Choi JW, Kim BJ, Youn SW, Park KC, Huh CH.
Author information
1Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi Department of Dermatology, Chung-Ang University, Seoul, Korea.
Abstract
BACKGROUND:
Various treatments have been attempted for female pattern hair loss (FPHL), including topical minoxidil, oral antiandrogen and finasteride. But, there is no consensus on the standard treatment options. Clinical efficacy of finasteride in treating FPHL is still in controversy, but there is a tendency to high dose finasteride, which is more effective than lower dose.
OBJECTIVES:
The purpose of this study was to evaluate the clinical efficacy of high dose (5 mg/day) oral finasteride in normoandrogenic Asian women with FPHL.
METHODS:
Total of 87 normoandrogenic, pre and post-menopausal women with FPHL were enrolled in this study. They were treated with oral finasteride (Proscar(®)), 5 mg daily for 12 months. Efficacy was evaluated with hair density and thickness changes assessed by phototrichogram and global photographs using 7-point scale.
RESULTS:
Eighty-six patients completed 12 months of finasteride treatment schedule. One patient (1.1%) withdrew due to headache. At initial visits, mean hair density was 90 ± 22/cm(2) and mean hair thickness was 64 ± 11 μm. After 12 months of finasteride treatment, hair density was significantly increased to 107 ± 23/cm(2) (P<0.001), and hair thickness was also significantly increased to 70 ± 9 μm (P=0.02). In global photographs, 70 (81.4%) of the 86 patients were improved (57 were slightly, 10 were moderately and four were greatly improved). Patients without any changes were 13 (15.1%) and 3 (3.5%) patients reported slightly aggravated. Four patients (4.6%) reported adverse events (headache, menstrual irregularity, dizziness and increased body hair growth). However, these adverse events were mild and disappeared soon.
CONCLUSIONS: Oral finasteride, 5 mg/day, may be an effective and safe treatment for normoandrogenic women with FPHL.
=====================================
50.) Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know?
=====================================
Rev Endocr Metab Disord. 2015 Sep;16(3):177-98. doi: 10.1007/s11154-015-9319-y.
Traish AM1, Melcangi RC2, Bortolato M3, Garcia-Segura LM4, Zitzmann M5.
Author information
1Department of Biochemistry and Department of Urology, Boston University School of Medicine, 715 Albany Street, A502, Boston, MA, 02118, USA. atraish@bu.edu.
2Department of Pharmacological and Biomolecular Sciences- Center of Excellence on Neurodegenerative Diseases, Iniversità degli Studi di Milano, Milan, Italy.
3Department of Pharmacology and Toxicology, University of Kansas, Lawrence, KS, USA.
4Instituto Cajal, C.S.I.C, E-28002, Madrid, Spain.
5Centre for Reproductive Medicine and Andrology, University Clinics Muenster, Domagkstrasse 11, D-48149, Muenster, Germany.
Abstract
Steroids are important physiological orchestrators of endocrine as well as peripheral and central nervous system functions. One of the key processes for regulation of these molecules lies in their enzymatic processing by a family of 5α-reductase (5α-Rs) isozymes. By catalyzing a key rate-limiting step in steroidogenesis, this family of enzymes exerts a crucial role not only in the physiological control but also in pathological events. Indeed, both 5α-R inhibition and supplementation of 5α-reduced metabolites are currently used or have been proposed as therapeutic strategies for a wide array of pathological conditions. In particular, the potent 5α-R inhibitors finasteride and dutasteride are used in the treatments of benign prostatic hyperplasia (BPH), as well as in male pattern hair loss (MPHL) known as androgenetic alopecia (AGA). Recent preclinical and clinical findings indicate that 5α-R inhibitors evoke not only beneficial, but also adverse effects. Future studies should investigate the biochemical and physiological mechanisms that underlie the persistence of the adverse sexual side effects to determine why a subset of patients is afflicted with such persistence or irreversible adverse effects. Also a better focus of clinical research is urgently needed to better define those subjects who are likely to be adversely affected by such agents. Furthermore, research on the non-sexual adverse effects such as diabetes, psychosis, depression, and cognitive function are needed to better understand the broad spectrum of the effects these drugs may elicit during their use in treatment of AGA or BPH. In this review, we will summarize the state of art on this topic, overview the key unresolved questions that have emerged on the pharmacological targeting of these enzymes and their products, and highlight the need for further studies to ascertain the severity and duration of the adverse effects of 5α-R inhibitors, as well as their biological underpinnings.
48.) Side Effects Related to 5 α-Reductase Inhibitor Treatment of Hair Loss in Women: A Review.
=================================================
J Drugs Dermatol. 2016 Apr;15(4):414-9.
Seale LR, Eglini AN, McMichael AJ.
Abstract
5 α-reductase inhibitors such as finasteride and dutasteride have been studied for the treatment of hair loss in men, with finasteride being the only Food and Drug Administration-approved treatment. Increasingly, in recent years, off-label use of these drugs has been employed in the treatment of female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA) in women. Side effects with 5 α-reductase inhibitors can include changes in sexual function, and recent publications have characterized an increasing prevalence of these in men. A review of 20 peer-reviewed articles found that very few side effects, or adverse events, related to sexual function have been reported in studies in which dutasteride or finasteride has been used to treat hair loss in women. Future publications should investigate not only the efficacy of these drugs in treating FPHL and FFA, but the side effect profile in patients as well.
==================================================
49.) 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss.
=================================================
J Eur Acad Dermatol Venereol. 2011 Feb;25(2):211-4. doi: 10.1111/j.1468-3083.2010.03758.x. Epub 2010 Jun 21.
Yeon JH1, Jung JY, Choi JW, Kim BJ, Youn SW, Park KC, Huh CH.
Author information
1Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi Department of Dermatology, Chung-Ang University, Seoul, Korea.
Abstract
BACKGROUND:
Various treatments have been attempted for female pattern hair loss (FPHL), including topical minoxidil, oral antiandrogen and finasteride. But, there is no consensus on the standard treatment options. Clinical efficacy of finasteride in treating FPHL is still in controversy, but there is a tendency to high dose finasteride, which is more effective than lower dose.
OBJECTIVES:
The purpose of this study was to evaluate the clinical efficacy of high dose (5 mg/day) oral finasteride in normoandrogenic Asian women with FPHL.
METHODS:
Total of 87 normoandrogenic, pre and post-menopausal women with FPHL were enrolled in this study. They were treated with oral finasteride (Proscar(®)), 5 mg daily for 12 months. Efficacy was evaluated with hair density and thickness changes assessed by phototrichogram and global photographs using 7-point scale.
RESULTS:
Eighty-six patients completed 12 months of finasteride treatment schedule. One patient (1.1%) withdrew due to headache. At initial visits, mean hair density was 90 ± 22/cm(2) and mean hair thickness was 64 ± 11 μm. After 12 months of finasteride treatment, hair density was significantly increased to 107 ± 23/cm(2) (P<0.001), and hair thickness was also significantly increased to 70 ± 9 μm (P=0.02). In global photographs, 70 (81.4%) of the 86 patients were improved (57 were slightly, 10 were moderately and four were greatly improved). Patients without any changes were 13 (15.1%) and 3 (3.5%) patients reported slightly aggravated. Four patients (4.6%) reported adverse events (headache, menstrual irregularity, dizziness and increased body hair growth). However, these adverse events were mild and disappeared soon.
CONCLUSIONS: Oral finasteride, 5 mg/day, may be an effective and safe treatment for normoandrogenic women with FPHL.
=====================================
50.) Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know?
=====================================
Rev Endocr Metab Disord. 2015 Sep;16(3):177-98. doi: 10.1007/s11154-015-9319-y.
Traish AM1, Melcangi RC2, Bortolato M3, Garcia-Segura LM4, Zitzmann M5.
Author information
1Department of Biochemistry and Department of Urology, Boston University School of Medicine, 715 Albany Street, A502, Boston, MA, 02118, USA. atraish@bu.edu.
2Department of Pharmacological and Biomolecular Sciences- Center of Excellence on Neurodegenerative Diseases, Iniversità degli Studi di Milano, Milan, Italy.
3Department of Pharmacology and Toxicology, University of Kansas, Lawrence, KS, USA.
4Instituto Cajal, C.S.I.C, E-28002, Madrid, Spain.
5Centre for Reproductive Medicine and Andrology, University Clinics Muenster, Domagkstrasse 11, D-48149, Muenster, Germany.
Abstract
Steroids are important physiological orchestrators of endocrine as well as peripheral and central nervous system functions. One of the key processes for regulation of these molecules lies in their enzymatic processing by a family of 5α-reductase (5α-Rs) isozymes. By catalyzing a key rate-limiting step in steroidogenesis, this family of enzymes exerts a crucial role not only in the physiological control but also in pathological events. Indeed, both 5α-R inhibition and supplementation of 5α-reduced metabolites are currently used or have been proposed as therapeutic strategies for a wide array of pathological conditions. In particular, the potent 5α-R inhibitors finasteride and dutasteride are used in the treatments of benign prostatic hyperplasia (BPH), as well as in male pattern hair loss (MPHL) known as androgenetic alopecia (AGA). Recent preclinical and clinical findings indicate that 5α-R inhibitors evoke not only beneficial, but also adverse effects. Future studies should investigate the biochemical and physiological mechanisms that underlie the persistence of the adverse sexual side effects to determine why a subset of patients is afflicted with such persistence or irreversible adverse effects. Also a better focus of clinical research is urgently needed to better define those subjects who are likely to be adversely affected by such agents. Furthermore, research on the non-sexual adverse effects such as diabetes, psychosis, depression, and cognitive function are needed to better understand the broad spectrum of the effects these drugs may elicit during their use in treatment of AGA or BPH. In this review, we will summarize the state of art on this topic, overview the key unresolved questions that have emerged on the pharmacological targeting of these enzymes and their products, and highlight the need for further studies to ascertain the severity and duration of the adverse effects of 5α-R inhibitors, as well as their biological underpinnings.
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