DHT producers

[Dave001]

Some miscellaneous links to articles and letters that offer the full text online for free.

Proscar and Propecia--A Therapeutic Perspective -- Rosner 89 (7): 3096 -- Journal of Clinical Endocrinology & Metabolism
http://jcem.endojournals.org/cgi/content/full/89/7/3096

NEJM -- The Influence of Finasteride on the Development of Prostate Cancer
http://jcem.endojournals.org/cgi/ijlink ... =349/3/215

Proscar and Propecia--A Therapeutic Perspective -- Palusinski and Barud 89 (12): 6359 -- Journal of Clinical Endocrinology & Metabolism
http://jcem.endojournals.org/cgi/conten ... 89/12/6359

In the letter above, the author suggests a provocative alternative to finasteride treatment: dihydrotestosterone (DHT). Though it wouldn't benefit my hair, I'd choose systemic DHT to finasteride any day of the millennium.

 

[Old Baldy]

Dave: Have you seen the full study from this abstract from the 2005 European Hair Conference?

S9 TREATMENT: FINASTERIDE UPDATE
Whiting DA
Baylor Hair Research and Treatment Center, Dallas, Texas, USA

A 5 year US and International phase III study of 1553 patients with male pattern alopecia (MPA) showed that finasteride 1mg produced visible hair growth in 50% of patients at 1 year, 66% at 2 years, and 48% at 5 years. It prevented hair loss in 99% of patients at 1 year and 91% of patients at 5 years. 50% of 326 patients with frontal loss showed a 10% improvement on finasteride. Finasteride-induced hair gain was confirmed by phototrichogram, hair weight, scalp biopsy and identical twin studies. 40% of men aged 41 to 60 years with moderate vertex alopecia grew hair with finasteride. Finasteride 1mg did not regrow hair in 136 postmenopausal women with female pattern alopecia aged 18 to 60 years. Few side effects are encountered with finasteride 1mg. Recent studies suggest that sexual side effects are less common than reported in clinical trials. In the Prostate Cancer Prevention Trial 18,882 men, aged 55 or older, were studied; half took finasteride 5mg daily and half placebo. After 7 years prostate cancer was reduced by 24.8% in the finasteride patients. However, finasteride patients who did develop prostatic cancer had 1.3% more cancers of higher malignancy than those in the placebo group. Therefore, men aged over 40, taking finasteride, must have annual medical examinations.

This abstract seems to indicate prostate cancer occurs 25 percent less in men taking finasteride., however, if you do get prostate cancer you have a 1.5 percent better chance of developing a "stronger" cancer?

Does this study change your opinion on the dangers of finasteride.?

Also Dave, I've done alot of reading but can't find an explicit answer to this question:

Do you think a man my age (52) benefits from finasteride. any more so than using topical spironolactone. once a day?

I'm torn on the usage of finasteride. I haven't had any side effects but I certainly don't want to damage my internal system.

I mean, a 25 percent reduction in getting prostate cancer in the first place appears to be a good thing, (even though there is a 1.5 percent better chance of contracting a stronger form of prostate cancer if you do develop cancer).

I was a Norwood 5V before starting any treatments (i.e., before my hair transplant and using "medicines").

Have the androgens already done their damage? Thereby making internal finasteride. no better than topical spironolactone. for me? Or is topical spironolactone. going to work fairly the same as internal finasteride. if I'm a responder? I realize this is a very variable question, just want your opinion.

Maybe use a little homemade topical finasteride. now and then also?

(I do realize that "other" things, besides androgen suppressors, are probably more important and do use those other things.)

Thanks for any thoughts on this. Just want your opinion. I think you can see that I'm wavering on staying on internal finasteride.

Also, what is your bottom line dislike of internal usage of finasteride.? Is it only the possible chance of stronger prostate cancer? What else bothers you? You are definitely not for using internal finasteride. and I would like your "no holds barred" opinion on this. Let me have it!! Thanks again!

 

[Old Baldy]

Dave: Here's a copy of an article questioning the validity of the 2003 study you posted above.

What the he** am I supposed to believe for Godsakes!!! :evil:

PCRI News


The Finasteride Controversy
Monday, February 16, 2004

Last summer, a team of 16 researchers reported on the seven-year Prostate Cancer Prevention Trial study that followed almost 19,000 men. The article, entitled “The Influence of Finasteride on the Development of Prostate Cancerâ€, was published in the July 17, 2003 issue of The New England Journal of Medicine.

The report made quite a stir in the prostate cancer community because of two fundamental findings reported as follows. “Seven years of finasteride treatment resulted in a 24.8 percent reduction in the prevalence of prostate cancer [as compared to a placebo group] during that period. There was a reduction in relative risk among men who underwent a prostate biopsy before seven years and among men who underwent biopsy at the end of the study. The risk reductions were similar in subgroups defined according to age, race or ethnic group, family history of prostate cancer, and stratum of PSA level at randomization.â€

The second finding reported was that “high-grade disease [as defined by Gleason Scores of 7, 8, 9, or 10] was noted in 6.4 percent of the men in the finasteride group, as compared with 5.1 percent of those in the placebo group. A difference in the rate of high-grade disease was seen within the first year of the study.

One possible explanation for this difference is a grading bias: histologic changes that mimic those of high-grade disease are caused by androgen-deprivation therapy.†And five different published papers were cited as sources for this explanation. (emphasis added)

However, in that same issue, Peter D. Scardino, M.D. published an editorial concerning the PCPT results. Apparently not too impressed with a 25% reduction in the prevalence of PC, he concentrated on the apparent increase in incidence of high-grade cancers to 6.4 percent of the finasteride group (as compared to 5.1 percent of the placebo group). Ignoring the possible grading-bias and other explanations offered by the study authors, he concentrated on the possible dangers of highgrade PC, saying, “Cancers with a Gleason Score of 7 to 10 contain poorly differentiated components that are known to behave aggressively.

The risk of death due to prostate cancer within 15 years of diagnosis among men with such cancers that are managed conservatively ranges from 42 percent to 87 percent, depending on age and Gleason grade at diagnosis, according to one study…[t]he study results suggest that finasteride may accelerate the growth of high-grade cancers, which may pose a threat to life and health if they are not treated successfully.â€

There is little question that high-grade cancer is a serious situation, pathologists would agree, but pathologists question whether Gleason grading should be used to assess PC aggressiveness after ADT treatment—and Gleason himself agrees. According to pathologist David Bostwick, M.D., “treated cancer has a significantly higher architectural (Gleason) grade, lower nuclear grade, and smaller nuclear diameter than untreated controls, thus creating the potential for grading bias. I’m convinced that this is what occurred in the PCPT study.†(emphasis added)

The accompanying article Does Finasteride Alter the Pathology of the Prostate and Cancer Grading? by Dr. Bostwick provides the scientific basis for this conviction.

Reproduced from PCRI Insights vol.7, no. 1

 

[Dave001]

Dave: Have you seen the full study from this abstract from the 2005 European Hair Conference?

S9 TREATMENT: FINASTERIDE UPDATE
Whiting DA
Baylor Hair Research and Treatment Center, Dallas, Texas, USA

A 5 year US and International phase III study of 1553 patients with male pattern alopecia (MPA) showed that finasteride 1mg produced visible hair growth in 50% of patients at 1 year, 66% at 2 years, and 48% at 5 years. It prevented hair loss in 99% of patients at 1 year and 91% of patients at 5 years. 50% of 326 patients with frontal loss showed a 10% improvement on finasteride. Finasteride-induced hair gain was confirmed by phototrichogram, hair weight, scalp biopsy and identical twin studies. 40% of men aged 41 to 60 years with moderate vertex alopecia grew hair with finasteride. Finasteride 1mg did not regrow hair in 136 postmenopausal women with female pattern alopecia aged 18 to 60 years. Few side effects are encountered with finasteride 1mg. Recent studies suggest that sexual side effects are less common than reported in clinical trials. In the Prostate Cancer Prevention Trial 18,882 men, aged 55 or older, were studied; half took finasteride 5mg daily and half placebo. After 7 years prostate cancer was reduced by 24.8% in the finasteride patients. However, finasteride patients who did develop prostatic cancer had 1.3% more cancers of higher malignancy than those in the placebo group. Therefore, men aged over 40, taking finasteride, must have annual medical examinations.

This abstract seems to indicate prostate cancer occurs 25 percent less in men taking finasteride., however, if you do get prostate cancer you have a 1.5 percent better chance of developing a "stronger" cancer?

Does this study change your opinion on the dangers of finasteride.?

Also Dave, I've done alot of reading but can't find an explicit answer to this question:

Do you think a man my age (52) benefits from finasteride. any more so than using topical spironolactone. once a day?

I'm torn on the usage of finasteride. I haven't had any side effects but I certainly don't want to damage my internal system.

I mean, a 25 percent reduction in getting prostate cancer in the first place appears to be a good thing, (even though there is a 1.5 percent better chance of contracting a stronger form of prostate cancer if you do develop cancer).

I was a Norwood 5V before starting any treatments (i.e., before my hair transplant and using "medicines").

Have the androgens already done their damage. Thereby making internal finasteride. no better than topical spironolactone. for me? Or is topical spironolactone. going to work fairly the same as internal finasteride. if I'm a responder? I realize this is a very variable question, just want your opinion.

Maybe use a little homemade topical finasteride. now and then also?

(I do realize that "other" things, besides androgen suppressors, are probably more important and do use those other things.)

Thanks for any thoughts on this. Just want your opinion. I think you can see that I'm wavering on staying on internal finasteride.

Also, what is your bottom line dislike of internal usage of finasteride.? Is it only the possible chance of stronger prostate cancer? What else bothers you? You are definitely not for using internal finasteride. and I would like your "no holds barred" opinion on this. Let me have it!! Thanks again!

The potentially increased risk of high-grade prostate cancer from finasteride doesn't concern me in the least. I'm skeptical that it does increase the risk, and will so remain until such risk is confirmed by subsequent studies.

Finasteride's relationship to prostate cancer is a non-issue to me personally, because I would never consider chemically castrating myself with antiandrogens (if we're going to allow the use of "DHT inhibitor", then I'm going to call finasteride an antiandrogen :wink:, which in principle it is, even if indirectly) in the first place. I care about my appearance like everyone, but function has got to come before aesthetics.

When it comes to "male hormones" -- i.e., androgens -- DHT is king. DHT is the most potent endogenous activator of the androgen receptor (AR). Testosterone also activates the AR, but does so with less potency. That's the reason inhibiting the formation of DHT arrests androgenetic alopecia (Androgenetic Alopecia). There is nothing special about DHT per se in the development of Androgenetic Alopecia, apart from its role as a potent androgen. Testosterone can induce Androgenetic Alopecia too; it's just that more of it is required to achieve the same effect. I wouldn't consider the systemic use of finasteride for the same reason that I wouldn't consider the use of any other antiandrogen; e.g., flutamide.

 

[Old Baldy]

Ok, time to wean myself off of finasteride. I'll use the spironolactone. topical and maybe a little finasteride. topical now and then.

Time to be a male again!

 

[Dave001]

Ok, time to wean myself off of finasteride. I'll use the spironolactone. topical and maybe a little finasteride. topical now and then.

Time to be a male again!

OB,

I wasn't saying that *you* should stop using finasteride. I was just giving you my opinion of why *I* wouldn't use it. The side effects that concern me are the ones that would be reversible after discontinuation (except for gynecomastia, which I do not not seem vulnerable to anyway). However, that's sort of moot as the drug must be taken indefinitely.

A long time ago -- before Androgenetic Alopecia -- I experimented briefly (a couple of weeks or so) with "supplemental" DHT. I felt *great*! More drive, mental clarity, physical energy, confidence, and no side effects either. Suffice it to say, I do *not* want to reduce, much less eliminate this hormone from my body. It's true that anecdotes are very weak, and I don't doubt that some of what I felt was owed to a placebo effect, but those effects are precisely what one would expect from a potent androgen.

 

[Old Baldy]

Dave: I was skeptical of finasteride. right from the start. You gave me an honest answer and THAT'S what I wanted.

Ironically, I had little regrowth the first 6 months I used finasteride., minoxidil., copper peptides and various home concoctions. About 5.5 months ago I started using spironolactone. cream, Prox N more often and phenytoin with minoxidil. and I'm getting regrowth 5.5 months later.

(Two months ago I started using Retin-A and Azelaic Acid and bolstered my homemade stuff with anti-oxidants and amino acids.)

Do I know what caused this regrowth? No, but I suspect spironolactone. is enough of an anti-androgen for me at this stage in my life and balding situation. Just a feeling. That's all.

I will still use topical finasteride. now and then to vary the anti-androgens. Your "second" study showing finasteride. doesn't systemically affect men , but still might work, was what put me over the top.

I KNOW that DHT makes us men to a pretty good extent. I'm going to wean myself off of finasteride., VERY slowly, and see what happens. I'm a slow balder and don't think any "damage" will result. (However, at the same time I'm probably a "slow" regrower and therin lies the rub. Oh well.)

I've always been skeptical of "adjusting" my hormones internally. Just the way I am. You didn't influence that basic feeling of mine.

Dave: I emailed a couple of WELL known doctors asking their opinions about this but received no answers. So I have to do this myself and your opinion helped. Don't shy away from what you said. It was honest and I appreciate that.

 

[Old Baldy]

UPDATE:

I received a response from one of the two well known doctors and was told the following, (in so many words).

1 - The Doctor feels finasteride. is not recommended for men over 50. Two reasons, (1) increased libido type problems and (2) increased chance of precancerous cells converting to cancerous cells.

2 - spironolactone. should work as well for me as finasteride. would. If I'm a responder, spironolactone. should be ok.

3- Slowly wean myself off of finasteride. over a 1 to 2 month period, (i.e., don't do it too quickly). Lower the dose and/or skip days. "The exact method doesn't seem to be all that important" is what the Doctor said.

The Doctor's answers are the final straw for me. I'll wean myself off of internal finasteride. and use various topical anti-androgen stuff. There's alot of topical stuff I can use afterall.

You know guys, I figured right from the start that I might be too old to really benefit much from finasteride. You know, the balding process has set in and already done "it's stuff". Not much to "prevent" anymore if you know what I mean. (Well, not near as much as for a young guy just coming down with male pattern baldness.)

I should also note that Peter Mac mentioned a while ago that, in a hair transplant conference attended by him and many surgeons, it was stated that men over 60 shouldn't even bother with finasteride. Here I am at 52. No more finasteride. internally for me. (I assume the surgeons felt the same way as the Doctor mentioned above, [i.e., the DHT part of the balding process has already done it's "stuff" and I should be more concerned with the immune system reaction and regrowth]).

I should still be concerned about androgens just not near as much as a younger man who just contracted male pattern baldness.

It's a BUMMER because I had no real perceived problems except for watery semen and a little weight gain. Oh well, that's life.

 

[Red Rose]

I care about my appearance like everyone, but function has got to come before aesthetics.

Very, very true.

 

[Dave001]

I received a response from one of the two well known doctors and was told the following, (in so many words).

[...]

By any chance was it doctor Proctor who told you this? Sounded like him...

You know guys, I figured right from the start that I might be too old to really benefit much from finasteride. You know, the balding process has set in and already done "it's stuff". Not much to "prevent" anymore if you know what I mean. (Well, not near as much as for a young guy just coming down with male pattern baldness.)

I should also note that Peter Mac mentioned a while ago that, in a hair transplant conference attended by him and many surgeons, it was stated that men over 60 shouldn't even bother with finasteride. Here I am at 52. No more finasteride. internally for me. (I assume the surgeons felt the same way as the Doctor mentioned above, [i.e., the DHT part of the balding process has already done it's "stuff" and I should be more concerned with the immune system reaction and regrowth]).

I should still be concerned about androgens just not near as much as a younger man who just contracted male pattern baldness.

Contracted male pattern baldness? Perhaps from his parents? :wink:

I don't think that finasteride should necessarily be any less effective in older individuals. It is probably just that the older one is, the longer their follicles are likely to have been dormant. You've mentioned that you had transplants. The transplanted follicles should not be vulnerable to androgens, assuming they were transplanted from ordinarily non-susceptible regions of the scalp.

An interesting question is to what extent the miniaturization and follicular damage continues beyond the stage at which there is no visibly remaining hair produced by the follicle; i.e, does the process continue indefinitely?

It's a BUMMER because I had no real perceived problems except for watery semen and a little weight gain. Oh well, that's life.

What do you mean except ...? :lol:

 

[Old Baldy]

Ya, ya, ya Dave. Ok, you got me on pretty much everyting you said! :lol: :lol: :lol:

I didn't ask the Doctor if I could say who he was. Sorry.

Dave you said:

An interesting question is to what extent the miniaturization and follicular damage continues beyond the stage at which there is no visibly remaining hair produced by the follicle; i.e, does the process continue indefinitely?

My guess is no. The process stops once the follicle is deemed "neutralized" by the immune system. I don't think the follicle really dies. But..... I obviously am making a GUESS!!

Why do I say this, strictly anecdotal, I'm getting regrowth from follicles that should have died if that theory is correct. But, I was a late, slow balder.

I just don't see any reason for our bodies to kill the follicles. They aren't life threatening for Godsakes and male pattern baldness isn't a cancerous disease. But I obviously don't really know.

I do remember reading in an old alt.baldspot post that Doctor Proctor thinks the follicle dies but that he said he is in the minority amongst other doctors' opinions.