Thanks, I looked up that study (Rafi and Katz 2011) but they take its 5AR inhibiting properties for granted (none of the sources listed supports that statement) so I did some more research and found more secondary sources (including Kelly et al. 2016) which eventually led me to compile a list of primary sources:
Sonino, N. 1986. The endocrine effects of ketoconazole.
Sonino et al. 1990. Low-dose ketoconazole treatment in hirsute women.
Shaw, J. C. 1996. Antiandrogen Therapy in Dermatology.
[Hugo] Perez, B. S. 2004. Ketocazole [sic.] as an adjunct to finasteride in the treatment of androgenetic alopecia in men.
Inui, S., and Itami, S. 2007. Reversal of androgenic alopecia by topical ketoconzole [sic.]: relevance of anti-androgenic activity.
Kind of disheartening that 2 out of 4 authors misspell kcz in the title but never mind. Sadly most of these studies are not freely accessible, so most of my questions are still unanswered. However, my first impression is that the AA properties of kcz are only documented for oral doses several times higher than the therapeutic dose for fungal infections. When Nizoral shampoo was found to be somewhat effective for hair loss, some researchers understandably connected this with said properties but the evidence for such connection is still unconclusive. Kelly et al. summarize the Perez study as "its use in combination with oral finasteride ... might produce an additional decrease in scalp DHT levels" and other authors are similarly cautious about this effect. The hypothesis that it is its antifungal properties that are beneficial for some or all hair loss patients is usually presented with more confidence.
To me this is good news because I have been using Nizoral for about 6 years, although not on a regular basis, and from what I learned today it seems that endocrine effects are highly unlikely at the dose/frequency usually recommended for hair loss. Also, when they did appear they were reported to reverse rather quickly and fully...
That's interesting, thanks!
You might try punching those articles into google scholar, if you haven't. It will often offer a link to a free version, or, failing that, you might try Library Genessis to get access.
Perhaps there still are AA effects, because the dosage required for such effects might be lower when applied topically, directly on the follicles, then when it is taken orally - this is just rank speculation by me, mind you. I don't know whether that's possible, but I imagine it could be. It does appear, based on the study I referenced, that when applied topically it doesn't get into blood, so, presumably, any AA effects would only be local.
I'm also glad to hear that there aren't any AA effects, because I'm considering using a kz shampoo or even cream, but I don't want to use anything that screws with hormones. You say "when they did appear they were reported to reverse rather quickly", so you have found some studies in which they've found some hormonal effects? Do you have a link per chance?
There may be something to the antifungal theory, because there've been studies which have shown that essential oils, alone or in combination with minoxidil, will give results. I'm not sure whether the mechanism by which this is achieved through EO is known, but most of them have some kind of antimicrobial property, so perhaps that's the mechanism common to EO and kz.
