New pubmed study on anti-androgens (nizoral, finas included)

[michael barry]

IN this study for women's hirsutism (too much body and facial hair), the drugs cyterperone acetate, flutamide, ketoconazale (nizoral's active ingredient), and finasteride were tested.

The results were cyterperone acetate was the most potent anti-androgen
flutamide was the second most potent anti-androgen
ketoconazale was the third most potent anti-androgen
finasteride was (kinda by far) the weakest anti-androgen


My comment before posting the tests description is this: Internal finasteride and topical nizoral every other day is a super-strong anti-androgenic regimine. One probably would never need more.

Here's the study:

: J Clin Endocrinol Metab. 1999 Apr;84(4):1304-10. Related Articles, Links


A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism.

Venturoli S, Marescalchi O, Colombo FM, Macrelli S, Ravaioli B, Bagnoli A, Paradisi R, Flamigni C.

Reproductive Medicine Unit, Institute of Obstetrics and Gynecology, University of Bologna, Italy.

Sixty-six hirsute women were randomized and treated with 1) flutamide (n = 15), 250 mg/day; 2) finasteride (n = 15), 5 mg/day; 3) ketoconazole (n = 16), 300 mg/day; and 4) ethinyl estradiol (EE)-cyproterone acetate (CPA; n = 20), 0.01 mg EE/day for the first week, 0.02 mg EE/day for the second week, and 0.01 mg EE/day for the third week, followed by a pause of 7 days, then 12.5 mg CPA/day added during the first 10 days of every month for 12 months. Hirsutism was evaluated by the Ferriman-Gallwey score, and hair diameter and hair growth rate were determined by a special image analysis processor in basal conditions and after 90, 180, 270, and 360 days of treatment. All treatments produced a significant decrease in the hirsutism score, hair diameter, and daily hair growth rate: flutamide, -55 +/- 13%, -21 +/- 14%, and -37 +/- 18%; finasteride, -44 +/- 13%, -16 +/- 12%, and -27 +/- 14%; ketoconazole, -53 +/- 18%, -14 +/- 12%, and -30 +/- 21%; and EE-CPA, -60 +/- 18%, -20 +/- 11%, and -28 +/- 21%. Some differences existed among treatments with regard to effectiveness; EE-CPA and flutamide seem to be the most efficacious in improving hirsutism. For the hirsutism score, a greater decrease was seen with EE-CPA (-60 +/- 18%) than with finasteride (-44 +/- 13%; P < 0.01) and a greater decrease was seen with flutamide (-58 +/- 18%) than with finasteride (-44 +/- 13%; P < 0.05). Flutamide is the fastest in decreasing hair diameter; EE-CPA is the fastest in slowing down hair growth, even though at the end of the treatment there was a significant difference between flutamide and finasteride only (-41 +/- 18% vs. -27 +/- 14%; P < 0.05). Flutamide, ketoconazole, and EE-CPA induced a significant decrease in total and free testosterone, 5alpha-dihydrotestosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione plasma levels. During the EE-CPA treatment, gonadotropins were suppressed, and the sex hormone-binding globulin level increased. Finasteride induced a decrease in dehydroepiandrosterone sulfate and 5alpha-dihydrotestosterone and an increase in testosterone levels. Very few side-effects were observed during treatment with low doses of flutamide, EE-CPA, and particularly finasteride. Flutamide induced a decrease whereas EE-CPA induced an increase in triglycerides and cholesterol, showing higher values within the normal range. Ketoconazole induced several side-effects and complications, and several people dropped out of the study. Despite different modalities of action and significantly different effects on androgen levels, low doses of flutamide, finasteride, and EE-CPA constitute very satisfactory alternative therapeutic regimens in the treatment of hirsutism.

 

[Guest]

thanks michael. too bad they didn't test dutasteride as well, along with the rest, huh?

regards,
jayman

 

[michael barry]

Jayman,

Here is another nizoral study for alopecia:


Authors
Pierard-Franchimont C. De Doncker P. Cauwenbergh G. Pierard GE.
Institution
Department of Dermatopathology, University of Liege, Belgium.
Title
Ketoconazole shampoo: effect of long-term use in androgenic alopecia.
Source
Dermatology. 196(4):474-7, 1998.
Abstract
BACKGROUND: The pathogenesis of androgenic alopecia is not fully understood. A microbial-driven inflammatory reaction abutting on the hair follicles might participate in the hair status anomaly. OBJECTIVE: The aim of our study was to determine if ketoconazole (KCZ) which is active against the scalp microflora and shows some intrinsic anti-inflammatory activity might improve alopecia. METHOD: The effect of 2% KCZ shampoo was compared to that of an unmedicated shampoo used in combination with or without 2% minoxidil therapy. RESULTS: Hair density and size and proportion of anagen follicles were improved almost similarly by both KCZ and minoxidil regimens. The sebum casual level appeared to be decreased by KCZ. CONCLUSION: Comparative data suggest that there may be a significant action of KCZ upon the course of androgenic alopecia and that Malassezia spp. may play a role in the inflammatory reaction. The clinical significance of the results awaits further controlled study in a larger group of subjects



Yet again............it pretty much equals two percent minoxidil. Two percent minoxidil grows more hair than finasteride over the first year or two. My conclusion is that nizoral (especially nizoral 2-percent now available) is probably a more potent anti-androgen than finasteride. If used together, since we know ketoconazale is something of a weak androgen-receptor blocker in addition to an interrupting agent on androgen synthesis.......they are probably a very strong-anti-androgenic duo.

Add green tea extract internally.......................and that should be all the anti-androgenic regimine one would need.

 

[Guest]

michael,

i thought that 1% keto was equal to 2% in effectiveness. i thought a study showed this. that is the conventional wisdom trumpeted on HairLossTalk.com anyway. am i wrong?

also, you mention gte, but what about curcumin to take care of another pathway?

jayman

 

[So]

Jayman I assume you are referring to Curcumin for the inhibition of TGF-b.

Also, procyanidins are said to inhibit TGF-beta, so either take supplements which are rich in procyanidins or each procyanidin rich foods.

I strongly believe that TGF-beta will be of strong focus this year as an alternative pathway in which must be inhibited in conjunction with that of DHT. In fact I am confident that TGF-beta will eventually become more substantially important in the role of male pattern baldness than DHT alone. The inhibition of both however should help in theory.

"Androgenetic alopecia (Androgenetic Alopecia) is a dihydrotestosterone (DHT)-mediated process, characterized by continuous miniaturization of androgen reactive hair follicles and accompanied by perifollicular fibrosis of follicular units in histological examination. Testosterone (T: 10(-9)-10(-7) M) treatment increased the expression of type I procollagen at mRNA and protein level. Pretreatment of finasteride (10(-8) M) inhibited the T-induced type I procollagen expression at mRNA (40.2%) and protein levels (24.9%). T treatment increased the expression of transforming growth factor-beta 1 (TGF-beta1) at protein levels by 81.9% in the human scalp dermal fibroblasts (DFs). Pretreatment of finasteride decreased the expression of TGF-beta1 protein induced by an average of T (30.4%). The type I procollagen expression after pretreatment of neutralizing TGF-beta1 antibody (10 mug/ml) was inhibited by an average of 54.3%. Our findings suggest that T-induced TGF-beta1 and type I procollagen expression may contribute to the development of perifollicular fibrosis in the Androgenetic Alopecia, and the inhibitory effects on T-induced procollagen and TGF-beta1 expression may explain another possible mechanism how finasteride works in Androgenetic Alopecia."

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

 

[michael barry]

So,
Yup, thats pretty much it. I think Doctor is quite right about TGF-beta.......


By the way, green tea inhibits TGF beta if a study I read recently is correct, that along with TNF_alpha.



Jayman, green tea catechin ECGC (or some such) inhibits type one pretty effectively and also has some sort of anti-androgenic effect on DHT directly according to a hamster flank organ study that Bryan posted ages ago. DHT itself was directly applied to hamster flank organs (thus they should grow and get larger a great deal), but when a green tea catechin was put on the flank organ with the DHT, its growth was inhibited a great deal. Thus the researchers concluded that green tea catechin (I think it was ECGC, could have been another one) has an effect directly on DHT itself.


A biproduct of soy digestion in about a third of all people called equol, also seems to bind to DHT in the bloodstream and in tissues, kinda "handcuffing it" so it cant get to receptor sites.


The thing about aggressively attempting to inhibit TGF beta 1 and 2 internally COMPLETELY is that we dont know if there might be some kind of long term negative side effect to doing so. Perhaps one could safely take an internal supplement of something like curcumin in the morning and use a topical TGF-beta inhibitor like apple proanthcyandins in the afternoon? Just a guess.

I had posted a link on one of these threads about people who have a higher incidence of dementia who have low tgfbeta over long periods of time. Ive read some doctors who have said that it might not be a good idea to rid the body of ALL free radicals as they might do some good things too, etc.


My "theme" of this thread however, is that nizoral one percent or two percent is an easy effective aid in hairloss. Ive seen some transplant surgeons really "downplay" nizoral. I suscpect I know why too. Guys who get on finas and nizoral would probably lose hair very very very slowly over the years, and baldness will likely be cured before they would need any work.

 

[chino20]

Wow, thanks for the info michael barry! I'd kinda always considered nizoral as a useless addition, that information totally changed my view, thanks!

 

[JWM]

I am at work now so I don't have time to find it, but I believe it was either Kevin Davis or Bryan shelton who believed that Nizoral's effectiveness was likely NOT due to its antiandrogenic abilities, but more so for its anti-fungal/anti-inflammatory abilities.

The reasoning was that 1% nizoral performed roughly the same as 2% nizoral in increasing hair thickness and shaft diameter, BUT 2% nizoral had more of an effect on sebacious gland activity suggesting a better ability at inhibiting androgens over the 1%. Yet, still they performed almost equally well.

 

[Johnny24601]

re:

Can we give a more concise summary of this discussion?
Also, what are your opinions on cyterperone acetate and/or flutamide use for men with male pattern baldness? Is it potentially effective? Is it safe?

 

[roki]

ive been using the nizoral 2% two times a week
im gonna up the dose now to EOD because of that study
thanks for the info michael barry
i have another qustion: im on dutasteride do you think adding green tea extract well be good for my hair?

 

[EasyEd]

Is Nizoral 2% available in a local pharmacy, like a Walgreens?? If not, where can I get it?

 

[StoptheMadness]

Is it recommended to take green tea extract in pill form or to drink a cup of green a day (or both?)?

Actually would that be helpful, to drink green tea (at least once per day), and take a green tea extract pill?

 

[stax]

michael barry, if you dont mind can you tell me what you think the ultimate regimen for halting hairloss and hair regrowth is? Like internally and topically?


Thanks!

 

[Guy Legend]

Hmm, I may have to check into Revita. Supposidely, they are using 2% Ketoconazole and advise to use their shampoo a minimum of 5 times per week. With the other stuff they have in their too, it looks pretty tempting, despite the $30+ price tag.

 

[Strange Days]

Jayman I assume you are referring to Curcumin for the inhibition of TGF-b.

Also, procyanidins are said to inhibit TGF-beta, so either take supplements which are rich in procyanidins or each procyanidin rich foods.

Talking of which, just happened to come across this:

Proanthocyanidins – a final frontier in flavonoid research?

The foods with the highest levels of total proanthocyanidins were, in decreasing order....

ground cinnamon
sorghum (sumac bran)
dry grape seed
unsweetened baking chocolate
raw pinto beans
sorghum (high-tannin whole grain)
choke berries
red kidney beans
hazelnuts
pecan nuts

Could cinnamon be utilised in a topical?

Concentration of PAs in common foods

mg/100 g (fresh weight foods)

GSE - 3532.3
Cinnamon - 8108.2

 

[abcdefg]

Does curcumin actually inhibit tgf b? I used green tea it didnt seem to help me at all.

 

[michael barry]

2% nizoral is available at nizoralshampoo.com


A great hairloss regimine would be finas, nizoral (2% just to be safe) every other day, left in for a couple of minutes, and prox-N in my opinion. If one took a little green tea and a curcumin pill in the morning with their multivitamin over an oatmeal breakfast........I'd consider it pretty much optimized. An MSM tablet also.

Possible addition of topical spironolactone....................


If you still lost hair after all of that...................face it, you have cueball genetics.

 

[stax]

Thx michael barry, so you dont think minoxidil is worthy in a regimen?


Also, do you think testosterone itself can cause hairloss? I havent read any studies showing it.

 

[abcdefg]

Finasteride is the weakest of those? I cant believe nizoral is stronger. So basically I should skip finasteride and take nizoral instead? nizoral 1 percent did nothing for me except irritate the hell out of head. Revivogen shampoo and baby shampoo are the best things ive used.

 

[StoptheMadness]

Finasteride is the weakest of those? I cant believe nizoral is stronger. So basically I should skip finasteride and take nizoral instead? nizoral 1 percent did nothing for me except irritate the hell out of head. Revivogen shampoo and baby shampoo are the best things ive used.

It is recommended to add nizoral 2% to your finasteride regimen. Don't even think about skipping finasteride for nizoral only.