Study: Ketoconazole Is A Highly Effective Oral Anti-androgen

IdealForehead

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In researching other oral anti-androgens, I came across this very interesting study from 1996:

Comparison of four different treatment regimes in hirsutism related to polycystic ovary syndrome.
https://www.ncbi.nlm.nih.gov/pubmed/8908525

They compared 4 medication regimens for excess facial hair and hair loss in women suffering from PCOS:
  • Group 1 (n = 48): low-dose combined oral contraceptive
  • Group 2 (n = 65): cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate
  • Group 3 (n = 12): spironolactone (100-200 mg daily)
  • Group 4 (n = 16): ketoconazole (400 mg daily)
Suprisingly, the regimen that was most effective was actually ketoconazole!

In their words: "All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole". In addition, although it wasn't significant, ketoconazole reduced testosterone slightly more than the other treatment regimens.

I find this fascinating, especially since still in 2017, no one quite knows how ketoconazole works. I'm guessing it never picked up as a standard therapy due to risks of liver inflammation with regular oral dosing. But it clearly shows this is a powerful drug that shouldn't be ignored.

I have to go buy some more Nizoral ...
 

countjulian

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Two percent keta at my pharmacy (I have Kaiser Permanente) is actually cheaper for me than Nizoral.
 

DHTpolice

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I can't believe it's more potent than spironolactone!
Spironolactone alone is not really potent. Even 200 mg a day usually is not enough to drop Testosterone. But in combination with estrogen works pretty good.
 

countjulian

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Aha. If it doesn't have a lot of feminizing affects without estrogen why isn't it used more often for male pattern baldness in cis men?
 

IdealForehead

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Aha. If it doesn't have a lot of feminizing affects without estrogen why isn't it used more often for male pattern baldness in cis men?

I delve into the pros/cons of it in this thread:

https://www.hairlosstalk.com/intera...gimens-based-on-rates-of-gynecomastia.108990/

In short, spironolactone is highly effective, but at 150-200 mg carries a ~52% chance of gynecomastia.

Cyproterone would probably make a better oral antiandrogen for most men, if you're looking to nuke your hair loss and hormones, as it seems to max out at around 23% gynecomastia at the most massive doses.
 
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countjulian

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I delve into the pros/cons of it in this thread:

https://www.hairlosstalk.com/intera...gimens-based-on-rates-of-gynecomastia.108990/

In short, spironolactone is highly effective, but at 150-200 mg carries a ~52% chance of gynecomastia.

Cyproterone would make a better oral antiandrogen for most men, if you're looking to nuke your hair loss and hormones, as it seems to max out at around 23% gynecomastia at the most massive doses.

What's the DHT reduction on that though? If you're totally getting rid of DHT that's gotta cause ED and psych side.
 

IdealForehead

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What's the DHT reduction on that though? If you're totally getting rid of DHT that's gotta cause ED and psych side.

Any strong systemic drugs like cyproterone or spironolactone are going to destroy your sexual function, unless you have an incredibly high sex drive to begin with. Cyproterone also has a 30% risk of depression (higher than spironolactone).

These are heavy duty drugs.
 
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countjulian

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Any strong systemic drugs like cyproterone or spironolactone are going to destroy your sexual function, unless you have an incredibly high sex drive to begin with. Cyproterone also has a 30% risk of depression (higher than spironolactone).

If you're considering doing stuff like this you should already know all that and not care.

It's not for guys who are nervous about side effects. These are heavy duty drugs.

Sidenote I suppose but I just don't get why any cis man would do this. I understand hair is about more than sex but castration has to be worse, and this basically amounts to chemical castration. This is an awful disease but at some point the cure is worse than the disease.
 

BaldyBalderBald

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IdealForehead

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Yes it is, even banned from some EU countries, in France i'm sure of it anyway, due to his liver toxicity.

Basically long-term usage can f*** your liver, there's no cure for that.

https://www.nursingtimes.net/fungal-infection-drug-banned-due-to-liver-risk/5061874.article

https://www.fda.gov/Drugs/DrugSafety/ucm362415.htm

Yeah, it would be a very poor long term oral medication as said above due to liver toxicity.

I posted this just for information purposes only, as it was a shockingly effective treatment. It shows ketoconazole is a pretty potent antiandrogen after all.
 
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BaldyBalderBald

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My bad, i though you were going to use it orally
 

Michael1986

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Its a shame it is so dangerous to take orally considering how effective it would be. How strong is the actual evidence for its effectiveness topically? My understanding is that the reason Ketoconazole is in the Big 3 is mainly to do with convenience as it is used as a shampoo and therefore nicely compliments the other two ingredients of the Big 3.
 
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