Bryan said:I don't think there's ever been a published study which used RU58841 on humans.
Jack said:And Dr.Proctor , you're one of the few people on these forums who often talks about reflex hyperandrogenity and that it plays an effect even for finasteride users . I am curious where you got that opinion from , do your patients often show symphtons of it ? Or do you have many finasteride non responders and therefore you believe it must be linked to hyperandrogenity because there's no other explanation ? I am really just a layman , but have researchers taken scalp samples from finasteride users and examiend them and found increased androgen receptors in follicles?
I ask because i haven't seen any evidence for this phenomen in studys and i consider the often quoted 83 % response rate of the phase 3 finasteride studys quite spectacular , but what you write really DOES scare me sometimes.
Question:
I had a bad reaction to Propecia, including severe shedding (especially in the front) that commenced within a few days of starting Propecia, and stopped within a few days of stopping Propecia. I'm assuming this is Reflex Hyperandrogenicity (let's call it R.H.).
Could it be that I have a particularly low tolerance to the effects of Propecia, and that if I take less (say perhaps 1/4 of a pill per day, or every couple of days) that I'll avoid the R.H.
I suppose to word it another way, is the R.H. caused by the inhibition of just too much 5ar, making it so if I inhibit less, I may avoid it while still getting the benefits of Propecia ?
Dr Proctor Answers:
Shedding that occurs before about 2-4 months after starting a treatment was of hair that was already in the loss phase when you started. That is, such hair shedding is just coincidental or due to early fallout of loss-phase hair as follicles come out of dormancy under the influence of a hair-growth-stimulator. This hair was about to fall out anyway.
Not that hair loss due to reflex hyperandrogenicity doesn't occasionally happen with Finasteride. However, Finasteride (Propecia) differentially "protects" hair follicles. Thus, enough reflex hyproandrogenicity to exacerbate balding is very likely to be associated with other hyperandrogenic symptoms such as increased libido, skin oiliness, etc. In the absence of these, I consider it unlikely. So you can rest reasonably easily. I hope....
Peter H Proctor, PhD, MD
Question:
What exactly is reflex hyperandrogenicity and what causes it? Is it when the androgen receptors become more sensitive to DHT or is it an increase in overall testosterone that negatively impacts the follicles. Also, should a topical antiandrogen counter this effect?
Dr Proctor Answers:
Reflex hyperandrogenicity is caused by a combination of increased testosterone and increased tissue sensitivity to male sex hormones ( androgens ). The latter is cause at least partially by an increase in the numbers of androgen receptors. Whether the receptors also get more sensitive is not clear, but seems likely.
Reflex hyperandrogenicity is proportional to the strength of an antiandrogen. It limits the use of antiandrogens in (e.g.) treatment of prostate cancer and is why most such patients get castrated.
Because the action of Finasteride is mostly limited to tissues where type-2 5-AR is the important source of androgenic activity, it elicits less reflex hyperandrogenicity than other antiandrogens when used to treat hair loss or prostate enlargement. So this is usually not limiting in hair loss-treatment, at least in the short run. It may even help minimize side-effects such as libido decrease during the use iof finasteride for hair loss. Whether this is also true for Dutasteride ( which blocks both type-1 and type-2 5 Alphareductases ) is not clear yet. And yes, topical antiandrogens such as spironolactone, which do not elicit the increase in testosterone, are likely helpful.
Peter H Proctor, PhD, MD
finfighter said:DR. Proctor, I have been on finasteride for six months and I have had a moderatly increased sex drive, and sometimes i notice oily skin should I be concerned?
Empire said:Please only vote for the selection that has either
A. Worked for you
B. Provided so much study and research (that you've thoroughly) read to put you beyond reasonable doubt would be the best.
After voting, please leave your explanation to why you voted your option.
Old Baldy said:Empire said:Please only vote for the selection that has either
A. Worked for you
B. Provided so much study and research (that you've thoroughly) read to put you beyond reasonable doubt would be the best.
After voting, please leave your explanation to why you voted your option.
None of them work all that great for me but I started when I was 51 years old. Way TOO late in the ballgame IMHO. I'd say finasteride works as well (i.e., for me) as any but I've never tried RU58841.
My guess is dutasteride would work the best for most people but don't expect it to grow back hairs that have been minaturized for a long period of time.
Guys have been saying for YEARS that the earlier you start treatment, the greater possibility of regrowth. I started too late for much of my scalp but did get some regrowth. Maintenance was good though.
FWIW, I use finasteride three days a week and homemade spironolactone cream with other stuff in it. I'd say I use spironolactone. about 6 times a week, one time each of those 6 days. Like I said, maintenance has been good, maybe even very good.
I tried Dave's finasteride in cream method for quite some time but get better results with oral finasteride three times a week. (The hairs seem to be more cosmetically acceptable and maybe a little more regrowth for me with oral finasteride.)
If you can find a study that answers "B" in your question I'd be interested in reading it. Based on your research, what do YOU think is the best?
Enden said:Considering the options on the list, I'll vote for Kraemer & Bohn's 5% RU58841 solution. It's more effective and safer than Propecia. However, one of RU58841's metabolites may still accumulate and cause systemic side effects.