5-Alpha Reductase Inhibitors for Male Lower Urinary Tract Symptoms: A Cochrane Systematic Review and Meta-Analysis

Topical androgen receptor antagonists may not be necessary if 5-AR inhibitors like finasteride or dutasteride effectively reduce DHT levels. Combining a 5-AR inhibitor with a topical androgen antagonist could potentially enhance treatment, but oral use of androgen antagonists is too risky due to severe side effects.

Finasteride and dutasteride are discussed for hair loss, with concerns about their effects on neurosteroids and potential side effects like depression. Alternatives like topical estrogen and lifestyle changes are considered, with varying opinions on mental health and hair regrowth.

The conversation is about considering pyrilutamide 1% as an alternative treatment for hair loss due to intolerance to 5-alpha reductase inhibitors. Some users suggest it might be effective, while others view it as a temporary solution.

The conversation discusses the need for a localized 5-alpha reductase inhibitor that only affects the scalp without systemic side effects, similar to pyrilutamide's approach. Current treatments like topical liposomal finasteride and dutasteride are mentioned, but concerns about their systemic effects and lack of research are highlighted.

Saw palmetto, a 5-alpha reductase inhibitor, caused unexpected side effects like breast changes and altered semen consistency, which resolved after stopping its use. Concerns about similar side effects with finasteride or dutasteride were expressed, and another user reported low libido and depression from saw palmetto.

The user experienced sexual side effects after starting finasteride and later switched to dutasteride, noticing hormonal changes. They are considering using P5P and possibly aromatase inhibitors to manage high prolactin and estradiol levels.