5α-Reductase Inhibitors

    November 1997 in “ Andrology ”
    Roger S. Rittmaster
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    TLDR Finasteride effectively treats enlarged prostate and male baldness, improves symptoms of hirsutism in women, but doesn't work for acne, and may delay prostate cancer progression with few side effects.
    In the 1997 document, finasteride, a 5α-reductase inhibitor, was shown to be effective in treating benign prostatic hyperplasia (BPH) by reducing prostate size and improving urinary flow rates, with a decrease in serum DHT by about 70% and prostatic DHT by about 90%. It also demonstrated potential in treating male pattern baldness, with a 1-year study showing a 107-hair improvement over placebo and 48% of men experiencing improvement. For hirsutism, finasteride at 5 mg daily showed significant improvement without adverse side effects in women. However, it was not effective for acne due to the predominance of type 1 5α-reductase in sebaceous glands. While finasteride did not affect the size of metastatic prostate cancer lesions, it delayed the increase in PSA levels post-surgery. An ongoing trial with 18,000 men was investigating its potential to prevent prostate cancer. The safety profile of finasteride was considered favorable, with a low incidence of side effects. Further long-term studies were needed to confirm these findings.
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      A 15-year-old is concerned about hair loss, possibly at Norwood 2 or 3, and is using shampoos and conditioners recommended by a trichologist. Suggestions include considering topical minoxidil and consulting a doctor about topical anti-DHT treatments like finasteride or RU58841, but avoiding 5-alpha-reductase inhibitors at this age.

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