Antiandrogens and Androgen Inhibitors in Dermatologic Treatments

    January 2021 in “ Elsevier eBooks
    Najwa Somani, Marty E. Sawaya
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    TLDR Antiandrogens and androgen inhibitors like spironolactone, finasteride, and dutasteride can treat hair loss and skin conditions, but they have risks and side effects, including potential harm to pregnant women and risks of cancer and heart issues. Herbal remedies also have antiandrogenic effects but lack safety validation.
    The document reviews the use of antiandrogens and androgen inhibitors in treating dermatologic androgen excess disorders such as acne, female-patterned hair loss (FPHL), hirsutism, and hidradenitis suppurativa. Spironolactone, an antiandrogen, is used off-label to treat these conditions and has shown to stabilize hair loss and induce scalp hair growth in some women with FPHL. Finasteride, an androgen inhibitor, is FDA-approved for treating male pattern baldness and has shown to increase total hair counts. Dutasteride, more potent than finasteride, can decrease serum DHT by over 90% within 24 hours and has shown promising results in treating male androgenetic alopecia. However, both finasteride and dutasteride are teratogenic and should not be handled by women who may become pregnant. Combined oral contraceptives can significantly reduce hirsutism scores but carry risks such as breast cancer, stroke, and myocardial infarction. Herbal remedies have antiandrogenic activity but lack strict manufacturing standards and safety validation.
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