Editor's Picks January 2021

Androsterone may help with sexual and affective dysfunction from finasteride by replacing disrupted neurosteroids without increasing androgenic side effects. Controlled testing is needed to confirm its effectiveness and safety.

The conversation discusses topical androgen receptor blockers for hair loss, mentioning Clascoterone, Pyrilutamide, GT20029, and RU58841. Ketoconazole's effectiveness and application methods are also debated.

Clascoterone in Winlevi, a topical AR antagonist, is being re-examined due to concerns about HPA axis suppression in adolescents, but it's unlikely to be banned for adult use in androgenetic alopecia (AGA). The European Medicines Agency recommended refusing Winlevi for acne vulgaris, but this may not affect Breezula's approval for AGA.

AH-001 is a new topical treatment designed to degrade androgen receptors, targeting the root cause of androgenetic alopecia without the side effects of oral treatments like finasteride. It has shown a strong safety profile and good local tolerability in early trials.

GT20029 is a topical treatment that degrades androgen receptors to prevent hair thinning and loss, potentially offering fewer side effects than systemic treatments like finasteride. Concerns include its impact on hair texture and potential systemic effects, with market availability speculated in 3 to 5 years.

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.