Endocrinology of Hirsutism: From Androgens to Androgen Excess Disorders

Dihydrotestosterone (DHT) impacts various skin conditions, including Androgenetic alopecia and seborrheic dermatitis, by causing overactivity in sebaceous glands. Topical medications Tacrolimus and Clobetasol can reduce these inflammatory conditions, and treatments like RU58841, Minoxidil, and Finasteride may also be beneficial.

The conversation discusses the hypothesis that a lack of the enzyme 3-alpha hydroxysteroid dehydrogenase (3α-HSD) on the scalp may contribute to hair loss by allowing DHT to accumulate. Despite interest in this theory, no recent research has been conducted, and current treatments like finasteride and minoxidil remain the most supported options.

The user experienced high estradiol levels and side effects after stopping finasteride and is concerned about whether these hormonal imbalances are temporary. They are seeking advice on reversing the condition without starting new treatments due to hypersensitivity to finasteride.

A 20-year-old female with PCOS is experiencing hair loss and excessive facial hair. She is using ketoconazole and caffeine shampoos, microneedling, and considering anti-androgens like finasteride, but is cautious about minoxidil due to facial hair concerns.

High DHEA levels may contribute to hair loss by increasing DHT in hair follicles, potentially explaining why finasteride is ineffective for some. Treatments like high-dose dutasteride and RU58841 are suggested, but the underlying cause, such as adrenal issues, should be investigated.

Some users have experienced good hair regrowth with estradiol, cyproterone acetate, spironolactone, and bicalutamide, but these treatments may cause feminization and other side effects. It's advised to consult a doctor before using these treatments, as they can lower testosterone and have significant risks.