Antiandrogen or Androgen Antagonist factors are a group of hormone antagonist compounds that are capable of preventing or inhibiting the biologic effects of androgens; the male sex hormones. Antiandrogens usually work by blocking the appropriate receptors competing for binding sites on the cell's surface or they block production of enzymes responsible for conversion of less potent androgens to more potent androgens such as dihydrotestosteron(DHT). Androgen antagonists do not stop the production or conversion of androgens but they counteract the actions of androgens. The anti-androgens and androgen atagonists which are used to prevent or reverse premature hair loss are: progesterone, spironolactone (Aldactone®), flutamide (Eulexin®), finasteride (Proscar®), cimetidine (Tagamet®), Serenoa repens (Permixon®) and cyproterone acetate (Androcur/Diane®). Out of these the following anti-androgens are in use as the Medication for Hair Loss in male pattern balding.
The most effective anti-androgens are oral finasteride (Propecia®, Proscar®). Finasteride (Proscar®) was originally developed to treat benign prostatic hyperplasia (BPH). It is available by prescription in 5-mg tablets. Finasteride (Propecia®) is FDA-approved for hair loss treatment. It is available by prescription in 1-mg tablets for men at $45 to $50 per month. Offically, Propecia cannot be taken by women although some dermatologists in Europe are using it for women with the requirement that the women must use contraceptives to avoid pregnancy while on the drug. Finasteride was once thought to be useless for androgenic alopecia treatment because it primarily affected 5-alpha-reductace, the type 2 DHT-producing enzyme. However, finasteride in doses as low as 0.2 mg daily can decrease scalp skin, and serum DHT levels.
Finasteride can produce visible hair growth in most men with mild-to-moderate alopecia and can stop hair loss in a majority of patients. Finasteride (1 mg daily over 5 years) was well-tolerated, produced durable improvement in scalp hair growth, and slowed further hair loss progression. In a comparative control group taking placebo pills, hair loss continued with no treatment. The most common side effect of finasteride treatment is decreased sexual desire or a lowered amount of ejaculate. However, the numbers of men experiencing this side effect was less than 2% and almost as many men receiving placebo experienced the same side effects). Initial results of the Prostate Cancer Prevention Trial produced concerns that finasteride might promote prostate cancer. Finasteride was seen to reduce the incidence of prostate cancer in men over 55 in one research trial. However, trial participants who did develop prostate cancer had slightly more high-grade tumors.
Many Hair Transplant Surgeons think Propecia to be an excellent adjunctive medication and an excellent male hair loss treatment for Preparation in Advance of Hair Restoration Surgery for several reasons:
1) Propecia works best in younger men; some of them may not be hair transplant candidates yet.
2) The medication works better in the crown area, and often the crown requires more surgically harvested donor hair than may be available.
Dutasteride (GG745), similar to Propecia®, blocks enzymatic conversion of testosterone to DHT.
AvodartTM (Dutasteride) is approved for the treatment of Benign Prostatic Hyperplasia (BPH) which is not to be confused with prostate cancer. Avodart is a synthetic 4-azasteroid compound. It is the first FDA approved drug which blocks two enzymes that create DHT rather unlike finasteride which only blocks one, and therefore dutasteride and may be a more potent treatment for hair loss.
Avodart standard dosage is 0.5mg of the active ingredient dutasteride per soft gelatin capsule. The capsule is compounded by dissolving 0.5mg of dutasteride in a combination of mono-di-glycerides caprylic/capric acid and butylated hydroxytoluene. Other ingredients include BSE-free bovine gelatin, glycerin and yellow ferric oxide.
If you are able to obtain Dutasteride in its raw form, you might even be able to compound your own Dutasteride topical solution. It was reported in Avodart's prescribing information that the medication is absorbed through the skin as well. Dutasteride in its raw form is a white-yellowish powder. It is insoluble in water, but can easily be dissolved in ethanol (44mg/mL), methanol (64 mg/mL) and polyethylene glycol 400 (3mg/mL). However, please note that effectiveness of Dutasteride or Avodart as a hair loss treatment has not been clinically established.
Some patients may prefer a systemic agent as a hair loss medication, whereas others may favor a topical agent such as a growth stimulator like Minoxidil. But in case the condition has not stabilized after 1 year, or if the patient wants greater hair density, Hair Transplantation as a hair loss treatment can be considered. Hair Transplant Replacement under the age of 25 is not generally recommended because the ultimate extent and pattern of hair loss cannot usually be predicted. But for patients with a more advanced condition, most of the hair loss medications are not very effective and Hair Restoration Surgery is the best option.