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To evaluate the efficacy of oral finasteride therapy associated with an oral contraceptive containing drospirenone and ethinyl estradiol in premenopausal women with female pattern hair loss. Outpatient consultation for hair disorders at the Department of Dermatology, University of Bologna. Thirty-seven women with female pattern hair loss were treated with oral finasteride, 2.5 mg/d, while taking an oral contraceptive containing drospirenone and ethinyl estradiol. Treatment efficacy was evaluated using global photography and the hair density score from videodermoscopy. A self-administered questionnaire was used to assess patient evaluation of treatment effectiveness. At 12-month follow-up, 23 of the 37 patients were rated as improved using global photography (12 were slightly improved, 8 were moderately improved, and 3 were greatly improved). No improvement was recorded in 13 patients. One patient experienced worsening of the condition. There was a statistically significant (P = .002) increase in the hair density score in 12 patients. No adverse reactions to the drug were reported. Sixty-two percent of the patients demonstrated some improvement of their hair loss with the use of finasteride, 2.5 mg/d, while taking the oral contraceptive. It is unclear whether the success was due to a higher dosage of finasteride (2.5 mg instead of 1 mg) or to its association with the oral contraceptive containing drospirenone, which has an antiandrogenic effect. Further studies are necessary to understand which patterns of female pattern hair loss respond better to this treatment.
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STUDY
Finasteride Treatment of Female Pattern Hair Loss
Matilde Iorizzo, MD; Colombina Vincenzi, MD; Stylianos Voudouris, MD;
Bianca Maria Piraccini, MD, PhD; Antonella Tosti, MD
Objective: To evaluate the efficacy of oral finasteride
therapy associated with an oral contraceptive contain-
ing drospirenone and ethinyl estradiol in premeno-
pausal women with female pattern hair loss.
Setting: Outpatient consultation for hair disorders at the
Department of Dermatology, University of Bologna.
Patients and Intervention: Thirty-seven women with
female pattern hair loss were treated with oral finaste-
ride, 2.5 mg/d, while taking an oral contraceptive con-
taining drospirenone and ethinyl estradiol. Treatment ef-
ficacy was evaluated using global photography and the
hair density score from videodermoscopy. A self-
administered questionnaire was used to assess patient
evaluation of treatment effectiveness.
Results: At 12-month follow-up, 23 of the 37 patients
were rated as improved using global photography (12 were
slightly improved, 8 were moderately improved, and 3
were greatly improved). No improvement was recorded
in 13 patients. One patient experienced worsening of the
condition. There was a statistically significant (P=.002)
increase in the hair density score in 12 patients. No ad-
verse reactions to the drug were reported.
Conclusions: Sixty-two percent of the patients demon-
strated some improvement of their hair loss with the
use of finasteride, 2.5 mg/d, while taking the oral con-
traceptive. It is unclear whether the success was due to
a higher dosage of finasteride (2.5 mg instead of 1 mg)
or to its association with the oral contraceptive contain-
ing drospirenone, which has an antiandrogenic effect.
Further studies are necessary to understand which pat-
terns of female pattern hair loss respond better to this
treatment.
Arch Dermatol. 2006;142:298-302
F
EMALE PATTERN HAIR LOSS
(FPHL), the most common
form of hair loss, affects up
to 50% of women during
their life.
1
Although hair
thinning in women with FPHL may be dif-
fuse, 3 different clinical patterns have been
described: the Christmas tree pattern,
2
the
Ludwig pattern,
3
and the Hamilton pat-
tern.
4
Patients who experience hair thin-
ning complain of social anxiety and em-
barrassment. If left untreated, FPHL may
be rapidly progressive.
Treatment for FPHL consists mainly of
topical minoxidil, which is effective
5
but
sometimes is not well accepted by the pa-
tient. The efficacy of oral antiandrogens
is not well established. Although cyprot-
erone acetate is prescribed in Europe to
treat FPHL,
6-8
its efficacy is still contro-
versial. A controlled 12-month random-
ized trial
9
compared the effects of cyprot-
erone acetate, 52 mg/d, with 2% topical
minoxidil in FPHL. All the patients took
oral contraceptives. After 6 months of
treatment, minoxidil was effective in
women with a low body mass index and
the absence of hyperandrogenism. Cy-
proterone was effective when other signs
of hyperandrogenism were present and
when body mass index was high.
In a recent study,
10
treatment with oral
antiandrogens (spironolactone and cy-
proterone and oral contraceptives in pre-
menopausal women) produced hair re-
growth in 35 (44%) of 80 women with
FPHL.This study showed no relationship
between response to treatment and pa-
tient age, menopausal status, and serum
hormone levels. Spironolactone (100-
200 mg/d) and cyproterone acetate (50-
100 mg/d) produced similar results. In a
small 12-month randomized trial,
11
flu-
tamide was reported to be effective at 250
mg/d and was better than cyproterone ac-
etate, 50 mg/d, and finasteride, 5 mg/d. We
report herein our experience with finas-
teride, 2.5 mg/d, taken with an oral con-
traceptive containing drospirenone and
ethinyl estradiol in 37 premenopausal
women with FPHL.
For editorial comment
see page 362
Author Affiliations:
Department of Dermatology,
University of Bologna,
Bologna, Italy.
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METHODS
STUDY PATIENTS AND DESIGN
Thirty-seven premenopausal women with FPHL seen for con-
sultation regarding hair loss were enrolled in this study
(
Table 1). The thinning hair was not associated with in-
creased shedding, and the pull test result was negative. Other
inclusion criteria were normal androgen levels and ovulatory
cycles, normal iron and ferritin levels, and negative thyroid
function test results. Patients affected by acne or hirsutism
were excluded.
After providing informed consent, patients were pre-
scribed finasteride, 2.5 mg/d, and an oral contraceptive con-
taining drospirenone, 3 mg, and ethinyl estradiol, 30 µg (Yas-
min; Schering AG Germany, Berlin, Germany). All 37 women
had refused to apply topical minoxidil. Camacho
12
reported good
results with this finasteride dose in patients with FPHL. Fin-
asteride treatment, which is teratogenic, requires oral contra-
ception to prevent pregnancy. Ethinyl estradiol–drospir-
enone, which has antiandrogenic activity, was selected because
of its possible adjuvant effect on FPHL.
EVALUATION PROCEDURES
Global photography, using a Nikon-Canfield D1 camera with
a Nikon 60-mm f2.8 lens (Nikon Inc, Melville, NY), was per-
formed at baseline and after 12 months of treatment. The pa-
tient’s head was placed in a stereotactic device to ensure con-
sistent positioning and photographic distance. Pictures obtained
at 12 months were compared with those obtained at baseline
and rated by one of us (M.I.), who was not involved in the clini-
cal study. A 7-point scale was used to evaluate hair density in
response to treatment
13
: −3, greatly decreased; −2, moderately
decreased; −1, slightly decreased; 0, no change; 1, slightly in-
creased; 2, moderately increased; and 3, greatly increased.
Hair density score at baseline and after 12 months was evalu-
ated using computerized light videodermoscopy (FotoFinder
dermoscope; Teachscreen Software GmbH, Bad Birnbach, Ger-
many) with 20 magnification lenses. Probed images were digi-
tized and stored. To assess the hair density score, we adapted
the scale proposed by de Lacharrière et al
14
to our instrument.
The reference scores for hair density were obtained by count-
ing the number of hairs on 1 side from center parting within
the same area at the vertex (cross between nose line and ear
implantation): 1, baldness (15 hairs); 2, very low hair den-
sity (15-20 hairs); 3, low hair density (21-30 hairs); 4, me-
dium hair density (31-40 hairs); 5, high hair density (41-50
hairs); and 6, very high hair density (50 hairs).
One of us (C.V.) showed the patients their photographs at
baseline and at 12 months and requested that they assess the
results of treatment using a self-administered questionnaire. They
were questioned about their satisfaction, the appearance of their
hair, the stabilization of hair loss, and the promotion of hair
growth using the 7-point scale described previously herein.
STATISTICAL ANALYSIS
A t test for matched samples was run on hair density values to
corroborate the qualitative findings.
RESULTS
The patients ranged in age from 19 to 50 years (mean,
33.7 years) (Table 1). After 12 months, 23 of the 37 pa-
tients were rated as improved using global photography
(12 were slightly improved, 8 were moderately im-
proved [
Figure 1], and 3 were greatly improved
[
Figure 2]). No improvement was recorded in 13 pa-
tients. One patient experienced worsening of the condi-
tion despite treatment. Hair density scores increased in
12 patients (
Figure 3) from a mean density of 4.5 at
baseline to 4.8 at 12 months (t=−3.375; P=.002). Using
the self-administered questionnaire, 29 patients judged
their condition as improved and 8 as stabilized. None of
the women considered their condition worsened
(
Table 2). No patients experienced adverse reactions
during treatment.
COMMENT
Finasteride is a 5-reductase type II inhibitor currently
approved to treat male androgenetic alopecia at a dos-
age of 1 mg/d. Because of the potential risk of terato-
genicity in a male fetus,
15
finasteride is contraindicated
Table 1. Characteristics of 37 Women
With Female Pattern Hair Loss
Patient
Age, y
Baseline Clinical
Pattern
12-mo
GPA
(−3 to 3)
Hair Density Score
Baseline 12 mo
39 Christmas tree 1 4 4
25 Ludwig I 2 5 6
38 Ludwig I 0 5 5
34 Christmas tree 0 5 5
24 Christmas tree 0 5 5
24 Ludwig II 2 4 5
30 Ludwig I 2 4 5
28 Ludwig I 0 4 4
22 Ludwig II 2 3 4
30 Christmas tree 1 4 4
38 Christmas tree 1 5 5
26 Ludwig I 0 5 5
29 Christmas tree 0 5 5
44 Christmas tree 0 5 5
42 Ludwig II 3 4 5
48 Ludwig I 1 5 5
42 Ludwig I 1 5 5
47 Ludwig II 2 3 4
43 Ludwig I 0 5 5
41 Ludwig I −1 5 4
43 Ludwig I 0 5 5
34 Christmas tree 1 4 5
19 Christmas tree 2 4 5
27 Christmas tree 3 4 6
50 Ludwig I 0 5 5
30 Christmas tree 2 5 6
27 Ludwig I 1 5 5
21 Ludwig II 3 3 5
31 Christmas tree 1 5 5
25 Ludwig I 0 5 5
48 Christmas tree 1 5 5
32 Ludwig II 0 4 4
36 Christmas tree 1 5 5
36 Christmas tree 1 5 5
38 Christmas tree 1 5 5
29 Christmas tree 0 4 4
29 Christmas tree 2 4 5
Abbreviation: GPA, global photography assessment.
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in women of childbearing potential. The efficacy of fin-
asteride in FPHL is still controversial.
A multicenter, double-blind, placebo-controlled, ran-
domized study
16
of finasteride, 1 mg/d, in postmeno-
pausal women with FPHL showed negative results in in-
creasing hair growth and slowing the progression of hair
thinning. After 12 months of treatment, patients in the
finasteride and placebo groups had a modest decrease in
hair count from baseline. Scalp biopsies also revealed no
differences in the anagen-telogen ratio and the terminal
hair–miniaturized hair ratio. In this study, the lack of ef-
ficacy of finasteride may have been related to the older
age of the patients. Hair thinning may not be androgen
dependent in senescent scalps. Moreover, in this study
with negative findings, finasteride was administered at
a dosage of 1 mg/d, which might be inadequate for FPHL.
Recently, noncontrolled studies
12,17-19
indicated that
finasteride therapy can be effective in premenopausal and
postmenopausal women with and without signs of hy-
perandrogenism. Camacho
12
reported hair regrowth us-
ing finasteride, 2.5 mg/d, in 41 women with FPHL and
SAHA (seborrhea, acne, hirsutism, and alopecia) syn-
drome. Thai and Sinclair
17
administered finasteride at a
dosage of 5 mg/wk (1 mg/d) to a 67-year-old post-
menopausal woman without signs of hyperandrogen-
ism and with Ludwig FPHL. After 12 months of treat-
ment the patient showed a significant increase in hair
density. Shum et al
18
administered finasteride to 4 women
with hyperandrogenism at a dosage of 1.25 mg/d. Two
of these patients had a Ludwig-type FPHL, and the other
2 had a Hamilton pattern. Only 2 of the women were post-
menopausal, but the others had a history of infertility with
irregular menses. Increased hair growth and decreased
progression of hair loss were observed in all the patients
after 6 months and 1, 2, and 2.5 years of treatment, re-
spectively. The efficacy of finasteride in postmeno-
pausal normoandrogenic women with FPHL was re-
ported by Trueb
19
as early as after 6 months of treatment.
Finasteride was administered at 2.5 mg/d in 4 women, 1
with the Christmas tree pattern and 3 with the Ludwig
pattern, and finasteride, 5 mg/d, in 1 woman with the
Hamilton pattern.
A recent case report
20
also indicated that the dual 5-
reductase inhibitor dutasteride, 0.5 mg/d, can improve
FPHL. All these studies of oral antiandrogens in pre-
menopausal women with FPHL used oral contraception
to prevent pregnancy. However, different contracep-
tives were used, and information about a possible effect
of these agents on treatment efficacy is lacking.
In the present study, 62% of patients demonstrated
some improvement of their hair loss after 1 year of treat-
ment with finasteride, 2.5 mg/d, taken with an oral con-
traceptive containing drospirenone and ethinyl estra-
diol (32% slightly improved, 22% moderately improved,
and 8% greatly improved). Finasteride was well toler-
ated compared with the other oral antiandrogens, and
BA
Figure 1. Christmas tree pattern of hair loss shows moderate improvement compared with baseline (A) after 12 months of oral finasteride treatment (B).
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none of the patients reported adverse effects. This treat-
ment was well accepted by the patients, who judged the
results to be even better than did the investigators. The
patient’s opinion being generally more optimistic than
that of the investigator is not surprising. In double- blind
clinical trials on the efficacy of finasteride on male an-
drogenetic alopecia,
13
patients treated with placebo re-
ported improvement of their condition.
The efficacy of finasteride in two thirds of our pre-
menopausal women may be due to the higher dosage used.
The contraceptive contains drospirenone, a progestin ana-
log of spironolactone. It is possible that even at a very
low dosage (3 mg), drospirenone might have had an ad-
ditional effect in promoting hair growth. Owing to its an-
tiandrogenic and diuretic activities, this pill may be use-
ful for FPHL, but it is also well accepted because it provides
weight stability or even loss.
21
The potential risk of tera-
togenicity of finasteride in women with childbearing po-
tential requires oral contraception. We used the same con-
traception in all the patients to avoid the confounding
role of contraceptive pills containing progestins with pos-
sible androgenic activity.
BA
Figure 2. Ludwig pattern of hair loss shows great improvement compared with baseline (A) after 12 months of oral finasteride treatment (B).
BA
Figure 3. Improvement in the hair density score compared with baseline (A) at 12 months of oral finasteride treatment (B).
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Although our study is not randomized, blinded, and
placebo controlled and does not include scalp biopsies,
the clinical results using global photography, hair den-
sity scores, and patient self-assessment provide a basis
for future work. Further studies are needed to establish
the optimal dosage and mode of administration of fin-
asteride in premenopausal women and to definitively as-
sess the efficacy of this drug compared with oral anti-
androgens.
Accepted for Publication: November 1, 2005.
Correspondence: Antonella Tosti, MD, Department of
Dermatology, University of Bologna, Via Massarenti,
1-40138 Bologna, Italy (tosti@med.unibo.it).
Author Contributions: Study concept and design: Iorizzo
and Tosti. Acquisition of data: Voudouris. Analysis and in-
terpretation of data: Iorizzo, Vincenzi, and Tosti. Draft-
ing of the manuscript: Iorizzo, Piraccini, and Tosti. Criti-
cal revision of the manuscript for important intellectual
content: Iorizzo and Tosti. Study supervision: Iorizzo
and Tosti.
Financial Disclosure: None.
Acknowledgment: We thank Gabriella Fabbrocini, MD, Uni-
versity of Naples (Naples, Italy), for statistical analysis.
REFERENCES
1. Price VH. Androgenetic alopecia in women. J Investig Dermatol Symp Proc. 2003;
8:24-27.
2. Olsen EA. Female pattern hair loss. J Am Acad Dermatol. 2001;45:S70-S80.
3. Ludwig E. Classification of the types of androgenetic alopecia (common bald-
ness) occurring in female sex. Br J Dermatol. 1977;97:247-254.
4. Venning VA, Dawber RP. Patterned androgenetic alopecia in women. J Am Acad
Dermatol. 1988;18:1073-1077.
5. Price VH, Menefee E. Quantitative estimation of hair growth, I: androgenetic alo-
pecia in women: effect of minoxidil. J Invest Dermatol. 1990;95:683-687.
6. Dawber RPR, Sonnex T, Ralfs I. Oral antiandrogen treatment of common bald-
ness in women [abstract]. Br J Dermatol. 1982;107(suppl 22):20.
7. Mortimer CH, Rushton H, James KC. Effective medical treatment of common bald-
ness in women. Clin Exp Dermatol. 1984;9:342-350.
8. Peereboom-Wynia JD, van der Willigen AH, van Joost T, Stolz E. The effect of
cyproterone acetate on hair roots and hair shafts diameter in androgenetic alo-
pecia in females. Acta Derm Venereol. 1989;69:395-398.
9. Vexiau P, Chaspoux C, Boudou P, et al. Effects of minoxidil 2% vs cyproterone
acetate treatment on female androgenetic alopecia: a controlled, 12-month ran-
domized trial. Br J Dermatol. 2002;146:992-999.
10. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with
oral antiandrogens. Br J Dermatol. 2005;152:466-473.
11. Carmina E, Lobo RA. Treatment of hyperandrogenic alopecia in women. Fertil
Steril. 2003;79:91-95.
12. Camacho F. Hirsutismo: enfoque clinico terape´utico. Act Terap Dermatol. 2001;
24:190-206.
13. Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with
androgenetic alopecia. J Am Acad Dermatol. 1998;39:578-588.
14. de Lacharrière O, Deloche C, Misciali C, et al. Hair diameter diversity. Arch Dermatol.
2001;137:641-646.
15. Prahalada S, Tarantal AS, Harris GS, et al. Effects of finasteride, a type 2 5-
reductase inhibitor, on fetal development in the rhesus monkey (Macaca mulatta).
Teratology. 1997;55:119-131.
16. Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in post-
menopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000;
43:768-776.
17. Thai KE, Sinclair R. Finasteride for female androgenetic alopecia. Br J Dermatol.
2002;147:812-813.
18. Shum KW, Cullen DR, Messenger AG. Hair loss in women with hyperandrogen-
ism: four cases responding to finasteride. J Am Acad Dermatol. 2002;47:733-
739.
19. Trueb RM. Finasteride treatment of patterned hair loss in normoandrogenic post-
menopausal women. Dermatology. 2004;209:202-207.
20. Olszewska M, Rudnicka L. Effective treatment of female androgenic alopecia with
dutasteride. J Drugs Dermatol. 2005;4:637-640.
21. Batur P, Elder J, Mayer M. Update on contraception: benefits and risks of the
new formulations. Cleve Clin J Med. 2003;70:681-696.
Table 2. Patient and Investigator Assessments
of FPHL After 12 Months of Treatment*
Patient
Assessment
(Questionnaire)
Investigator
Assessment
(GPA)
Improvement (1, 2, 3) 29 23
Stabilization (0) 8 13
Worsening (−1, −2, −3) None 1
Abbreviations: FPHL, female pattern hair loss; GPA, global photography
assessment.
*Data are given as numbers.
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... Histological examination of scalp biopsy specimens correspondingly showed no significant differences between the groups with respect to alterations from baseline regarding terminal-to-vellus hair ratio and anagen-to-telogen ratio. 30,31 A subsequent open-label, uncontrolled study using lowdose finasteride (1.25 mg) in 18 normoandrogenic FPHL patients similarly failed to demonstrate increasing hair density evaluated by phototrichogram. 32 No clinical response was observed by patient self-assessment and physician's GPA compared to baseline. ...
... A single-center, uncontrolled, prospective trial further evaluated the efficacy of the medium-dose finasteride in 37 pre-menopausal women with FPHL in the absence of hyperandrogenism. 30 Finasteride was given for 12 months at a dose of 2.5 mg daily with concomitant use of an oral contraceptive containing drospirenone and ethinyl estradiol to prevent pregnancy. After 12 months, global photography displayed the enhancement of hair density in 62% of patients. ...
Article
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The currently approved treatment for female pattern hair loss (FPHL) includes topical minoxidil administration; however, this treatment fails to achieve hair regrowth in some patients. Finasteride, a selective 5α-reductase inhibitor (5-ARI), may be considered as an alternative treatment. However, because of its potential teratogenic effects, clinical studies and use of finasteride for FPHL are limited. In this review, we aim to summarize the literature regarding the pharmacology, clinical efficacy, and adverse effects of oral finasteride for the treatment of FPHL and to provide novel therapeutic options including topical finasteride and dutasteride, a new generation 5-ARI, for the treatment of FPHL.
... While finasteride at a 1mg daily dose was shown to be ineffective in post-menopausal women, 9 several case reports have demonstrated efficacy in FPHL using 2.5-5.0mg daily. ...
... Subsequently, other studies done in the United States and around the world using higher daily doses of 2.5-5mg finasteride showed some significant results. [13][14][15] The largest of these came from South Korea, showing that 70/86 (81.4%) of normoandrogenic women treated with 5mg finasteride for 12 months had improvement in global photographs. There were statistically significant improvements in hair caliber and hair density using scalp tattooing with microscopic scalp analysis. ...
... Regarding the use of FT in women for AGA, its efficacy has not been established and is used as an off label treatment with doses ranging from 2.5 to 5 mg/day. [45][46][47] In AGA in males, it has been concluded that: ...
... It has been considered a treatment option also in women even though its teratogenic effects tend to limit its prescription. Reports of its efficacy in women are contradictory, with less consistent results than in men [7,8]. Recently, topical formulations have been evaluated to limit the side effect profile of the drug [9]. ...
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Background and objectives: Female pattern hair loss (FPHL) is a common form of scalp hair loss that occurs in 38% of females. Currently, minoxidil solution is the only therapy approved by the US Food and Drug Administration, but many other treatments are used, including cyproterone acetate, spironolactone, topical 17α-estradiol, and prostaglandin analogs. Systemic finasteride has been considered a treatment option in women even though its teratogenic effects tend to limit its prescription. Recently, topical finasteride has been evaluated to limit the side effect profile of the drug. The objective of the present study is to compare retrospectively the efficacy of topical 0.05% 17α-estradiol solution and a 0.5% finasteride lotion in the treatment of FPHL. Patients and methods: We enrolled 119 postmenopausal female patients. The first group comprised 69 women treated with finasteride 0.5% and minoxidil 2%. The second group included 50 women treated with 17α-estradiol 0.05% and minoxidil 2%. At baseline and at 6- and 12- to 18-month follow-up, global photographs were systematically taken. Three operators blind to the prescribed treatment evaluated photographs using a 7-point scale. One-way analysis of variance and unpaired Student t tests were performed to analyze 7-point scale scores. Results: The improvement was statistically significant from 6 months to 12-18 months, both for finasteride (P < 0.005) and 17α-estradiol (P < 0.05). The efficacy of topical finasteride was significantly greater than that of 17α-estradiol solution, both at the 6-month (P < 0.05) and at the 12- to 18-month follow-up (P < 0.005). In general, the highest improvement was observed after 12-18 months of treatment with topical finasteride therapy. Conclusions: Topical finasteride 0.5% in combination with minoxidil 2% could represent a valid therapeutic option for the treatment of postmenopausal FPHL, showing higher efficacy than topical 17α-estradiol with minoxidil 2% both at 6-month and 12- to 18-month follow-up.
... Our experiments revealed that FIN yielded similar effects on stress reactivity in both sexes as well as in castrated males. Although FIN is only approved for clinical use in male patients, FIN is often used in women as a treatment for hirsutism, hair loss, and other hyperandrogenic conditions [44][45][46][47]. Thus, caution should be exercised in recommending FIN therapy in women with a well-known predisposition to depression and other psychological problems. ...
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Finasteride (FIN) is the prototypical inhibitor of steroid 5α-reductase (5αR), the enzyme that catalyzes the rate-limiting step of the conversion of progesterone and testosterone into their main neuroactive metabolites. FIN is clinically approved for the treatment of benign prostatic hyperplasia and male baldness; while often well-tolerated, FIN has also been shown to cause or exacerbate psychological problems in vulnerable subjects. Evidence on the psychological effects of FIN, however, remains controversial, in view of inconsistent clinical reports. Here, we tested the effects of FIN in a battery of tests aimed at capturing complementary aspects of mood regulation and stress reactivity in rats. FIN reduced exploratory, incentive, prosocial, and risk-taking behavior; furthermore, it decreased stress coping, as revealed by increased immobility in the forced-swim test (FST). This last effect was also observed in female and orchiectomized male rats, suggesting that the mechanism of action of FIN does not primarily reflect changes in gonadal steroids. The effects of FIN on FST responses were associated with a dramatic decrease in corticotropin release hormone (CRH) mRNA and adrenocorticotropic hormone (ACTH) levels. These results suggest that FIN impairs stress reactivity and reduces behavioral activation and impulsive behavior by altering the function of the hypothalamus–pituitary–adrenal (HPA) axis.
... Finasteride, a 5 alpha-reductase inhibitor, currently FDA approved for male androgenic alopecia (AGA) at a dose of 1mg/day also fills a controversial role in FPHL treatment at high dose of 5mg/day, due to the 1mg/day being found insufficient to produce results. 2,3 Linda was skeptical about the overall efficacy of the available treatment options for her after seeing her husband's past dissatisfaction in treatment and was concerned that starting a new medication would lead to experiencing potential side effects such as irritation or contact dermatitis, and hypertrichosis, without clinical improvement in her hair density. 4 Because of this, Linda wished to defer treatment at the current time until having a discussion with her dermatologist for a second opinion about starting a medication for treatment of FPHL. ...
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p>A critical appraisal and clinical application of Oliveira-Soares R, Silva JE, Correia M, André M. Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women. International Journal of Trichology . 2013;5(1):22-25. doi: 10.4103/0974-7753.114709 .</p
... Moreover, obvious differences in clinical response of female androgenetic alopecia to clinical trials with oral finasteride [22][23][24][25][26][27][28][29] have led to the suggestion that not all types of hair loss in women have the same pathophysiology (i.e., a distinction should be made between alope cia with early [premenopausal] or with late [postmenopausal] onset, and with or without hyperandrogenemia [30]. ...
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Evidence-based medicine (EBM) aims for the ideal that healthcare professionals make conscientious, explicit, and judicious use of the best available evidence gained from the scientific method to clinical decision-making. It seeks to assess the strength of the evidence for benefits of diagnostic tests and treatments, using techniques from science, engineering, and statistics, such as the systematic review of medical literature, meta-analysis, risk-benefit analysis, and randomized controlled trials. The limited success rate of EBM therapies suggests that the complex nature of hair loss may be inadequately served by the present levels of evidence, and that physicians treating hair loss may have fallen short of adequately researching a robust evidence to underpin their practices. Against this backdrop, the concept of precision medicine (PM) is evolving. PM refers to the customization of medical care to the patient’s individual characteristics based on the patient’s genetic background and other molecular or cellular analysis, while classifying patients into subpopulations that differ in their susceptibility to a particular medical condition, in the biology or prognosis of those medical conditions, or in their response to a specific treatment. With the advances in hair research, the powerful tools of molecular biology and genetics, and innovative technologies, we have the robust scientific data and tools to adapt the concept of PM to the practice of trichiatry. Finally, databases pertaining to the development and efficacy of PM must be analyzed and be used to form the basis of evidence-based personalized trichiatry.
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Introduction This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction. Materials and Methods A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques Results Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement. Conclusions Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Background: Finasteride, an inhibitor of type 2 5alpha-reductase, inhibits conversion of testosterone to dihydrotestosterone, resulting in a decrease in serum and scalp dihydrotestosterone levels believed to be pathogenic in androgenetic alopecia. Oral finasteride has been shown to be effective in the treatment of hair loss in men, while its efficacy in women has remained controversial. Methods: 5 postmenopausal women without clinical or laboratory signs of hyperandrogenism were given 2.5 or 5 mg/day oral finasteride for the treatment of pattern hair loss. Efficacy was evaluated by patient and investigator assessments, and review of photographs taken at baseline and at months 6, 12 and 18 by an expert panel. Results: Finasteride treatment improved scalp hair by all evaluation techniques. The patients' self-assessment demonstrated that finasteride treatment decreased hair loss, increased hair growth and improved appearance of hair. These improvements were confirmed by investigator assessment and assessments of photographs. No adverse effects were noted. Conclusions: Oral finasteride in a dosage of 2.5 mg/day or more may be effective for the treatment of pattern hair loss in postmenopausal women in the absence of clinical or laboratory signs of hyperandrogenism.
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Background: Androgenetic alopecia (male pattern hair loss) is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone (DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II 5α-reductase, decreases serum and scalp DHT by inhibiting conversion of testosterone to DHT. Objective: Our purpose was to determine whether finasteride treatment leads to clinical improvement in men with male pattern hair loss. Methods: In two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator assessments, and review of photographs by an expert panel. Results: Finasteride treatment improved scalp hair by all evaluation techniques at 1 and 2 years (P < .001 vs placebo, all comparisons). Clinically significant increases in hair count (baseline = 876 hairs), measured in a 1-inch diameter circular area (5.1 cm2 ) of balding vertex scalp, were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years, respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients’ self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair growth, and improved appearance of hair. These improvements were corroborated by investigator assessments and assessments of photographs. Adverse effects were minimal. Conclusion: In men with male pattern hair loss, finasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years. (J Am Acad Dermatol 1998;39:578-89.)
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‘Patterned’ hair loss of the so-called male type (androgenic alopecia) has long been regarded as a marker of pathological virilization when it occurs in women—an indicator of specific ovarian or adrenal disease. We have believed for many years that patterning is relatively common in normal women, although it is generally masked by the hair styles adopted to convey an appearance of dense hair. Since it is medically important to confirm the physiological nature of female patterning, we carried out a population survey of 564 normal women. The hair density of each subject was carefully examined from above and the hair style flattened or wetted to show the vertex pattern, using the standard grading methods of Hamilton and Ludwig. Thirteen per cent of premenopausal and 37% of post-menopausal women had detectable Hamilton grades of 2–7 which were not obvious from frontal viewing. We conclude that in the absence of other signs of virilization, patterned alopecia in women is a poor indicator of significant androgen metabolism diseases.
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Androgenetic alopecia in the female occurs much more frequently than is generally believed. The condition is still considered infrequent, for it differs, in its clinical picture and in the sequence of events leading to it, from common baldness in men. To facilitate an early diagnosis (desirable in view of the therapeutic possibilities by means of antiandrogens) a classification of the stages of the common form (female type) of androgenetic alopecia in women is presented. The exceptionally observed male type of androgenetic alopecia can be classified according to Hamilton or to the modification of this classification proposed by Ebling & Rook.
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Quantitative growth of hair over a 40-week period is reported for eight women with androgenetic alopecia. Using a random, double-blind protocol, the women were given either a 2% minoxidil solution or a placebo of vehicle only. Hair in a permanently marked site on the fronto-parietal scalp was pulled through a 1-cm-square clear plastic template, and the outline of the template was drawn on the scalp. The hair was carefully hand clipped and collected at five eight-week intervals (one untreated and four treated), using great care to collect only hairs within the marked area. Subsequent measurements included the total weight of hair grown in the marked area, the total number of hairs, and, on a randomized 50-hair subsample, the weight, lengths, and optical diameters. Calculated quantities included average weight per hair, average length, and average optical width. The average total hair weight of minoxidil-treated subjects increased over the 32-week test period by 42.5%, compared to 1.9% for the placebo-treated subjects (average p = 0.018). Changes for the average number count were 29.9% and -2.6%, respectively (average p = 0.022). These increases, observed using an unusually small number of subjects, clearly distinguished the treated subjects from the untreated. During the same test period, the averaged quantities of weight, diameter, and length from the 50-hair subsample showed insignificant change (p usually greater than 0.5). In addition to showing a larger percentage increase than did the total number, the total weight is not only easier to obtain, but less prone to error during sampling and measurement. Therefore, we recommend that total weight from a defined area be considered as the primary quantitative estimator for hair growth.
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Twenty female patients suffering from androgenetic alopecia were treated for 1 year with 50 µg ethinylestradiol plus 2 mg cyproterone acetate and an additional 20 mg cyproterone acetate on days 5–20 of the menstrual cycle. The control group consisted of eight untreated female patients with androgenetic alopecia. The parameters used to evaluate therapeutic results were trichogram hair shaft diameter of full anagen and number of hairs measuring less than 40 µm. Hair roots were epilated from two locations of the scalp: frontocranial and left temporal (reference point). After therapy the results of the treated group were compared with the control group. The trichogram of the frontocranial scalp region showed an increase of anagens as well as a decrease of telogens. These changes were statistically highly significant. Further, there was a decrease of dysplastic/ dystrophic forms. The left temporal scalp region showed no significant differences. The mean hair shaft diameter of full anagen (n = 8) increased, while the number of hairs measuring less than 40 µm (n = 8) decreased. The last two findings showed no statistically significant differences. The therapeutic results warrant the conclusion that cyproterone acetate seems to be effective in androgenetic alopecia in women.
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Recession of the frontal and frontoparietal hair line in women has been regarded as a marker for pathologic virilization. In a clinical survey of 564 normal women in the population, frontal and frontoparietal recessions were found in 13% of premenopausal and in 37% of postmenopausal women. Patterned hair loss in women is commoner than hitherto described, particularly after the menopause. In the absence of other signs of virilization, "male-pattern" hair loss would therefore appear to be a poor indicator of gross abnormality of androgen metabolism.