5‐Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms, current concepts, comparative efficacy, and safety

@article{Dhurat20205AlphaRI,
  title={5‐Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms, current concepts, comparative efficacy, and safety},
  author={Rachita Dhurat and Aseem Sharma and Lidia Rudnicka and George Kroumpouzos and Martin Kassir and Hassan I Galadari and Uwe Wollina and Torello M Lotti and Ma{\vs}a Golubovi{\'c} and Ivana I Binic and Stephan Grabbe and Mohamad Goldust},
  journal={Dermatologic Therapy},
  year={2020},
  volume={33}
}
Androgenetic alopecia (AGA) is a multifactorial disease that carries a significant psychological burden with it. Dihydrotestosterone, the main pathogenic androgen in AGA, is produced by conversion of testosterone, which is catalyzed by the 5‐alpha reductase (5‐AR) isoenzyme family. Finasteride and dutasteride are inhibitors of these enzymes. Finasteride, which is a single receptor 5‐alpha reductase inhibitor (5‐ARI), acts by blocking dihydrotestosterone (DHT). Dutasteride, a dual receptor DHT… 
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References

SHOWING 1-10 OF 41 REFERENCES
Controversies in the treatment of androgenetic alopecia: The history of finasteride
TLDR
Controversy surrounding potential adverse sexual side effects has negatively affected public perception of the drug and may significantly reduce the number of patients that can benefit from the drug.
Effect of dutasteride 0.5 mg/d in men with androgenetic alopecia recalcitrant to finasteride
TLDR
Dutasteride, a dual inhibitor of both type I and type II 5 alpha‐reductase, inhibits the conversion of testosterone to dihydrotestosterone, which is the key contributor of AGA.
Multi‐therapies in androgenetic alopecia: review and clinical experiences
TLDR
The treatment for AGA should be based on personalized therapy and targeted at the different pathophysiological aspects of AGA, since the benefit will not be maintained upon ceasing therapy.
Physiopathology and current treatments of androgenetic alopecia: Going beyond androgens and anti‐androgens
TLDR
A review of the mechanisms and extrinsic factors involved in the AGA physiopathology as well as its conventional and emerging treatments and the association of different strategies could improve the treatment outcomes.
Dutasteride: A Review of Current Data on a Novel Dual Inhibitor of 5α Reductase
TLDR
The efficacy of dutasteride in symptomatic relief, improvements in quality of life and peak urinary flow rate, and reduction of acute urinary retention events and need for surgery are shown, and the anticancer properties of dUTasteride have been shown in placebo-controlled trials and are being investigated in the ongoing REDUCE trial.
Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor.
TLDR
Dutasteride appeared to be well tolerated with an adverse event profile similar to placebo and reduction in its level with 5alpha-reductase inhibitors improves the symptoms associated with BPH and reduces the risk of acute urinary retention and prostate surgery.
Can we halt male androgenetic alopecia progression without antiandrogenic drugs?
TLDR
According to a recent meta-analysis of randomized controlled trials, finasteride, minoxidil, and low-level laser light therapy (LLLT) are the only treatments that have demonstrated efficacy for male-pattern hair loss, but it is likely that in the long term, these patients will experience a decrease in their hair counts below the baseline.
The Dark Side of 5α-Reductase Inhibitors' Therapy: Sexual Dysfunction, High Gleason Grade Prostate Cancer and Depression
TLDR
Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5α-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life, which need to be aware of.
ANDROGEN METABOLISM AS IT AFFECTS HAIR GROWTH IN ANDROGENETIC ALOPECIA
The effects of chronic 5-alpha-reductase inhibitor (dutasteride) treatment on rat erectile function.
TLDR
The 5ARIs, as demonstrated in these rat cavernosal smooth muscle studies, have a detrimental effect on erectile function and enhanced iNOS expression may protect penile smooth muscle from fibrosis.
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