Antiandrogens:

Star rating: ***** Antiandrogens are not covered in depth here. There's a lot more to know than I'm going to cover. Antiandrogens have been shown to substantially improve virtually every symptom of PCOS. No other treatment is more effective for hirsutism or hair loss. In fact, most other treatments are really not very effective for hair. Nonetheless, they have their drawbacks and side effects. Your doctor would probably have you take an OCP with an antiandrogen because of the birth defects they can cause, especially in males (males need those androgens). So, they are not an option if you are TTC. When using antiandrogens for androgenic hairloss, it's important to understand that the hair cycle is long, and it is practically impossible to see new hair growth before 3 to 6 months. Also, the hair cycle progresses through its stages in order. Hair enters the resting (telogen) phase, then the hair is a shed before a new hair starts growing (anagen). Any hair in telogen must fall out before it will start growing again. This means that any hair loss treatment that works will probably be associated with initial shedding as new hairs come out of telogen. This is naturally alarming to see. If you indeed have androgenic hair loss, and you are using something that is proven to treat androgenic hair loss, like any strong antiandrogen, and you are worried it is making things worse after a few weeks, it's probably only temporary (of course, you should ask your doctor in case it's something else). Also, if you started using a new treatment yesterday or last week and it looks like you have more hair, you're kidding yourself - it's the humidity or your shampoo or you're just in a good mood. The lesson here is, use something that is proven to work and then try not to think about it for a few months. Don't think you're going to try something for a couple weeks just to see if it works. A lot of studies on hair loss and hirsutism sound impressive, but really they aren't. In medical studies, the words "effective" and "significant" may only mean there was a tiny effect that was statistically significant. The word "significant" does not mean "a lot," it only means the effect, however small, was not due to chance. So, you can read a study that claims "this was an effective treatment for hair loss", and "there was significant new hair growth", and what really happened was a tiny, "non-cosmetic" improvement that you can't even see. The improvement could be a lot, but you have to read the details to know. It's my speculation, and from reading forums, that one could use an antiandrogen temporarily for, say, a year or two, and then taper off and stop taking it. After some time on an antiandrogen, you would reverse a lot of the hyperandrogenic symptoms. Then you could stop and hopefully the symptoms would not come back as long as you continued with your other treatments to keep your weight, insulin and androgens low, like with diet, exercise and insulin sensitizers. Because, if you're androgens are low enough and being kept in check with other treatments, your symptoms shouldn't come back to any large degree. At least, I hope. I could be wrong and I don't have proof. Flutamide (Eulexin) has many articles demonstrating liver damage and death. It's too bad because Flutamide is a very potent antiandrogen. However, in almost every case they are at doses above 350mg/day. Several studies show efficacy in PCOS at low to very low doses of flutamide (62mg to 250mg per day), and suggest that these doses are safe. If you take it, your doctor will probably watch your liver closely with blood tests. There is no doubt that it can greatly improve PCOS symptoms. Flutamide is the strongest antiandrogen and the most effective treatment for hirsutism and hair loss that I know of (except maybe for Dutasteride). Quote: "After only 6 months of therapy, flutamide caused a maximal reduction in the hirsutism score to a value within almost normal range; during the same period, spironolactone caused only a 30% reduction of the hirsutism score. Whereas flutamide caused a dramatic (80%) decrease in total acne, seborrhea, and hair loss score after only 3 months of therapy, spironolactone caused only a 50% reduction in acne and seborrhea, with no significant effect on the hair loss score." Reference: Cusan L. et al. Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial. Fertil Steril. 1994 Feb;61(2):281-7. The enzyme your liver uses to process Flutamide is the same enzyme used to process caffeine, Prozac and Echinacea. It may be a good idea to avoid things that inhibit the CYP1A2 liver enzyme, if you are taking Flutamide. However, even though caffeine is metabolized by CYP1A2, it also increases the activity of CYP1A2 at the same time, and thus "caffeine increases its own metabolism". So, whether caffeine is good or bad to take with Flutamide is unclear - I doubt it matters. One study notes that "CYP1A2 index was 33% decreased in women who used oral contraceptives." Also, the antioxidant carotinoid, Astaxanthin has been shown to be a strong inducer of CYP1A1 and CYP1A2 liver enzymes. This implies Astaxanthin may help detoxify the byproducts of Flutamide. But, I have no idea if any of this matters in practice, and I may be confused. Spironolactone (Aldactone) is a good antiandrogen. It is safer than Flutamide (depending on the dose), but typically a little less effective. This drug is a potassium sparing diuretic and it also blocks aldosterone. In contrast to the glowing reference for Flutamide above, several studies showed no significant difference between Flutamide and Spironolactone - both were effective. Dutasteride (Avodart) is a 5 alpha-reductase inhibitor (both types 1 and 2) that reduces dihydrotestosterone (DHT). It is the most potent 5-ar inhibitor and will greatly lower DHT levels. Unfortunately, there are not many studies on Dutasteride yet and none specifically on hirsutism. The following case study shows a full reversal of androgenic hair loss. Quote: "After 6 months of therapy, significant improvement was observed and after 9 months the clinical diagnosis of androgenic alopecia could no longer be made in this patient." Reference: Olszewska M, et at. Effective treatment of female androgenic alopecia with dutasteride. J Drugs Dermatol. 2005 Sep-Oct;4(5):637-40. Finasteride (Proscar or Propecia) is also a 5 alpha-reductase inhibitor (type 2 only). Finasteride is less potent than Dutasteride. It probably has the least side effects, and is the least effective, but studies show that it has merit. Saw Palmetto extract (Serenoa Repens) may have effects similar to Finasteride. Two studies suggest it may be beneficial for hirsutism based on Saw Palmetto's ability to inhibit 5 alpha-reductase. A recent study comparing Saw Palmetto to Finasteride found Saw Palmetto was completely ineffective. Previous studies showed some effect, however. I have grouped this here with the antiandrogens, but I'd only give it 3-stars. My feeling is, if you want to take a 5-ar inhibitor, take one that really works.