198 Dutasteride for men with androgenic alopecia unresponsive to finasteride

Abstract

198 Dutasteride for men with androgenic alopecia unresponsive to finasteride IG Motofei, DL Rowland, SR Georgescu, M Tampa, VD Constantin, S Paunica, BC Baleanu and I Sinescu 1 Surgery and Urology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 2 Psychology, Valparaiso University, Valparaiso, IN, 3 Dermatology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 4 Urology, Hermann-Josef KH, Kreisfreie Stadt Aachen Area, Germany and 5 Urology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania About 30% of men with androgenic alopecia have no significant improvement at six months after Finasteride administration. For this subgroup, dutasteride could represent an alternative therapy being more efficient and with reasonable adverse effects, according to some authors. Starting from this perspective, we intended to verify the dutasteride efficiency and side effects in androgenic alopecia, on unresponsive men to finasteride. From ninety-two men treated with Finasteride (1 mg/ day) for androgenic alopecia, twenty three subjects finished the treatment with no result on the target hair area, as confirmed by global photograph assessment and phototrichogram. From those 23 unresponsive men, 16 started a new treatment with dutasteride 0.5 mg/ day, being evaluated after six months again by dermatologists and urologists. In response to dutasteride, 9 subjects (56.25%) registered a significant improvement (hair density/ thickness) after six months, according to photograph and phototrichogram assessments. The other 7 subjects were appreciated as unresponsives to dutasteride, no aggravation being reported. Dutasteride adverse effects were reasonable, consisting in transient erectile dysfunction (in two responsive patients) and erectile dysfunction plus slight depressive episode (in 1 unresponsive patient). In contrast to Finasteride, dutasteride inhibits both type I and II of 5-a reductase enzyme, being able to ameliorate androgenic alopecia in some subjects who registered no improvement after finasteride administration. Dutasteride could be thus viewed as a secondary therapeutic option for androgenic alopecia, and a possible first therapeutic choice at subjects with predisposed (anticipated) finasteride side effects. 199 Hand preference and sexual orientation as useful elements to predict finasteride side effects in male androgenic alopecia DL Rowland, IG Motofei, SR Georgescu, M Tampa and I Sinescu 1 Psychology, Valparaiso University, Valparaiso, IN, 2 Surgery and Urology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 3 Dermatology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania and 4 Urology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania This study further investigated the distribution of finasteride adverse effects (according to hand preference and sexual orientation) on men treated for male androgenic alopecia, based on the existing interrelation among sexual hormones, pheromones, cognitive and sexual laterality of information processing. Finasteride 1 mg daily, human axillary pheromones, questionnaires regarding hand preference (Edinburgh Handedness Inventory) and related to sexual orientation/ behavior were used, to delineate within the brain hormonal and pheromonal neuromodulation of sexuality on 68 men with androgenic alopecia. Participants’ responses delineated four distinct groups. Group Awith 12 men, involving especially the left hemibrain: sensitive to female axillary pheromones, left nostril and right visual hemifield, with left hand preference and predominantly heterosexuals (9 men). Group B (16 men) related to the right hemibrain: sensitive to male axillary pheromones, right nostril, and left visual hemifield, with right hand preference, six being homosexuals and ten heterosexuals. Group C with 11 men related to the left hemibrain: sensitive to androgens, with right hand preference and heterosexuals. Group D (29 men) related to right hemibrain: sensitive to estrogens, with left hand preference and mixed sexual orientation (17 heterosexuals and 12 homosexuals). Finasteride adverse effects were encountered especially in groups C (on 8 men) and group D (on 7 men), specifically on subjects who were either right handed heterosexuals or left handed homosexuals. In psycho-physiological terms, androgens seem to modulate only the left hemibrain, and more precisely, the left dorsal thalamic route.