Oral Finasteride Research Articles

Phytotherapeutic Interventions using Rodent Models of Hair Loss: Current Research and Future Strategy

Hair follicles are special additions to mammalian skin with intricate differentiation and growth characteristics. They constantly undergo cycles of regression and regeneration throughout the lifespan of animal. Several rodent models have been studied for androgenetic alopecia and alopecia areata in humans with only handful of products approved by United States Food and Drug Administration; topical minoxidil (men and women) and oral finasteride (only men) for hair loss indication. This review summarizes rodent models of human hair loss to emphasize their role in testing traditional medicinal plants as hair growth promoters. Review also discusses the mechanisms of action of various herbs. Currently, both natural and synthetic products are in use to remedy alopecia. Although, use of natural products has shown measurable efficacy, the option is open to test chemically synthesized active fractions of plants as monotherapy or polytherapy to facilitate approval by regulatory agencies. Overall, purpose of this review is to discuss the rodent models of efficacy and how modifications in herbal preparations may bring more alternatives and a better value to the products in future.

Letter to the Editors

We have read with great interest the article titled, “Finasteride for androgenetic alopecia is not associated with sexual dysfunction: a survey-based, single-centre, controlled study.”[1][1] Oral finasteride is one of the two U.S. FDA (United States Food and Drug Administration) approved drugs

Maintenance of optimised hair growth from viable terminal scalp hair follicles at baseline with oral finasteride in male pattern hair loss and first evidence of a "drug dependency" and a post-finasteride "rebound effect".

Analytical measures for the pharmacodynamics understanding of drug induced scalp hair responses are lacking. The present study measured in detail dynamics of hair productivity on two scalp test sites showing male pattern hair loss. The natural regression decay rate established after 2years without treatment was followed by treatment with daily oral intake of 1mg finasteride. While terminal hair (diameter ≥40μm) were maintained "on-drug," within 30months "off-drug" MPHL significantly worsened as 94% terminal hair miniaturised and became unproductive. Accordingly, the viable drug responding follicles were qualified as "finasteride dependent" unravelling a hereto unreported "rebound effect" after interruption of the drug intake. Interestingly, the transformation of terminal hair into miniaturised hair occurred only after 12months without treatment, that is the time necessary to complete a clinically significant full hair cycle initiated during the drug intake. This explains why exogen hair release and miniaturisation occurred only between 12 and 30months "off-drug" while resistant hair grew also slower. Drug dependency and rebound phenomenon are new findings along with evidence against the hypothesis claiming that terminal hair growth arises from initial vellus hair follicles in drug-treated MPHL.

The Effects of Oral 5-alpha Reductase Inhibitors on Penile Intracavernosal Pressures and Penile Morphology in Rat Model.

Benign prostatic hyperplasia (BPH), and erectile dysfunction (ED) are urological diseases which affect more than 50 % of men older than 50 years of age. It has been reported that 5-alpha-reductase inhibitors (5-ARIs) used in clinical studies for the treatment of BPH caused ED in 0.8-15.8% of the patients. The aim of this study is evaluation of the effects of oral finasteride and dutasteride on penile intracavernosal pressures and penile morphology in a rat model. Thirty Wistar Albino strain male rats were randomized into control (n = 10), finasteride (n = 10), and dutasteride (n = 10) groups. After 8 weeks of treatment erectile responses were evaluated in all rats measuring intracavernosal pressure (ICP) changes during erectile responses to cavernosal nerve electrical stimulation. Serum hormone levels were studied and all rats underwent prostatectomy and penectomy. All tissue samples were examined histomorphologically and a semiquantitative scoring system was used for cavernosal tissue collagen density grading. One-way analysis of variance was used for statistical analysis and P < .05 was accepted as the level of statistical significance. For two group comparisons Tukey HSD test was used as post hoc test of one way analysis of variance. Approximately 50% decrease was seen in mean ICPs in the finasteride and dutasteride groups compared to the control group for all voltages (2.5 V, 5 V. 7.5 V). Mean ICPs for 7.5 V were 62.17 ± 30.89mmHg in control group, 35.27 ± 31.94 in the finasteride, and 36.01 ± 19.20mmHg in the dutasteride group. But regarding ICPs there was no statistically significant difference between the groups (P > .05). The serum testosterone (T) concentrations were higher in treatment groups (P < .001). Serum dihydrotestosterone (DHT), luteinizing hormone (LH) and follicle stimulating hormone (FSH) concentrations were not significantly different between the groups. As a result of histomorphological studies, a statistically significant increase in cavernosal tissue collagen density, and marked atrophic changes in prostatic epithelial tissues were observed in the treatment groups. Although 5-ARIs cause marked atrophic changes in prostatic epithelial tissues, and prominent collagen deposition in penile cavernosal tissues, no significant effect on penile ICPs was seen in this study. The failure to show a statistically significant difference was attributed to higher standard deviations of ICP values. If sample size and duration of the treatment are increased, statistically significant results in ICPs may be reached. The penile morphology evaluation results point to a negative effect of 5-ARIs on erectile function.

Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia

Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia

The efficacy and use of finasteride in women: a systematic review.

Physicians are beginning to use finasteride as treatment for hair loss, hirsutism, and various other dermatologic conditions in women. However, the reported efficacy and use of finasteride in the female population varies widely. The purpose of this study is therefore to better define the efficacy and use of finasteride in women and identify research gaps that require further investigation. A systematic review of the current literature describing finasteride use in women. A total of 2,683 patients participated in 65 studies involving finasteride use in women published between January 1997 and July 2017. Most randomized controlled trials (RCTs) evaluated finasteride use in women with hirsutism (48.7%) or female pattern hair loss (34.7%). RCTs recommend finasteride treatment for women with hirsutism or polycystic ovarian syndrome. Meanwhile, other forms of hair loss were studied such as alopecia, lichen planopilaris, and frontal fibrosing alopecia, but no RCTs evaluating finasteride therapy were identified. Other prospective and retrospective studies report that finasteride may improve hair loss in women with female pattern hair loss or frontal fibrosing alopecia. Overall, doses of oral finasteride ranged from 0.5 to 5mg/day, in females aged 6-88, over a duration of 6-12months (57.6%), as monotherapy (88.9%), and for continuous use (96.4%). The studies reviewed highlight the finasteride dosage, length of treatment, and candidate conditions that can benefit from finasteride therapy. Future long-term studies are necessary to fully assess the therapeutic mechanisms and potential consequences of finasteride use and to optimize treatment protocols.

Evaluation of long-term efficacy of finasteride in Korean men with androgenetic alopecia using the basic and specific classification system.

Finasteride 1 mg is considered to be the standard treatment method for male androgenetic alopecia (AGA). However, there have only been a few studies investigating its long‐term efficacy. Moreover, its effect on various types of AGA remains unknown. In this study, the authors investigated the 5‐year efficacy of finasteride 1 mg in Korean men with AGA and analyzed the changes in hair growth according to the distribution of hair loss. The medical records of male AGA patients who were treated with oral finasteride for a period of at least 5 years at two university hospitals were retrospectively reviewed. Patients' photographs were evaluated using the basic and specific (BASP) classification and investigator's global assessment. Of the total 126 patients, 108 (85.7%) showed improvement after 5 years of treatment. According to the BASP classification, hair loss of the anterior hair line (basic type), vertex (V type), and frontal area (F type) was improved in 44.4%, 89.7% and 61.2% of patients, respectively. The V type showed a more rapid and steady improvement compared with the other types. Progression of alopecia after peak improvement was seen in 10.3% of cases of the V type, 16.2% of the F type and 0% of the basic type. In conclusion, finasteride 1 mg showed a sustainable effect for at least 5 years in Korean male AGA patients. The exact time points showing signs of first clinical improvement and sustainability were different depending on the type of alopecia.

The Higher Number and Longer Duration of Kenogen Hairs Are the Main Cause of the Hair Rarefaction in Androgenetic Alopecia

The progressive reduction of the number of terminal hairs and the simultaneous increase in the number of vellus hairs (hair miniaturization) are the current explanation of human baldness. In a 2.5-year study on 43 male subjects with androgenetic alopecia (AGA), we found that oral finasteride augmented the total number of hairs by 55%, but failed to decrease the prevalence of vellus hairs. While our data may explain why, in AGA, hairs become progressively softer and combable, they cannot explain why areas of hair rarefaction develop. We propose that the longer duration and higher frequency of kenogen hairs are the real mechanism through which the scalp hairs rarefy.

Serum Levels of Androgen-Associated Hormones Are Correlated with Curative Effect in Androgenic Alopecia in Young Men

BackgroundAndrogenic alopecia (AGA) is the most common type of hair loss in men. However, the pathogenesis is not yet fully understood and therapeutic approaches are limited. This retrospective study investigated the association between levels of androgen-associated hormones and curative effect in androgenic alopecia in young male AGA patients.Material/MethodsBy using chemiluminescence immunoassay, serum levels of androgens and upstream regulated hormones were measured in 178 young male patients with AGA and in 61 normal controls before therapy, 1 and 2 weeks after administration of finasteride.ResultsBefore oral finasteride therapy, we found significantly higher levels of serum free testosterone (FT) and dihydrotestosterone (DHT) in AGA patients than in normal controls. The levels of serum sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were similar in the 2 groups. There were no significant differences in serum androgen levels, including DHT and FT, among AGA patients with different grades of hair loss severity (p>0.05). After finasteride therapy, the levels of DHT decreased significantly (p<0.05). Increased serum levels of LSH or LH were also observed in 55 patients after therapy (p<0.05). The levels of SHGB did not change significantly after therapy (p>0.05). Patients with lower levels of serum FT and DHT than before who accepted finasteride therapy had a higher ratio of curative effect manifested by improved severity grade (p<0.05). Patients with higher levels of LSH or LH had a lower curative rate compared to those without change after therapy (p<0.05).ConclusionsWe confirmed the role of the androgens hypothalamus-hypophysis-sexual gland axis in the pathogenesis of AGA and the treatment effect of oral anti-androgen therapy in young male Chinese patients.

Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol.

Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within the alpha granules of platelets act on stem cells in the bulge area of the hair follicles and stimulate the development of new follicles along with neovascularization. PRP has become a promising treatment modality for AGA. Although there have been several studies previously reported, a standard practice for PRP preparation and administration as well as a method to evaluate results have not been established. This literature review was conducted to evaluate the effectiveness of PRP for AGA and discuss the various treatment protocols that have been proposed.

Commentary on article on clinical efficacy of oral finasteride by Won, Lew, and Sim.

Dermatologic TherapyVolume 31, Issue 6 e12708 Review Article Commentary on article on clinical efficacy of oral finasteride by Won, Lew, and Sim Mary P. Lupo, Mary P. Lupo orcid.org/0000-0003-0549-3353 Lupo Center for Aesthetic and General Dermatology, New Orleans, LouisianaSearch for more papers by this author Mary P. Lupo, Mary P. Lupo orcid.org/0000-0003-0549-3353 Lupo Center for Aesthetic and General Dermatology, New Orleans, LouisianaSearch for more papers by this author First published: 05 September 2018 https://doi.org/10.1111/dth.12708Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume31, Issue6November/December 2018e12708 This article also appears in:Spotlight: Professor Torello Lotti RelatedInformation

Comparing the therapeutic efficacy of topical minoxidil and finasteride with topical minoxidil and oral finasteride in androgenetic alopecia: a randomized trial

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There is an increased interest in the development and use of topical finasteride for treating androgenic alopecia (AGA) due to growing evidence of side effects from oral finasteride. In this study we aimed to compare the treatment outcomes of topical 5% minoxidil with 0.1% finasteride and topical 5% minoxidil with oral 1 mg finasteride.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 50 patients of stage III and IV of Hamilton-Norwood scale were randomly assigned to either Group A receiving topical 5% minoxidil and oral finasteride 1 mg and Group B receiving topical 5% minoxidil and topical 0.1% finasteride. After taking uninterrupted treatment for 12 months, patients were assessed for hair regrowth and maintenance using global photography and trichoscopy and compared with baseline parameters. Patients in both the groups were assessed for any adverse effects as well.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At baseline, patients in both the treatment groups were similar with respect to their age at the time of presentation, family history of hair loss and Hamilton Norwood scale. In group A, three discontinued treatment and of the rest 65% maintained a good hair density and reduced hairfall. In group B, five discontinued treatment, of the rest 83% patients demonstrated good improvement in hair density (p&amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of this study strongly support the use of topical finasteride in combination with topical 5% minoxidil for AGA and this may obviate the need of taking long term oral finasteride.&lt;/p&gt;

A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in the treatment of male androgenetic alopecia.

The synergism of combined use between oral finasteride and topical minoxidil has been established in treating androgenetic alopecia among men. However, the concern regarding adverse effects of finasteride use has been rising. To compare the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in men with androgenetic alopecia. Forty men aged 18-60years with androgenetic alopecia were randomized to 24weeks of treatment with a finasteride/minoxidil or minoxidil solution twice daily. Primary efficacy endpoint was the change from baseline in hair density and hair diameter at week 24. Secondary endpoints included global photographic assessment by treatment-blinded investigators and subjects. Changes in plasma dihydrotestosterone levels and adverse events were recorded. At week 24, the combined solution of finasteride and minoxidil was significantly superior to minoxidil alone in improvements of hair density, hair diameter and global photographic assessment (all P<0.05). About 90% of patients treated with the combined solution experienced moderate to marked improvement. The combined solution also had minimal effect on plasma dihydrotestosterone levels, approximately 5% reduction. There were also no systemic adverse events reported by patients in both groups. Treatment with topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution for promoting hair growth in male androgenetic alopecia, and well tolerated.

Prescribing Habits for Androgenic Alopecia Among Dermatologists in Spain in 2017: A Cross-Sectional Study

BackgroundTopical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Material and methodsDescriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. ResultsThe responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%).A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. ConclusionsThe most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

Estudio transversal acerca de los hábitos de prescripción en alopecia androgénica de los dermatólogos en España en 2017

BackgroundTopical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Material and methodsDescriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. ResultsThe responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%).A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. ConclusionsThe most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

Scrotal Rejuvenation.

Genital rejuvenation is applicable not only to women (vaginal rejuvenation) but also to men (scrotal rejuvenation). There is an increased awareness, reflected by the number of published medical papers, of vaginal rejuvenation; however, rejuvenation of the scrotum has not received similar attention in the medical literature. Scrotal rejuvenation includes treatment of hair-associated scrotal changes (alopecia and hypertrichosis), morphology-associated scrotal changes (wrinkling and laxity), and vascular-associated scrotal changes (angiokeratomas). Rejuvenation of the scrotum potentially may utilize medical therapy, such as topical minoxidil and oral finasteride, for scrotal alopecia and conservative modalities, such as depilatories and electrolysis, for scrotal hypertrichosis. Lasers and energy-based devices may be efficacious for scrotal hypertrichosis and scrotal angiokeratomas. Surgical intervention is the mainstay of therapy for scrotal laxity; however, absorbable suspension sutures are postulated as a potential intervention to provide an adequate scrotal lift. Hair transplantation for scrotal alopecia and injection of botulinum toxin into the dartos muscle for scrotal wrinkling are hypothesized as possible treatments for these conditions. The interest in scrotal rejuvenation is likely to increase as men and their physicians become aware of both the conditions of the scrotum that may warrant rejuvenation and the potential treatments of the scrotum for these individuals.

Proprietary Herbal Extract Downregulates the Gene Expression of IL-1α in HaCaT Cells: Possible Implications Against Nonscarring Alopecia.

BackgroundCurrently while, topical minoxidil and oral finasteride are the only medications approved in androgenetic alopecia (AGA), the cause oriented treatment and immunsupressive treatment are being performed in telogen effluvium (TE) and alopecia areata (AA) respectively. Considering the inflammatory factors in the pathogenesis of these three nonscarring alopecia forms, we have formulated a mixture for topical usage composed of six different herbal extracts (HE) which have already known antiinflammatory and antioxidant features.Materials and MethodsIn addition to performing the phytochemical analysis of HE, we detected the gene expression level of IL-1α, the crucial hair loss mediator, for the putative efficacy in nonscarring alopecia. Cell proliferation assay was performed by XTT reagent. After determination of non-cytotoxic concentration, HaCaT cells were treated with HE. RNA isolations were carried out from both non-treated and treated cell groups by using TRI-reagent. Gene expressions of IL-1α and as control GAPDH were determined by RT-qPCR analysis.ResultsResults were represented as “IL-1α/GAPDH Fold Change”. HE solution caused statistically significant downregulation of IL-1α gene expressions (p<0.0001), compared to untreated control cells. HE treatment ended up with 0.1900 fold change for IL-1α.ConclusionIL-1α is a direct growth inhibitory agent in hair follicles and an important actor in the pathogenesis of AGA , TE, and AA. Considering together the vitamins, flavonoids, and trace elements identified in the phytochemical analyses and downregulation of IL-1α in HaCaT cells, our HE may be an auxiliary agent in the therapy of these three nonscarring alopecia forms.

A comment on the post-finasteride syndrome

The post-Finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat hair loss or benign prostatic hyperplasia. While the incidence of persistent sexual, mental, and physical side effects despite quitting finasteride is unknown, and the condition is not recognized by the scientific community, individuals who suffer from PFS do present with very distinctive and homogenous symptoms. The concept has emerged from reports of nondermatologists, neuroendocrinological research, case reports, and uncontrolled studies. These have been scrutinized by hair experts who found that persistent sexual side effects were only documented in low-quality studies with a strong bias selection and a significant nocebo effect. Others totally dispute the credibility of the PFS. In any case, the PFS is a problem that has to be dealt with. Low-quality studies neither confirm nor refute the condition as a valid nosologic entity. Therefore, it is as inappropriate to dismiss the condition, as it would be to demonize finasteride for the treatment of male pattern hair loss. Whether the PFS represents a nocebo reaction or a real drug adverse event is irrelevant, while the best way to alleviate the emotional distress related to hair loss is to effectively treat the condition causing the problem. It is not sufficient to only discuss the plausibility of the PFS. There is a need for practical recommendations to include such important issues as patient selection and risk assessment, appropriate patient information, how to react in case of drug-related adverse events, issues of fertility and malignancy, management of the PFS, and alternatives, specifically the use of topical finasteride. It is the aim of this commentary to provide the respective information.

Abstract: The Use of Nanofat in Androgenic Alopecia. a Prospective Blinded Study

INTRODUCTION: The many proprieties of nanofat in regenerative and aesthetic surgery are just being discovered.1–3 The purpose of this study was to investigate the efficacy and safety of nanofat in androgenic alopecia. METHODS: We enrolled 12 consecutive male patients affected with androgenic alopecia at our private practice. Patients were excluded if they were or had been under treatment with oral finasteride or laser or injectable treatment for hair regrowth in the previous 6 months. Patients under topical minoxidil (2% or 5%) were given a wash out period of 60 days. Each patient was given a single injection session of nanofat, following the microbolus technique over the interested areas of the scalp. One area was selected as control and was not treated. The nanofat was obtained from the liposuction aspirate using the Tulip NanoTM kit device and immediately after it was injected in the treated scalp area. Each patient underwent trichoscopy of the sample marked area and a thricogram examination at baseline, and then 1, 3, 6 and 12 months after treatment by a blinded physician. A patient satisfaction VAS score was also recorded at the post-treatment visits. Adverse events were recorded at each follow up. RESULTS: Each treated area in every patient showed an increase in number and thickness of hairs at the trichoscopy examination, superior to the control area, starting at the 3 months follow up and partially persisting at 12 months. The patient satisfaction VAS increased significantly, from the 6 months-follow up on. DISCUSSION: Many therapeutic solutions for androgenic alopecia fail or deliver temporary improvement4. Our experience indicates a significant and enduring response (up to 12 months) to treatment with a single session of nanofat in androgenic alopecia in male patients. At 12 months the results partially persisted in 6 cases; the other 6 recurred. Considering that these patients were treated with a single session of nanofat and were not under any other treatment for androgenic alopecia these results are indeed notable. No adverse events were recorded during our observation. This is a pilot study based on a limited cohort and with no control group. Controlled studies will be needed in order to validate our preliminary results. Reference Citations: 1.Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg. 2013; 132: 1017–1026. 2. Banyard DA, Sarantopoulos CN, Borovikova AA, et al. Phenotypic Analysis of Stromal Vascular Fraction after Mechanical Shear Reveals Stress-Induced Progenitor Populations. Plast Reconstr Surg. 2016; 138: 237e-247e. 3. Alexander RW. Biocellular Regenerative Medicine: Use of Adipose-Derived Stem/Stromal Cells and It’s Native Bioactive Matrix. Phys Med Rehabil Clin N Am. 2016; 27: 871–891. 4.Kelly Y, Blanco A, Tosti A. Androgenetic Alopecia: An Update of Treatment Options. Drugs. 2016; 76: 1349–1364.

Therapeutic experience with oral finasteride for androgenetic alopecia in female-to-male transgender patients

Androgenic treatment of female-to-male transgender patients may result in androgenetic alopecia (AGA). Use of 5-alpha-reductase inhibitors are useful as oral treatment of AA in men. There are no previous studies of the use of finasteride in transgender men as treatment of AGA. To evaluate the effectiveness and safety of an oral 5α-reductase inhibitor (finasteride) for AA developed in transgender men. This single-centre retrospective study enrolled female-to-male transgender patients with a clinical diagnosis of AGA to receive 1 mg of an oral type II 5α-reductase inhibitor for at least 12 months. In all, 10 patients were included in the study. All the patients received a clinical diagnosis of male-pattern AGA, with 90% classified as stage IV on the Norwood-Hamilton scale. Mean onset of AGA was 3.25 years after the introduction of androgenic treatment, and 70% of the patients had a family history of AGA. All the patients improved one grade on the Norwood-Hamilton scale after a mean of 5.5 months (range 4-6 months) since the start of finasteride treatment. Two patients stopped treatment for economic reasons and one stopped due to dyspepsia. No sexual or other adverse effects were observed. Patients were given periodic physical and analytical examinations by endocrinologists without any significant finding. Mean follow-up of patients was 16.2 months. AA in transgender men has a delayed onset, and is clinically and therapeutically similar to the common male-pattern-AGA in cis-gender men.