The effect of DHT inhibitors (Finasteride and Dutasteride) on BHT is an issue that has come up on the boards every now and then. It is an important question since a bulk of prospective BHT patients have either used/considered DHT inhibitors or are already on them.
Obviously the answer to this question would impact on the patient’s candidacy for BHT.
On the basis of existing dermatologic and endocrinologic concepts and related literature I had advised a cautious approach from the onset.Almost 2 years ago (August 2005) this was posted in response to a direct question:
Recommendations from the article:
Caution to be observed in the following BHT patients regrading the use of DHT inhibitors:
1.Breast symptoms have occurred and persist (following the use of DHT inhibitors).
Libido problems have occurred and persist.
5AR inhibitors have been used for less than 6 months.
Special attention to the use of dutasteride (an effective 5AR-1 and 5AR-2 inhibitor), and patients using higher doses (of either meds) than is the standard recommendation for hair loss treatment.
The implication was of course obvious in patients that have a history of diminished body hair upon starting DHT inhibitors.
The rationale from the article:
The pathway that leads to the production of the 3 androgens (DHT, testosterone and Androstenedione, also has a route that leads to the production of Estrogen). When you block DHT production by 5AR inhibition, the path to testosterone and/or estrogen production tends to be upregulated. The degree to which either of these two hormones (testosterone and Estrogen) are affected by 5AR inhibition should depend on several factors including the patient’s idiosyncratic predispositions, drug dosage, drug type and actions (eg Dutasteride blocks both 5AR-1 and 5AR-2 hence leaves less room for DHT production via the 5AR1 pathway -the case with finateride)etc.
In healthy individuals, most body hair *(relevant to BHT) responds especially to testosterone positively. Hence if DHT blockage results in more testosterone production than estrogen, you may actually end up with a positive effect on body hair than in premedication periods. If however, more estrogen is produced than is testosterone, you may well have a slowing of body hair growth and/or breast enlargement and/or loss of libido etc. If these hormones (Testosterone and and Estrogen) are raised to the same degree activity-wise, then you may have no change in body hair status as the effects of the 2 will balance out (most patients on alopecia reduction doses). This is the basis for a previous statement: “Some activities of 5AR inhibitors (dutasteride and finasteride) are not a direct result of DHT or lack of it” As cab be judged from the aforementioned, some activities of 5AR inhibitors is as a direct result of Testosterone and/or estrogen upregulation, rather than DHT.
A study on chest hair suggests that when slowing of hair growth occurs with finasteride use, it sustains for about 6 months following which it ceases to affect it either way as evidenced by observations in months 6 through 12. It is believed that even in these cases, the effect of testosterone increases to balance the intial estrogenic burst that may have occured in the earlier months. Also these uncommon negative effects tend to reverse with cessation of meds.
*Apocrine /Wet zone and facial hair would not be subject to these principles.
As I continue to process incoming BHT data and related literature on the subject, most elements of the above article have sustained with the addition that there are reasons to be more stringent about informing on the possible negative impact of DHT inhibitors on transplanted body hair in all individuals coming in for BHT. Thus, a cautious approach has been adopted in all my BHT patients at consultation and during preoperative instructions effective shortly after August 2005.
BHT practitioners would be presented with individuals that require DHT inhibitors to sustain the bulk of their remaining thinning hair who would also like to have BHT. My recommendation has been to continue DHT inhibitors if the remaining DHT-susceptible scalp hair is worth saving at the time. The decision to stop DHT inhibitors in a completely bald individual is not a difficult one to make.
S. Umar, M.D., FAAD
Redondo Beach, California
1-877-DERMHAIR (US residents)
Single Follicule Extraction & Transfer (SFET)
Using Head and Body hair