Journal of the American Academy of Dermatology
Volume 55, Issue 6 , Pages 1014-1023 , December 2006

The importance of dual 5α-reductase inhibition in the treatment of male pattern hair loss: Results of a randomized placebo-controlled study of dutasteride versus finasteride

  • Elise A. Olsen, MD

      Affiliations

    • From Duke University Medical Center, Durham
    • Corresponding Author InformationReprint requests: Elise A. Olsen, MD, Box 3294, Durham, NC 27710.
    • ,
  • Maria Hordinsky, MD

      Affiliations

    • Fairview University Medical Center, Minneapolis
    • ,
  • David Whiting, PhD

      Affiliations

    • Baylor Hair Research and Treatment Center, Dallas
    • ,
  • Dow Stough, MD

      Affiliations

    • The Stough Clinic, Hot Springs
    • ,
  • Stuart Hobbs, PharmD

      Affiliations

    • Clinical Development, GlaxoSmithKline, Research Triangle Park
    • ,
  • Melissa L. Ellis, PharmD

      Affiliations

    • Clinical Development, GlaxoSmithKline, Research Triangle Park
    • ,
  • Timothy Wilson, MS

      Affiliations

    • Clinical Development, GlaxoSmithKline, Research Triangle Park
    • ,
  • Roger S. Rittmaster, MD

      Affiliations

    • Clinical Development, GlaxoSmithKline, Research Triangle Park
    • ,
  • for the Dutasteride Alopecia Research Team

      Affiliations

    • The Dutasteride Alopecia Research Team includes W. Bergfeld, Z. Draelos, F. E. Dunlap, T. Funicella, S. Kempers, A. W. Lucky, D. J. Piacquadio, V. Price, J. L. Roberts, R. C. Savin, J. S. Shavin, L. Stein, D. Thiboutot, E. Tschen, G. F. Webster, and G. D. Weinstein.

References 

  1. Olsen E. Pattern hair loss. In: Disorders of hair growth. Diagnosis and treatment. New York: McGraw Hill; 2003;p. 321–362
  2. Sinclair R. Male pattern androgenetic alopecia. BMJ. 1998;317:865–869
  3. Whiting DA. Male pattern hair loss: current understanding. Int J Dermatol. 1998;37:561–566
  4. Wilson JD, Griffin JE, Russell DW. Steroid 5 alpha-reductase 2 deficiency. Endocr Rev. 1993;14:577–593
  5. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998;39:578–589
  6. Russell DW, Wilson JD. Steroid 5 alpha-reductase: two genes/two enzymes. Annu Rev Biochem. 1994;63:25–61
  7. Sato T, Sonoda T, Itami S, Takayasu S. Predominance of type I 5alpha-reductase in apocrine sweat glands of patients with excessive or abnormal odour derived from apocrine sweat (osmidrosis). Br J Dermatol. 1998;139:806–810
  8. Thiboutot D, Harris G, Iles V, Cimis G, Gilliland K, Hagari S. Activity of the type 1 5 alpha-reductase exhibits regional differences in isolated sebaceous glands and whole skin. J Invest Dermatol. 1995;105:209–214
  9. Eicheler W, Tuohimaa P, Vilja P, Adermann K, Forssmann WG, Aumuller G. Immunocytochemical localization of human 5 alpha-reductase 2 with polyclonal antibodies in androgen target and non-target human tissues. J Histochem Cytochem. 1994;42:667–675
  10. Courchay G, Boyera N, Bernard BA, Mahe Y. Messenger RNA expression of steroidogenesis enzyme subtypes in the human pilosebaceous unit. Skin Pharmacol. 1996;9:169–176
  11. Sawaya ME, Price VH. Different levels of 5alpha-reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J Invest Dermatol. 1997;109:296–300
  12. Bayne EK, Flanagan J, Einstein M, Ayala J, Chang B, Azzolina B, et al. Immunohistochemical localization of types 1 and 2 5alpha-reductase in human scalp. Br J Dermatol. 1999;141:481–491
  13. Bramson HN, Hermann D, Batchelor KW, Lee FW, James MK, Frye SV. Unique preclinical characteristics of GG745, a potent dual inhibitor of 5AR. J Pharmacol Exp Ther. 1997;282:1496–1502
  14. Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5 alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004;89:2179–2184
  15. Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975;68:1359–1365
  16. Roberts JL, Fiedler V, Imperato-McGinley J, Whiting D, Olsen E, Shupack J, et al. Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol. 1999;41:555–563
  17. Canfield D. Photographic documentation of hair growth in androgenetic alopecia. Dermatol Clin. 1996;14:713–721
  18. Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology. 2002;60:434–441
  19. Dallob AL, Sadick NS, Unger W, Lipert S, Geissler LA, Gregoire SL, et al. The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab. 1994;79:703–706
  20. Clark RV. Effective suppression of dihydrotestosterone (DHT) by GI198745, a novel, dual 5 alpha reductase inhibitor. J Urol. 1999;161:1037
  21. Kaufman KD. Clinical studies on the effects of oral finasteride, a type II 5a-reductase inhibitor, on scalp hair in men with male pattern baldness. In:  Van Neste D,  Randall V editor. Hair research for the next millennium. New York: Elsevier Science; 1996;p. 363–365
  22. Drake L, Hordinsky M, Fiedler V, Swinehart J, Unger WP, Cotterill PC, et al. The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol. 1999;41:550–554
  23. Debruyne F, Barkin J, van Erps P, Reis M, Tammela T, Roehrborn C, et al. Efficacy and safety of long-term treatment with the dual 5 alpha-reductase inhibitor dutasteride in men with symptomatic benign prostatic hyperplasia. Eur Urol. 2004;46:488–495
  24. Prescribing information for Avodart® (dutasteride) Soft Gelatin Capsules. USA. GlaxoSmithkline [updated May 2005]. Available from: http://us.gsk.com/products/assets/us_avodart.pdf.
  25. Sudduth SL, Koronkowski MJ. Finasteride: the first 5 alpha-reductase inhibitor. Pharmacotherapy. 1993;13:309–325discussion 325-9

 Supported by GlaxoSmithKline.Disclosure: Drs Olsen, Hordinsky, Whiting, and Stough as well as the Dutasteride Alopecia Resarch Team all received study grant support from GSK; Drs Olsen, Hordinsky, Stough, and Whiting served as consultants to GSK during the conduct of the study; Stuart Hobbs, Melissa Ellis, Timothy Wilson, and Roger Rittmaster are employees of GSK.

PII: S0190-9622(06)01287-4

doi: 10.1016/j.jaad.2006.05.007

Journal of the American Academy of Dermatology
Volume 55, Issue 6 , Pages 1014-1023 , December 2006

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