http://orcid.org/0000-0003-4495-6541
Dear Editor,
We appreciate the perspective of Ong et al. In response to their comments, consideration of the following points is relevant.
Androgenic alopecia is a condition that especially affects a person’s self-image and esteem, aspects that are subjectively constructed and thus relative and changeable. In other words, androgenetic alopecia is not considered an effective disease, as it has minimal or no impact on body physiology. In addition, androgenic alopecia involves a multifactorial etiology, with androgens being only partly responsible for the hair loss (people with androgenic alopecia have normal androgen levels). Androgens are implied not only in hair loss but also in hair growth, antiandrogens like finasteride being useful for example to treat hirsutism [Citation1]. Yet, ongoing (and thus long term) antiandrogen administration to achieve androgenic suppression is required to obtain and maintain therapeutic reversal of hair loss [Citation2].
Dutasteride and finasteride are both associated with adverse effects as reported in the literature. As a consequence, any procedure that results in androgenic suppression (decreasing the level of dihydrotestosterone below the normal physiological level) should be advised with caution for androgenic alopecia, in order to minimize adverse effects described. For this reason, we have initially suggested that finasteride should be preferred to dutasteride because some plasmatic degree of dihydrotestosterone is maintained [Citation3]. In addition, we have suggested afterwards that oral administration of finasteride for androgenic alopecia should be also reevaluated, in favor of topical therapies [Citation4].
Finally, our concern is perhaps as ideological as it is medical, as our discussion regarding the therapeutic approach of androgenic alopecia relates to the risk–benefit ratio, the benefit being related to an esthetic aspect, while the risk is related to very real organic adverse effects [Citation4].
Declaration of interest
No potential conflict of interest was reported by the author.
References
- Barrionuevo P, Nabhan M, Altayar O, et al. Treatment options for hirsutism: a systematic review and network meta-analysis. J Clin Endocrinol Metab. 2018;103(4):1258-1264.
- Motofei IG, Rowland DL, Păunică I, et al. Finasteride as a model for personalized medicine. J Mind Med Sci. 2017;4(2):125–131.
- Motofei IG, Rowland DL, Baconi DL, et al. Androgenetic alopecia; drug safety and therapeutic strategies. Expert Opin Drug Saf. 2018;17(4):407–412.
- Rowland DL, Motofei IG, Păunică I, et al. Androgenic alopecia; the risk–benefit ratio of finasteride. J Mind Med Sci. 2018;5(1):1–6.