Bryan said:
Siberian said:
Well, a number of transsexuals are telling me that there's a certain dosage threshold for spironolactone where the T levels fall dramatically - and into the range of genetic females. Usually around 100mg - 200mg.
Not scientific evidence of course, and they could be wrong, but these folk take their T levels *very* seriously
Can you ask them if they can find any scientific evidence for that? If they can, then I'll believe it. But until then, I'll have the same objection that I stated above, which is that spironolactone was in use for a number of years before androgen-related side-effects began to be documented.
Bryan
AHA!!! It just occurred to me that there's some scientific evidence against your claim (that spironolactone causes T levels to fall dramatically to female levels), and it's in a small study oral spironolactone that I've already posted a number of times on the hairloss sites! I'd forgotten that they had measured hormone levels in that test! :wink: Here it is again:
Clinical Endocrinology (1997) 47, 759-761
Letters to the Editors
"Beneficial effect of spironolactone on androgenic alopecia"
"Sirs, Spironolactone, an established anti-hypertensive agent, has a marked anti-androgenic activity, which has been exploited for the treatment of hirsutism and acne. These are the commonest skin manifestations of mild to moderate androgen excess in women of reproductive age. Androgenic alopecia, the loss of scalp hair occurring in genetically predisposed subjects, is also related to raised androgen bioactivity. Drugs with anti-androgen action have been extensively employed for the treatment of hirsutism and acne with fairly good results although the evaluation procedures usually employed have been recently criticized. On the other hand, the usefulness of these agents in treating androgenic alopecia has never been properly assessed. We have recently had the chance to evaluate the effects of spironolactone (
100 mg twice daily for six months) on the rate of scalp hair loss and the distribution of hair root phases in 4 young patients, 18-23 years of age (2 women, cases a,b and 2 men, cases c,d) with partial androgenic alopecia.
"
Measurement of androgens and sex hormone binding globulin, were performed in all patients and ovarian ultrasound assessment was performed in the female patients. Furthermore, measurements of hair loss after daily washing for 10 days and hair phase evaluation with trichograms were carried out before, after 6 months on spironolactone and 3-4 months after its withdrawal. Unit area trichogram provides a proportional assessment of the 4 phases of scalp hair (anagen, catagen, telogen and dysmorphic).
"
No marked changes in the endocrine parameters were observed as a result of treatment, with serum testosterone being slightly elevated in one of the female patients both of whom had polycystic ovary syndrome. A marked reduction in the rate of daily hair loss and an improvement in the trichogram score were noted during treatment, in all 4 cases, but with a partial relapse following its cessation (Table 1).
"This improvement was shown by a 50.0 to 62.9% decline in hair loss in the 4 patients, compared to their pre-treatment assessments. In terms of trichogram score changes, an increase in anagen phase was noted during treatment (from 22.0 to 84.5% over basal evaluation percentage) whereas the proportion of dysmorphic hairs during treatment was markedly lower than pre-treatment values in all 4 cases. Post-treatment evaluation showed a considerable degree of relapse in anagen hair (from 17.0 to 43.8% over treatment values), although a fair part of the improvement was retained. No adverse effects, particularly on the menstrual cycle, sperm count or sexual activity were noted. However, it should be pointed out that spironolactone may cause erectile inadequacy in other patients. A fall in blood pressure was noted in all patients, who were normotensive, and no change in renal or liver function was recorded. The beneficial effect of spironolactone on scalp hair was probably mediated through its anti-androgenic action mainly at the level of pilosebaceous unit. Recently such an effect has been also demonstrated for the 5alpha-reductase inhibitor finasteride.
"It is concluded that, in view of the beneficial effects noted in these cases, spironolactone may be a useful agent for restraining scalp hair loss in androgenic alopecia. However, a properly designed clinical trial would be necessary to prove this conclusively."
D.A. Adamopoulos, M. Karamertzanis, S. Nicopoulou and A. Gregoriou
Endocrine Department, Elena Venizelou Hospital, Athens 115 21, Greece
Table 1 Mean daily hair loss and scalp hair trichograms.
---------------------------------------------------------------
.................. Hair loss ..........Trichogram phases* (%)
Treatment ... number/day .....I.........II.......III........IV
---------------------------------------------------------------
before... case a .... 156 .... 42 ...... 4 ..... 29 ...... 25
..................... b ..... 204 .... 33 ...... 7 ..... 32 ...... 28
..................... c ....... 60 .... 50 ...... 0 ..... 31 ....... 19
..................... d ..... 140 .... 41 ...... 4 ..... 29 ....... 26
during .. case a ..... 98 ....... 58 ..... 3 ...... 26 ...... 13
..................... b .... 103 ...... 61 ..... 4 ...... 27 ........ 8
..................... c ..... 30 ....... 61 ..... 1 ...... 31 ......... 7
..................... d ..... 88 ....... 55 ..... 5 ..... 25 ....... 15
after .... case a ..... 130 ..... 47 ..... 4 ...... 35 ...... 14
..................... b ..... 180 ..... 49 ..... 6 ...... 33 ...... 12
..................... c ....... 50 ...... 55 ..... 3 ...... 31 ...... 11
..................... d ...... 106 .... 48 ..... 6 ...... 29 ...... 17
-------------------------------------------------------
*I anagen, II catagen, III telogen, IV dysmorphic.
