Prevent sides with DHT patch?

[CMartel2]

First, finasteride typically works. It's really the only agent we have that seems to produce great results. That's great, but it has some pretty horrible side effects, or at least that potential.

Part of the problem is that the body is deprived of what is an important hormone in DHT by 5-alpha reductase inhibitors. Some have tried to get finasteride to work topically, but it seems it is absorbed and acts systemically, even at low doses (see blood work in those who have tried topical finasteride). But why not try this exact opposite?

Look at this:
http://www.medscape.com/viewarticle/405823_4

When applied topically, a testosterone gel yielded DHT levels according to the site of application. In other words, DHT doesn't have the mobility of some of these other hormones or compounds.

Why not look into the option of applying a DHT patch locally to the scrotum, for instance, to attempt to concentrate DHT there. The potential I see in this is the ability to locally increase DHT levels in the scrotal area while keeping systemic levels low. Blood levels could be monitored, and the time of application of the patch could be varied to achieve optimal results.

I guess one of the major problems I've seen regarding finasteride dosing is that it's very difficult to get much variance in effect by changing the dose: 025 mg works about as well at suppressing DHT as 0.5, which works as well as 1.0, and so it goes. With the DHT patch, you actually have some control over DHT levels and might be able to avoid sides by still suppressing DHT, but only to a limited degree and not so much to the scrotal/prostate area, as with just oral finasteride.

 

[Mew]

Why not look into the option of applying a DHT patch locally to the scrotum, for instance, to attempt to concentrate DHT there. The potential I see in this is the ability to locally increase DHT levels in the scrotal area while keeping systemic levels low.

Unfortunately such DHT applications will not be "local" in nature, they will be absorbed through the skin and thus be systemic ... the same way transdermal Testosterone patches are.

Look at this:
http://www.medscape.com/viewarticle/405823_4

Article inaccessible unless logged in/cookie expired. Suggest you copy & paste it here.

With the DHT patch, you actually have some control over DHT levels and might be able to avoid sides by still suppressing DHT, but only to a limited degree and not so much to the scrotal/prostate area, as with just oral finasteride

And you base this theory on... what exactly?

Here's mine: Taking Finasteride and DHT at the same time is pointless since the finasteride would likely negate the effects of the DHT... and even if not, you'd still be facing a hairloss issue due to introducing extra DHT into the body.

On top of that, taking external DHT would likely exert negative feedback on the HTPA and lower endogenous Testosterone production as noted here:

http://jcem.endojournals.org/cgi/conten ... /9/4078/F1

"Among 33 (17 dihydrotestosterone, 16 placebo) men completing the study with a high degree of compliance, dihydrotestosterone had significant effects on circulating hormones (increased dihydrotestosterone; decreased total and free testosterone, LH, and FSH; ..."

And here:

http://jcem.endojournals.org/cgi/content/full/83/8/2749

"Concomitant with the rise in serum DHT levels after gel application, serum levels of T, free T, E2, FSH, and LH also showed consistent suppression. Previous studies demonstrated that DHT administration suppressed pulsatile LH secretion (13, 15), resulting in decreased production of T and E2.

Our study showed that significant suppression of serum T levels was present on day 14, and the suppression was most marked with the 64-mg dose. The degree of suppression of serum T with the 64-mg DHT dose was similar to previous reports by Schaison et al. (14), where 250 mg DHT gel was administered every day"


However, despite the above, since Finasteride typically increases T production 10-20%, no telling what might happen there... but basically introducing all these extra variables is, in my opinion, a recipe for hormonal disaster.

finasteride reduces DHT, shrinks the prostate, can alter androgen/estrogen ratio in favor of estrogens, and a host of other issues... taking DHT gel would not likely counteract this since one is still taking Finasteride.

 

[CMartel2]

I've done a bit more research, and I partially agree with you. Yes, absolutely, the introduction of DHT to the body, be it topically (andractim) or orally (procerin? is that right?) results in systemic increases in DHT.

I'll note that in the studies you cite, they're using DHT in higher doses than what I had in mind.

Regarding, HPTA suppression with the introduction of DHT, that's something I'm a little less concerned about. Yes, testosterone production will be decreased, but so will estrogen and prolactin. DHT acts as an aromatase inhibitor, so it will suppress estrogen levels. Further, as testerone levels slowly decline, so will conversion to E2. This is essentially a reset button for the body. I do think that some of these sides are caused by elevated prolactin and progesterone levels in addition to high E2. Well, in addition to the fact that DHT controls erections.

As for finasteride negating the effects of the DHT, that depends on what you mean. When you introduce DHT into your body, you've already bypassed 5-alpha reductase, which is where finasteride acts. In other words, finasteride be darned, you have some DHT lurking around that wouldn't have been there before--ideally, however, far less than you'd have if you weren't on finasteride.

What I was going for in this is maybe decreasing DHT by only say 40% as opposed to the 70-90% you see on 5-alpha reductase inhibitors alone.

The aim here in my eyes is to lower DHT levels and still maintain while avoiding sides, I think most of us will be beyond happy. Perhaps the best strategy is lowering the dosage of finasteride to 0.2 or so mg daily or EOD. Or in the end, going off.

 

[Mew]

I'll note that in the studies you cite, they're using DHT in higher doses than what I had in mind.

FWIW, I seem to recall reading that it does not in fact matter wether it is an extremely low or high dosage... only the fact that extraneous androgens (in whatever amounts), when systemically introduced to the body, can signal the HTPA to shutdown endogeneous production. But I'm not 100% sure on that...

What I was going for in this is maybe decreasing DHT by only say 40% as opposed to the 70-90% you see on 5-alpha reductase inhibitors alone

Yes, it would be great if finasteride acted in a dose dependent manner such that lower doses inhibited lower amounts of DHT... but unfortunately it is so potent even at microscopic doses that this is not possible. See:
http://www.physics.upenn.edu/facultyinf ... peciafda2/

Regarding, HPTA suppression with the introduction of DHT, that's something I'm a little less concerned about. Yes, testosterone production will be decreased, but so will estrogen and prolactin. DHT acts as an aromatase inhibitor, so it will suppress estrogen levels. Further, as testerone levels slowly decline, so will conversion to E2. This is essentially a reset button for the body.

Yes, in normal controls that are NOT using Finasteride, such surpression would be expected to be the case (note: surpressing T levels is NOT something many guys want to do, unless they have a reason to chemically castrate themselves such as androgen-dependent cancer).

Unfortunately men taking Finasteride may already have increased T/E2 levels as a result of usage... throwing extraneous DHT into the equation may or may not have a HTPA feedback effect... I'm no endocrinologist but it just seems that throwing a wrench into such a situation is just asking for trouble.

When you introduce DHT into your body, you've already bypassed 5-alpha reductase, which is where finasteride acts. In other words, finasteride be darned, you have some DHT lurking around that wouldn't have been there before

Yes, I also thought along the same lines, since finasteride acts on 5AR2 and prevents the metabolism of T-->DHT... not necessarily DHT itself if given after the fact. Nonetheless, you are then in a chicken and egg scenario in terms of hairloss since the whole point of taking finasteride is to reduce DHT to maintain/regrow hair... if one adds DHT back into the equation, it kind of defeats the point of Finasteride, since with reduced DHT inhibition comes less gains in terms of preventing hairloss.

Perhaps the best strategy is lowering the dosage of finasteride to 0.2 or so mg daily or EOD.

Again, same as above... 0.2mg will have nearly same effect on DHT levels as 1mg or 5mg due to near flat dose response rate of drug.

Unfortunately 5AR is involved in more than just T-> DHT metabolism, but includes other pathways as well... and since DHT mediates Nitric Oxide activity in 5AR2 dependent tissues (NO is involved in erections etc), that is another issue one must consider when it comes to the consequences of inhibiting DHT.

There are no easy answers. The best solution would be a topical anti-androgen that acted locally in the scalp without systemic side effects or the need to reduce DHT systemically.... keep your libido, dick and your hair.

 

[CMartel2]

"extraneous androgens (in whatever amounts), when systemically introduced to the body, can signal the HTPA to shutdown endogeneous production. But I'm not 100% sure on that... "

Well, it would cause your body to shut down momentarily. You essentially have an androgenciity gauge in your body, and when you exceed that amount, your HPTA will slow. On finasteride the body is producing excess testosterone to make up for the decrease in DHT. Toss in a little DHT, and the test is going to drop a bit. Not necessarily a bad thing seeing as castrated rats got erections with DHT and not testosterone.

Yes, it would be great if finasteride acted in a dose dependent manner such that lower doses inhibited lower amounts of DHT... but unfortunately it is so potent even at microscopic doses that this is not possible. See:

Yes, that exact UPenn graph is the reason I'd considered 0.25 mg every other day in my answer. If you wanted daily dosing, it should be fairly easy to target a 0.03 mg or so daily dosage via suspension in an aqueous/ethyl alcohol solution, which would ideally place you somewhere along the curve. I guess you could check DHT levels in your blood to monitor that.

I'd absolutely agree that the ideal means of addressing the problem would in theory be with a local-acting anti-androgen without systemic effects, but the only candidates for that role are Eucapil, ketoconazole, and spironolactone. Unforuntately, despite a few positive studies, none of them really amount to a Holy Grail by an stretch, as you well know.

We shall see. I just don't think it's a good idea to completely shut your body off from DHT. The idea of Dutasteride honestly scares me a bit, but some seem to like it.