ARE ANTIANDROGENS SAFE?

Antiandrogens are the medications we use in trichology to treat cases of androgenetic alopecia that require them. These drugs have shown high efficacy; however, there is much talk about potential risks they cause, which gives them a bad reputation and makes some patients reluctant to use them. I have prepared this article with the most frequently asked questions and the scientific evidence available to answer them. I also provide references to scientific articles if you are interested in reading more.

What is an antiandrogen?

As the name suggests: a drug that counteracts the effect of androgens, also known as male hormones. Androgens are called male hormones because they predominate in males, but women also have androgens (just as men also have female hormones). There are many androgens in the body, and for them to have an effect, they must bind to specific receptors found in different parts of the body. Hair follicles contain many androgen receptors, which is why this is an important therapeutic target. The hormone most specific to the hair follicle is dihydrotestosterone. Antiandrogens will act in 3 ways:

1. Decrease androgen production. (Specific contraceptives, bicalutamide, androcur, spironolactone)

2. Block the androgen receptor so that it does not receive as many signals (Bicalutamide, androcur, spironolactone)

3. Decrease the formation of dihydrotestosterone. (Dutasteride and finasteride)

In which pathologies are they used?

Antiandrogens are used in any pathology where the effect of these hormones is excessive. The most frequent are prostate hyperplasia, acne in women, alopecia, hirsutism, and polycystic ovary syndrome. As you can see, androgens are more frequently a problem in women than in men.

They say they can decrease libido or cause other sexual problems. Is that true?

Finasteride and dutasteride, the drugs with such a bad reputation, were first used for prostate conditions in older men. These patients not only had urination disorders but also cardiovascular problems, both situations potentially causing alterations in the sexual sphere. Studies in these patients showed a slight increase in sexual side effects compared to other patients of the same age. As for their use in alopecia, the dose is lower and patients are generally younger and healthier, so this decrease in libido or other problems are almost negligible, appearing in a minimal percentage. Even so, there are patients who do report these alterations; in them, we modify the medication or the route of administration (for example, we switch to mesotherapy), causing the alterations to disappear. In women, alterations in the sexual sphere are scarcely described.

Are antiandrogens compatible with pregnancy?

The first and most important rule is that in women of childbearing age, antiandrogens are completely contraindicated if pregnancy is being sought. These drugs, while taken, can cause abnormalities in the developing fetus. Contraceptives, Androcur, and spironolactone must be discontinued when deciding to seek offspring. Bicalutamide and finasteride are recommended to be discontinued two months prior, and dutasteride six months prior. The latter are partially stored in the body, which is why a washout period is necessary. If these guidelines are followed, there is no problem, as no cases of abnormalities in births of patients who had previously taken these drugs have been described. As for men, it is considered that they can be taken without problem for the partner, except for dutasteride, which seems to be partially released in semen, so it is sometimes recommended not to use it during pregnancy.

Will antiandrogens damage my liver or kidney?

Since these drugs do not cure diseases but control them, they are used for long periods of time. Therefore, it is not surprising that patients worry that the remedy may ultimately be worse and they end up with pathology in another organ. If an antiandrogen is prescribed by a doctor, a minimal number of alterations in other organs are observed. The ones most likely to be affected would be contraceptives, spironolactone, or bicalutamide, but with correct analytical control there is no problem (in fact, no cases of this problem have been described in the scientific literature).

Do antiandrogens increase the risk of cancer?

Short-term and long-term studies do not show an increased risk of tumor presentation in patients taking these medications short-term or long-term. Even so, in female patients who have already had breast cancer, not all antiandrogens are recommended, as the only one that has shown safety would be spironolactone. In patients with neoplasms, always before starting any treatment for alopecia, whether with antiandrogens or other medications, evaluation of the possible therapeutic plan by the oncologist is recommended.

What effect can antiandrogens have on the prostate?

Knowing that the drug also affects the prostate, you might ask what effect it will have on it. Basically, it will decrease its size, which is a good thing since what happens with age is that it grows, and this causes alterations. Although there is talk of a possible increased risk of prostate cancer, this is not only unproven, but the opposite may even occur, that it decreases the probability of low-grade prostate cancer appearing. No increased risk of breast cancer has been demonstrated either.