Hair Loss - Let's carefully specify the meaning of a "local" effect!

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Let's carefully specify the meaning of a "local" effect! (Topicals)

posted by Bryan, 28.05.2008, 17:17

» Bryan,
»
» In studies directly comparing spironolactone and flutamide,flutamide has
» been shown to be a more potent antiandrogen (Moghetti, P: J. Clin.
» Endocrinol. Metab. 85(1) 2000).
I acknowledge that flutamide is a generally more powerful antiandrogen than spironolactone, at least at the doses of both drugs which are typically used. But spironolactone does have one PROFOUND advantage over flutamide: it has at least a modest "local" antiandrogenic effect when applied topically, but flutamide doesn't have any at all.

If you were a virile young male who is concerned about the possibility of developing nasty sexual side effects, which drug would YOU choose to use: topical spiro, which has virtually ZERO chance of systemic absorption (although its "local" effect is only mild-to-moderate), or topical flutamide, which has no "local" effect at all (according to the animal studies), and whose antiandrogenic effects come about EXCLUSIVELY by way of systemic absorption? :-)

Again I point out that if topical flutamide has no "local" antiandrogenic effect at all, there's really no particular reason to use it topically in the first place. It would be a lot simpler and far less messy just to SWALLOW a proper dose of the drug.

» But more importantly from a practical
» perspective, spironolactone has an objectionable odor especially when
» combined with minoxdil and requires a viscid base to remain stable in
» solution. This imposes a dilemma on patients: they must either tolerate
» the odor or messyness (most do not) or separate the spironolatone
» application from the minoxidil application--a ritual that quickly becomes
» too bothersome for the patient, who eventually looks for another type of
» treatment.

Dr. Proctor says he's developed a way to keep spironolactone and minoxidil stabilized when used together. He uses that technique in Proxiphen (which, BTW, has no objectionable odor). That would appear to make a choice of topical spironolactone easily preferable to topical flutamide, especially considering the other points I've made about the lack of a "local" effect with flutamide.

» RU58841 is a wonderful drug that will never see the light of day because
» of the disinterest of Roussel Uclaf (now a part of Aventis) to pursue the
» expense of an FDA approval. (Compounders don't need an FDA approval for
» hair loss, but we are legally bound to use components that are FDA approved
» for some legitimate indication.)
Considering that there's no Federal law (yet) establishing RU58841 as a prescription drug, I can't help but question the accuracy of your claim that you would be "legally" prohibited from using RU58841, assuming that you obtained a license to use it from the company that owns the rights (see the other nearby comment from another poster about this same issue).

» Bryan, of course we looked at alternatives that you consider worthy,
» and there is a reason why we rejected them.
I think you should go back and and reconsider those reasons, taking into account what I've said in this thread.

.

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