Br J Dermatol. 2008 May;158(5):1121-4. Epub 2008 Mar 20.
Value of hormonal levels in patients with male androgenetic alopecia treated with finasteride: better response in patients under 26 years old.
Camacho FM, García-Hernández MJ, Fernández-Crehuet JL
Department of Dermatology, Hospital Universitario Virgen Macarena, Avda. Dr Fedriani s/n. 41071 Sevilla, Spain.

      Background Finasteride is a 5alpha-reductase inhibitor that has proved to be an effective treatment for men with androgenetic alopecia. Objectives To investigate the hormonal influence of finasteride 1 mg daily on hormonal levels and hair growth in men of different ages and with different degrees of alopecia according to the Hamilton-Norwood scale. Methods Two hundred and seventy men aged 14-58 years with male androgenetic alopecia III-VI Hamilton-Norwood score (II-III Ebling score) were treated with finasteride 1 mg daily. Steroid hormone (free testosterone, 5alpha-dihydrotestosterone, dehydroepiandrosterone-sulphate, delta4-androstenedione, 17-hydroxyprogesterone), prostate-specific antigen (PSA) and sebum levels, and trichogram changes were determined at baseline, and at 6 and 12 months of treatment. Results According to significant hormonal statistical analysis, the patients were divided by age (up to or over 26 years). In the group of patients younger than or 26 years old, higher levels of 5alpha-dihydrotestosterone were found at the beginning of the treatment, but there was a 50% decrease between the onset of treatment and month 12, particularly noticeable at 6 months (P < 0.05) of treatment, running parallel to an improvement of the alopecia and an increase of anagen hairs in the trichogram. At 1 year, PSA levels decreased 20%, particularly in patients younger than 26 years old. No variations in sebum levels were observed. Conclusions High levels of 5alpha-dihydrotestosterone in patients younger than or 26 years old at the beginning of treatment are a predictive factor of good response to treatment with finasteride 1 mg daily.

Editor’s Note
      As we’ve been saying for years, DHT becomes less and less of a factor in Androgenetic Alopecia the older one gets. Although DHT remains a factor, it is a relatively minor factor in older men. Other variables, notably inflammation, estrogen dominance, and senescent thinning of hair (a seemingly universal age related diffuse hair loss, principally caused by atherosclerosis and the diminishment of peripheral microcapillary circulation) become more prominent.

      A real challege in hair loss treatment is simultaneously dealing with senescent thinning juxtaposed on thinning caused by Angrogenetic variables. Our treatment recommendations, which are continually updated, takes into account these age related variables, not solely hormonal variables, such as DHT, Androstenedione, and Prolactin.