Endocrinologist prescibed Avodart and Accutane

[austinstories]

Hello,
I recently visited an Endocrinologist and he prescribed Avodart (im currently taking proscar) for my hair loss and Accutane (my 3rd course, i will be on it a few months at a normal dose then he will put me on long-term, low-dose if all goes well). If not he will give me Spiro, but he said better to try Accutane because of the potential side effects of Spiro.
Anyone here ever take Avodart and Accutane at the same time?
just curious
michael

[austinstories]

anyone here on avodart?

[BorderGirl]

And my endocrinologist always says how wonderful spiro is because there is no risk to the liver or kidneys I hate conflicting opinions in medicine!

[SweetJade1]

very few people have tried avodart. If you are a male you are much more likely to get prescribed this than a female because as with accutane, they don't want us to get preganant, and in this case with a male, and cause him birth defects (as in less masculine).

Avodart is the same thing as Duatsteride which is supposed to be a 99% Type I & Type II 5-alpha reductase enzyme inhibitor. these enzyms are responsible for the production of DHT, which is supposed to be the BIG bad guy when it comes to acne. However i've heard conflicting results about this drug. It may help with your hairloss, and it may even help with your acne, but some people that NEVER had acne were taking this and it actually gave them a form of acne. Yet, you will be on accutane so you may not get any new acne because of that.

If I was an endocrinologist, knowing that accutane isn't usually permanent, wich in your case seems to be true, I would have given you spiro especially since you've already been given something more potent than Spiro, Avodart, and that has not at all been approved for acne (which is why you are getting if for alopecia). Spiro has never broken anyone out, and it actually seems safer to me, with less physical side effects (no hair loss, extremely dry skin, lips, etc)

So tell me something, why are you going on a 3rd course of accutane? How long did the 1st 2 courses last for you? Did they ever clear you 100%? I ask this because people that accutane doesn't clear, and these people have goine on up to 5 treatments, probably have an underlying hormonal disorder. There are studies with accutane and males that have also further supported this by testing their testosterone levels and found that the males that didn't "take" to accutane had (possibly insulin resistance or hypothyroid induced) Hyperandrogenism or Adrenal Disorder induced hyperandrogensm, which would help explain your androgenic alopeica/male patterned baldness (??). So I'm just wondering if you really think it's worth a 3rd try? Do you actually have a hormonal disorder or have ever been tested to see if you do? If you do, Spiro would be a much better bet for it (especially if avodart does'nt work) or glucocorticoids (if it's adrenal related).

Best of luck

[SweetJade1]

OK, to further expound on what I'm saying about accutane, it is a growth inihbitor (hence it's uses as a cancer treatment) and probably why it reduces your sebum production & pore size, but it's also an androgen antagonsit in 3 ways (reduces total testosterone, DHT & 3 alpha diol G). However it's androgen antagonizing abilites are not permanent, they cease once treatment ceases, so if accutane truely works for people (and they just didn't grow out of getting acne), it probably has something to do with it's growth inhibiting (IGF-1) abilities.

Acta Derm Venereol. 1997 Sep;77(5):394-6. Related Articles, Links


Isotretinoin, tetracycline and circulating hormones in acne.

Palatsi R, Ruokonen A, Oikarinen A.

Department of Dermatology, University Central Hospital, Oulu, Finland.

Isotretinoin, used to treat severe acne, has been shown to induce hormonal changes, especially to reduce 5 alpha-reductase in the production of the tissue-derived dihydrotestosterone (DHT) metabolite 3 alpha-Adiol G. However, the effects of isotretinoin on other pituitary, adrenal or gonadal hormones have not been thoroughly elucidated. In the present study, isotretinoin administered at a dose of 0.5 mg/kg/day for 4 weeks caused no marked changes in the serum levels of pituitary, adrenal or gonadal hormones or 3 alpha-Adiol G in patients with severe papulopustulotic acne (n = 19). After 12 weeks of therapy, there was a decrease in the levels of the precursor androgens androstenedione, testosterone and 3 alpha-Adiol G in 6/9 patients. Acne improved after 4.5 months in all but 2 male patients, who had very low serum hormone binding globulins (SHBG) and a high free androgen index (FAI). Isotretinoin did not affect the elevated LH/FSH ratio in a patient with the polycystic ovarian syndrome (PCOS); nor did it change the high FAI or low SHBG in the male patients. For comparison, tetracycline had no effects on the serum hormonal levels of patients with mild acne (n = 19) after 7 days of treatment. This study confirms that the effects of isotretinoin on the serum hormone levels are small and unlikely to be of relevance for the resolution of acne or the suppression of sebum excretion.
[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9298137[/url]

So above with what I underlined & bolded are examples of hormonal disorders that accutane doesn't have any effect on. Women & Men can both have high & lows in those areas though, and I personally have high FAI (Free Androgen Index/ or Free Testosterone) and as such probalby a low SHBG (Sex Hormone Binding Globulin) which go hand-in-hand (SHBG binds FA). I personally never took accutane (afraid of side effects) but I see that I probably wouldn't have been helped anyway. Yet some people that have hormonal disorders did find that accutane helped reduce/eliminate a type of acne for them, so I suppose even if you do have a hormonal disorder you could try it. At the same time, usually if you just treat your hormnal disoder....you wouldn't need the accutane ;-)

Ann Dermatol Venereol. 1999 Jan;126(1):17-9. Related Articles, Links

[Acne in the male resistant to isotretinoin and responsibility of androgens: 9 cases, therapeutic implications]

[Article in French]

Chaspoux C, Lehucher-Ceyrac D, Morel P, Lefrancq H, Boudou P, Fiet J, Vexiau P.

Service d'Endocrinologie, Hopital Saint-Louis, Paris.

INTRODUCTION: Treatment failures with isotretinoin in female patients are frequently related to endocrinological dysfunctions. Such a concept has never been discussed in male patients. CASE REPORTS: An extensive endocrinological work-up has been performed in nine male patients who presented with an acne refractory to conventional treatment and to isotretinoin. Adrenal dysfunction was found in four patients and isolated 5-alpha reductase hyperactivity in 2 cases. Three work-ups were normal. A suppressive treatment in three patients with adrenal dysfunction provided immediate efficacy. COMMENTS: These results would provide insight into the mechanism of refractory acne in men.
[url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10095884[/url]