Endocrinologist prescibed Avodart and Accutane

[SweetJade1]

Originally Posted by Dragon68

I'm a 36yo male and I just started my 4th course of Accutane (the first two times I was on a low dose, the third time I did 80mg all throughout which was 6 years ago). My acne has been getting worse over the last year (probably because I went back to school full-time and under stress most of the time) and wanted to buy myself some more time. I've had an acne problem related to simple sugars for half my life and eat pretty strictly like many on this board do. I too believe that it is hormonally related and thought about the 5-alpha reductase theory but have never had alopecia - so I suspect it may not be that. I can understand now how it would be a good idea to have broad spectrum endocrine level testing done to find out if there is something out of whack. Hope all works out well for everyone!!

Hey newbie =) First all, you do NOT have to have androgenic alopecia to have a hormonal disorder, particularly one relating to hyperandrogenism. Androgens aren't just responsible for androgenic alopecia, hirsutism & acne, but also ezcema & psoriasis (& rosacea), rheumatoid arthritis, certain cancers, and even obesity. So when you think that someone is getting away with eating too much sugars, for example, because they don't have acne, they may not be getting away with anything. There's always more than one reaction to a particular...aggrevator or hormonal disorder.

2nd of all, if you know that your problem is simple sugars, why do you eat them? ;-) If you know that it IS sugar, then why not take an Insulin Sensitizing drug (Avandia or Metaformin) instead of actually thinking that another course of accutane is going to help you. Have you ever had your blood sugar & insulin levels checked? Does anyone in your family have high cholesterol, weight problems, or Type II Diabetes or Insulin Resistance???

This is my problem, Insulin Resistance Syndrome, also now known as Metabolic Syndrome induced Hyperandrogenism. Avandia wasn't enough for me, as I found my dietary changes to be far superior, but everyone is different and it may be the answer that you need. =)

[SweetJade1]

Originally Posted by Neca

Hey SweetJade how's it going , wow it's good to see that you are still here helping people out with your amazing knowledge. I don't know what a lot of us would do without your insight! Well I was just browsing the forum and have stumbled on a lot of info regarding anti-androgens especially amongst your post and it is beginning to really interest me as I am convinced my acne is hormonal. In your last post you wrote:



Do you know how effective these A/As are at preventing acne and do you have any info regarding the types available, preferably in natural form. I have read that Saw Palmetto is an A/A but many people have suffered from Thyroid problems as a result? So how risky is A/A use and does it need to be carefully monitored by a doc?

Thanks in advance for any info and good to see ya again

Oh wow, well thank you =) Regarding Androgen Antagonsits, they fall in many catagories. Some are best used for certain genders, but some of these should probably be used for all genders. The most popular ones used orally for the treatment of acne are Accutane (see previous posts), Spironolactone (androgen receptor blocker), Estrogen/BC (increases SHBG to bind free androgens) & it's questionable when it comes to the prescription specific 5-alpha reductase inhibitors such as Avodart & Proscar.

There's herbals that can act as 5-alpha reductase inhibitors as well as Saw Palmetto is one of these. If you are concerned about it messing with your thyroid, then you can take the active component, Beta Sitosterol instead. I actually have a list of natural androgen antagonists and I look for that and post it for you later.

In the mean time, as for prescription androgen antagonists, there's also the indirect ones such as Glucocorticoids & Insulin Sensitizers. Normally glucorticoids (dexamethasone & prednisone) could induce acne, but if you have an adrenal imbalance they will do the opposite & they are also anti-inflammatory too. The Insulin Sensitizers help to either limit the amount of insulin you produce (Metaformin) or enable your body to better utilize insulin (Avandia). Either way, they both work to lower you androgens, free androgens and boost your SHBG levels, thus help reduce/eliminate acne. The same goes for thyroxine hormone for those that are hypothyroid. Hypothyroids also have a reduced level of SHBG due to lacking thyroid hormone. Boost your thyroid hormone & your SHBG will also increase and thus your acne should also be eliminated.

Depending on the severity, the susceptibility to one's environment (diet, toxins), and perhaps sensitivity, will determine how effective prescription & supplement androgen antagonists are for you. As you may have noted on the board, some of these drugs alone are enough to get people 100% and other times, such as for myself, they were not. I'm more influenced by my diet (which is also an indirect androgen antagonist) and as such I found that I got better results by changing my diet, even when I dropped the avandia (BC, & spiro). I actually have a studyposted around here (bread & acne thread?) that shows that dietary changes with metaformin was no different than dietary changes alone! I'm 24 and have had acne since I was at least 10, yet something that "simple" worked for me. Indeed, the success of any treatment really depends on one's genes & environmental influences.

[SweetJade1]

OK, so here's the rest of the hormonal tests you should get. I'm also including the lipid panel because this is also an indicator. Steriod hormones (progesterone, androgen, estrogen, cortisol) are made from cholesterol. Furthermore, inflammatory products such as pro-inflammatory prostaglandins (PGE2) are made from the wrong fatty acids. There was actually a study that showed that the genetic connection among twins with acne, was that they had low levels of adiponectin 1A, which is responsible for forming HDL cholesterol (good stuff), thus they probably had high-normal or high levels of LDL cholesterol, which is associated with the production of inflammatory products!

Androgens:
Total Testosterone
Female Ref. Range of [6 – 86] NG/DL

Free Testosterone
Male Ref. Range is [4 – 26] NG/DL (SmithKline Beecham)
Female Ref. Range [0 – 1.4] NG/DL

DHEA (unconjugated)
Male Ref. Range [180 – 1250] NG/DL (Quest Diagnostics)
Female Ref. Range [130 – 980] NG/DL

Androstenedione
Male & Female Ref. Range of [65 - 270] NG/DL (Quest Diagnostics)

Dihydrotestosterone (DHT)

Sex Hormone Binding Globulin (SHBG) - SHBG & Free Testosterone/Androgen are inveresly connected and thus are indicators of the other so you neccessarily don't need to get both.


Lipid Profile:
Cholesterol: [120 – 230] mg/dl

Triglyceride: [30 – 140] mg/dl

LDL: [100 – 160] mg/dl

HDL: [40 – 100] mg/dl

HDL/Chol Ratio: [0 – 3.7]

Choles. Individual: [0 – 62]

(Every lab has different reference ranges which is why I try to post them as well as the lab)

Oh, I almost forget, when a male hits middle age, he starts to go through something known as Andropause. As such one may find that they actually have lower levels of certain androgens including Free Androgens, and higher levels of estrogen such as pro-inflammatory estrogen (where active estrogen is kinda the bad guy). In a way these males are still producing lots of androgens, as androgens MUST be created before estrogens, but more of them are being converted to estrogens. I don't know if this applies to middle aged males with obvious signs of androgen excess such as acne, androgenic alopecia, & prostate problems, but if you guys get tested I'm sure you can let us know. However, what is interesting is that the same insulin sensitizing medications, the same anti-androgenic/anti-inflammatory diets, etc will still BOOST a males SHBG levels (as these can still be low), balancing out his estrogen & androgen levels and thus can improve his health/hormonal balance.

[Dragon68]

Originally Posted by SweetJade1

Hey newbie =) First all, you do NOT have to have androgenic alopecia to have a hormonal disorder, particularly one relating to hyperandrogenism. Androgens aren't just responsible for androgenic alopecia, hirsutism & acne, but also ezcema & psoriasis (& rosacea), rheumatoid arthritis, certain cancers, and even obesity. So when you think that someone is getting away with eating too much sugars, for example, because they don't have acne, they may not be getting away with anything. There's always more than one reaction to a particular...aggrevator or hormonal disorder.

2nd of all, if you know that your problem is simple sugars, why do you eat them? ;-) If you know that it IS sugar, then why not take an Insulin Sensitizing drug (Avandia or Metaformin) instead of actually thinking that another course of accutane is going to help you. Have you ever had your blood sugar & insulin levels checked? Does anyone in your family have high cholesterol, weight problems, or Type II Diabetes or Insulin Resistance???

This is my problem, Insulin Resistance Syndrome, also now known as Metabolic Syndrome induced Hyperandrogenism. Avandia wasn't enough for me, as I found my dietary changes to be far superior, but everyone is different and it may be the answer that you need. =)

Hi SweetJade,
I actually have eliminated most carbohydrates (especially simple carbos) for many years now and still have oily/acne prone skin. After asking my mother this morning about any genetic abnormailities in the family I found out that two of my Aunts have Hypoglycemia (and that they have thrived under the Atkins diet). That is a good idea to have my insulin levels checked as a first step. Thanks for your response!

[SweetJade1]

Originally Posted by Dragon68

Hi SweetJade,
I actually have eliminated most carbohydrates (especially simple carbos) for many years now and still have oily/acne prone skin. After asking my mother this morning about any genetic abnormailities in the family I found out that two of my Aunts have Hypoglycemia (and that they have thrived under the Atkins diet). That is a good idea to have my insulin levels checked as a first step. Thanks for your response!

Ahh, so it does run in the family. In that case definately get your blood levels checked and ask about Avandia. Also, in case you are wondering, I don't follow a Low Carb or No-simple carb diet. I had to eliminate Gluten as it was a BIG contributer to blood sugar problems. Actually Wheat and Millet (which is gluten-free) will increase your Insulin Resistance (can cause Hypoglycemia) more so than Rice or Corn will! That's basically the grains that I eat daily now (if I eat any grains). Other acne sufferers around here found that they had to eliminate either wheat, gluten or ALL grains to get improved/clear skin. If you've already done this and also dabbled with the possibilitiy of other foods affecting you (nuts & certain fruits related to nuts do for me), then hopefully the Insulin Sensitizing drugs will do the trick!

Best of luck =)