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

Oh yeah, definately get your endocrinologist to do some blood work. I'm really surprised that he doesn't want to give you spiro due to it's (libido reducing) side effects, when you were taking Proscar and are now on Avodart. Don't those also affect your libido, as I've read that proscar does???

As for the blood tests, well he'll probably run a Male Panel on you which will include your PSA, you Androgens (will include DHT), estrogen, progesterone, along with a liver panel, CBC (complete blood count), and lipid profile. Yet every lab is different, but those are the usual tests run, in particular when taking medication that can mess with your liver.

Now, if you read the last abstract I posted, it mentions that males that accutane didn't work for had either an adrenal dysfunction or had high levels of 5-alpha reductase. Well, you can have a "normal" total testosterone levels, as I do, and yet still have high levels of a form of testosterone. Usually it's going to be DHEA or DHEA-S or Free Androgens that wil be high. Of course, that means that you will probably have high levels of DHT and 3-alpha diol-G which, are supposed to responsible for acne, hirsutism, sebum production, alopecia, and prostate & breast growth problems (like cancer).

Hormonal disorders that you could be checked for may involve one or more of the following: Pituitary, Thyroid, Adrenal gland, Gonads (testes or ovaries), or Liver/Pancreas. It could be a genetic defect, sensitivity, tumor, or greatly influenced (not always caused) by something in your lifestyle (toxins in environment, diet, nutrient deficiency, etc).

So when you think of acne, well when I do, two major forms of treatments come to mind: Androgen Antagonists and Anti-inflammatories. Well it turns out that is basically what happens when you have hormonal disorder (or health problem) that is giving you acne. It usually increases your androgens and/or inflammatory product production!


Basic Hyperandrogenism
Tumor or defect in testes or ovary production

Health/Hormonal Disorder Induced Hyperandrogenism
Adrenal Disorders:
-- Non-classical congenital Adrenal Hyperplasia (NCCAH) or Late-onset adrenal hyperplasia (LOCAH) - too little cortisol could mean too much of the other steriod hormones being produced as a result of the body TRYING to produce more cortisol. There's 5 possible enzyme defects here.

-- Hypercortisolism / Cushings Syndrome - too much cortisol could mean too much of the other steriod hormones being produced as well

-- Hypocortisolism / Addison's Disease - probably similar to NCCAH/LOCAH

Thyroid:
-- Hyperthyroidism / Grave's Disease - not as common for acne, but doctors will usually test this before ANY other hormonal tests (???)

-- Hypothyroidism - more common for acne as it leads to a reduction of SHBG & increased inflammatory products.

-- Thyroiditis / Hashimoto's Thyroiditis - should be the same as for hypothyroidsim

Liver/Pancreas:
-- Insulin Resistance - reduces SHBG & increases inflammatory products
-- Diabetes Type II
-- High Cholesterol - contribute to inflammatory products

Quote from Neca:

Hey SweetJade how's it going :wave: , 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.