What exactly is reflex hyperandrogenicity and what causes it? Is it when the androgen receptors become more sensitive to DHT or is it an increase in overall testosterone that negatively impacts the follicles. Also, should a topical antiandrogen counter this effect?
Dr Proctor Answers: Reflex hyperandrogenicity is caused by a combination of increased testosterone and increased tissue sensitivity to male sex hormones ( androgens ). The latter is cause at least partially by an increase in the numbers of androgen receptors. Whether the receptors also get more sensitive is not clear, but seems likely.
Reflex hyperandrogenicity is proportional to the strength of an antiandrogen. It limits the use of antiandrogens in (e.g.) treatment of prostate cancer and is why most such patients get castrated.Because the action of Finasteride is mostly limited to tissues where type-2 5-AR is the important source of androgenic activity, it elicits less reflex hyperandrogenicity than other antiandrogens when used to treat hair loss or prostate enlargement. So this is usually not limiting in hair loss-treatment, at least in the short run. It may even help minimize side-effects such as libido decrease during the use iof finasteride for hair loss. Whether this is also true for Dutasteride ( which blocks both type-1 and type-2 5 Alphareductases ) is not clear yet. And yes, topical antiandrogens such as spironolactone, which do not elicit the increase in testosterone, are likely helpful.
Peter H Proctor, PhD, MD