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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Guideline for the treatment of alopecia in women and men
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<blockquote data-quote="madman" data-source="post: 192088" data-attributes="member: 13851"><p><strong>Androgenetic alopecia in women and men: <span style="color: rgb(184, 49, 47)">Italian guidelines adapted from European Dermatology Forum/European Academy of Dermatology and Venereology guidelines</span> </strong></p><p><span style="color: rgb(44, 130, 201)">Aurora ALESSANDRINI, Michela STARACE, Roberto D’OVIDIO, Lucia VILLA, Alfredo ROSSI, Teodora R. STAN, Piergiacomo CALZAVARA-PINTON, Bianca M. PIRACCI </span></p><p></p><p></p><p><strong>Abstract</strong></p><p></p><p><span style="color: rgb(184, 49, 47)">Androgenetic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life.</span> <span style="color: rgb(44, 130, 201)"><u>AGA is caused by a progressive reduction in the diameter, length, and pigmentation of the hair, resulting from the effects of the testosterone metabolite dihydrotestosterone (DHT) on androgen-sensitive hair follicles</u>.</span> <span style="color: rgb(184, 49, 47)">Clinical presentation is different in men and women. Trichoscopy is used routinely in patients with androgenetic alopecia, for diagnosis and differential diagnosis with other diseases, allowing staging of severity and monitoring the progress of the disease and the response to treatment.</span> <span style="color: rgb(44, 130, 201)"><u>Medical treatment of AGA includes topical minoxidil, antiandrogen agents, 5-alpha reductase inhibitors, and many other options</u>. </span><span style="color: rgb(184, 49, 47)">This guideline for the treatment of androgenetic alopecia has been developed by an Italian group of experts taking into account the Italian pharmacological governance. The article is adapted from the original of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). It summarizes evidence-based and expert-based recommendations (S3 level). </span></p><p><span style="color: rgb(184, 49, 47)"></span></p><p><span style="color: rgb(184, 49, 47)"></span></p><p><span style="color: rgb(184, 49, 47)">Androgenetic alopecia (AGA) is the most common cause of non-scarring alopecia, affecting respectively up to 50% of women and 80% of men in the course of their life,1 with a frequency that increases with age after puberty.</span> <span style="color: rgb(44, 130, 201)">Androgenetic alopecia is characterized by a progressive miniaturization of hair follicles usually occurring in a pattern distribution.</span> <span style="color: rgb(184, 49, 47)"><u>The term AGA was introduced to define a form of alopecia developing under the influence of androgens against a background of genetically determined susceptibility of the hair follicle</u>.</span><span style="color: rgb(44, 130, 201)"> Hair loss represents a problem for the patient for cosmetic and psychological reasons because hair symbolizes an important mirror of our image and physical attractiveness to self-perception of beauty. </span><span style="color: rgb(184, 49, 47)"><strong><u>The primary objective of this Italian guideline is to describe complete information about the disease and prescribing treatment for androgenetic alopecia</u>. These guidelines are adapted from the original article under the guidance of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). This article summarizes evidence-based treatment for androgenetic alopecia according to Italian legislation (S3 level),2 associated also with expert-based recommendations and most frequently prescribed options (Table I). </strong></span></p><p></p><p></p><p><strong>1. General evaluation </strong></p><p></p><p><span style="color: rgb(26, 188, 156)">Androgenetic alopecia is the progressive non-scarring miniaturization of hair follicles located in characteristic areas of the scalp, in genetically predisposed people. The clinical presentation of androgenetic alopecia can be different in men and women, sharing the same pathogenesis. A correct diagnosis is the first step to choose an efficacious therapy.</span></p><p></p><p><span style="color: rgb(184, 49, 47)">1.1 Objectives </span></p><p><span style="color: rgb(184, 49, 47)">1.2 Pathogenesis </span></p><p><span style="color: rgb(184, 49, 47)">1.3 Patient’s history </span></p><p></p><p></p><p><strong>2. Clinical examination </strong></p><p><span style="color: rgb(184, 49, 47)">2.1 Male </span></p><p><span style="color: rgb(184, 49, 47)">2.2 Female </span></p><p><span style="color: rgb(184, 49, 47)">2.3 Scale of severity </span></p><p></p><p></p><p><strong>3. Laboratory/instrumental investigations </strong></p><p><span style="color: rgb(184, 49, 47)">3.1 Pull test </span></p><p><span style="color: rgb(184, 49, 47)">3.2 Trichogram and phototrichogram </span></p><p><span style="color: rgb(184, 49, 47)">3.3 Trichoscopy </span></p><p><span style="color: rgb(184, 49, 47)">3.4 Biopsy </span></p><p></p><p></p><p><strong>4. Therapeutic management </strong></p><p><strong></strong></p><p><strong>4.1 Objectives </strong></p><p><strong></strong></p><p><strong>4.2. Topical treatment </strong></p><p><strong></strong></p><p><strong>4.2.1 Minoxidil</strong></p><p><span style="color: rgb(184, 49, 47)">4.2.1.1 Response to treatment</span></p><p><span style="color: rgb(184, 49, 47)">4.2.1.2 Useful instructions for the patient </span></p><p><span style="color: rgb(184, 49, 47)">4.2.1.3 Side effects of minoxidil </span></p><p><span style="color: rgb(184, 49, 47)">4.2.1.4 Pregnancy and lactation </span></p><p></p><p><span style="color: rgb(0, 0, 0)"><strong>4.2.2 Prostaglandin analogs </strong></span></p><p><span style="color: rgb(184, 49, 47)">4.2.2.1 Response to treatment </span></p><p><span style="color: rgb(184, 49, 47)">4.2.2.2 Side effects </span></p><p></p><p></p><p><span style="color: rgb(0, 0, 0)"><strong>4.3 Systemic treatment </strong></span></p><p></p><p><strong><span style="color: rgb(0, 0, 0)">4.3.1 Alpha-reductase inhibitors </span></strong></p><p><span style="color: rgb(184, 49, 47)">4.3.1.1 Finasteride in male </span></p><p><span style="color: rgb(184, 49, 47)">4.3.1.2 Finasteride in female </span></p><p><span style="color: rgb(184, 49, 47)">4.3.1.3 Dutasteride (Avodart®) </span></p><p></p><p><strong>4.3.2 Hormones </strong></p><p><span style="color: rgb(184, 49, 47)">4.3.2.1 Cyproterone acetate (Androcur®) </span></p><p><span style="color: rgb(184, 49, 47)">4.3.2.2 Spironolactone (Aldactone®) </span></p><p><span style="color: rgb(184, 49, 47)">4.3.2.3 Flutamide (Drogenil®, Eulexin®, Flutamide®) </span></p><p></p><p></p><p><strong>5. Platelet-rich plasma </strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>6. Surgery </strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>7. Low-level laser (light) therapy (LLLT, laser hair comb)</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Conclusions </strong></p><p><strong></strong></p><p><strong><span style="color: rgb(184, 49, 47)">Androgenetic alopecia is a progressive disease that, if left untreated, tends to worsen with time. </span><span style="color: rgb(44, 130, 201)">Progression of the disease can be slow or very fast, especially in patients with a strong family history or with hormonal disturbances.</span> <span style="color: rgb(184, 49, 47)">Regular clinical, trichoscopical, and (photo) trichogram follow-ups are very important to monitor disease activity and treatment tolerance.</span><span style="color: rgb(44, 130, 201)"> <u>If used correctly, in most cases available medical treatments for AGA arrest the progression of the disease and reverse miniaturization</u>.</span> <span style="color: rgb(26, 188, 156)"><u>In some advanced cases, hair replacement surgery is the only option.</u> </span></strong></p></blockquote><p></p>
[QUOTE="madman, post: 192088, member: 13851"] [B]Androgenetic alopecia in women and men: [COLOR=rgb(184, 49, 47)]Italian guidelines adapted from European Dermatology Forum/European Academy of Dermatology and Venereology guidelines[/COLOR] [/B] [COLOR=rgb(44, 130, 201)]Aurora ALESSANDRINI, Michela STARACE, Roberto D’OVIDIO, Lucia VILLA, Alfredo ROSSI, Teodora R. STAN, Piergiacomo CALZAVARA-PINTON, Bianca M. PIRACCI [/COLOR] [B]Abstract[/B] [COLOR=rgb(184, 49, 47)]Androgenetic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life.[/COLOR] [COLOR=rgb(44, 130, 201)][U]AGA is caused by a progressive reduction in the diameter, length, and pigmentation of the hair, resulting from the effects of the testosterone metabolite dihydrotestosterone (DHT) on androgen-sensitive hair follicles[/U].[/COLOR] [COLOR=rgb(184, 49, 47)]Clinical presentation is different in men and women. Trichoscopy is used routinely in patients with androgenetic alopecia, for diagnosis and differential diagnosis with other diseases, allowing staging of severity and monitoring the progress of the disease and the response to treatment.[/COLOR] [COLOR=rgb(44, 130, 201)][U]Medical treatment of AGA includes topical minoxidil, antiandrogen agents, 5-alpha reductase inhibitors, and many other options[/U]. [/COLOR][COLOR=rgb(184, 49, 47)]This guideline for the treatment of androgenetic alopecia has been developed by an Italian group of experts taking into account the Italian pharmacological governance. The article is adapted from the original of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). It summarizes evidence-based and expert-based recommendations (S3 level). Androgenetic alopecia (AGA) is the most common cause of non-scarring alopecia, affecting respectively up to 50% of women and 80% of men in the course of their life,1 with a frequency that increases with age after puberty.[/COLOR] [COLOR=rgb(44, 130, 201)]Androgenetic alopecia is characterized by a progressive miniaturization of hair follicles usually occurring in a pattern distribution.[/COLOR] [COLOR=rgb(184, 49, 47)][U]The term AGA was introduced to define a form of alopecia developing under the influence of androgens against a background of genetically determined susceptibility of the hair follicle[/U].[/COLOR][COLOR=rgb(44, 130, 201)] Hair loss represents a problem for the patient for cosmetic and psychological reasons because hair symbolizes an important mirror of our image and physical attractiveness to self-perception of beauty. [/COLOR][COLOR=rgb(184, 49, 47)][B][U]The primary objective of this Italian guideline is to describe complete information about the disease and prescribing treatment for androgenetic alopecia[/U]. These guidelines are adapted from the original article under the guidance of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). This article summarizes evidence-based treatment for androgenetic alopecia according to Italian legislation (S3 level),2 associated also with expert-based recommendations and most frequently prescribed options (Table I). [/B][/COLOR] [B]1. General evaluation [/B] [COLOR=rgb(26, 188, 156)]Androgenetic alopecia is the progressive non-scarring miniaturization of hair follicles located in characteristic areas of the scalp, in genetically predisposed people. The clinical presentation of androgenetic alopecia can be different in men and women, sharing the same pathogenesis. A correct diagnosis is the first step to choose an efficacious therapy.[/COLOR] [COLOR=rgb(184, 49, 47)]1.1 Objectives 1.2 Pathogenesis 1.3 Patient’s history [/COLOR] [B]2. Clinical examination [/B] [COLOR=rgb(184, 49, 47)]2.1 Male 2.2 Female 2.3 Scale of severity [/COLOR] [B]3. Laboratory/instrumental investigations [/B] [COLOR=rgb(184, 49, 47)]3.1 Pull test 3.2 Trichogram and phototrichogram 3.3 Trichoscopy 3.4 Biopsy [/COLOR] [B]4. Therapeutic management 4.1 Objectives 4.2. Topical treatment 4.2.1 Minoxidil[/B] [COLOR=rgb(184, 49, 47)]4.2.1.1 Response to treatment 4.2.1.2 Useful instructions for the patient 4.2.1.3 Side effects of minoxidil 4.2.1.4 Pregnancy and lactation [/COLOR] [COLOR=rgb(0, 0, 0)][B]4.2.2 Prostaglandin analogs [/B][/COLOR] [COLOR=rgb(184, 49, 47)]4.2.2.1 Response to treatment 4.2.2.2 Side effects [/COLOR] [COLOR=rgb(0, 0, 0)][B]4.3 Systemic treatment [/B][/COLOR] [B][COLOR=rgb(0, 0, 0)]4.3.1 Alpha-reductase inhibitors [/COLOR][/B] [COLOR=rgb(184, 49, 47)]4.3.1.1 Finasteride in male 4.3.1.2 Finasteride in female 4.3.1.3 Dutasteride (Avodart®) [/COLOR] [B]4.3.2 Hormones [/B] [COLOR=rgb(184, 49, 47)]4.3.2.1 Cyproterone acetate (Androcur®) 4.3.2.2 Spironolactone (Aldactone®) 4.3.2.3 Flutamide (Drogenil®, Eulexin®, Flutamide®) [/COLOR] [B]5. Platelet-rich plasma 6. Surgery 7. Low-level laser (light) therapy (LLLT, laser hair comb) Conclusions [COLOR=rgb(184, 49, 47)]Androgenetic alopecia is a progressive disease that, if left untreated, tends to worsen with time. [/COLOR][COLOR=rgb(44, 130, 201)]Progression of the disease can be slow or very fast, especially in patients with a strong family history or with hormonal disturbances.[/COLOR] [COLOR=rgb(184, 49, 47)]Regular clinical, trichoscopical, and (photo) trichogram follow-ups are very important to monitor disease activity and treatment tolerance.[/COLOR][COLOR=rgb(44, 130, 201)] [U]If used correctly, in most cases available medical treatments for AGA arrest the progression of the disease and reverse miniaturization[/U].[/COLOR] [COLOR=rgb(26, 188, 156)][U]In some advanced cases, hair replacement surgery is the only option.[/U] [/COLOR][/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Guideline for the treatment of alopecia in women and men
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