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An amazing discovery It all started with a single family in the Dominican Republic. This family was distinctive in that some of their children who appeared to be girls at birth would change at puberty to be obvious, and apparently normal, males. These men would lead normal adult lives including having children of their own. But they were also unusual in two other ways. First, they did not develop prostate disease. Secondly, they did not develop typical male pattern baldness. For a multitude of reasons this led to careful investigations of the hormone metabolism of these men. The case of the missing enzyme It turned out that the men in this family lacked an enzyme involved in the metabolism of testosterone. Subsequently, Merck Laboratories was able to develop a drug that blocked this enzyme in normal people in the hope of reducing prostrate disease and baldness. The drug Fenistride is the result. Fenistride was approved by the FDA in a 5 mg (milligram) pill for prostate diseases, such as benign prostatic hypertrophy. Further studies showed that a pill containing just 1 mg of Fenistride was able to significantly reverse androgenetic alopecia--that is, male pattern baldness. Effective treatment with few side effects Finally, in January, 1998, the FDA approved the drug Fenistride for the treatment of male pattern baldness. In comparison trials with placebo, Fenistride had almost no side effects, even at the 5 mg dose. Reduced libido was seen in 1.8 % of those taking the 1 mg dose of the drug, compared with 1.3% of those on placebo. This side effect disappeared in most (58%) of the individuals who continued to take the active drug. Therapeutically, about 65% of the men on the active drug noted significant regrowth at 1 year and slightly more at 2 years. This compares with about 30% in those treated with Minoxidil. As a dermatologist with extensive training in hair diseases, I have been treating men with Fenistride at the 1 mg dose for over a year. We have seen dramatic improvement in most of them. Most have been delighted, especially those who have tried other alopecia therapies. |
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