Premature Balding in Men

Premature Balding in Men

A Symptom of Metabolic Syndrome and Benign Prostatic Hyperplasia

Written by Women’s International Pharmacy Staff

premature balding in menAccording to Statistic Brain, 35 million men in the US experience hair loss, 40% of which have hair loss by the age of 35.(i) The same hormonal imbalances that contribute to early onset balding may also cause more serious conditions. Because of its strong association with hormone imbalances, prostate enlargement, and metabolic syndrome, premature hair loss could be indicator for men of deeper health concerns.

A Male Version of PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. At the Progressive Medical Education meeting in Irvine, CA in August 2017,(ii) Dr. Matthew Cavaiola presented a hypothesis published by Kurzrock et al.(iii) He stated because the primary defect underlying PCOS may not be a defect in the ovaries themselves, it is possible that this condition can also occur in men.

Symptoms of PCOS in women include:

  • High androgen hormones (like DHEA and testosterone) in the blood
  • Obesity focused on the waistline
  • High insulin levels
  • Development of diabetes
  • Infertility

Dr. Cavaiola stated that young men can suffer from similar symptoms:

  • Insulin resistance
  • Obesity
  • Increased risk for diabetes and cardiovascular disease
  • Early onset of male pattern baldness
  • Excessive body hair
  • High levels of testosterone and dihydrotestosterone (DHT, the active form of testosterone)

In addition to the symptoms listed above, sex hormone binding globulin (SHBG) levels may be low which further increases the amount of available testosterone and DHT in the body. Dr. Cavaiola also pointed out that when SHBG levels are low, insulin levels are abnormally high. Persistently high levels of insulin may lead to metabolic syndrome, prediabetes, and diabetes.

Prostate Enlargement and Insulin Resistance

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland and is a common condition as men age. Common signs and symptoms of BPH include a frequent or urgent need to urinate, increased frequency of urination at night (nocturia), difficulty starting urination, a weak urine stream or a stream that stops and starts, dribbling at the end of urination and an inability to completely empty the bladder. There appears to be a strong correlation with early onset balding and BPH, as men with BPH tend to have more inherited baldness and an increased severity of baldness. Some studies also point to an increased risk of prostate cancer.(iv, v)

Insulin Resistance

Insulin is a hormone made by the pancreas. It allows cells in the body to use glucose (sugar) for energy. Insulin resistance (also called metabolic syndrome or prediabetes) is a condition where cells throughout the body don’t recognize insulin as they should. This causes the cells to have trouble absorbing glucose, which causes a buildup of sugar in the blood. It also causes the body to produce more insulin leading to high insulin levels in the body. These high levels of insulin may be a major contributor to BPH and early onset balding as postulated by Ajit Vikram et al.(vi)

Insulin resistance may also be associated with, high blood pressure, high triglycerides and acanthosis nigricans (dark patches of skin usually on the back of the neck, groin, and armpits).

Treatment Options

Addressing Baldness and Prostate Enlargement with Finasteride

Drug companies have come up with a possible solution for hair loss and prostate hyperplasia with a synthetic molecule, finasteride. Finasteride is the generic name for two prescription drugs: Propecia and Proscar. Propecia has been approved by the FDA to treat male pattern baldness at a dose of 1 mg per day. Proscar is the same drug in a 5 mg dose, and has been approved to treat BPH. Finasteride inhibits the 5 alpha reductase enzyme, which is the enzyme responsible for converting testosterone into its more active form, (DHT). Studies suggest high levels of DHT may be responsible both for male pattern baldness and BPH.

Negative Side Effects of Finasteride

There are a number of negative side effects that have been associated with finasteride. The Post Finasteride Syndrome Foundation studies these persistent adverse effects,(vii) which include:

  • Loss of penis sensitivity
  • Decreased ejaculatory force and volume
  • Loss of libido and low penile temperature
  • Reduced feeling of pleasure or emotions
  • Lack of mental concentration
  • Loss of muscle tone/mass
  • Severe depression, suicidal ideation, and suicide
Why Not Progesterone?

Progesterone, a hormone that naturally occurs in the human body, also acts as a 5 alpha reductase inhibitor,(viii) as well as having a great number of other important functions in the body. The drug, finasteride, structurally resembles progesterone. The prostate has receptors for progesterone in addition to receptors for androgens (testosterone and derivatives) and estrogens. While many studies have explored the relationship of prostate enlargement and prostate cancer to androgen and estrogen receptors, little research exists for the relationship to progesterone.

Progesterone is produced in men by the testes and the adrenal glands. Men have progesterone levels similar to a woman’s progesterone levels during the follicular phase of the menstrual cycle. RuiQi Chen et al. present a case for inhibition of prostate enlargement—and possibly prostate cancer—using progesterone.(ix)

Conclusion

Some men may consult a practitioner when confronting hair loss and may be prescribed Propecia in an attempt to grow hair back, but why use a synthetic drug when rebalancing hormone levels with progesterone, a hormone natural to the body, may help? Hair loss may be the first sign of hormone imbalances that could lead to metabolic syndrome and prostate hyperplasia. Other potential risks may include high blood pressure, high cholesterol, obesity, diabetes, and heart disease. By proactively considering hormone balancing solutions, men may forestall the loss of their hair and prevent more drastic declines in their health.

  • (i) Statistic Brain. Hair Loss Statistics. https://www.statisticbrain.com/hair-loss-statistics/. August 2016.
  • (ii) Cavaiola M. Environmental Medicine: Focus on Men’s Health & Longevity. A presentation at the Progressive Medical Education Meeting. August 2017.
  • (iii) Kurzrock R, Cohen PR. Polycystic ovary syndrome in men: Stein-Leventhal syndrome revisited. Med Hypotheses. 2007;68(3):480-3. Epub 2006 Nov 28. (3)
  • (iv) Oh BR, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998 May;51(5):744-8.
  • (v) Papa NP, et al. Early onset baldness and the risk of aggressive prostate cancer: findings from a case-control study. Cancer Causes Control. 2018 Jan;29(1):93-102. doi: 10.1007/s10552-017-0981-0. Epub 2017 Nov 14.
  • (vi) Vikram A, et al. “Insulin-resistance and benign prostatic hyperplasia: The Connection” Eur J Pharmacol. 2010 Sep 1;641(2-3):75-81. doi: 10.1016/j.ejphar.2010.05.042. Epub 2010 Jun 9.
  • (vii) Post-Finasteride Syndrome Foundation. https://www.pfsfoundation.org. Last accessed: April 2018.
  • (viii) Ling YZ, et al. Synthesis and in vitro activity of some epimeric 20 alpha-hydroxy, 20-oxime and aziridine, pregnene derivatives as inhibitors of human 17 alpha-hydroxylase/C17,20-lyase and 5 alpha-reductase. Bioorg Med Chem 1998;6:1683-1693. https://www.ncbi.nlm.nih.gov/pubmed/9839000
  • (ix) Chen R, et al. Progesterone receptor in the prostate: A potential suppressor for benign prostatic hyperplasia and prostate cancer. J Steroid Biochem Mol Biol. 2017 Feb;166:91-96. doi: 10.1016/j.jsbmb.2016.04.008. Epub 2016 Apr 25.
  • Fung J. The Obesity Code: Unlocking the Secrets of Weight Loss. Greystone Books; Vancouver, BC, Canada: 2016.
Premature Balding in Men2018-07-17T16:31:21+00:00

A Tribute to Dr. Katharina Dalton

A Tribute to Dr. Katharina Dalton

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

Even though they’re not really funny, PMS jokes abound in today’s society. It’s very likely that most of us toss around the acronym of PMS (for premenstrual syndrome) without giving a thought as to where or how it originated.

In 1994, there was a movie titled Tom and Viv about the relationship of the American poet T.S. Eliot and his wife, Vivienne Haight-Wood Eliot, whom he married in 1915. Upon their marriage, he became the custodian not only of her money, but also of her physical being. Vivienne suffered terribly each month from what we now would recognize as PMS. After unsuccessfully trying to help her, T.S. Eliot had his wife committed to an asylum where she spent the remainder of her days. He never saw her again after she was committed. This movie reflected the thinking at that time. Women who suffered from hormone disturbances were thought to have mental rather than physical problems.

Dr. Katharina Dalton made a huge contribution to our understanding of hormone disturbances, and she is also the one who named the syndrome PMS. She identified and successfully treated many problems that were uniquely female. As we explore the mysteries and benefits of hormone therapies today, we are standing on the shoulders of her achievements, which include a tremendous amount of observation and study.

On her death at the age of 87 on September 17, 2004, Dr. Dalton’s life and work were reviewed by many major newspapers in Great Britain, where she practiced, and in the United States, where she also made a huge impact by identifying physical reasons for issues that had previously been dismissed as hysterical or only a figment of the mind. The concept of a women’s health movement may very well have started with her work.

At age 32, Dr. Dalton was still a medical student and pregnant when she wondered why she was suddenly free of the severe headaches she had experienced monthly. She took her observations to Dr. Raymond Greene, an endocrinologist, and speculated that progesterone, which is abundant during pregnancy and also should be abundant during the luteal phase (the second half of the menstrual cycle), might be the key. She and Dr. Greene first published their clinical experiences and theory in British medical journals in 1958, and proposed the term premenstrual syndrome. By then, Dr. Dalton had successfully treated premenstrual asthma, epilepsy, and migraine headaches with progesterone.

Progesterone, which has an effect throughout the body, is produced in the adrenal glands in addition to the progesterone produced by the ovaries. Dr. Dalton used progesterone that was equivalent in structure to the hormone found naturally in the human body. She was adamant that other synthetic derivatives of progesterone could not be used, contrary to what her medical colleagues believed.

Throughout her career, Dr. Dalton carefully examined her patients, collected data, posed theories, and tested her ideas. She developed a system of charting to help monitor the large number of symptoms that could present with PMS. An adaptation of the Symptoms Chart is available for download from our website.

One of Dr. Dalton’s observations was that some of the symptoms of PMS (including edema, hypertension, and albumin in the urine) seemed to also occur as early signs of toxemia in pregnancy. She began trials of intervention with progesterone, in collaboration with a maternity hospital. The hospital records showed an average incidence of toxemia to be 9%. After the first patients who were treated delivered babies in 1955, the incidence dropped to a low of 1.0%. Each patient was given a test dose of progesterone when early symptoms occurred, and then treated continually if symptoms resolved, while moderating the doses according to symptom relief.

Men, women, and children all have progesterone receptors in operation throughout their lifetime. Dr. Dalton focused her attention on progesterone receptors and, because only natural progesterone fits the receptors, she felt this was the only appropriate hormone to use. She also understood that, if there was too much adrenalin being produced, progesterone would not be able to be picked up by the receptors. Similarly, if women were experiencing swings of low blood sugar, progesterone would also not activate the receptor.

Dr. Dalton used very generous doses of progesterone to treat women; often a 400 mg suppository would be the minimum dose. Tests to measure levels of progesterone in the body using various means were immaterial, in her opinion, because the only meaningful test would be at the receptor sites. Successful treatment would be verified by a positive response to supplementation.

Dr. Dalton observed that progesterone has a very positive effect on hair growth in women. After delivery of a baby, many women experience significant hair loss because of the sudden drop in progesterone. When progesterone is supplemented for those women, the hair regrows luxuriantly.

Progesterone has also proven to be effective for brain trauma because of its protective effect on the myelin sheath, which covers nerve tissue. Additionally, progesterone can reduce swelling in the brain and has even been used by neurosurgeons prior to surgery.

Dr. Dalton also claimed that there was no unsafe dose of progesterone. In high enough doses, started before ovulation, progesterone could be used as a safe contraceptive. It was also safe to use with breast cancer, even concurrent with breast cancer treatments.

Prior to menopause, Dr. Dalton noticed that progesterone would typically start to become deficient for at least two years. During this time, women would develop symptoms that were similar to those she identified as PMS, which we now identify as symptoms of perimenopause.

She also identified the onslaught of symptoms some women experience after childbirth as having a pattern similar to PMS. She advocated for using large doses of progesterone immediately after childbirth, especially in those women with a history of PMS, to cushion them from the effects of the huge drop in progesterone that occurs at delivery.

Unlike current conventional thinking, Dr. Dalton claimed that women who have had a hysterectomy need more than the amount of progesterone needed by a woman who has undergone a natural menopause. The reasons behind most hysterectomies are consistent with a long-term progesterone deficiency; thus, so much more progesterone is needed to relieve symptoms afterwards. Ignoring the considerable research on progesterone receptors throughout the body, many practitioners today still believe that women with a hysterectomy do not need any progesterone because they maintain that it is only the uterus that benefits from progesterone and, because the uterus has been removed, progesterone no longer has any function.

As an active advocate in the justice system, Dr. Dalton also published a book titled Premenstrual Syndrome Goes to Court. She studied women serving time in prison and found that a large majority of the violent crimes committed (such as manslaughter, baby battering, and assault) occurred during the luteal phase in women who had a history of PMS symptoms. As part of her study, Dr. Dalton devised a menstrual chart indicating symptoms and their cyclical occurrence, helping the women establish the cyclical and hormone dependent nature of the symptoms. She appeared in court in about 50 trials in defense of women suffering from PMS and claiming a state of diminished responsibility if their criminal actions occurred during the luteal phase of their cycle.

She tried to find an independent marker for PMS and studied sex hormone binding globulin (SHBG). In the groups studied, she found that SHBG, which would bind estrogens and testosterone tightly, was low in the women suffering with PMS. She theorized that low SHBG translated into more free estrogens, which then created inadequate progesterone activity. This premise, unfortunately, was not verified by other scientists.

Dr. Dalton practiced the true scientific method. She made her observations based on the evidence she found, devised a theory that tested the observations she made, and tested her theory. She even applied her theory to situations beyond PMS, recognizing the implications of a host of different symptoms, to further an understanding of the importance of progesterone, as illustrated by her observations of patients with post-partum depression and toxemia during pregnancy.

Today, faced with the numerous symptoms that present with PMS, scientists only look at one issue at a time. Instead of turning to progesterone, which is indeed the golden key for progesterone receptors (as Dr. Dalton has shown), we treat PMS piecemeal with diuretics for edema, with narcotics and anti-inflammatories for pain, with anti-epileptics for seizures, and with antidepressants, anxiolytics, and antipsychotics for mood disorders.

Some say it takes 50 years for a new idea to take hold in our collective minds and, since we are now more than 50 years from her first publication, the time is now ripe for acceptance of Dr. Katharina Dalton’s work with progesterone. Pointing to the current widespread use of bioidentical hormone therapies in women’s health today as proof, perhaps her ideas have at last garnered a place in our consciousness.

  • Gilbert B. Tom & Viv. Oxford, Oxfordshire, England, UK; Miramax Films; 1994.
  • Oliver M. Katharina Dalton, 87; First Doctor to Define, Treat PMS [obituary]. Los Angeles Times. September 28, 2004.
  • Dalton K, Holton W. Depression after Childbirth: How to Recognise, Treat, and Prevent Postnatal Depression (4th Edition). Oxford, United Kingdom: Oxford University Press; 2001.
  • Allen LV Jr, et al. Interview: Katharina Dalton, MD: Progesterone and Related Topics. Int J Pharm Compd. 1999 Sep/Oct:332-9.
  • Dalton K, Holton W. Once a Month: Understanding and Treating PMS (6th Edition). Alameda, CA: Hunter House Publishers; 1999.
  • Dalton K. Premenstrual Syndrome Goes to Court. Droitwich, UK: Peter Andrew Publishing Co Ltd; 1990.
  • Dalton K. Should Premenstrual Syndrome be a Legal Defense? In: Ginsburg BE, Carter BF, eds. Premenstrual Syndrome: Ethical and Legal Implications in a Biomedical Perspective. Boston, MA: Springer-Verlag US; 1987:287-300.
  • Dalton ME. Sex hormone-binding globulin concentrations in women with severe premenstrual syndrome. Postgrad Med J. 1981 Sep;57(671):560-1.
  • Dalton K. Toxaemia of Pregnancy Treated with Progesterone during the Symptomatic Stage. Br Med J. 1957 Aug 17;2(5041):378-81.
A Tribute to Dr. Katharina Dalton2018-04-03T11:13:16+00:00

Propecia: Wonder Drug or Dangerous Trade-off?

Propecia: Wonder Drug? Or Dangerous Trade-off?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

 

It is very apparent that society places a lot of importance on hair. As I watched a commercial for a hair transplant clinic, one of the men said, “80% of men’s emotional health is dependent upon having a full head of hair.” It is also often quoted from the Bible that a woman’s “crowning glory” is her hair. For men, it’s as if the ability to grow hair is intimately tied to his abilities, success, and manliness.

The FDA has approved two drugs for hair loss. The first is Rogaine (minoxidil), which appears to work by increasing circulation to the scalp and can be used by men and women. It is available without a prescription. The second is Propecia (finasteride), which, at a 1 mg dose, is a smaller dose of a drug called Proscar, which is used to treat an enlarged prostate at 5 mg doses. This drug is only approved for men; it is not approved or recommended for women, and doesn’t appear to work on women.

As potential users comb the internet, it appears that Propecia is a very safe option and that hair regrowth is satisfactory. However, things may not be as rosy as the official FDA approved language states. It was an eye-opener to find the site propeciahelp.com and learn another part of the story.

Finasteride is absorbed into the brain and has a negative effect on the production of the brain neurosteroids, including DHT and allopregnenolone (from progesterone). Not only does this enzyme affect DHT, but it also affects the conversions of progesterone, cortisol and aldosterone in the brain. In addition, German researchers found that use of the drug prevents the regrowth of neurons in the hippocampus. Emotional flatness, depression, anxiety, decreased concentration and memory loss–all of which continue on after the drug has been stopped–have been documented. Suicidal thoughts, and even suicide, have also been reported.

Physical side effects include curvature of the penis, testicular and scrotal pain, atrophy of the penis and testicles, breast enlargement, inability to achieve erections, and loss of the ability to reach orgasm. Because testosterone becomes deficient, cardiac, and muscular problems may also emerge. A very aggressive form of prostate cancer can occur after using Propecia.

Class action law suits have been initiated against Propecia in Israel and Canada. Not only are there significant side effects involving sexual function, a significant number of young men continue to have these effects even years after stopping the drug. Sexual therapy, testosterone, and Viagra do not work to resolve their issues, and their progesterone levels tend to continue to be low. Some investigators believe that permanent damage has been done and that the problems resulting from finasteride use are not reversible.

An explanation for the damage perhaps lies with finasteride’s chemical structure. Finasteride might be classified as a synthetic progestin and/or testosterone when you examine the features common in all three molecules. As we already know from many studies and observations, progestins never substitute for the action of progesterone. The Women’s Health Initiative study demonstrated this issue quite well.

A solution has not yet been determined. It may take careful restoration of many hormones to help resolve the symptoms and restore proper function. It is a great concern that older men who seek relief from enlarged prostate glands may be suffering greatly from these symptoms when they use Proscar, only to have their concerns dismissed as part of the aging process.

Should we consider that male pattern baldness is a natural process that should be left alone? Is this long-held theory regarding DHT really the truth of the matter? Some investigators are looking into the hydroxysteroid dehydrogenase (HSD) family of enzymes as the culprit. Apparently it is a medical mystery still waiting to be solved.

  • Propeciahelp.com propeciahelp.com
  • Traish AM, et al. Adverse Side Effects of 5a-Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients. J Sex Med. 2011 Mar;8(3):872-84. doi: 10.1111/j.1743-6109.2010.02157.x. Epub 2010 Dec 22.
  • Melcangi RC, et al. Neuroactive Steroid Levels are Modified in Cerebrospinal Fluid and Plasma of Post-Finasteride Patients Showing Persistent Sexual Side Effects and Anxious/Depressive Symptomatology. J Sex Med. 2013 Oct;10(10):2598-603. doi: 10.1111/jsm.12269. Epub 2013 Jul 24.
  • Stárka L, et al. Hormonal profile of men with premature balding. Exp Clin Endocrinol Diabetes. 2004 Jan;112(1):24-8.
Propecia: Wonder Drug or Dangerous Trade-off?2018-04-05T11:51:59+00:00

Can Melatonin Help With Hair Loss?

Can Melatonin Help with Hair Loss?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

 

Women and men alike often express frustration with their attempts to slow down the effects of aging on their hair, particularly with regards to hair loss. A recent review article on hair loss examined the results of five studies conducted between January 2003 and October 2006. The studies used a topical hair solution formulated in Switzerland that contained 0.0033% melatonin. This product also included ginkgo biloba and biotin, which provide hair roots with beneficial nutritional support.

These studies yielded positive results for both men and women with early androgenetic alopecia or general hair loss. The melatonin solution was found to be safe and effective, decreasing hair loss while fostering new hair growth, in a significant number of study participants.

An earlier pilot study also found a 0.1% melatonin-alcohol solution to be effective. The theory is that, because hair follicles have melatonin receptors, melatonin may counteract androgenic hormone-induced hair loss.

Can Melatonin Help With Hair Loss?2018-04-05T12:02:15+00:00