Dutasteride: How and When To Use It
Summary
TLDRمرحبا بكم في برنامج الهزال الرأسي، يناقش الأطباء روسل نودسون و فيكام جاش القضايا المتعلقة بالهزال الرأسي والعلاجات الطبية والجراحية لالهزال في الرجال والنساء. يناقشون في هذا الحلقة الدواء دوتاستيريد، الذي يمنع تحول الكورتنول إلى ديهيدروكورتنول، ويناقشون الفرق بين دوتاستيريد وفيناستريد في تثبيت الهرمونات، ولماذا قد نختار الدواء الذي يمنع 90% بدلاً من 63%، ويناقشون العوامل التي تؤثر على القرار الطبي مثل الحالة الجسدية والعمر، ويشددون على الضرورة من التعامل مع الأدوية بطريقة مخصصة لحالة كل مريض.
Takeaways
- 😀 د. راسل نوسون ود. فيكام جاش يناقشان في برنامج الPELADA (الPELADA) عن المشاكل المتعلقة بفقدان الشعر والعلاجات الطبية والجراحية لفقدان الشعر للرجال والنساء.
- 🔍 يناقشون الاستخدام الدوائي للدواء دوتاستيريد (Dutasteride)، الذي يمنع تحول التستوسترون إلى ديهيدروتيستوسترون، مما يساعد في منع فقدان الشعر.
- 💊 يوضحان أن دواسة دوتاستيريد تمنع تحول التستوسترون بنسبة 90%، مقارنة بـ 63% من فيناستريد (Finasteride)، بسبب تفاعله مع نوعين من المادة الحيوية التي تؤدي إلى تحول التستوسترون.
- ⚖️ يناقشان التوازن بين التأثير القوي على فقدان الشعر وتقليل الآثار الجانبية، مع التركيز على أن الأدوية يجب أن تكون مخصصة لكل مريض.
- 👦 يذكران أن المرضى الجدد الذين يعانون من فقدان شعر مكثف يمكن أن يحتاجون إلى دواسة أقوى مثل دوتاستيريد، بينما يمكن أن يفضلوا فيناستريد للمرضى الأكبر في سن.
- 📈 يشيران إلى أن الأدوية يمكن أن تؤخذ لفترات طويلة من الزمن، حتى 10 أو 20 أو 30 عامًا، بغض النظر عن تغيرات في الأدوية الطبية.
- 🚫 يشددان على أن التأثير الجانبي يمكن أن يؤدي إلى خوف المرضى من متابعة العلاج، مما يتطلب من الأطباء التعامل مع الأدوية بعناية.
- 🧪 يناقشان الأبحاث الحديثة المتعلقة بتطبيق دوتاستيريد بشكل طبيعي، مما يمكن أن يؤدي إلى نتائج أفضل بدون زيادة التأثير الجانبي.
- 📝 ينصحان بمعالجة المناطق التي تعاني من الضعف في الشعر وليس المناطق التي تعاني من الPELADA، حيث أن الPELADA لا تاستجابة لأي علاج.
- 🔑 يشددان على أن العلاج يجب أن يكون مخصصًا للمريض وغير عام، مع التأكيد على أن الأدوية يجب أن تكون الأقل دواءً القوية التي تعمل لفترة أطول.
- 🕒 يذكران أن أي نمو في الشعر لن يكون ملحوظًا قبل 6 أشهر من البدء في العلاج، وينصحان بالصبر والاستمرار في العلاج لسنوات.
- 👋 ينصحان المرضى الذين يحاولون العلاج بالإيفاء للوقت والمال إذا لم يستمروا في العلاج لفترة كافية لرؤية النتائج.
Q & A
ما هي القضية الرئيسية التي يناقشها الأطباء في هذا البرنامج؟
-الأطباء يناقشون في البرنامج القضية المتعلقة بتدهور الشعر والعلاجات الطبية والجراحية لتدهور الشعر في الرجال والنساء.
لماذا يُطرح سؤال المرضى عن دواستريد على الأطباء؟
-يطرح المرضى سؤالا عن دواستريد لأنهم يحققون على الإنترنت ويجدون أنه له تأثير أقوى على مستقبل الـ 5r بسبب تأثيره القوي على مستقبل الـ 5r.
ما هي الفرق بين فيناستريد ودوباستريد؟
-فيناستريد يمنع تحويل التستوستيرون إلى ديهيدرو-testosterone بنسبة 63%، في حين أن دواستريد يفعل ذلك بنسبة 90% من خلال كسر نوعين من الـ 5r محول العنصري.
لماذا لا يبدأ الأطباء على دواستريد مباشرة لمرضى تدهور الشعر؟
-الأطباء يفضلون تخصيص العلاج بناءً على الحالة التي يواجهونها، ويختارون الأدوية التي تتناسب مع الحالة الطبية والعمر والمدى التدريجي للتدهور.
في أي الحالات قد يختار الأطباء دواستريد كعلاج أول خطوي؟
-قد يختار الأطباء دواستريد كعلاج أول خطوي في حالات التدهور العدواني للشعر، مثل المرضى الجدد الذين لديهم تطور كبير في التدهور.
لماذا يُنصح بتجنب الأدوية القوية في بعض الحالات؟
-ينصح بتجنب الأدوية القوية لتجنب التأثيرات الجانبية التي قد تكون مزعجة للمرضى، وللحفاظ على التوازن بين ال治疗效果 وتقليل التأثيرات الجانبية.
ما هي الرسالة الرئيسية التي يحاول الأطباء إ达ها للمرضى في هذا البرنامج؟
-الأطباء يحاولون إ达ة الرسالة التي تتضمن أن العلاج يجب أن يكون مخصصًا للمريض وأنه يجب أن يكون مستمرًا وآمن، وأنه يجب الانتظار لمدة كافية لرؤية النتائج.
ما هي الأهمية الأساسية لاستخدام دواستريد بشكل ذكوي؟
-استخدام دواستريد بشكل ذكوي يمكن أن يكون مفيدًا جدًا لمنع التدهور السريع للشعر وتحسين النتائج الطبية.
لماذا يُنصح بالتفكير في العمليات الطبية الغير التقليدية مثل المعالجة البيئية؟
-العمليات الطبية الغير التقليدية مثل المعالجة البيئية قد تظهر نتائج أفضل بدون زيادة التأثيرات الجانبية، مما يجعلها خيارًا مفيدًا للمرضى.
ماذا تعني الأطباء بـ 'اللعب على الطول'؟
-اللعب على الطول يشير إلى أن العلاج ال毛发 يجب أن يستمر لفترة طويلة من الزمن، وقد يتطلب حتى 10 أو 20 أو 30 أعوام، بغض النظر عن التطورات في العلاج الطبية.
لماذا يُنصح بالتفكير في التأثير البيئي للأدوية عند التعامل مع التدهور السريع للشعر؟
-التأثير البيئي للأدوية يمكن أن يوفر نتائج أفضل وأقل عرضة لتأثيرات الجانبية، مما يجعله خيارًا مفيدًا للمرضى الذين يرغبون في تجنب التأثيرات الجانبية ال全身ية.
Outlines
💊 Medication Choices for Hair Loss Treatment
In this segment, Dr. Russell and Dr. Vicam J discuss the use of dutasteride and finasteride in treating hair loss. They explain the biochemical differences between the two drugs, with dutasteride blocking both type I and type II 5-alpha reductase enzymes more effectively than finasteride, which only blocks type II. The doctors emphasize the importance of customizing treatment based on the severity and aggressiveness of hair loss, with dutasteride being prescribed for more aggressive cases, especially in younger patients with significant hair loss. They also discuss the long-term considerations of hair loss treatment, balancing effectiveness with minimizing side effects, and the importance of patient education on the duration and expectations of treatment.
🧪 Topical and Injectable Treatments for Hair Loss
The second paragraph delves into the topic of topical and injectable treatments for hair loss, specifically focusing on dutasteride. The doctors discuss the benefits of localized treatment to reduce systemic side effects, particularly sexual side effects that are a common concern. They highlight the importance of treating areas of thinning rather than balding, as the latter will not respond to such treatments. The conversation also touches on the increasing use of dutasteride in their practice, the preference for a customized approach to therapy, and the avoidance of 'kitchen sink' therapy where multiple treatments are used without clear outcomes. The doctors stress the need for patience, as significant hair growth is not expected within the first six months, and recommend a commitment of at least a year to assess the effectiveness of any treatment.
Mindmap
Keywords
💡شير
💡ديوستريد
💡فاينستريد
💡التحويلة الخمسية
💡الأدوية الطبية
💡العمليات الجراحية
💡التشخيص الشخصي
💡تأثيرات الجانبية
💡العلاج التدريجي
💡الأدوية الطبية المباشرة
💡التشخيص المبكر
Highlights
Introduction of the topic: Discussion on dutasteride as a treatment for hair loss.
Comparison of finasteride and dutasteride in terms of their effectiveness on the 5-alpha reductase enzyme.
Explanation of the conversion of testosterone to dihydrotestosterone and the role of 5-alpha reductase enzymes.
Differences between type 1 and type 2 5-alpha reductase enzymes and their inhibition by finasteride and dutasteride.
Customization of therapy based on the aggressiveness of hair loss and patient's age.
The concept of using the lowest effective dose for the longest time to minimize side effects.
Importance of considering long-term treatment and the balance between stopping hair loss and side effects.
Discussion on the fear of side effects and how it affects patient compliance with medication.
Advantages of topical application or injection of dutasteride for localized treatment and reduced systemic side effects.
The significance of treating areas of thinning rather than balding for better response to treatment.
Increasing use of dutasteride in practice and the reasons behind its growing popularity.
The role of intermittent therapy and the addition of dutasteride to finasteride for patients not fully stable.
Emphasis on the need for precise measurement and photography to monitor hair loss progress.
Customization of treatment according to individual needs rather than a one-size-fits-all approach.
The importance of patience and commitment to treatment, with a minimum of 6 months to a year for significant growth.
Advice against kitchen sink therapy and the need to give treatments enough time to work before evaluating effectiveness.
Conclusion on the effectiveness of dutasteride when used wisely and the importance of proper patient education.
Transcripts
[Music]
welcome to the hair loss show Dr Russell
nudson and Dr vicam J aash discuss
issues relating to hair loss and the
medical and surgical treatment of hair
loss in both men and
women hi everybody Welcome to the hair
loss show I'm Dr Russell nudson and I'm
Dr vicam J
aash today's topic we're going to talk
about dutasteride I know we've talked
about this before absolutely um but I
get increasingly asked by patients who
are doing their research on the internet
as to why we start them some mostly on
fide and why we don't start them on
dutasteride that um has potentially
greater benefit because of its stronger
effect upon the 5r productor receptor
yeah so a lot of people would come go
well look I mean dester sounds a lot
stronger than than finest why don't we
research shows it works yeah so let's
you know um you know throw the big guns
at the at the problem uh and I get the
the concept of that as well just a quick
recap and we've talked about uh the the
concept before which is testosterone
gets converted into dihydrotestosterone
that's the and the five Alpha reductase
enzyme uh blocks uh results in that
conversion and that's the simple story
The the more detail version of the story
is that there are uh two types of um
well three types of the the enzymes but
two types that we we will consider type
one and type two and type one sorry type
two is generally bed by finest ride and
we got dester that blocks type both type
one and type two just to summarize the
the difference between them is that if
you measure it in the blood which is
really the only easy way to do it an
asri blocks conversion by about 63% so
that's 2/3 dutasteride is 90% block
right so it's by taking that extra
subtype of the enzyme and blocking it it
is a significant boost so why don't we
do it first well the short answer
is Vic I like to customize our therapy
according to what we see in front of us
so if you think of boldness in terms of
the aggression of the Bolding if I'm
seeing a more aggressive version of
baling I'm going to go harder uh because
I realize that faside may not be enough
um as a two3 block may not be enough to
get this patient under control so what
do I mean by aggressive well I mean a
younger patient with a lot more hair
loss so if you've got a very bad family
history and you come to see me and
you're under 25 and you got a lot of
thinkning then I'm probably going to
bypass fide and go straight to jride
because I realize this is going to be
harder to manage in the long term MH you
know and it's devastating if you're only
slowing down the loss for them rather
than stopping the loss for them yes so
that's what that's that's where it
becomes first line therapy if however I
see a guy come in in these 40s and
saying hey you know I've just got this
little bit of heal on something be
worried about it I'm not going to throw
dutasteride in him I'm going to give him
fin astero because I'm going to figure
that's going to work perfectly well 30
years post puberty he's already lost a
tiny bit of hair um it's not an
aggressive version of Bing I don't feel
the need to use the sledgehammer so I
think there's a there's a few things
there that we should probably unpack as
well and and make sure everyone is on
the on the same page there I think one
aspect is you got to play the long game
right so this is not a question of take
this you know take a course of you know
one week or two we course of this
medication and then everything it's not
like high dose anybody correct right so
that's the first thing so you you're
you're looking it potentially taking it
for 10 20 30 years unless the landscape
of medical therapy changes which you
know it it very well do right um so
that's one thing secondly there's always
going to be a balance
between stopping the progression of hair
loss and minimizing side effects and we
you know we know that uh D test ride
whilst yes 90% sounds better than you
know 63% that's great but what is the
you know the interplay between the
incidents of side effects at the high do
so you know resist the temptation to go
oh yeah 90% sounds better therefore
forget it you know I'm losing a bit of
hair but I just I really love my hair
let's throw the sledgehammer at the at
the problem because we're always trying
to not hold anything back but we're just
trying to make sure that you're in it
for the long game you're stabilizing
things and giving you the best chance of
minimizing side effects well see the
thing is that once patients get side
effects it becomes problematic cuz then
they're scar scared to to to treat with
that product at all yes and so avoiding
that unfortunate consequences pretty
high on our list of goals of therapy so
you know I kind of said it's I like to
use the lowest dose of the weakest drug
for the longest time that works um
because I think that that is the safest
thing and if you've got fear of
finasterid side effects jumping you do
jide isn't necessar going to make you
feel any better when I tell you it's a
stronger drug yeah so you know you keep
that in mind as well for the patients
that are very very fearful of doing it
but that said um if we're talking about
tropically and the research that's being
done now into topical dasto whether it's
done um by application or done by
injection shows Superior results without
increasing side effects then that would
change the metric yes because again if
you're applying it and it's localized in
its effect it's therefore less likely to
give you the systemic side effects
uh that people are worried about and
generally that is sexual side effects
the thing that that concerns another
people um and just remember again you've
got to treat the area of thinning not
the area of Bolding the Bolding area is
not going to respond to anything like
this so you've got to treat just the
areas of thinning if you're going to do
anything um you know topically treat the
area that's got some degree of thinning
and the the less thinning you have the
better the response so yeah we use dest
in our practice increasingly yes and I
think that and I keyword being
increasing because if you look at over
the last 10 years you know we've been
using it more as a Mainline therapy I
often sort of you know like because I
use intermittent for anyway I often say
well if you're going to use three fin
right a week we'll just throw one dest
right in because you're not quite stable
the problem with not quite stable is the
patients always think they're not quite
stable right right and and I'm not
always convinced um but you they kind of
feel oh I couldn't see this freckled a
year ago and I can see it now and so I I
I tend to believe them even if I'm
struggling to find it myself I'm I'm
often measure the height I take
photography and these things are not
very precise they are relatively precise
but not not incredibly precise um I tend
to go along with it so if I'm going to
go along with that without being overly
convinced I'll add a bit of dast in
rather than stop the faside and swap it
I have to be convinced um myself before
I'm going to completely swap out so
again it's making sure that the type of
therapy that you've got is customized
for you that is specific for you and
your needs it's not a cookie cutter
approach for and I also don't like
kitchen SN therapy which we talked about
before so the patients ask me about
three different things on top of the two
things I've mentioned I'm so that's
going to be five things you're doing and
then you're going to ask me what's
working what isn't working and I'm not
going to be able to answer that so if
we're going to do two things let's give
two things a chance to work nobody gets
any significant growth really under 6
months whatever we do um so unless
you're prepared to keep it to a year
don't do it at all because you're going
to waste your time people come to me and
say oh I tried it for two months it
didn't work you know well it was never
going to work in two months you wasted
your time you wasted your money so just
remember that um but dast very very
effective medicine and if it's used
wisely it can be very helpful brilliant
okay very good uh so again hope you
found that useful and thanks again for
watching please remember to like And
subscribe to the channel and we'll see
you again on the next episode thank you
everybody see
[Music]
you
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