Posted: 30 Mar 2013 07:24 AM PDT
Khidhir KG, Woodward DF, Farjo NP, et al. The prostamide-related glaucoma therapy, bimatoprost, offers a novel approach for treating scalp alopecias. Faseb J 2013;27(2):557-67. http://www.fasebj.org/content/
Balding causes widespread psychological distress but is poorly controlled. The commonest treatment, minoxidil, was originally an antihypertensive drug that promoted unwanted hair. We hypothesized that another serendipitous discovery, increased eyelash growth side-effects of prostamide F(2alpha)-related eyedrops for glaucoma, may be relevant for scalp alopecias. Eyelash hairs and follicles are highly specialized and remain unaffected by androgens that inhibit scalp follicles and stimulate many others. Therefore, we investigated whether non-eyelash follicles could respond to bimatoprost, a prostamide F(2alpha) analog recently licensed for eyelash hypotrichosis. Bimatoprost, at pharmacologically selective concentrations, increased hair synthesis in scalp follicle organ culture and advanced mouse pelage hair regrowth in vivo compared to vehicle alone. A prostamide receptor antagonist blocked isolated follicle growth, confirming a direct, receptor-mediated mechanism within follicles; RT-PCR analysis identified 3 relevant receptor genes in scalp follicles in vivo. Receptors were located in the key follicle regulator, the dermal papilla, by analyzing individual follicular structures and immunohistochemistry. Thus, bimatoprost stimulates human scalp follicles in culture and rodent pelage follicles in vivo, mirroring eyelash behavior, and scalp follicles contain bimatoprost-sensitive prostamide receptors in vivo. This highlights a new follicular signaling system and confirms that bimatoprost offers a novel, low-risk therapeutic approach for scalp alopecias.
Possible Mechanism For The Stimulation Of Hair Growth By Bimatoprost
Bimatoprost stimulates eyelash growth in vivo, human scalp hair growth in organ culture, and mouse pelage hair growth in vivo. In our hypothesis, these effects are due to bimatoprost binding to appropriate receptors on the plasma membrane of cells in the regulatory dermal papilla in the hair bulb (middle panel). This probably stimulates intracellular signaling pathways, which trigger alterations in the gene expression of paracrine signals and their extracellular release. Some of these factors would leave the dermal papilla, crossing the basement membrane, isolating it from the rest of the follicle, to stimulate the coordinated activity of the keratinocytes and melanocytes to produce increased hair growth and pigmentation. Red dots indicate FP and/or prostamide F2α receptors, blue arrows indicate direction of movement of paracrine factors.
For more information on a compounded version of the drug: Click Here
Sunday, March 31, 2013
Bimatoprost is known as the brand name Latisse. It was used for glaucoma for years and it was found that one of its side effects was eyelash growth. So it was approved for that purpose with the name Latisse. Emerging data show that this drug may also work to reverse hair loss in men and women.
Monday, March 18, 2013
Testosterone+ HCG Preserves Healthy Sperm in Men on Testosterone Replacement Therapy (Injections and gels)
Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†
From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College ofMedicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island
Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin (HCG). Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.
Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p<0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.
Conclusions: Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.
More information on HCG+TRT
Low-Dose Human Chorionic Gonadotropin
Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced
This study shows that HCG can keep intratesticular (inside the testes) testosterone - ITT normal even when they are exposed to testosterone injections. An HCG dose of 500 IU every other day increased ITT to levels higher than baseline. All other doses failed to achieve normalization of baseline ITT. ITT is crucial for Leydig cells to work properly so that they do not atrophy (lose volume due to inactivity)
More information on HCG+TRT
Saturday, March 16, 2013
Medication Adherence and Treatment Patterns for Hypogonadal
Patients Treated with Topical Testosterone Therapy: A Retrospective Medical Claims Analysis
Michael Jay Schoenfeld, MA, Emily Shortridge, PhD, Zhanglin Cui, PhD, and David Muram, MD
Eli Lilly and Company, Indianapolis, IN, USA DOI: 10.1111/jsm.12114
A B S T R A C T
Introduction. There is limited information on adherence to topical testosterone replacement therapy (TRT) among hypogonadal men.
Aim. To determine adherence rates among men treated with topical testosterone gels and to examine factors that may inﬂuence adherence, including age, presence of a speciﬁc diagnosis, and index dose.
Methods. Included were 15,435 hypogonadal men, from the Thomson Reuters MarketScan® Database, who had an initial topical testosterone prescription in 2009 and who were followed for 12 months.
Main Outcome Measures. Adherence to testosterone was measured by medication possession ratio (MPR), with high adherence deﬁned as >0.8. Persistence was deﬁned as the duration of therapy from the index date to the earliest of the following events: end date of the last prescription, date of the ﬁrst gap of >30 days between prescriptions, or end of the study period (12 months).
Results. Adherence to topical TRT was low. By 6 months, only 34.7% of patients had continued on medication; at 12 months, only 15.4%. Adherence rates were numerically similar among men who received AndroGel® or Testim® topical gels and did not differ among men of different age groups. Approximately 80% of patients initiated at the recommended dose of 50 mg/day. Over time, an increased proportion of men used a higher dose. This change was the result of dose escalation, rather than of greater adherence among men initiating therapy at a high dose. Dose escalation was seen as early as 1 month into therapy. Approximately 50% of men who discontinued treatment resumed therapy; most men used the same medication and dose.
Conclusions. Discontinuation rates are high among hypogonadal men treated with testosterone gels, irrespective of their age, diagnosis, and index dose. Further study, evaluating other measurable factors associated with low adherence among patients receiving topical TRT, may lead to interventions designed to improve adherence with therapy.
About 50% of patients who were followed over time resumed TRT. It is possible that some patients experienced alleviation of symptoms and were not sure they needed to remain on therapy. Once therapy was discontinued and symptoms recurred in some patients, the beneﬁts of replacement therapy may have become clearer; thus, prompting these men to restart therapy at the same effective dose.
An important limitation of the study is that claims data do not include important patient level data, such as symptoms, reasons for discontinuation (e.g., application method), side effects (e.g., skin reaction), testosterone levels, responses to therapy, and so forth. While perception of efﬁcacy has signiﬁcant effect on patient adherence, this study was unable to assess severity of symptoms or of symptomatic relief, once patients initiated therapy.
The study was unable to identify characteristics that were associated with the time patients would be on therapy before treatment was interrupted or who would resume therapy after a brief interruption. Most patients who resumed therapy did so by using the same topical TRT agent and the same dose they used prior to the interruption. It is possible that these patients perceived efﬁcacy, were proﬁcient in the application method, and possibly had a prescription that they were able to use or reﬁll without the need for an ofﬁce visit. Only a small percentage of patients using topical therapy resumed therapy by using a different method or a change in the dosing regimen.
Patients on testosterone should have their blood levels and symptoms evaluated after a few weeks on therapy. Depending on these follow up results, dose adjustment or change of delivery method should be explored as well as other issues that may potentially affect efficacy and adherence (life style, other medications, body mass index, etc). Expectations should also be clearly described at the start of therapy (for more on what to expect, read this ) so that patients have realistic views. Stamina and sexual function are multifactorial and testosterone blood levels are only part of the puzzle.