Search Results (47)

Background and Objectives: Benign prostatic hyperplasia (BPH) is one of the most common chronic conditions in older men, significantly impairing quality of life (QoL) by causing lower urinary tract symptoms (LUTSs). 5-alpha-reductase inhibitors (5-ARIs), including finasteride and dutasteride, remain a cornerstone of pharmacotherapy for BPH; however, comparative real-world data remain limited. The aim of this retrospective clinical study was to compare the therapeutic efficacy and safety of finasteride and dutasteride in patients with BPH. Materials and Methods: A total of 401 patients with BPH were retrospectively analyzed: 162 received finasteride and 239 received dutasteride. Clinical parameters, including the International Prostate Symptom Score (IPSS), Quality of Life (QoL) index, and International Index of Erectile Function-5 (IIEF-5) score; urodynamic outcomes, including maximum urinary flow rate (Qmax), average flow rate (Qave), and post-void residual urine volume (PVR); and biochemical markers, including prostate-specific antigen (PSA) and serum creatinine levels, were evaluated at baseline and after at least 6 months of continuous therapy. Statistical significance was defined as p < 0.05. Results: Both treatment groups demonstrated significant within-group improvements in LUTS severity and urodynamic outcomes (p < 0.001 for IPSS, Qmax, and QoL). Compared with finasteride, dutasteride achieved greater reductions in prostate volume (−26.3% vs. −18.1%, p = 0.008) and PSA levels (−43.7% vs. −32.5%, p = 0.014), as well as a slightly greater improvement in IPSS (−6.8 ± 3.9 vs. −5.9 ± 3.6, p = 0.042). Both drugs showed comparable effects on erectile function, as indicated by similar IIEF-5 score changes (Δ = −0.9 ± 2.8 vs. −0.7 ± 2.5, p = 0.51), confirming that neither agent demonstrated a clinically meaningful difference in sexual outcomes. Renal function parameters remained stable in both cohorts. Multivariate analysis identified higher BMI and older age as independent predictors of lower IIEF-5 scores in the finasteride group, while baseline prostate volume was the principal determinant of response in the dutasteride group. Conclusions: Both 5-ARIs effectively reduced LUTS severity and improved urodynamic parameters in men with BPH. Dutasteride demonstrated superior reductions in prostate volume and PSA, while both agents had comparable effects on sexual and renal function. These findings provide real-world evidence supporting the individualization of 5-ARI therapy according to patient-specific clinical characteristics. Full article

Background: Androgenetic alopecia (AGA) is the most prevalent form of hair loss in humans. Oral minoxidil and dutasteride are widely used treatments, while intradermal dutasteride mesotherapy has recently gained interest as a complementary approach. However, comparative studies in real-world settings are lacking. Objective: The aim was to compare the effectiveness and safety of four AGA therapies: oral minoxidil alone (OM), OM plus oral dutasteride (OM + OD), OM plus mesotherapy (OM + MD), and a combination of all three (CT). Methods: A retrospective study was conducted, including 280 adult patients (mean age 35 ± 9.4 years) with AGA, excluding those with recent treatment (last 3 months) or other hair loss disorders. The therapeutic response was assessed by comparing treatment outcomes from standardized clinical images at 6 and 12 months using a four-point improvement scale. Patient satisfaction was also assessed using a four-point subjective scale. Results: Participants were divided into four treatment groups. In total, 74 patients (26.4%) were treated with OM, 65 patients (23.2%) with OM + OD, 61 patients (21.8%) with OM + MD, and 80 patients (28.6%) with CT. At 12 months, group 4 treated with CT showed significantly better results in both frontal and vertex areas (p < 0.001), while group 3 (OM + MD) performed best at 6 months in the vertex. Side effects were mild and infrequent, with hypertrichosis being the most common. Erectile dysfunction was reported with a lower incidence than reported in the literature: two patients (3.1%) in group 2 (OM + OD) and three (3.8%) patients in CT. Overall, no serious adverse events were detected. Conclusions: Combining oral minoxidil, oral dutasteride, and mesotherapy with dutasteride yields the most effective results for AGA with a favorable safety profile. Full article

Background: Prostate-specific antigen (PSA) levels can be transiently elevated in benign conditions. Therefore, guidelines recommend repeat PSA testing before a biopsy. However, PSA should be adjusted for the prostate volume to improve its predictive accuracy for prostate cancer. This study aimed to compare the diagnostic performance of the PSA density and PSA change for prostate cancer and to evaluate whether their combination can further reduce unnecessary biopsies. Methods: We retrospectively analyzed patients who underwent a prostate biopsy between January 2020 and December 2024. Inclusion criteria were an initial PSA level between 3 and 20 ng/mL and two PSA measurements within an eight-week interval prior to the biopsy. Patients using 5-alpha reductase inhibitors before the biopsy were excluded. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to compare the diagnostic performance of each predictor for prostate cancer and clinically significant prostate cancer (csPCa). Results: A total of 291 patients were included. Patients with prostate cancer had higher PSA levels, smaller PSA declines, and a higher PSA density. The PSA density showed a superior diagnostic accuracy compared with the PSA change for both prostate cancer and csPCa. The PSA density calculated by a transrectal ultrasound or MRI yielded a similar diagnostic performance. However, the accuracy of the PSA density decreased in patients with a large prostate volume. Incorporating a criterion of a >20% PSA decline to exclude biopsy candidates improved the performance of the PSA density and further reduced unnecessary biopsies. Conclusions: The PSA density demonstrates good diagnostic accuracy for predicting prostate cancer. However, incorporating the PSA change further reduces unnecessary biopsies. Therefore, combining both factors provides a more effective approach for determining the need for a prostate biopsy. Full article

The inhibition of steroid 5-alpha reductase (S5AR), a key mechanism for managing dihydrotestosterone-dependent conditions, has been demonstrated in teak (Tectona grandis L.f.) leaf extracts. Our recent clinical study confirmed the effectiveness of a hair growth formulation containing teak leaf extract in males with androgenic alopecia. However, significant variability in S5AR inhibitory activity among teak leaf samples from different regions underscores the need for quality control of raw materials. This study applied a metabolomics approach to investigate the influence of leaf age, harvesting period, and geographic origin on chemical composition and S5AR inhibitory activity, as well as to identify active S5AR inhibitors. Geographic origin emerged as the primary determinant of variations in chemical profiles and S5AR inhibitory activity. Using orthogonal partial least squares analysis, six diterpenoid S5AR inhibitors were identified, including four compounds reported for the first time as S5AR inhibitors: rhinocerotinoic acid, 7-oxo-8-labden-15-oic acid, 8-hydroxy-labd-13-en-15-oic acid, and a novel diterpene, 7-hydroxy-labd-8,13-dien-15-oic acid. These findings highlight the potential of metabolomics as a powerful tool for discovering bioactive compounds and optimizing raw material selection. By prioritizing proven geographic sources, consistent bioactivity can be achieved, supporting the therapeutic potential of teak leaves in managing S5AR-related conditions. Full article

Background: Finasteride, a 5α-reductase inhibitor, is used for androgenetic alopecia and benign prostatic hyperplasia. However, concerns have emerged about its psychiatric side effects, including suicidality. This study analyzed finasteride-related reports from the FDA Adverse Event Reporting System (FAERS) to identify potential safety signals. Methods: Adverse events reported from 2015 to 2024 were extracted using preferred terms, quantified using Bayesian analysis and disproportionality metrics, including empirical Bayesian geometric mean (EBGM), information component (IC), reporting odds ratio (ROR), and proportional reporting ratio (PRR). Results: Most were male (87%), with 43% aged 18–40 years, primarily using finasteride for hair loss. Disproportionality metrics for suicidality-related events fluctuated between 2019 and 2024. In 2019, the ROR was 27.51 (95% CI: 23.22–32.58), the PRR was 21.96 (95% CI: 18.54–26.01), the EBGM was 20.50, and the IC was 4.36. A slight decline was observed in 2020, a surge in 2021, and a peak in 2022 (ROR 34.64 (95% CI: 28.36–41.88), PRR 27.82 (95% CI: 22.30–34.61), EBGM 24.96, IC 4.64). Although a sharp rise in suicidality reports was noted in 2024, the rates of ROR and PRR dropped to 19.04 (95% CI: 17.02–21.30) and 16.53 (95% CI: 14.78–18.50), respectively. Serious outcomes such as disability (18.7%), life-threatening events (12.9%), and death (7.5%) were also noted. Conclusions: The upward trend in suicidality-related safety signals among young male users since 2019, which peaked in 2024, reflects emerging safety concerns among finasteride users, reinforcing the need for pharmacovigilance. Collaborative action among healthcare professionals, regulatory authorities, and pharmaceutical companies, along with clear warnings and mental health assessments before and throughout finasteride therapy, can mitigate potential psychiatric risks and enhance patient safety. Full article

Objectives: This study aimed to evaluate perceptions and practices of urologists in Saudi Arabia regarding discussions of erectile dysfunction (ED) and ejaculatory dysfunction (EjD) with patients before initiating BPH treatments. Methods: A cross-sectional survey was conducted using a structured questionnaire distributed during the 36th Saudi Urological Annual Conference held in Riyadh in February 2025 among urologists in Saudi Arabia. A binary outcome variable, “frequent and open discussion,” was created based on a scoring system using the median score of these responses. Data analysis included descriptive statistics and univariate (p < 0.25) and multivariate (p < 0.05) logistic regression using SPSS version 27. Results: Discussions about ED risks were most frequent before prescribing 5-alpha reductase inhibitors (5-ARIs) (51.3%) and combined alpha-blockers and 5-ARIs therapy (50.0%), whereas EjD risks were more frequently addressed before alpha-blocker monotherapy (59.2%) and transurethral resection of the prostate (TURP) (56.6%). A substantial proportion of urologists discussed alternative treatments based on sexual dysfunction risks, particularly before TURP (53.9%), alpha-blockers (47.4%), and 5-ARIs (43.4%). Univariate analysis revealed a trend towards more open discussions among non-Saudi urologists (OR 4.58, 95% CI 0.88–23.74, p = 0.06) and a significant association with working in private hospitals (OR 3.68, 95% CI 0.39–35.14, p = 0.03). However, these associations did not hold in multivariate analysis. Conclusions: Urologists in Saudi Arabia demonstrate variability in discussing sexual complications with patients before BPH treatments. Consistent and comprehensive discussions about ED and EjD risks are crucial for informed patient decision-making. Standardized guidelines and educational programs are needed to enhance urologists’ communication skills and ensure consistent patient counseling. Full article

Background/Objectives: Prostate cancer (PCa) is the second most common malignancy among men worldwide and a leading cause of cancer-related mortality. In 2022, over 1.4 million new cases were reported globally, with a prevalence exceeding 5 million. Despite its widespread occurrence, the incidence and mortality of PCa show substantial geographic variation, influenced by factors such as genetic predisposition, healthcare access, lifestyle, and the adoption of screening programs. Regions with high PCa incidence, such as Northern America and Oceania, often have lower mortality rates due to early detection and advanced healthcare infrastructure. Conversely, areas with limited access to medical resources, such as parts of Africa and Latin America, experience higher mortality rates. Methods: This review explores non-modifiable risk factors such as age, family history, and race, emphasizing their role in PCa development and progression. Results: Modifiable factors, including diet, physical activity, alcohol consumption, and smoking, are also addressed, with evidence suggesting their potential in mitigating risk. Emerging data on medications such as 5-alpha reductase inhibitors and statins, as well as dietary supplements such as vitamins D, indicate their potential for chemoprevention, though further research is needed to solidify these findings. Healthcare disparities, especially in low- and middle-income regions, highlight the need for equitable access to diagnostic tools and treatment options. The review underscores the significance of tailored screening approaches, particularly in high-risk populations, to optimize outcomes while minimizing overdiagnosis and overtreatment. Conclusions: The review concludes with recommendations for future research, including the need for standardized screening protocols and the exploration of novel biomarkers for early detection. By synthesizing epidemiological data and current evidence, this review aims to enhance understanding of PCa risk factors, geographic disparities, and preventive strategies, ultimately contributing to improved global PCa management and outcomes. Full article

Background: In prostate cancer (PCa) patients, discrepancies between biopsy-assigned Gleason Scores and those determined from surgical specimens are frequently reported. This phenomenon, known as Gleason score upgrade (GSU), can have significant clinical implications. This work aims to understand the factors contributing to GSU for refining prostate cancer management strategies. Methods: Data from 779 patients diagnosed with histologically confirmed PCa who underwent robot-assisted radical prostatectomy at a single tertiary care institution between January 2005 and December 2020 were examined. Results: In the univariable setting, 5-alpha reductase inhibitor (5-ARI) use was associated with a higher percentage of upgrading (42.3% vs. 30.4% among non-users; p = 0.03942). A more advanced pathological T stage (p = 0.01114) and lymph node positivity (p < 0.00001) correlated significantly with GSU. In the logistic regression model, advanced pathological stage increased the odds more than twofold (OR = 2.807, p = 0.00135). 5-ARI use was associated with notably higher odds of upgrading (OR = 3.809, p = 0.00004). Younger age slightly increased the likelihood of GSU (OR = 0.951 per year increase in age, p = 0.01101). Conclusions: Younger age, advanced pathological stage, and the use of 5-alpha reductase inhibitors were identified as significant predictors of GSU. Full article

Background: Evidence to help avoid unnecessary prostate biopsies is being actively pursued. Our goal was to develop and internally validate a nomogram for predicting clinically significant prostate cancer (csPC) in men with low suspicion of disease (prostate specific antigen [PSA] < 10 ng/mL, normal digital rectal examination [DRE]), in whom magnetic resonance imaging (MRI) findings are positive. Methods: Patients with no prior prostate cancer diagnosis who underwent MRI–ultrasound fusion biopsy of the prostate were retrospectively analyzed. Inclusion criteria were PSA < 10 ng/mL, normal DRE, Prostate Imaging Reporting And Data System (PIRADS) category ≥ 3, and no extraprostatic extension or seminal vesicle invasion reported on MRI. Associations between csPC diagnosis and patient or lesion characteristics were analyzed, and a multivariable model was developed. Internal validation of the model with 5-fold cross-validation and bootstrapping methods was performed. Results: Among 209 patients, 67 were diagnosed with csPC. Factors incorporated into the model for predicting csPC were age, 5-alpha reductase inhibitor use, PSA, prostate volume, PIRADS > 3, and lesion location in the peripheral zone. The model’s ROC AUC was 0.86, with consistent performance at internal validation (0.84 with cross-validation, 0.82 with bootstrapping). With an empirical threshold of <10% csPC probability to omit biopsy, 72 (50.7%) unnecessary biopsies would have been avoided, at the cost of missing 2 (3.0%) csPC cases. Conclusions: Our nomogram might serve as a valuable tool in refining selection criteria in men considered for prostate biopsy. The major limitation of the study is its retrospective character. Prospective, external validation of the model is warranted. Full article

Background/Objectives: Pteridine reductase 1 (PTR1) has been one of the prime targets for discovering novel antileishmanial therapeutics in the fight against Leishmaniasis. This enzyme catalyzes the NADPH-dependent reduction of pterins to their tetrahydro forms. While chemotherapy remains the primary treatment, its effectiveness is constrained by drug resistance, unfavorable side effects, and substantial associated costs. Methods: This study addresses the urgent need for novel, cost-effective drugs by employing in silico techniques to identify potential lead compounds targeting the PTR1 enzyme. A library of 1463 natural compounds from AfroDb and NANPDB, prefiltered based on Lipinski’s rules, was used to screen against the LmPTR1 target. The X-ray structure of LmPTR1 complexed with NADP and dihydrobiopterin (Protein Data Bank ID: 1E92) was identified to contain the critical residues Arg17, Leu18, Ser111, Phe113, Pro224, Gly225, Ser227, Leu229, and Val230 including the triad of residues Asp181-Tyr194-Lys198, which are critical for the catalytic process involving the reduction of dihydrofolate to tetrahydrofolate. Results: The docking yielded 155 compounds meeting the stringent criteria of −8.9 kcal/mol instead of the widely used −7.0 kcal/mol. These compounds demonstrated binding affinities comparable to the known inhibitors; methotrexate (−9.5 kcal/mol), jatrorrhizine (−9.0 kcal/mol), pyrimethamine (−7.3 kcal/mol), hardwickiic acid (−8.1 kcal/mol), and columbamine (−8.6 kcal/mol). Protein–ligand interactions and molecular dynamics (MD) simulation revealed favorable hydrophobic and hydrogen bonding with critical residues, such as Lys198, Arg17, Ser111, Tyr194, Asp181, and Gly225. Crucial to the drug development, the compounds were physiochemically and pharmacologically profiled, narrowing the selection to eight compounds, excluding those with potential toxicities. The five selected compounds ZINC000095486253, ZINC000095486221, ZINC000095486249, 8alpha-hydroxy-13-epi-pimar-16-en-6,18-olide, and pachycladin D were predicted to be antiprotozoal (Leishmania) with Pa values of 0.642, 0.297, 0.543, 0.431, and 0.350, respectively. Conclusions: This study identified five lead compounds that showed substantial binding affinity against LmPTR1 as well as critical residue interactions. A 100 ns MD combined with molecular mechanics Poisson–Boltzmann surface area (MM/PBSA) calculations confirmed the robust binding interactions and provided insights into the dynamics and stability of the protein–ligand complexes. Full article

Prolactin (PRL) has recently been found to play a role in lipid metabolism in addition to its traditional roles in lactation and reproduction. However, the effects of PRL on lipid metabolism in liver and adipose tissues are unclear. Therefore, we aimed to study the role of PRL on lipid metabolism in goats. Twenty healthy eleven-month-old Yanshan cashmere goats with similar body weights (BWs) were selected and randomly divided into a control (CON) group and a bromocriptine (BCR, a PRL inhibitor, 0.06 mg/kg, BW) group. The experiment lasted for 30 days. Blood was collected on the day before BCR treatment (day 0) and on the 15th and 30th days after BCR treatment (days 15 and 30). On day 30 of treatment, all goats were slaughtered to collect their liver, subcutaneous adipose, and perirenal adipose tissues. A portion of all collected tissues was stored in 4% paraformaldehyde for histological observation, and another portion was immediately stored in liquid nitrogen for RNA extraction. The PRL inhibition had inconclusive effects found on BW and average daily feed intake (ADFI) in goats (p > 0.05). PRL inhibition decreased the hormone-sensitive lipase (HSL) levels on day 30 (p < 0.05), but the effects were inconclusive on days 0 and 15. PRL inhibition had inconclusive effects found on total cholesterol (TCH), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fatty acid synthase (FAS), 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR), and acetyl-CoA carboxylase (ACC) on days 0, 15, and 30 (p > 0.05). Furthermore, hematoxylin–eosin (HE) staining of the liver, subcutaneous adipose, and perirenal adipose sections showed that PRL inhibition had inconclusive effects on the pathological changes in their histomorphology (p > 0.05), but measuring adipocytes showed that the area of perirenal adipocytes decreased in the BCR group (p < 0.05). The qPCR results showed that PRL inhibition increased the expression of PRL, long-form PRL receptor (LPRLR), and short-form PRL receptor (SPRLR) genes, as well as the expression of genes related to lipid metabolism, including sterol regulatory element binding transcription factor 1 (SREBF1); sterol regulatory element binding transcription factor 2 (SREBF2); acetyl-CoA carboxylase alpha (ACACA); fatty acid synthase (FASN); 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR); 7-dehydrocholesterol reductase (DHCR7); peroxisome proliferator-activated receptor gamma (PPARG); and lipase E, hormone-sensitive type (LIPE) in the liver (p < 0.05). In the subcutaneous adipose tissue, PRL inhibition increased SPRLR gene expression (p < 0.05) and decreased the expression of genes related to lipid metabolism, including SREBF1, SREBF2, ACACA, PPARG, and LIPE (p < 0.05). In the perirenal adipose tissue, the inhibition of PRL decreased the expression of the PRL, SREBF2, and HMGCR genes (p < 0.05). In conclusion, the inhibition of PRL decreases the serum HSL levels in cashmere goats; the effects of PRL on lipid metabolism are different in different tissues; and PRL affects lipid metabolic activity by regulating different PRLRs in liver and subcutaneous adipose tissues, as well as by decreasing the expression of the PRL, SREBF2, and HMGCR genes in perirenal adipose tissue. Full article

Background: 5-alpha reductase inhibitors (5-ARIs) change hormonal pathways and reduce prostate size. We evaluated the effects of 5-ARIs on prostatic multiparametric magnetic resonance imaging (mpMRI) suspicious findings and in the identification of prostate cancer using targeted biopsies. Methods: We conducted a retrospective study including 600 consecutive patients who, between 2017 and 2021, underwent combined transperineal fusion biopsies. Primary outcomes were Prostate Imaging Reporting and Data System version 2 (PIRADS v2) scores and the identification of clinically significant prostate cancer from suspicious lesions (targeted CSPC). Outcomes were compared between patients treated with 5-ARIs for a minimum of 6 months and the other patients. Results: Patients treated with 5-ARIs were older (p < 0.001) with higher rates of previous prostate biopsies (p = 0.004). PIRADS scores were 3, 4, and 5 in 15 (29%), 28 (54%), and 9 (17%) patients among the 5-ARI group and 130 (24%), 308 (56%), and 110 (20%) patients among the others, and the scores were not different between the groups (p = 0.69). The targeted CSPC identification rate among 5-ARI patients was 31%, not different compared to the non-5-ARI group (p = 1). Rates of targeted CSPC for each PIRADS score were not affected by 5-ARI treatment. The 5-ARI was not associated with neither PIRADS ≥ 4 score nor targeted CSPC on logistic regression analyses (OR = 0.76, 95% CI 0.4–1.4 and OR = 1.02, 95% CI 0.5–1.9, respectively). Conclusions: 5-ARI treatment is not associated with PIRADS score alterations or targeted biopsy results. Patients treated by 5-ARIs with suspicious lesions should not be addressed differently during the mpMRI-related diagnostic process. Full article

Introduction: 5-phosphodiesterase inhibitors (PDE-5I) have been investigated as a treatment for urinary dysfunction for almost a decade. The general perception is that they play a significant role in managing lower urinary tract symptoms (LUTS), particularly those associated with benign prostatic hyperplasia (BPH). However, the specific biochemical processes by which PDE-5I repairs urinary function are still poorly understood and there is little instrumental evidence of significant improvement in urinary symptoms. Therefore, we explore the role of 5-phosphodiesterase inhibitors (PDE-5I) as complementary to the conventional treatment of symptomatic BPH; we provide the suggested biological procedures involved in the association between PDE-5 inhibitor use and improvement in LUTS; and we propose new approaches to this topic. Material and Methods: A systematic search for clinical trials, experimental studies, and systematic reviews was performed in electronic libraries (PubMed, EMBASE, Scopus) using the terms “benign prostate hypertrophy”, “benign prostate hyperplasia”, “lower urinary tract symptoms”, “storage symptoms”, “voiding symptoms”, “bladder outlet obstruction” and the keywords “mechanism of action”, “synergy”, “PDE-5 inhibitor”, “alpha1-adrenergic antagonist”, “5-alpha-reductase inhibitors” in various combinations. There was no restriction on publication date. Results: To date, only a few randomized studies have been published in which the effect of the combination of a conventional drug for the treatment of symptomatic BPH and a PDE-5I was investigated. Almost all showed significant improvement in IPSS and QoL. Some studies showed significant improvements in maximum urine flow (Qmax) and postvoiding residual volume (PVR) with combination therapy compared with a single agent alone. Conclusions: PDE-5I seems effective in relieving symptoms of some BPH patients when administered as complementary to agents currently used to treat BPH. However, the mechanism of action of PDE-5 inhibitors in LUTS remains poorly understood and it is difficult to determine the specific subset of BPH patients who will benefit from the combination of PDE-5 inhibitors with the current treatment. Well-designed, sufficiently informative comparative studies focusing on specific target group profiles (age, urogenital parameters) are needed to define new therapeutic options. Full article

Androgenetic alopecia (AGA) is the most common form of hair loss, significantly affecting both men and women worldwide. Characterized by progressive hair thinning and loss, AGA is primarily mediated by dihydrotestosterone (DHT). Recent research has identified numerous single-nucleotide polymorphisms (SNPs) associated with AGA, particularly in genes involved in androgen metabolism, prostaglandin pathways, and vasodilation. These genetic markers offer insights into AGA pathophysiology and potential therapeutic targets. Pharmacogenetics, the study of how genetic variations influence drug response, holds promise for personalized AGA treatment. Identifying SNPs that affect the efficacy of treatments like minoxidil and finasteride enables the development of tailored therapeutic strategies. For instance, genetic variants in the SRD5A2 gene, which affects DHT metabolism, can predict responsiveness to 5-alpha-reductase inhibitors. Beyond pharmacogenetics, RNA interference (RNAi) technologies, e.g., small interfering RNAs (siRNAs), present new therapeutic avenues. Studies have shown the efficacy of RNAi-based treatments in targeting androgen receptors, promoting hair growth in AGA models. Integrating genetic and pharmacogenetic research into clinical practice can transform AGA management, enhancing treatment efficacy and patient outcomes. In conclusion, genetic and pharmacogenetic insights are crucial for developing personalized treatments for AGA, while emerging RNAi technologies offer promising new interventions. These advancements represent significant steps toward more effective and individualized AGA therapies. Full article

The most common type of alopecia in women is female androgenetic alopecia (FAGA), characterized by progressive hair loss in a patterned distribution. Many oral therapies, including spironolactone (an aldosterone antagonist), androgen receptor blockers (e.g., flutamide/bicalutamide), 5-alpha-reductase inhibitors (e.g., finasteride/dutasteride), and oral contraceptives, target the mechanism of androgen conversion and binding to its respective receptor and therefore could be administered for the treatment of FAGA. Despite significant advances in the oral treatment of FAGA, its management in patients with a history of gynecological malignancies, the most common cancers in women worldwide, may still be a concern. In this review, we focus on the safety of antiandrogens for the treatment of FAGA patients. For this purpose, a targeted literature review was conducted on PubMed, utilizing the relevant search terms. To sum up, spironolactone seems to be safe for the systemic treatment of FAGA, even in high-risk populations. However, a general uncertainty remains regarding the safety of other medications in patients with a history of gynecologic malignancies, and further studies are needed to evaluate their long-term safety in patients with FAGA and risk factors to establish an optimal risk assessment and treatment selection protocol. Full article