Clinical application of 5alpha-reductase inhibitors

The inhibitors of 5alpha-reductase isoenzymes (1 and 2) can be schematically divided in three groups according they substrate specificity: a) pure or preferential inhibitor of 5alpha-reductase 1; b) pure or preferential inhibitor of 5alpha-reductase 2; c) dual inhibitors. Despite the fact that several steroidal and non-steroidal inhibitors have been synthesized and experimented in pharmacological models, only finasteride has been extensively used for clinical purposes. The largest application of finasteride in man has been human benign prostative hyperplasia (BPH). In addition, finasteride has been recently used for treatment of male baldness with a 50% of objective response. In women, finasteride has been used in some control trials for treatment of hirsutism with an objective favorable response. In conclusion, finasteride appears be useful for BPH, baldness and hirsutism (with caution) treatment. On the basis of experimental observations on distribution of 1 and 2 isoenzymes in human skin, scalp and prostate, the dual inhibitors should be more indicated for treatment of BPH and baldness. Similarly, the dual inhibitors seem indicated in attempting to prevent prostatic cancer. The pure 5alpha-reductase 1 inhibitors seem the ideal drugs for treatment of acne and hirsutism.