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Desmolase
2%
2/120
Aromatase
8%
9/120
5-alpha-reductase
89%
107/120
cGMP phosophodiesterase
1%
1/120
Cyclooxygenase 2
Select Answer to see Preferred Response
The patient is concerned that he may be going bald; therefore, the physician prescribes finasteride, which inhibits the enzyme 5-alpha-reductase. Finasteride is a 5-alpha-reductase inhibitor that decreases the conversion of testosterone to dihydrotestosterone (DHT) in peripheral tissues. DHT is involved in the development of the male external genitalia and in prostate enlargement. Additionally, elevated levels of DHT and 5-alpha-reductase are found in androgenetic alopecia. Therefore, finasteride is useful in treating benign prostatic hyperplasia and androgenetic alopecia. Scow et al. review the treatment for male-patterned hair loss. The first possible treatment is an over-the-counter topical agent called minoxidil. The second is a prescription medication, finasteride. Effectiveness differs for each individual, but both can maintain the hair that has not been lost. These medications are best at treating hair loss at the vertex of the scalp whereas hair loss at the anterior scalp or hairline do not respond as well. Mounsey and Reed discuss various causes of hair loss, in particular, female-pattern hair loss. They state ~50% of women will experience some type of hair loss during their lifetime. It typically presents as hair thinning over the vertex of the scalp sparring the frontal hairline. The only FDA-approved treatment for female hair loss is minoxidil 2%. Incorrect Answers: Examples of inhibitors for each of the incorrect answers are given. None are used clinically to treat male-pattern baldness Answer 1: Ketoconazole is both an anti-fungal (lower dose) and anti-androgen (higher dose) and functions by inhibiting desmolase. Answer 2: Anastrozole is an aromatase inhibitor that decreases estrogen levels by preventing the peripheral conversion of testosterone. It is used to treat breast cancer. Answer 4: Sildenafil is a cGMP phosphodiesterase V inhibitor that prevents the degradation and increases the concentration of cGMP. It is used to treat erectile dysfunction and pulmonary hypertension. Answer 5: Celecoxib is a selective cyclooxygenase 2 inhibitor used to treat pain.
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