Cilotti A, Danza G, Serio M
Department of Clinical Physiopathology, Endocrine Unit, University of Florence, Italy.
J Endocrinol Invest. 2001 Mar;24(3):199-203. doi: 10.1007/BF03343844.
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.
5α-还原酶同工酶（1型和2型）抑制剂可根据其底物特异性大致分为三组：a）5α-还原酶1型的纯抑制剂或优先抑制剂；b）5α-还原酶2型的纯抑制剂或优先抑制剂；c）双重抑制剂。尽管已经合成了几种甾体和非甾体抑制剂并在药理模型中进行了试验，但只有非那雄胺被广泛用于临床。非那雄胺在男性中的最大应用是治疗人类良性前列腺增生（BPH）。此外，非那雄胺最近已被用于治疗男性脱发，客观有效率为50%。在女性中，非那雄胺已在一些对照试验中用于治疗多毛症，取得了客观的良好疗效。总之，非那雄胺似乎对治疗BPH、脱发和多毛症（需谨慎使用）有用。根据对1型和2型同工酶在人皮肤、头皮和前列腺中分布的实验观察，双重抑制剂应该更适用于治疗BPH和脱发。同样，双重抑制剂似乎也适用于预防前列腺癌。纯5α-还原酶1抑制剂似乎是治疗痤疮和多毛症的理想药物。
