Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Andrology. 2021 Nov;9(6):1729-1731. doi: 10.1111/andr.12881. Epub 2020 Sep 2.
This commentary will explore the important clinical question regarding whether the antiandrogen class of 5α-reductase inhibitors should be considered as an effective and safe treatment option for transfeminine and/or transmasculine individuals. The use of finasteride in transfeminine individuals is based upon the theory that the goal of medical treatment is to reduce the concentrations of androgens, including dihydrotestosterone. Nonetheless, it is unclear that finasteride will have any additive clinical benefit once testosterone levels have already been lowered with standard treatment regimens (i.e. estrogen with spironolactone or cyproterone acetate). For transmasculine individuals, 5α-reductase inhibitors may be a potential treatment option for a subset with androgenetic alopecia but may come at the expense of impairing virilization driven by dihydrotestosterone. In the absence of efficacy and safety data on 5α-reductase inhibitors in gender diverse populations, clinicians should discuss this issue with patients who request or are contemplating their use.
本评论将探讨一个重要的临床问题，即是否应将 5α-还原酶抑制剂这一类抗雄激素药物视为跨性别女性和/或跨性别男性的有效且安全的治疗选择。在跨性别女性中使用非那雄胺是基于这样一种理论，即医疗的目标是降低雄激素的浓度，包括二氢睾酮。然而，目前尚不清楚在已经通过标准治疗方案（即雌激素与螺内酯或醋酸环丙孕酮）降低睾酮水平后，非那雄胺是否会有任何额外的临床获益。对于跨性别男性，5α-还原酶抑制剂可能是雄激素性脱发亚群的潜在治疗选择，但可能会损害由二氢睾酮驱动的男性化。在缺乏 5α-还原酶抑制剂在性别多样化人群中的疗效和安全性数据的情况下，临床医生应该与要求或考虑使用该药物的患者讨论这个问题。
