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Comment & Response
November 2017

Women Also Use 5α-Reductase Inhibitors

Author Affiliations
  • 1Division of Endocrinology, Diabetes and Metabolism, University of California, Davis, Sacramento
JAMA Intern Med. 2017;177(11):1701-1702. doi:10.1001/jamainternmed.2017.6087

To the Editor The Original Investigation by Welk at al1 and the accompanying Invited Commentary by Thielke2 both published in a recent issue of JAMA Internal Medicine should have included the words “in Men” in the titles.

It is clear that there are significant differences between sex-specific and gender-specific responses to hormonal manipulations. In men androgen deficiency or deprivation can promote insulin resistance, metabolic syndrome, and vascular disease. In contrast, in women androgen excess leads to cardiometabolic disorders. Striking parallels between the metabolic consequences of male hypogonadism and female hyperandrogenism have been recognized.3 5α-Reductase inhibitors are now approved for treatment for hirsutism and alopecia in women.4 Use of 5α-reductase inhibitors can be associated with increased estrogen levels in women.5 It is anticipated that inhibition of testosterone bioactivity will exert different endocrine, metabolic, vascular, and psychological responses in men vs women. It is important to acknowledge the sex specificity of the research findings and, whenever possible, to conduct the studies in both sexes.

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