Does Azelaic Acid Stop Hair Loss?

Does Azelaic acid in Xandrox block DHT? Will it will inhibit virtually all synthesis of DHT in the scalp at the follicle level as claimed by some [people? It has been said that it will not bind with the 5 alpha reductase enzymes (Propecia binds with type 2, 5-alpha reductase.), but it will inhibit the synthesis of all of the hormones in the 17-hydroxy group, which would include testosterone, DHT and androstenediol, the most potent of the androgens. Can you clarify this for me?

I reached out to my colleagues and Drs. Shaprio and Cooley responded with one of the better answers given to me. The focus of the quoted study was on in-vitro (in the laboratory) studies and there are no invivo (in patients) studies. The finding in the laboratory is interesting, but it is a big jump to answering it for people like you who seem to research things in great depth. I would warn most of my readers that there is a long stretch to findings in the laboratory and responses in patients. we have seen cancers killed in the laboratory and no impact on patients. Certainly safety issues are pre-eminent and drive much of what I recommend for my patients.

“I think Dr Lee is referring to this old in vitro data. I’m skeptical azelaic acid is a good in vivo topical 5AR inhibitor and even if it is”, as Dr. Shapiro said, “there’s still the systemic DHT that must be addressed. I doubt that azelaic acid does much for hair growth. ”

Read the citation summarized below from British Journal of Dermatology, 1988 Nov;119(5):627-32.

Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid, by Stamatiadis D, Bulteau-Portois MC, Mowszowicz I., Laboratoire de Biochimie B, Hopital Necker-Enfants-Malades, Paris, France.

The effects of zinc sulphate and azelaic acid on 5 alpha-reductase activity in human skin were studied using an in vitro assay with 1,2[3H]-testosterone as substrate. When added at concentrations of 3 or 9 mmol/l, zinc was a potent inhibitor of 5 alpha-reductase activity. At high concentrations, zinc could completely inhibit the enzyme activity. Azelaic acid was also a potent inhibitor of 5 alpha-reductase; inhibition was detectable at concentrations as low as 0.2 mmol/l and was complete at 3 mmol/l. An additive effect of the two inhibitors was observed. Vitamin B6 potentiated the inhibitory effect of zinc, but not of azelaic acid, suggesting that two different mechanisms are involved. When the three substances were added together at very low concentrations which had been shown to be ineffective alone, 90% inhibition of 5 alpha-reductase activity was obtained. If this inhibition is confirmed in vivo, zinc sulphate combined with azelaic acid could be an effective agent in the treatment of androgen related pathology of human skin.