From the Guidelines
I would not recommend adding finasteride to your current medication regimen without consulting your healthcare provider. You're already taking estradiol, progesterone, and spironolactone, which is a complex hormone therapy combination, and adding finasteride could create unwanted interactions. Spironolactone already has anti-androgenic effects similar to finasteride, so adding another anti-androgen might be redundant or potentially harmful. For your hot flashes, adjusting your current hormone therapy doses might be more appropriate than adding another medication. High DHEA levels can convert to testosterone and potentially worsen hot flashes, so your provider might consider adjusting your current medications first.
Key Considerations
- Hot flashes often respond to optimized estrogen therapy, and your provider might consider increasing your estradiol dose or changing the delivery method (patches, pills, etc.) before adding new medications.
- According to a study on managing menopausal symptoms 1, nonhormonal treatments such as venlafaxine, paroxetine, and gabapentin are effective in treating hot flashes, which might be a better option than adding finasteride.
- Schedule an appointment with your healthcare provider to discuss your persistent hot flashes and explore appropriate adjustments to your current regimen.
Potential Alternatives
- Adjusting the dose of estradiol, progesterone, or spironolactone to optimize hormone therapy and alleviate hot flashes.
- Considering nonhormonal treatments for hot flashes, such as venlafaxine or gabapentin, as suggested by the study 1.
- Monitoring DHEA levels and adjusting the treatment plan accordingly to minimize the potential impact of high DHEA on hot flashes.
From the FDA Drug Label
The development and enlargement of the prostate gland is dependent on the potent androgen, 5α -dihydrotestosterone (DHT). Finasteride is a competitive and specific inhibitor of Type II 5α-reductase with which it slowly forms a stable enzyme complex. In man, a single 5-mg oral dose of finasteride tablets produces a rapid reduction in serum DHT concentration, with the maximum effect observed 8 hours after the first dose.
The patient's symptoms of hot flashes, while taking estradiol and progesterone and spironolactone, with elevated DHEA levels, are not directly addressed by the mechanism of action of finasteride, which is primarily concerned with reducing DHT levels.
- Finasteride does not have a direct effect on DHEA or estradiol and progesterone therapy.
- The use of finasteride in this context is not supported by the provided drug label information 2. Therefore, finasteride should not be used to treat the patient's symptoms without further consideration of its potential effects on the patient's hormone regimen.
From the Research
Treatment Options for Hot Flashes
The patient is currently experiencing hot flashes while taking estradiol and progesterone, and spironolactone (an anti-androgen). The use of finasteride to treat symptoms in a patient with elevated Dehydroepiandrosterone (DHEA) levels is not directly addressed in the provided studies.
Hormone Replacement Therapy
- Hormone replacement therapy (HRT) is effective for relieving vasomotor symptoms such as hot flashes 3, 4, 5.
- Low-dose HRT is safe and effective for prevention of postmenopausal bone loss and reducing the number and severity of hot flashes 4.
- The FDA recommends using the lowest effective dose of hormones 5.
Non-Hormonal Therapies
- Non-hormonal therapies such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are suitable alternatives to reduce the frequency and intensity of hot flashes 6.
- The SSRI paroxetine is FDA-approved for the treatment of hot flashes, and other SSRIs such as fluoxetine, citalopram, escitalopram, and sertraline have also been shown to provide similar benefits 6.
- The SNRI venlafaxine has also been well tolerated and has been shown to reduce the frequency and severity of hot flashes 3, 6.