在国外有一些服用Finasteride的网友，因为服用之后出现一些身理特征(易出油、易长青春痘)，或是怀疑效果，而会提到一个名词‘Reflex Hyperandrogenicity’。
到底什么是reflex hyperandrogenicity呢？是雄性激素接受体对DHT更为敏感？ 或是增加的睾固酮对毛囊产生负面的影响，反而影响效果？ 此外，外用抗雄激素会出现这种效果吗？
Reflex Hyperandrogenicity照字面上的翻译是‘反射性过多雄性特征’，主要症状是体毛增加，或是皮肤或脸部变得更会出油等。我找了Hairlosshelp.com与Dr. Peter H Proctor的说法，翻译给大家参考。
当雄性激素在体内的作用变少，例如通过降低DHT的或全身性的激素受体阻断剂，身体就会寻求一个平衡，这个过程被称为上调(upregulation)。
这可能需要采取增加激素的生产和(或)增加组织对其他激素的敏感性的形式进行。之所以在临床中，发现服用Finasteride的副作用会逐渐消失，就可能是由于上调的作用。
但有一小部分人，可能是这上调进程超过了标准，造成明显的hyperandrogenicity 。这会在身体上出现一些特征，包括脸部出油增加，粉刺、暗疮(青春痘)增加，甚至提高性欲。
在某些情况下，hyperandrogenicity反而强过了Finasteride对雄性秃掉发的改善作用，这是可能发生的，但也仅限极少数人。(Hairlosshelp.com)
Reflex hyperandrogenicity 是结合了睾固酮增加以及组织对男性荷尔蒙的敏感度增加的结果。后者部分原因可能是由于雄性激素接受体数量的增加。
Reflex hyperandrogenicity的强度是与抗雄激素的强度成正比。它同时也限制了使用抗雄性激素疗法的使用，例如在治疗摄护腺癌的同时，大多数这类病人的性功能也会失去或受到影响。
由于Finasteride的作用大多局限于组织上的第二型5-AR还原脢，降低其活性。所以会引发较少的Reflex hyperandrogenicity。所以，服用Finasteride来治疗雄性秃掉发还是有所成效的，也可降低治疗过程中的副作用，如性欲减低等。至于目前在临床阶段的Dutasteride，可以抑制两种类型的还原脢活性，但是否能够确定其安全性与副作用，就等待其结果发表了。
外用的抗雄性激素产品，例如 spironolactone，并不会引起睾固酮的增加，也是有所帮助。
刚开始服用Finasteride的初期掉发增加可能导致发量还是在亏损的阶段，这是由于头发生长刺激导致正常的头发掉落与替换，这并不是由于Reflex hyperandrogenicity所导致，毕竟很少发生。
(Peter H Proctor, PhD, MD)
以下摘录Hairlosshelp.com的原文及另一网站的病人及医生提及Reflex Hyperandrogenicity的对话：
What's reflex hyperandrogenicity?
A: When the effects of androgens in the body are lessened, e.g. through lowering DHT or by systemic hormone receptor blockade, the body seeks equilibrium through a process called upregulation. This can take the form of increased hormone production and/or increased tissue sensitivity to the remaining hormones. The reason side effects usually gradually disappear with finasteride is probably due to such upregulation. In a small percentage of individuals, it may be that this process overshoots the mark, resulting in significant hyperandrogenicity. This is marked by such signs as greatly increased facial oil, increased pimples, and greatly elevated libido. It's possible that in certain cases such hyperandrogenicity overcomes the hair-protective effect of, say, finasteride, though this does not appear to be the case for the vast majority of people.
(From Hairlosshelp.com)
Propecia and Reflex Hyperandrogenicity
Dr. Rassman, if you could, please answer this question. It’s very important, I’ve seen a ton of people online that really need this clarified for them by an expert in this field. Can Propecia cause Reflex Hyperandrogenicity, thus actually accelerating your MPB and, if so, what are the symptoms? I can’t tell if this is happening to me or not. Also, if I have lost hair due to Reflex Hyperandrogenicity is that hair gone forever or is there a chance I can get it back?
HairLossHelp.com has a good explanation of reflex hyperandrogenicity –
“When the effects of androgens in the body are lessened, e.g. through lowering DHT or by systemic hormone receptor blockade, the body seeks equilibrium through a process called upregulation. This can take the form of increased hormone production and/or increased tissue sensitivity to the remaining hormones. The reason side effects usually gradually disappear with finasteride is probably due to such upregulation. In a small percentage of individuals, it may be that this process overshoots the mark, resulting in significant hyperandrogenicity. This is marked by such signs as greatly increased facial oil, increased pimples, and greatly elevated libido. It’s possible that in certain cases such hyperandrogenicity overcomes the hair-protective effect of, say, finasteride, though this does not appear to be the case for the vast majority of people.”
The term “reflex hyperandrogenicity” is a new one to me, and while I unfortunately do not have the answers to your questions directly, hair loss from genetic causes in men is usually not reversible.
