The Clinical Importance of 5 alpha-reductase
Alan McDaniel, MD
Alan McDaniel, MD is a 1977 Tulane medical graduate. He trained in General Surgery and Emergency Medicine before becoming Board-certified in Otolaryngology with sub-specialties in Neurotology and Allergy. He has practiced privately since a two-year faculty appointment at the University of Louisville. 

He has presented at various national meetings in the U.S. (AAO-HNS, AAOA, ANS, AAEM, IFM, PAAS) and Mexico. Topics of his lectures and publications have included General Surgery and Otolaryngology; Otology and Neurotology; Allergy; Chronic fatigue and Endocrinology. He has been a faculty member for the American Academy of Otolaryngic Allergy Basic and Advanced Courses and for the American Academy of Environmental Medicine. His two-day course “New Endocrinology” has been presented at the AAEM and elsewhere since 2005, to physicians from five continents. 

Work with dizziness and allergy in the 1980s led him to seek solutions for Chronic Fatigue Syndrome. In turn, these investigations extended to the endocrine aspects of this and related conditions.  Since basic surgical training emphasizes the need to know several alternative approaches to an operation, he saw the logic of studying integrative and controversial medical methods. He has endeavored to understand these in the light of new facts from research, mindful that Medical history shows innovation begins as a minority opinion.  

He is excited that applying new research to patient care offers solutions to many of the chronic and worsening problems that are epidemic in modern society. 

  Lecture Description:
An unusual complication of transdermal testosterone-replacement introduces us to the clinical importance of 5alpha-reductase.  This enzyme modifies many steroids to increase, decrease or change their effects.  It is essential for normal physical development and sex-differentiation, both fetal and adult.  By its role in the synthesis of neurosteroids, it significantly alters the hypothalamic-adrenal stress response and the balance of excitatory/ inhibitory neural transmission to influence human mood and behavior. 

In some clinical situations, increased expression of 5alpha-reductase (5α-R) is a beneficial adaptive response.  However, the pathological over-expression of 5α-R manifests many problems.  Evidence is presented showing it influences the outcomes of hormone replacement for both men and women.  It causes the central features of polycystic ovarian syndrome.  It is causally involved in menstrual-related disorders including PMDD/ PMS; dysmenorrhea; catamenial siezures and menstrual headaches – even postpartum depression. 

The diagnosis of disorders related to abnormal 5α-R activity is largely clinical and these associations will be discussed.  Supporting laboratory evidence is available and several options are presented.  The treatment of these disorders is reviewed, including conventional allopathic and integrative interventions.  The latter include diet and lifestyle to prevent/ reverse excessive 5α-R production and the use of natural 5α-R-blockers. 

Learning Objectives:

1. Learn the importance of 5alpha-reductase in normal physiology and when it is abnormally expressed.

2. Improve your ability to diagnose patient problems related to abnormal levels of this enzyme.

3. Understand how to correct PMS/ PMDD, androgen excess and mood problems in PCOS and other issues related to 5alpha-reductase and its neurosteroid products. 


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