Which of the antifungal azoles effects testosterone the least?

[SpunkySkunk347]

Hi, didn't know whether this should go in ADD or Healthy Living.
I have Tinea Versicolor. Bad.. However I've always been too scared to get on antifungals because of all the side effects and drug interactions the azoles have. What I'm most concerned with is the azoles' affinity as an androgen antagonist - aka lowered testosterone levels, elevated estrogen levels, poor muscle growth, swelling of the breasts, the whole nine yards.

But my tinea versicolor, which has been getting steadily worse and worse over the years with no improvement whatsoever, is now starting to creep out into the open making its way down my forearms where people can see it, and it can no longer just be kept hidden by a t-shirt. So I have to do something.

So pharmacology aficionados, I would greatly appreciate any help or advice you can give me.

I'm trying to figure out, which would be the best antifungal azole for me to bring up to my doctor that would:
- be best at combating tinea versicolor
- wouldn't crash my youthful testosterone levels into oblivion
- be able to be taken orally as opposed to applying it topically

And, well, some might be saying "no advice is going to substitute your own doctor's advice", but the last time I brought my tinea versicolor up to a doctor, they prescibed me topical ketoconazole.. which seemed sort of silly to me since you're only supposed to apply topical ketoconazole in small patches of skin at a time and not all over your body, but my tinea versicolor is all over my entire body. 3 years and a few hundred tubes of ketoconazole later, I still doubt I would have made any progress at all. Even when I did use that ketoconazole for a week or two, there was no progress whatsoever. And let's be honest, probably not too many doctors are brushed up on the androgen antagonist affinity of the azoles. And I'm not going all dr strangelove water fluoridation paranoid about testosterone levels; I mean they use some azoles post prostate surgeries because of how potent of androgen antagonists they are.

Any advice is appreciated

 

[sekio]

Topical antifungals are so poorly absorbed I wouldn't be concerned about testosterone suppression.

Ciclopirox or selenium sulfide are probably worth a try, if triazoles don't do anything then there's no point taking them over and over.

 

[SpunkySkunk347]

What about any oral azoles that don't affect testosterone so much? Know of any?
I tried selenium sulfide for a few weeks, didn't work. Haven't heard of ciclopirox I'll look into it

 

[endotropic]

edit: I originally posted information about tinea corporis instead of tinea versicolor, updated correct information is below.


This is a pretty specific question, unless someone here has gone through this kind of infection themselves I would be surprised if anyone has this information off hand.

According to the text I'm reading indications for widespread tinea versicolor are: oral ketoconazole, oral itraconazole, or oral fluconazole. As far as anti-androgen effects this book only mentions that: "The triazoles are metabolized more slowly and have less effect on human sterol synthesis than the imidazoles"

Maybe doing a lit search for androgen effects for each of those drugs will turn up something?

 

[sekio]

I think part of the reason the azoles work as antibiotics is they interfere with steroid synthesis. So I think you're looking for a drug that does not exist.

if your "tinea" doesn't respond to topical azole antifungals or selenium sulfide, I would hazard a guess it may not actually be a fungal infection.

 

[Survival0200]

I wouldn't take oral ketoconazole until absolutely necessary. It carries a risk of liver damage.