Dutasteride – is it useful in balding men?

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For many years, we have used finasteride (Propecia) for male pattern hair loss and for many men, it has worked very well. However, in those men who are non-responders, another option may be dutasteride, a cousin to finasteride. Whereas finasteride is approved by the FDA for hair loss, dutasteride is not but has been used off-label for several years.

Both of these medications are 5-alpha-reductase inhibitors, which help improve hair loss by preventing the formation of dihydrotestosterone (DHT). The difference between them is that finasteride (FIN) inhibits 5-alpha reductase type 2, whereas dutasteride (DUT) inhibits 5-alpha reductase type 2 and type 1.

Which is stronger?

DUT is more potent and decreases DHT to a greater extent than FIN (90% versus 70%). However, the flip side is that side effects are potentially greater so many patients are reluctant to go on this medication for this reason.

How to take dutasteride

As it is not FDA approved for male pattern hair loss, there is no definitively accepted dosing regimen. However, in 2014, Jung and colleagues (Int J Dermatol. 2014 Nov;53(11):1351-7) treated several men who did not respond to FIN and gave them 0.5  mg daily of DUT. Three quarters of these men improved their hair density with the addition of this new medication.

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