What is the perfect dose of dutasteride for hair loss?
Summary
TLDRهذا النص يناقش الاستخدام الغير رسمي للدواء دوتاستيريد في علاج الهزال الرأسي الذكري، مع تحليل الدراسات الطبية التي أظهرت أن دوتاستيريد أكثر فعالية من فيناستيريد في تقليل مستويات DHT ويعزز النمو الرأسي. يناقش النص أيضاً الآثار الجانبية للأدوية وقارن بينها.
Takeaways
- 💊 **Finasteride و Dutasteride**: يستخدمان كBLOCKERS لـ 5 AR لعلاج خسارة الشعر والانكماش الذقنية.
- 🔍 **دراسة Dutasteride**: لم تحصل على الموافقة الرسمية لعلاج خسارة الشعر، لكنها تعتبر فعالة وAccessible ب剂量 0.5 مللي غرام يومياً.
- 📊 **Dosage Studies**: تم مقارنة مختلف الحزم من Dutasteride مع Finasteride في الدراسات لتقييم الأمان وفعالية العلاج.
- 🧬 **Mechanism of Action**: Dutasteride يمنع تحويل التستوستيرون إلى DHt بقوة أكبر من Finasteride، مما يؤدي إلى انكماش DHt في الدم والجلد.
- 🕰️ **Half-Life**: يمتلك Finasteride فترة نصف قصيرة مقارنة بـ Dutasteride التي لديها فترة نصف طويلة تتراوح بين 5 أسابيع.
- 📉 **DHT Suppression**: يؤدي Dutasteride إلى انكماش DHt في الجلد والدم بنسب أكبر من Finasteride، مما يعزز نمو الشعر.
- 📚 **Research Findings**: في الدراسات، أظهرت الحزم الأعلى من Dutasteride تفوقا في زيادة تعداد الشعر مقارنة بFinasteride.
- 🚫 **Side Effects**: يشير الأبحاث إلى أن التأثير الجانبي من Finasteride و Dutasteride منخفض، مع زيادة قليلة في التأثير الجانبي عند الحزم الأعلى من Dutasteride.
- 💡 **Treatment Considerations**: يمكن أن تكون Finasteride الخيار الأفضل للبدء به بسبب سهولة تعديل الحزم والأمان الطويلة الأجل.
- 🔄 **Long-Term Use**: يتوفر الأبحاث الطويلة الأجل لدعم فاعلية وأمان Finasteride على المدى الطويل.
- 🛑 **Liver Safety**: لم يتم الإبلاغ عن إصابات الكبد بسبب استخدام Finasteride أو Dutasteride، وهما كلاهما يعتبران غير مزعجين للكبد.
Q & A
ما هي المادة الرئيسية التي تناقشها النص؟
-النص يناقش دواسة دواستريد (dutasteride) وقارنها مع فيناسترايد (finasteride) في علاج خسارة الشعر.
لماذا لم تحصل دواستريد على الموافقة الرسمية من إدارة الأدوية والأدوية الغذائية للعلاج بخسارة الشعر؟
-على الرغم من أن دواستريد قد أجريت دراسات فاز 2 وفاز 3 لعلاج خسارة الشعر، لكن لم تتم الموافقة الرسمية الرسمية لأسباب غير معروفة، رغم أن دواستريد قد تمت الموافقة عليها لعلاج الورم البروستاتي الصالح (BPH).
ما هي الفرق بين دواستريد وفيناستريد في التعامل مع النزعة 5-AR؟
-فيناستريد يحجب نوع 2 من النزعة 5-AR التي توجد في خنادق الشعر، في حين أن دواستريد يحجب كلا النوع 1 والنوع 2 من النزعة 5-AR، ويقلل بشكل أكبر من فيناسترايد في حجب النوع 3.
ما هي الجرعات القياسية لدواستيريد وفيناستريد في الاستخدام؟
-الجرعات القياسية لدواستيريد هي 0.5 مللي غرام يومياً لعلاج BPH، وعادة ما يُستخدم هذا الجرار نفسه لعلاج خسارة الشعر. فيناستريد يُستخدم عادة بجرارة 1 مللي غرام يومياً أو أقل لعلاج خسارة الشعر.
ما هي النتائج الرئيسية لدراسة أولسان التي نشرت في عام 2006؟
-الدراسة أظهرت أن كل جرعات دواستريد كانت أكثر فعالية من البوصة، وأن جرارة 2.5 مللي غرام يومياً لدواستيريد كانت أفضل بكثير من 5 مللي غرام يومياً من فيناسترايد في زيادة تعداد الشعر.
كيف يؤثر تكاليف دواستريد وفيناستريد على مستويات الديهيدرو تستوسترون (DHT) في الدم والشعر؟
-دواستيريد يقلل من مستويات DHT في الدم و-scalp بأكثر من 90%، في حين يقلل فيناسترايد من 50% إلى 60%، اعتماداً على الجرار.
ما هي المدة الفعلية لنصف حياة فيناسترايد ودواستيريد في الدم؟
-نصف حياة فيناسترايد تتراوح بين 6 إلى 8 ساعات، في حين أن نصف حياة دواستريد يبلغ 5 أسابيع.
هل الزيادة في مستويات ال تستوسترون في الدم يمكن أن تؤدي إلى خسارة شعر؟
-لا توجد أدلة تشير إلى أن ال تستوسترون في النطاق الطبيعي يؤثر على خسارة الشعر، وALTHOUGH الدراسات أظهرت أن دواستريد وفيناستريد يزيدان من مستويات ال تستوسترون في الدم إلا أنهما يساعدان على تحسين نمو الشعر.
ما هي النتائج الرئيسية لدراسة هارچر التي نشرت في عام 2014؟
-الدراسة أظهرت أن دواستريد بجرارة 0.5 مللي غرام يومياً هو أفضل من فيناسترايد بجرارة 1 مللي غرام يومياً في زيادة تعداد الشعر، ولم تظهر الدراسة أي تفاوت معنوية في الآثار الجانبية بين الأدوية.
ما هي النصائح النهائية في النص بشأن الاختيار بين دواستريد وفيناستريد لعلاج خسارة الشعر؟
-النص يفضل فيناسترايد كعلاج أولي لأسباب تتعلق بسهولة التحكم في الجرارة والأبحاث الطويلة الأجل لأمانتها وفعالية، مع التأكيد أن دواستريد هو خيار جيد لأولئك الذين لا يجيبون بشكل جيد على فيناسترايد.
Outlines
🧪 Finasteride vs. Dutasteride: A Scientific Comparison
The paragraph introduces a discussion on finasteride and dutasteride, two 5-alpha reductase inhibitors used to treat hair loss. It highlights the off-label use of dutasteride for hair loss despite its FDA approval for benign prostatic hypertrophy (BPH). The script mentions the potency of dutasteride compared to finasteride, the standard dosages, and the potential for lower or higher doses to affect treatment efficacy and safety. It also touches on the different isoenzymes these drugs affect and their impact on dihydrotestosterone (DHT) levels, which is linked to hair loss.
🔍 Dutasteride Dosing and Clinical Studies
This section delves into the clinical studies that have examined various doses of dutasteride for hair loss treatment, comparing them to finasteride. It discusses a study by Olsen published in 2006, which included different doses of dutasteride and finasteride, and used hair count measurements as the primary endpoint. The study found that higher doses of dutasteride were more effective in increasing hair counts than finasteride. It also discusses the suppression of serum and scalp DHT levels by dutasteride and finasteride, and how dutasteride's longer half-life could influence treatment frequency and side effect duration.
📊 Efficacy and Safety of Dutasteride in Hair Loss Treatment
The paragraph summarizes the results of clinical studies on dutasteride, emphasizing its superior efficacy over finasteride in suppressing DHT levels and promoting hair growth. It also addresses concerns about the side effects of dutasteride, particularly sexual side effects, and compares them to those of finasteride. The studies suggest that while dutasteride may have a slightly higher incidence of sexual side effects, particularly at higher doses, both drugs are generally well-tolerated with a low risk of side effects.
📚 Review of Dutasteride Safety and Side Effects
This section reviews the safety profile of dutasteride, referencing various studies that have examined its side effects in comparison to placebo and finasteride. It highlights that while dutasteride may have a slightly higher incidence of sexual side effects, the overall risk is still low. The paragraph also discusses the potential for dutasteride to be used in combination with finasteride to leverage the benefits of both drugs, while managing potential side effects.
🌐 Comprehensive Analysis of 5α-Reductase Inhibitors
The paragraph provides a comprehensive analysis of the use of 5α-reductase inhibitors, specifically finasteride and dutasteride, in treating androgenetic alopecia. It discusses the potency of these drugs, their effects on serum and scalp DHT levels, and their safety and efficacy based on clinical studies. It also addresses the concerns about liver safety and the potential for dutasteride to be used at varying doses for individuals who do not respond well to finasteride.
🎉 Embracing the Best Treatment for Hair Loss
In conclusion, the paragraph emphasizes that both finasteride and dutasteride are effective treatments for hair loss, with dutasteride being a more potent option for those who do not respond to finasteride. It reassures viewers that using these drugs is the best course of action against hair loss and encourages them to make an informed decision based on their individual needs and potential risks. The paragraph ends with a light-hearted Thanksgiving wish, suggesting a community of individuals sharing a common goal of combating hair loss.
Mindmap
Keywords
💡Finasteride
💡Dutasteride
💡Androgenic Alopecia
💡DHT (Dihydrotestosterone)
💡5α-Reductase Inhibitors
💡FDA Approval
💡Scalp DHT Suppression
💡Serum DHT Levels
💡Side Effects
💡Study Results
💡Treatment Regimens
Highlights
Discussion on the science behind finasteride dosing and its side effects.
Introduction to dutasteride as an alternative to finasteride for hair loss treatment.
Dutasteride's FDA approval for benign prostatic hypertrophy but not for hair loss.
Dutasteride's off-label use for treating androgenic alopecia due to its potency.
Comparison of dutasteride and finasteride dosing for hair loss treatment.
Exploration of the different 5α-reductase isoenzymes and their blockage by finasteride and dutasteride.
Dutasteride's greater potency in blocking DHT production compared to finasteride.
The longer half-life of dutasteride versus the shorter half-life of finasteride.
Clinical studies comparing the efficacy of different doses of dutasteride to finasteride for hair loss.
Results from the Olsen study in 2006 showing the effectiveness of various dutasteride doses.
Findings on serum and scalp DHT suppression with dutasteride and finasteride.
No significant association between serum testosterone levels and hair loss.
Dutasteride's effect on serum and scalp testosterone levels during treatment.
Phase three study results by Harchér in 2014 on dutasteride's superiority over finasteride.
Analysis of side effects and safety profiles of dutasteride and finasteride.
Recommendation on starting with finasteride due to its long-term research and titration flexibility.
Dutasteride as a potent alternative for those not responding well to finasteride.
Assurance that both finasteride and dutasteride are safe and effective treatments for hair loss.
Transcripts
sup chums how y'all living hope
everything is moving you're all having a
prime week so in the last couple of
videos we have been getting back to
basics by going balls deep into the
science behind finasteride dosing and
the risk of side effects from
finasteride of course even though i am a
finasteride user myself and a proud one
at that i don't want to neglect my
fellow hair loss switchers who consider
themselves part of the dutasteride
master race so today we're going to do
the same thing for the other 5 ar
blocker you know the one that's not
officially approved for the treatment of
antarctic alopecia that's right we're
going to be talking about dutasteride or
as dr paul saladino would say
due to steroid or due to steroid now
it's not like dutastride isn't fda
approved at all like finasteride it was
originally fda approved for the
treatment of benign prostatic
hypertrophy also known as bph and this
approval was in 2001. it turns out
though that phase two and phase three
studies were performed aiming towards
fda approval for the treatment of hair
loss and we'll look at these studies
here but for whatever reason it never
went through the formal approval process
although it should be mentioned that
dutasteride is approved for the
treatment of male pattern baldness in
good korea nevertheless since it is
already fda approved for benign
prostatic hypertrophy dutasteride is
often used off label for the treatment
of antridic alopecia and it is
especially popular for the small number
of people who do not get a good response
to finasteride since dutasteride is
considered by many to be the more potent
drug unlike finasteride dutasteride is
usually used at the same dose as the
treatment for bph which is namely 0.5
milligrams per day but that's a little
strange because we know that finasteride
works just as effectively for hair loss
at just one-fifth of the finasteride
dose used for bph which is five
milligrams per day or even at lower
doses in that like 0.2 or 0.5 milligrams
per day so we normally use finasteride
for hair loss at one milligram per day
or less and we know this works about as
well as five milligrams per day while
possibly lowering the risk of side
effects and i went over the rationale
for this finasteride dosing and a recent
video that i'll link below so why is
dutasteride at 0.5 milligrams per day
consider the standard dose for treating
both benign prostatic hypertrophy and
hair loss do lower doses work as well
also what about higher doses like 2.5
milligrams per day would they be more
effective than just the standard 0.5
milligrams per day dose well let's take
a look at the dose-ranging studies that
were done on dutasteride and see how
different doses of dutasteride compared
to finasteride in terms of both safety
and efficacy before jumping into these
studies though it's important to realize
that dutasteride isn't an equivalent
drug to finasteride although they are
both five ar enzyme blockers that block
the conversion of testosterone into the
trash hormone dihydrotestosterone they
don't have the same effect on the 5ar
enzyme finasteride predominantly blocks
the type 2 5a or isoenzyme which is
predominantly present in the hair
follicles while dutasteride blocks both
the type 1 5a or isoenzyme which is
present in the sebaceous glands and to a
much less extent in the hair follicles
and it also blocks the type 2 isoenzyme
just like finasteride they both have
effects also on the type 3 isoenzyme as
well though dutasteride blocks the type
3 isoenzyme much more than finasteride
but the role of this type 3 isoenzyme is
not well known so it is not often talked
about in hair loss research though it is
widely distributed throughout the
tissues of the body so it might be
important in reducing serum dht although
keep in mind serum dht in adult men is
already very low hence why dht after
puberty is active predominantly in just
the skin scalp as well as the prostate
where it of course only does bad things
like give us acne enlarger prostate and
of course cause hair loss which is why i
often consider it a trash hormone but as
far as the type 1 and type 2 isoenzymes
go dutasteride is three times more
powerful than finasteride and blocking
the also important type 2 isoenzyme and
it is a full-blown 100 times more
powerful than finasteride and blocking
the type 1 isoenzyme so dutasteride
lowers serum dht over 90
while finasteride lowers it 70
they both lower scalp dht in the range
of 50 to 60 depending on the dosage
which we'll talk about in more detail
shortly one other very important
difference is that finasteride has a
much shorter half-life than detasteride
finasteride remains in the blood for
only about six to eight hours while
dutasteride has an immense half-life of
five weeks now that doesn't mean
dutasterod remains potent for five weeks
just that there will still be traces of
it in your system five weeks after you
take it now despite the short half-life
of finasteride its effects on lowering
dht last longer than its half-life so
you can take finasteride daily or even
three times per week without decreasing
its effectiveness as a dht blocker that
is one of the reasons why finasteride is
probably a better treatment to start
with first before do test drive when it
comes to fighting hair loss because if
you are a poor responder to finasteride
at least it gets out of your system
quickly and you can then titrate one of
the concerns with dutasteride is its
much longer half-life particularly if
you develop side effects from it since
it is possible that at least
theoretically the side effects could
persist for several weeks although it is
important to remember that current
research on both finasteride and
dutasteride shows that both drugs are
very well tolerated with a low incidence
of side effects so like i mentioned
before even though finaster i mean i'm
sorry even though dutasteride never
became fda approved for hair loss it
came pretty close to it at least as
there is a phase two and a phase three
study on dutasteride for the treatment
of androgenetic alopecia and in both of
these studies the investigators looked
at different dutasteride doses and then
compared the results to using
finasteride the first study was by olsen
and was published in 2006. this was a
multi-center randomized control study
that enrolled men aged 21 to 45 years
old with androgenic alopecia the norwood
scales were ranged from three to five
and there were 416 men initially
enrolled and they were randomized to
receive dutasteride at doses of 0.05
milligrams 0.1 milligrams 0.5 milligrams
which is the standard dose for bph and
they also measure doses as high as 2.5
milligrams per day which is the
equivalent of taking five avo dark
capsules which is the trade name for
dutasteride they also randomize men to
receive finasteride at five milligrams
per day and also a placebo group who are
given broccoli sprouts just kidding it
was probably just a sugar pill anyways
the study lasted for 24 weeks and the
primary endpoint of the study was hair
counts in a one inch diameter circle of
the scalp measured by macro photographs
which is the same thing as a
phototrichogram which is a tool that can
measure exact hair counts so it is more
accurate than a photo assessment
although the researchers also looked at
global photographs and investigator
assessments as well as subject
self-assessments of their hair they also
measured serum testosterone and dht
levels throughout the study and also 12
weeks after the study ended when the
subjects were off medication and then
every two months after that until the
dht levels were back to normal finally
they did scalp biopsies and measured
scalp testosterone and dht at baseline
and then after 24 weeks of treatment so
what were the results well as you can
see in this graph here all doses of both
drugs were more effective in increasing
hair counts than placebo both at 12
weeks and after 24 weeks so no surprise
that finasteride and detasterite both
work i think that very few people would
argue that in addition though while the
0.1 milligram dose and 0.5 milligram
doses of duetasteroid were comparable to
or slightly better than five milligrams
of finasteride the 2.5 milligram dose
was significantly better than 5
milligrams of finasteride at 12 and 24
weeks the increase in hair counts at 24
weeks were 95 hairs on dutasteride at
0.5 milligrams per day 110 hairs on
dutasteride at 2.5 milligrams per day
and 76 hairs on finasteride at five
milligrams per day the other endpoints
showed basically the same results which
you can see here on the left you have a
panel of experts rating global
photographs at 12 and 24 weeks and this
showed the most improvement with
dutasteride at 2.5 billions per day and
on the right you see similar results
with the investigators assessments of
improvement when the subjects were seen
in person so it looks like the 2.5
milligram dose of dutasteride is the
very best and doses of 0.1 milligram or
more are at least comparable or possibly
a little better than finasteride even at
five milligrams per day which again i
remind you is five times higher than the
standard dose for treating androgenic
alopecia so let's go ahead and look at
dht suppression both scalp and serum dht
suppression this graph here shows serum
dht suppression with the different doses
of the drugs there was 70 percent serum
dht suppression with dutasteride at 0.1
milligrams per day 92 percent
suppression with dutasteride at 0.5
milligrams per day and 96 suppression
with dutasteride at 2.5 milligrams per
day this compares with 70 suppression
with finasteride at 5 milligrams per day
so this shows just how potent dutastride
is being that even 0.1 milligrams of
detasteride seems to be as powerful as 5
milligrams of finasteride also the
researchers here measured serum
testosterone levels and as it turns out
testosterone rose in all the treatment
groups but more with dutasteride
dutasteride at 0.5 milligrams raised
serum testosterone by 24
and at 2.5 milligrams it raised serum
testosterone by 30
finasteride on the other hand had less
of an effect raising serum testosterone
only 10 percent now i know there are
some people out there who think that
testosterone causes hair loss and
therefore dutasteride raising
testosterone by higher levels and
finasteride is something we should be
concerned about i don't blame people for
believing this it's something i used to
believe myself but the good news is that
there is no evidence that testosterone
in the physiologic range affects hair
loss key word here being physiological
though meaning normal levels of
testosterone so for example a study of
373 men from northeastern germany
published in 2017
showed that there was no association
between serum testosterone levels and
the presence or absence of hair loss or
the severity of hair loss to quote this
study quote total testosterone was not
significantly associated with general
hair loss or the norwood hamilton scale
unquote they also found no correlation
between hair loss and free testosterone
levels so these increases in serum
testosterone from dutasteride are in the
normal physiological range and wouldn't
be expected to worsen hair loss and we
know they don't worsen hair loss because
both dutasteride and finasteride improve
hair growth despite raising testosterone
levels now if we're talking about using
testosterone as a performance enhancing
drug to get supraphysiological levels of
testosterone and you are not on a 5ar
blocker you might end up raising your
dht and that might lead to hair loss
since higher testosterone is correlated
with higher dht but these effects of
five ar blockers on serum testosterone
won't do that so a 10 to 30 increase in
serum testosterone really isn't all that
much i mean it might be enough to raise
your libido slightly but it's not going
to be comparable to taking steroids or
testosterone for the sake of performance
enhancement i mean that could easily
quadruple your testosterone levels but
anyways getting back to what happened to
dht levels specifically over time serum
dht took a longer time to return to
baseline with dutasteride than with
finasteride the dht was back to baseline
12 weeks after stopping dutasteride at
doses of 0.05 milligrams or 0.1
milligrams or after stopping finasteride
at 5 milligrams per day but not with
dutasteride at 0.5 milligrams or 2.5
milligrams per day as the authors of the
study say quote serum dht returned to
within 25 percent of baseline in a
median of 86 days after treatment for
the dutasteride 0.5 milligrams group and
in a median of 155 days for dutasteride
2.5 milligram group unquote of course
the big question about dutasteride is
scalp dht suppression so based on scalp
biopsies the suppression was 32 percent
with dutasteride at 0.1 milligram 51
with detasteride at 0.5 milligrams and
79 with dutasteride at 2.5 milligrams
with finasteride at five milligrams per
day the suppression of scalp dht was 41
so roughly between the 0.1 milligram and
0.5 milligram due tasterite doses now
even though the researchers here only
looked at 5 milligrams of finasteride
per day we can safely assume that one
milligram of finasteride likely
suppresses the same amount of scalp dht
because there has been research
comparing the efficacy of one milligram
of finasteride versus five milligrams
for hair loss and it was found that both
were equally as effective but this video
is about dutasteride so if you want to
know more about different doses for
finasteride for hair loss i'll go ahead
and link that video i made about it
below but for the sake of argument just
assume that anything that applies to
five milligrams of finasteride also
applies to one milligram of finasteride
so with finasteride and dutasteride it
was found that scalp testosterone also
increased for example with dutasteride
scalp testosterone increased from 23
percent to a whopping 222 percent when
going from 0.05 milligrams to 2.5
milligrams of dosing while the increase
in scalp testosterone on finasteride at
5 milligrams per day was only 23 but
again the higher dose was associated
with lower dht levels and increased hair
growth despite the increase in
testosterone levels which further
demonstrates that testosterone by itself
does not cause hair loss so in the very
rare circumstance where finasteride does
not suppress enough dht the good news is
that detasteride suppresses more scalp
dht with increasing doses than
finasteride does in fact finasteride
seems to peak at one milligram for scalp
dht suppression but dutasteride doesn't
have this in limitation so even in the
exceptionally rare circumstance where
the standard 0.5 milligram dose of
dutasteride isn't enough a patient can
go all the way up to 2.5 milligrams of
detasteride for even greater scalp dht
suppression so since we're talking
specifically about scalp biopsies and
not just serum dht suppression some of
the suppression of the scalp with
dutasteride is probably from the type 1
isoenzyme which is prevalent in the
sebaceous glands of the scalp this may
not be relevant to the hair follicles
though which predominantly contain the
type 2 5 ar isoenzyme and based on the
current data it is not known if the type
1 isoenzyme plays any role in hair loss
remember though that dutasteride is also
a more potent blocker of the type 2 iso
enzyme than finasteride so that probably
explains its greater potency in fighting
hair loss anyways the scalp dht levels
are more important than that of the
serum dht levels because if you look at
the scalp dht suppression versus changes
in hair count there is an inverse
correlation meaning the more you
suppress scalp dht the better the hair
counts are regardless of whether you're
using finasteride or dutasteride finally
getting to the side effects the good
news here is that there were no
statistically significant differences in
the side effects in any treatment group
as shown in this table however nine men
in the 2.5 milligram dutasteride group
complained of decreased libido versus
one in the 0.5 milligram dutasteride
group as well as three in the
finasteride group so there is at least a
trend towards more sexual side effects
on the highest dose of dutasteride
compared to standard and lower doses the
risk of side effects are going to be low
though even if you are using 2.5
milligrams daily but it stands to reason
that using a five times greater than the
standard dose likely puts you at at
least a slightly greater risk of
developing sexual side effects so to
summarize the study dutasteride is more
effective than finasteride in
suppressing serum and scalp dht as well
as reversing anaerobic alopecia with
finasteride at five milligrams a day
being about equivalent to a dose between
0.1 and 0.5 milligrams per day of
dutasteride 2.5 milligrams per day of
dutasteride is more effective but it
also seems like it has a more prolonged
effect on decreasing dht which is a bit
of a double-edged sword on one hand
there is a concern that since it hangs
around in the system for a long time it
therefore might take a long time for
side effects to resolve on their own the
good news though is that by having a
long half-life it may be possible to
take dutasteride just once or twice per
week while using finasteride on the
other days and i know some doctors have
prescribed regimens that center around
incorporating dutasteride use alongside
finasteride as a means of getting some
of the increased potency benefits of
dutasteride without having to use it
every day since you're using finasteride
on those other days of course nobody can
predict how well you're going to respond
to treatment but the fact remains is
that there is a lot of variability when
it comes to utilizing five ar inhibitors
as part of a hair loss prevention
program anyways based on the results of
the study a phase three study was
designed and this was published by
harcha in 2014 this was another
randomized controlled trial and it
enrolled 917 men aged 20 to 50 years old
with androgenic alopecia who were
norwood scales ranging from three to
five this time they threw out the 2.5
milligram due tasterite doses and you
know maybe that's because there are
concerns about prolonged side effects
and instead at this time they just
looked at dutasteride doses of 0.02
milligrams 0.1 milligrams as well as the
standard 0.5 milligram per day dose
thankfully this time they chose for
comparison the standard dose of
finasteride at one milligram per day
which at least gives us a familiar
landmark they also included a control
group who were just taking placebo
broccoli sprouts tablets the primary
endpoint was again like in the first
study hair counts measured by a
phototrichogram this time looking at
circles on the scalp of 2.54 centimeters
and 1.13 centimeter diameter the
secondary endpoints included hair growth
hair width terminal hair count and
investigator evaluations of the subjects
as well as self-assessments by the
subjects themselves the results showed
that dutasteride at 0.1 milligrams and
at 0.5 milligrams as well as finasteride
at 1 milligram were superior to placebo
in increasing hair counts at 12 and 24
weeks as you can see here also
dutasteride at 0.5 milligrams per day
was superior to finasteride at one
milligram per day there were similar
results looking at the other endpoints
as well including hair with and global
photographic assessments adverse events
were similar in the treatment groups and
there were no statistically significant
differences between the active treatment
groups and placebo in adverse events and
withdrawals from the study looking
specifically at sexual side effects
though the overall incidence of sexual
side effects was higher in the treatment
groups compared to placebo mostly due to
a higher incidence of altered libido in
the treatment groups but there was no
differences between the different drugs
and doses in the incidence of these
sides so we can conclude that both
finasteride and dutastride have a very
low incidence of side effects so this
study concludes that dutasteride at 0.5
milligrams per day is superior to
finasteride at one milligram per day and
both are blood better than placebo of
course the investigators felt that
dutasteride was tolerated as well as
finasteride with some increased risk of
sexual side effects versus placebo but
again the risk for both drugs was very
low so let's go ahead and circle back to
the review article i discussed in my
last video and look more closely at the
safety of dutasteride this table
compares 0.5 milligrams of detasteride
to placebo in various studies with high
and moderate levels of evidence
like the studies on finasteride went
over in my last video there is a
consistently higher level of sexual side
effects with dutasteride compared to
placebo though remember most of these
studies are for the use of dutasteride
in older men with benign prostatic
hypertrophy so you'd expect them to be
at greater risk of sexual side effects
to begin with since they're just older
men for example the larger study which
is shown in the first row is called the
reduced study and it included
6729 men it's found in incidents of
erectile dysfunction in nine percent of
men on dutasteride at 0.5 milligrams
daily versus 5.7 percent of placebo and
reduced libido was seen in 3.3 percent
of dutasteride versus 1.6 percent of
placebo the one study here that was a
study of men with androgenetic alopecia
the study from euan only included 148
men and it found a 4.1 percent incidence
of sexual dysfunction on dutasteride at
0.5 milligrams daily versus a 2.7
percent incidence in the placebo group
of the studies that compare to
testosterone to finasteride we have gone
over two of them already the olsen study
and the harcher study the first study in
the table the andreal study found
similar incidences of impotence
decreased libido and ejaculation
disorder for dutasteride at 0.5
milligrams per day versus finasteride at
5 milligrams per day but this was a
study of men being treated for bph
anyways in the study there was no
significant differences in sexual side
effects between dutasteride and
finasteride finally we have the kaplan
study which is the last study in this
table this study again looked at bph
patients treated with finasteride at 5
milligrams per day and due tasterite at
0.5 milligrams per day this study
included 378 men this study unlike the
others did find more sexual side effects
with dutasteride than finasteride though
the incidence of erectile dysfunction
was 5.1 percent with tetasteride versus
2.1 percent with finasteride the
incidence of ejaculatory dysfunction was
2.4 with dutasteride and 1.8 percent
with finasteride and the incidence of
decreased libido was 2.7 percent with
detasteride and only one point four
percent with finasteride these
differences were statistically
significant so this study contradicts
the other studies that showed no
difference in the incidence of side
effects between dutasteride and
finasteride though this study is the
smallest of all the studies that compare
the two drugs so maybe we have to take
this one with a little bit of a grain of
salt so after looking at all this data
we can probably assume that at the very
worst dutasteride only has a slightly
higher risk of side effects than
finasteride but considering how low the
risk of side effects from finasteride
already are there really is no harm in
trying either drug both will work very
well for hair loss and both have a very
low risk of side effects with that being
said based on the existing research at
least it does look like dutasteride is
the more potent drug in fighting
androgenic alopecia compared to
finasteride it suppresses more serum and
scalp dht than finasteride and that
results in better hair growth overall
however i still think that finasteride
is a better drug to start with because
unlike dutasteride you can't easily
titrate below 0.5 milligrams because
dutasteride is a soft gel unlike
finasteride which is a tablet that can
be easily halved or quartered so
finasteride gives users more variability
with titration which is especially
useful if you don't respond well to the
standard dose also finasteride does have
more long-term research in terms of its
safety and efficacy and it has been
shown that finasteride continues to get
benefits even after 10 years of use so i
prefer finasteride as i feel more
comfortable with it as a long-term
treatment also even if dutasteride is a
more powerful drug overall finasteride
is absolutely still a very effective
clinically proven treatment that will
work well in the overwhelming majority
of people who use it dutasteride is a
good choice for the small number of
people who don't respond well to
finasteride but for most of us
finasteride is absolutely good enough
and there is no reason to kill an imp
with the bfg 9000 when the plasma gun is
plenty good enough it is definitely
reassuring to know though that if for
some reason finasteride isn't good
enough you can always try to test ride
at 0.5 milligrams per day and if for
some reason that's not strong enough you
can titrate it all the way up to 2.5
milligrams per day to get even more
scalp and serum dht suppression and it
doesn't even look like the risk of side
effects is that much higher so it's a
good choice for people who have
extremely aggressive anti-alopecia or
even finasteride isn't strong enough one
potential concern some people may have
though is that since we know finasteride
dudasteride both metabolized through the
hepatic pathway and could thus cause
increased liver enzymes a lot of people
wonder if using higher doses of
dutasterod like this could potentially
cause liver issues well fortunately
there have been no clinical reports of
liver injury due to detasterite or
finasteride use and they are both
classified as a level e drug which means
they are unlikely to cause clinically
apparent liver injury of course if you
have pre-existing liver issues then your
dose may need to be adjusted by your
physician or this therapy may not be
appropriate for you at all other than
that though all the data suggests that
five ar inhibitors are the best and
safest treatment we have in the good
fight against antarctic alopecia and
whether you choose to use finasteride
dutastride or even some combination of
both you can rest assured you're doing
the absolute best thing you can possibly
do to save your hair from the slap head
curse and that is absolutely commendable
and with that i wish everybody a happy
thanksgiving i hope you all enjoy eating
your vegan tofurkeys with your friends
and family and i'll see you all next
time take care
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