Which Is The Best Medication For Hair Loss: Finasteride or Dutasteride?

Summary

In this video, Dr. Gary Linkov, a double-board certified facial plastic surgeon, discusses the differences between finasteride and dutasteride for hair loss treatment. While dutasteride is more potent, inhibiting both type 1 and type 2 forms of the enzyme that causes hair loss, finasteride remains the safer, FDA-approved option. Dr. Linkov shares insights from his clinical experience, highlighting the benefits and potential side effects of each medication, as well as practical guidance on when to consider switching between them. He emphasizes the importance of medical therapy alongside hair transplant surgery for optimal hair preservation and growth.

Takeaways

• 😀 Dutasteride is more effective than finasteride in blocking DHT, with a reduction of 90-98% compared to finasteride's 70%.
• 😀 Finasteride is FDA-approved for hair loss, while dutasteride is not, though it is used off-label for hair loss in the U.S.
• 😀 Dutasteride has a longer half-life (about 5 weeks), meaning it stays in the system longer than finasteride, which can be both beneficial and a drawback.
• 😀 Dutasteride’s greater DHT suppression may lead to higher incidences of side effects like erectile dysfunction (4-6%) and decreased libido (3-4%).
• 😀 Most side effects from both drugs tend to occur within the first 3-6 months of use and are generally reversible.
• 😀 Dutasteride’s lipophilicity means it accumulates in skin and scalp tissues, which prolongs its effect, even after stopping the medication.
• 😀 The standard starting dose for finasteride is 1 mg/day, while dutasteride is typically started at 0.5 mg/day for hair loss.
• 😀 Dutasteride is used after finasteride fails to maintain hair, with the option to increase the dose if needed, up to 2.5 mg/day.
• 😀 Some patients may opt for dutasteride over finasteride if they experience plateauing hair loss on finasteride, although side effects are monitored closely.
• 😀 Topical dutasteride is less effective due to its larger molecule size and difficulty penetrating the scalp barrier, with limited clinical trials on its use.

Q & A

What is the main difference between finasteride and dutasteride in terms of their effect on DHT?

The main difference is that finasteride inhibits only the type 2 form of the 5-alpha reductase enzyme, leading to about a 70% reduction in DHT. Dutasteride, however, inhibits both type 1 and type 2 forms of 5-alpha reductase, resulting in a 90-98% reduction in DHT.

Why is dutasteride not FDA-approved for hair loss in the United States?

Dutasteride is not FDA-approved for hair loss in the United States, though it is approved in certain other countries like Japan, South Korea, and Taiwan. The main reason is that clinical trials and studies specifically for hair loss have been limited, and more data is needed.

What are the side effects associated with dutasteride compared to finasteride?

Dutasteride has a higher incidence of side effects, with erectile dysfunction affecting 4-6% of users and decreased libido affecting 3-4%. In contrast, finasteride has lower rates of these side effects: erectile dysfunction occurs in 1.3-2% of cases, and decreased libido in 1.8-2.6%.

How does dutasteride’s longer half-life impact its use in hair loss treatment?

Dutasteride has a longer half-life (about 5 weeks) compared to finasteride, meaning it stays in the system longer and has a more prolonged effect. While this can be beneficial for preventing hair loss, it also makes it harder to stop the medication or adjust the dosage if side effects occur.

How do doctors generally approach the use of finasteride and dutasteride in clinical practice?

Doctors typically start patients on finasteride as it is the FDA-approved first-line treatment for male pattern hair loss. If patients continue to experience hair loss without side effects, doctors may then switch them to dutasteride to provide a more potent option.

Is dutasteride generally safe to use as a first treatment for hair loss?

No, most doctors, including the speaker, do not start patients on dutasteride right away due to its stronger potency and higher side effect profile. Finasteride is usually the preferred first choice, with dutasteride considered if finasteride is ineffective.

Can patients switch back from dutasteride to finasteride if needed?

Yes, patients can switch back to finasteride from dutasteride, although this is rarely necessary. The doctor found that patients who switched to dutasteride did not develop significant side effects and were generally satisfied with the results.

What is the general approach to switching doses of dutasteride for patients with hair loss?

Most patients start with a 0.5 mg dose of dutasteride, but if more aggressive treatment is needed, the dose can be increased to up to 2.5 mg per day. However, increasing the dose also increases the likelihood of experiencing side effects.

Why are topical or injected forms of dutasteride not commonly used for hair loss treatment?

Topical and injected forms of dutasteride are not widely used because dutasteride’s larger molecule size makes it difficult to penetrate the scalp barrier effectively. Even when compounded versions are used, they often don’t deliver enough of the drug into the follicles to significantly suppress DHT.

How does dutasteride interact with hair transplant surgery?

Dutasteride is often used in conjunction with hair transplant surgery because it helps to stabilize existing hair and prevent further hair loss. While hair transplant surgery can restore density, it cannot prevent transplanted hair from falling out if it is DHT-sensitive, which is why medical therapy like dutasteride is crucial.