What is the perfect dose of dutasteride for hair loss?

Summary

هذا 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

00:00

🧪 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.

05:01

🔍 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.

10:02

📊 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.

15:03

📚 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.

20:04

🌐 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.

25:04

🎉 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.

Keywords

💡Finasteride

Finasteride هو مسكن طبي يستخدم عادة لعلاج التهابات البروستاتية ال良性ة (BPH) ويُستخدم أحيانًا بشكل غير رسمي (off-label) لعلاج الهزال الرأسي. في النص، يُناقش الاستخدام المحتمل للفيناستريد لعلاج الهزال الرأسي وقارنه مع دواستريد، حيث يُظهر أن الفيناستريد يخفض مستويات الهرمون dihydrotestosterone (DHT) بنسب متفاوتة عن دواستريد.

💡Dutasteride

Dutasteride هو مسكن آخر يُستخدم لعلاج التهابات البروستاتية ال良性ة (BPH) ويتم ال商讨 في النص حول استخدامه لعلاج الهزال الرأسي. يُذكر أن دواستريد أكثر فعالية من الفيناستريد في تقليل مستويات DHT ويظهر أنه يُستخدم في م剂量 مختلفة، بما في ذلك الDosage 0.5 مللي غرام يوميًا، التي هي الDosage القياسية لعلاج BPH.

💡Androgenic Alopecia

Androgenic Alopecia هي نوع من الهزال الرأسي يُحدث بسبب تأثير الهرمونات الذكورية، ويتم ال商讨 في النص حول الأدوية التي يمكنها المساعدة في التعامل مع هذا النوع من الهزال، مثل الفيناستريد و دواستريد.

💡DHT (Dihydrotestosterone)

DHT هو هرمون ثانوي يلعب دورًا كبيرًا في تطور الهزال الرأسي. في النص، يُناقش كيف أن الفيناستريد و دواستريد يعملان على تقليل مستويات DHT في الجسم، مما يمكن أن يساعد على منع الهزال الرأسي.

💡5α-Reductase Inhibitors

5α-Reductase Inhibitors هي مجموعة من الأدوية التي تعمل على منع الـ 5α-Reductase الـ isoenzymes، التي هي الهياكل البيولوجية تحول التستوستيرون إلى DHT. في النص، يُناقش كيف أن الفيناستريد و دواستريد من هذه المجموعة وتقارن فعاليتها.

💡FDA Approval

FDA Approval هو الموافقة المطلوبة من إدارة الأدوية والأدوية الغذائية في الولايات المتحدة لأي دواء قبل التسويق والاستخدام العام. في النص، يُذكر أن دواستريد لم تحصل على الموافقة الرسمية من FDA لعلاج الهزال الرأسي، رغم أن هناك دراسات جرأت以此为目标.

💡Scalp DHT Suppression

Scalp DHT Suppression هو القدرة على تقليل مستويات DHT في الجلد الرأسي، التي يُعتقد أنها بالفعل تساعد في منع الهزال الرأسي. في النص، يُناقش كيف أن دواستريد أكثر فعالية في تقليل مستويات DHT في الجلد الرأسي مقارنة بالفيناستريد.

💡Serum DHT Levels

Serum DHT Levels هي مستويات DHT في الدم، والتي يُناقش في النص كمؤشر لتأثير الأدوية على مستويات DHT في الجسم. يُذكر أن دواستريد يُمكن أن يؤدي إلى تقليل أكثر من مستويات DHT في الدم مقارنة بالفيناستريد.

💡Side Effects

Side Effects هي التأثيرات الغير مرغوب فيها أو الغير متوقعة للأدوية. في النص، يُناقش كيف أن الفيناستريد و دواستريد يظهران أنهما متحملين بشكل جيد مع وجود تأثيرات جانبية منخفضة، مع بعض التباين في التأثيرات الجانبية بين الDosages المختلفة.

💡Study Results

Study Results هي النتائج التي تظهر في الدراسات الطبية التي يُناقشها في النص، مثل دراسات أولسن وهارچا التي تقارن بين الفيناستريد و دواستريد. يُذكر في النص أن الدراسة أظهرت أن دواستريد أكثر فعالية في تحسين النمو الرأسي مقارنة بالفيناستريد.

💡Treatment Regimens

Treatment Regimens هي البرامج الطبية التي يُستخدمها لعلاج الأمراض. في النص، يُناقش كيف أن بعض الأطباء قد ي开具治疗方案 يتضمن استخدام الفيناستريد و دواستريد معا لتحسين النتائج الطبية.

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