Finasteride (Proscar, Propecia) and Dutasteride (Avodart) are the most common drugs used for hair loss today.
Both drugs work by inhibiting 5AR that converts Testosterone to DHT. Hence they, on one hand, increase testosterone levels but on the other reduce DHT which is the active ingredient.
But Finasteride inhibits only Type II 5AR.
Dutasteride to its credit inhibits all three isoforms of 5α-reductase (i.e., type I, II, and III). As a result, almost all circulating DHT is eliminated. This results in superior hair growth results in comparison to finasteride, but greater chances of side effects.
Finasteride that was developed in 1976 was originally approved as Proscar for treatment of enlarged prostates by FDA only in 1992. It took another 5 years before FDA authorised its use in male pattern baldness in 1997.
Dutasteride followed the same route but though FDA approved or prostatic conditions in 2001, has not yet been given the go-ahead by FDA for androgenetic alopecia and we fear this will not happen in the near future what with Merck entangled with 1,100 lawsuits making FDA cautious.
This does not mean that Dutasteride is not effective in treating hair loss.
This is a controversial topic and papers so contradict one another that it is the observation of the patient taking the drugs and the doctor who is treating him counts more than any scientific study.
Clinical studies have shown specific dosages ut some patients have been experimenting and they found combinations more effective than specified dosages. This is interesting field to discuss.
Anecdotal evidence and experience of both client and clinician in the clinical setting than tomes of literature available.
I keep receiving emails from patients asking what to do and what not to do to get the best possible outcomes and the mails are so many that I decided on doing a video instead.
We need to understand that every person has a different metabolism and also a different risk tolerance. Everyone is unique in his mental make up and bodily robustness. This counts a hell of a lot when we discuss medications since it translates into compliance. And compliance is crucial.
For most patients 90% chance of hair maintenance with a 5% chance of significant side effects is preferable to 70% chance of hair maintenance but a 1 % chance of significant side effects. The reverse is also true.
Similarly for some a 70% reduction of DHT may be preferable than taking a higher dosage to reduce DHT further.
However, a majority do not even look towards these statistics and follow their doctor’s advice. This is the happiest lot!
Most of us are non-conformists. We may cut the 5 mg Finasteride (Proscar) into 4 pieces and take 1.25 mg daily dose which is not covered in any study.
Or they mistook this was the right dosage from some old postings on the forums. Till the Merck patent expired after 5 years in 2003, Propecia was exorbitantly priced compelling people to buy 5mg Proscar and to slice it into 4 pieces and then take 1.25 mg every day. Since in splitting the Proscar one could never be accurate given the small size of the tablet, you could be consuming 1.5 mg instead of 1.25 mg on one day and 1 mg on another! Not to mention the powder and small fragments that was wasted while splitting the Proscar. Ther are people who still do this and swear that the dosage variation is better than following the bland 1mg a day rescription. Probably the daily variation of dosage does help. This observation is purely anecdotal and reported by patients.
Others want to adjust their frequency of intake to unusual 3 times a week instead f 7 days a week.
This is also not covered in any Finasteride / Dutasteride related study.
Important points to note:
1. Milligram for milligram, Finasteride blocks 70% DHT as compared to 94% by Dutasteride. So the latter promotes more hair growth.
2. Dutasteride has a longer half-life: 4-5 weeks as compared to just 5-6 hours of Finasteride.
3. Whereas, 1.9% Finasteride users experience decrease in libido, 1.3% erectile dysfunction and another 1.2 % decreased ejaculate,
As a whole, the data shows that for most men, finasteride is safe and side effects are rare, reversible and generally not permanent.
In our study, dutasteride 0.5 mg was found to be significantly more effective than finasteride 1 mg in men aged 18–40 years with androgenetic alopecia as assessed by hair counts, subject self-assessment and blinded and non-blinded evaluation of global photographs.
However, it does not mean every patient will feel the way statistics dictate s to.
In my experience, most men experienced a slow decline in hair quality after the initial improvement that lasted for 2-5 years. This is where I experimented and came out with my formula of combination therapy.
If you combine 1mg Finasteride Daily with 0.5mg Dutasteride Once A Week, you can expect regrowth.
When to start after hair transplant so peak levels are adequate in the shedding phase?
There is a chart that can be found that tracks the serum levels of dutasteride when taken at .5mg per day vs. 1.5mg per day. The former takes around 60 days to reach peak blood concentration, while the latter takes only 10. I began with this loading phase and have noticed no side effects. From the drug (libido is actually increased from indirect testosterone increase via prevention of its conversion to DHT).
2% Ketoconazole shampoo once a week after 4 weeks.
However, it should be noted that most people who are currently taking the more powerful dutasteride have only been doing so for less than 15 years since the drug was only approved for use in 2001. So we still do not know the really long-term ramifications of taking dutasteride.
Err on the side of caution
By now, there must be well over 100,000 men around the world who have used Avodart off-label to try to regrow hair. When the drug was first approved in 2002 to treat enlarged prostates, people on online hair loss forums went berserk with excitement.
Studies are responsible to so much confusion here.
One study of 1999 confuses the maximum-
It concludes that Finasteride is almost as effective at 0.05 mg per day as it is at 1 mg per day or 5 mg per day when it comes to scalp skin DHT levels, and 0.2 mg per day is almost as effective as 1 mg per day or 5 mg per day when it comes to serum DHT levels.
Now is this study helpful?
What time to take the medicine?
Testosterone production peaks at around 1 AM and thus maximum prevention of DHT production would theoretically occur at night given the short half-life of Finasteride of 6-8 hours.
From the above numbers, one can deduce that in young adult males, Finasteride will result in estradiol levels rising by 15 %. This finding makes me a bit more comfortable in continuing to take Finasteride. Finasteride also increases circulating testosterone levels by 15%. Considering that men start to lose testosterone levels starting in their 20s, this is perhaps not such a bad thing. In fact an increasing number of older people take testosterone supplementation.
Finasteride isn’t something that will provide a boost for athletic performance unless you can block the estrogen rise. If estrogen goes up, the feedback loop would be to decrease testosterone to reduce estrogen.
Many hair loss forum members (and body-builders too) take a popular aromatase-inhibiting prescription drug called Arimidex. It supposedly prevents estrogen levels from rising when on Finasteride. I would never advise you to add another drug to your life, considering how much you hate taking just one at the moment. Though a relatively safe drug, it is still best to consult your doctor or dermatologist first before taking such drugs.
In addition, DHT is thought to aid in muscle development indirectly. I know its not used in muscle tissue directly but its thought to provide the neurological bridge to enhance muscle development.
Isn’t this drug thing very confusing?
Of course these observations are not scientific so take it with a grain of salt but there isn’t evidence that finasteride yield better athletes other than theorizing higher testosterone while ignoring the other side affects and negating the benefits of DHT, the most “active” form of testosterone.
Truth is this stuff works but it’s like using a blow torch to light a candle. Screwing with your hormones shouldn’t be done so callously.
I’m not trying to tell people to not use propecia. if you do and it works without side effects, great! but don’t be surprised if it doesn’t. after all, you are blocking an important hormone, and those complaining about side effects shouldn’t be scoffed as psychosomatic.
Based on many existing studies and anecdotal evidence, it is virtually guaranteed that Dutasteride will result in superior hair growth in comparison to Finasteride. However, the former will also result in higher rates of side effects compared to the latter.