Understanding Dutasteride for Hair Loss

What is Dutasteride

Dutasteride belongs to a group of medications known as 5 alpha-reductase inhibitors and is used to treat men with symptomatic benign prostatic hyperplasia (BPH). This causes an enlarged prostate due to the androgen hormone called dihydrotestosterone (DHT) and causes urinary problems.

Researchers noticed that BPH and hair loss, specifically pattern hair loss (or androgenic alopecia/androgenetic alopecia) have a common link: DHT. DHT shrinks hair follicles for men experiencing male pattern hair loss, resulting in shedding and weaker hair regrowth over time leading to a receding hairline or male pattern baldness. Since dutasteride blocks DHT production it can be used when treating male pattern baldness.

How Does Dutasteride Work for Hair Loss?

Androgenic alopecia is linked to increased 5 alpha reductase (5AR) enzyme activity. This enzyme converts 10% of the body's testosterone to DHT which is a male sex hormone that shrinks hair follicles, leading to male pattern hair loss. High DHT levels in the body increase DHT in the scalp, overstimulating hair follicles, resulting in shrinking or "miniaturisation". This gives the appearance of a receding hairline because there is a lower total hair count. It can also lead to bald spots on the crown as well.

DHT also contributes to the development of the prostate but when it is overproduced it can result in prostate enlargement and even prostate cancer.

Dutasteride is similar to another hair loss treatment; Propecia, which contains the active ingredient finasteride, which also blocks the enzyme 5AR from converting testosterone into DHT. Both drugs block type 2 enzymes but dutasteride additionally blocks type 1 enzymes as well which is why it is considered to be the more effective hair loss treatment.

By blocking the enzymes from converting testosterone to DHT, levels of DHT decline, allowing the anagen phase of the hair growth cycle to extend allowing hair growth to happen for longer. This also means that there are more healthy hair follicles meaning it will be less likely for you to experience further hair loss.

Dutasteride treatment is only effective whilst it is being taken. For this reason, it must be taken long-term to treat or prevent hair loss or an enlarged prostate.

Dutasteride vs. Finasteride: What's the Difference?

Both oral finasteride and dutasteride are similar in that they both block 5 alpha reductase enzymes which can be used to treat and reduce further hair loss. Dutasteride, however, blocks 2 different types of these enzymes compared to finasteride which only blocks 1 type.

Dutasteride reduces serum DHT levels by approximately 98% compared to 71% for finasteride which means dutasteride is the more effective hair loss treatment.

In a randomized placebo-controlled study patients treated with dutasteride had an improved hair count and width when compared to finasteride or placebo. The study also showed that dutasteride leads to hair growth in patients suffering hair loss from male pattern baldness/androgenetic alopecia.

When considering how best to treat hair loss, it is important to note that both dutasteride and finasteride have side effects. These include: erectile dysfunction, decreased libido and an increased risk of prostate cancer. They can also affect male fertility, cause an allergic reaction in some people, cause breast pain/tenderness/enlargement and also have an impact on your mental health.

Some people also experience a skin rash when taking dutasteride. Pregnant women women should avoid contact with dutasteride as it can negatively affect male foetuses. However, it's also important to note that side effects are quite rare and generally both finasteride and dutasteride are well tolerated.

The Benefits of Using Dutasteride for Hair Loss

Regular use of dutasteride as a male pattern hair loss treatment has been shown to result in decreased hair shedding as well as increased hair growth even compared with patients who take finasteride. Dutasteride acts on the 5 alpha reductase enzyme to reduce DHT in the scalp which leads to less miniaturisation of hair follicles.

Clinical trials have shown that as hair loss treatments, both the oral and topical forms of dutasteride are effective in treating hair loss. A 2019 study of multiple trials showed a significant increase in total hair count when taking dutasteride.

When looking at dutasteride versus finasteride, the evidence suggests there's a benefit to opting for dutasteride. It is more effective at blocking 5 alpha-reductase and appears to have a greater impact on reducing hair loss and potentially promoting hair growth, leading to thicker hair.

Potential Side Effects and Risks

Common side effects of dutasteride treatment include, not being able to achieve or maintain an erection (erectile dysfunction), decreased sex drive, difficulty with ejaculation, reduced semen quality (impotence) and breast enlargement or tenderness.

Serious side effects to look out for are breast enlargement or tenderness that becomes troublesome with breast lumps or nipple discharge as these may indicate breast cancer. Speak to your doctor if this occurs. A PSA (prostate-specific antigen) blood test is used to detect prostate cancer. Clinical studies have shown a serious form of prostate cancer (high-grade prostate cancer) being more common in those who are taking dutasteride than those who are not. Men using dutasteride should have their PSA tested regularly.

If you have any liver problems, do let your healthcare provider know before initiating treatment with dutasteride as you may need some additional checkups whilst you are on treatment.

Women who are pregnant or may be pregnant should not handle leaking capsules of dutasteride as it is absorbed through the skin and can affect the normal development of a male baby. Dutasteride has also been found in the semen of men taking the medication. If your partner is pregnant or could become pregnant, avoid exposing her to your semen. Dutasteride can also reduce sperm count, semen volume and sperm movement. Therefore, male fertility may be reduced.

Who Should Consider Dutasteride for Hair Loss?

Dutasteride is an effective treatment option for people suffering from male pattern hair loss or "male androgenetic alopecia" as it works by reducing the levels of DHT in the body, meaning less DHT in the scalp and less chance of hair follicles being miniaturised by DHT.

If you have used finasteride with minimal side effects then you can consider taking dutasteride as this has been shown to help regrow hair better than finasteride and is tolerated in much the same way as finasteride for most people.

Women of childbearing potential should avoid contact with dutasteride and finasteride and consider other hair loss medications/treatments. Dutasteride is also not suitable for people who are not suffering from androgenic alopecia, as it does work to block the male sex hormones or androgens. This means it is not suitable for people suffering from temporary hair loss or those suffering from traction alopecia.

You should always consult a healthcare professional before starting any treatment. They will be able to advise you on the appropriate hair loss medications for your situation and whether or not you would be a suitable candidate for dutasteride. It is especially important to discuss with a healthcare professional if you have any illnesses or take any other medication as there may be some negative interactions in these situations.

Dutasteride cannot be bought over the counter and will need a prescription from an appropriate healthcare professional.

Integrating Dutasteride into Your Hair Loss Treatment Plan

Determining the Right Dosage

Although Dutasteride can be used to treat benign prostatic hyperplasia (BPH) and androgenic alopecia, the dosages for both of these conditions can be different. Dutasteride was first developed to treat BPH at a dose of 0.5mg per day and there are usually no modifications to this. However, taking dutasteride to treat benign prostatic hyperplasia your doctor will take into account your individual circumstances to ensure the correct treatment plan is followed.

When treating hair loss the dosage is also typically 0.5mg per day however depending on your individual tolerances, preferences, severity of hair loss and advice from doctors this may be altered slightly. The next most common dosage is 0.5mg three times a week. This dosage may be prescribed for you if you have any concerns about taking the larger dose or if you are worried about side effects. Your personal tolerance to medication will also impact your dosage and your doctor should take all of this into account when prescribing dutasteride for hair loss.

Combining Dutasteride with Other Hair Loss Treatments

On its own, dutasteride may result in limited hair regrowth, as its main function appears to prevent hair loss (depending on your circumstances and level of hair loss). When combined with a topical application of minoxidil (whether this is branded such as Regaine or generic medication), patients can expect to see hair growth and regrowth, as well as a reduction in hair loss.

Minoxidil

Minoxidil can be applied as either a foam or serum directly to the skin. Patients using minoxidil should be aware of potential side effects including acne, chest pain, headache, lightheadedness and scalp irritation. This may be as a result of using too much minoxidil and therefore a dose reduction should be considered. You should also speak to a healthcare professional.

Minoxidil, unlike dutasteride, can be used to treat both male pattern baldness and hair loss in women however the dosages/strength used are different. When treating male pattern baldness/androgenetic alopecia a higher strength dosage is typically used.

Hair Transplant Surgery

Hair transplant surgery is another potential option to consider when dealing with hair loss. Unlike dutasteride, hair transplant surgery/hair transplantation can be suitable for both men and women. There are two main procedures FUE (Follicular Unit Extraction) and FUT (Follicular Unit Transplantation).

FUE (Follicular Unit Extraction)

FUE is the more modern procedure. If this method is used then each individual hair follicle is extracted from a donor location (usually from the sides or back of the head) with a small needle approximately 1mm in size. There may be a small scar less than 1mm in size where the hair follicle has been extracted; however, this is usually covered up by new hair growth. Once extracted, the donor follicles will be transplanted into small holes that will have punched into the scalp. This is where the new hair will grow; however, there may be some initial hair loss/shedding before the hairs grow in the 3-4 months following the surgery. You will be required to bandage your head for a few days following this treatment.

FUT (Follicular Unit Transplantation)

The other hair transplant procedure, FUT, involves removing a strip of skin that grows hair (usually from the back of the head). This is then split into several smaller sections before being transplanted where needed. This procedure usually leaves a visible scar due to the nature of the operation so it will require longer hair to cover up the scar.

As with the FUE procedure, there will be some initial hair loss and shedding before stabilised hair growth occurs. When comparing the two procedures, both will be effective in treating hair loss but there are some significant differences. With a FUE hair transplant, the recovery time is much shorter at 5-7 days whereas due to the more extensive nature of a FUT hair transplant, the recovery time can be 10-15 days. FUE procedures are typically more expensive and have a lower yield of hair so may not be suitable for those on a budget or those suffering from more extensive hair loss.

Following either procedure, your surgeon/consultant may recommend that you take either dutasteride or finasteride to prevent hair loss in the future and encourage growth/hair recovery to happen more quickly. For women, dutasteride/finasteride will not be recommended due to the side effect profile of the medications on women of childbearing potential.

While dutasteride may be a component of your treatment plan for hair loss, it can be combined with other measures to enhance its effectiveness. In addition to using minoxidil or undergoing a transplant procedure as discussed above, patients can also make some lifestyle changes to improve their hair health and minimise hair loss. Quitting smoking, exercising regularly, improving sleep, eating healthily and changes in how you brush/dry your hair can all help to improve your hair health and reduce hair loss. When combined with surgical or medical treatments, such as dutasteride/finasteride and minoxidil, many patients will see a significant reduction in hair loss and an increase in the amount of visible hair, as well as seeing an improvement in the quality/health of their hair.

Monitoring Progress and Adjusting Treatment

After starting a treatment course of dutasteride, as a result of androgenetic alopecia, you may not notice an immediate effect. However, the majority of patients will see a reduction in their hair loss within 1 to 3 months of their first dose. For some individuals, the effects will first begin to show within 3 to 6 months.

In all cases, it is generally best to wait for a year before fully assessing the effect dutasteride has had in terms of reducing hair loss and promoting growth. When you start your treatment you may notice some initial hair loss and the appearance of thinning This is most likely due to the miniaturised hairs shedding and is typically temporary before new healthy hairs begin to grow. For some patients the rate of hair loss due to androgenetic alopecia may outstrip the effectiveness of dutasteride.

Before beginning your treatment, it may be helpful to take some photos of your hairline/crown so that you can monitor your progress. You can track your progress at regular intervals, monthly to start for example, to make sure that the treatment is working for you.

As using dutasteride can lead to an increased risk of high-grade prostate cancer, you should pay attention to any changes in your urine, including difficulty/pain when urinating, blood/semen in the urine, a weak flow, an increased need to urinate or a burning sensation as these are symptoms associated with prostate cancer.

If you notice any other side effects, such as decreased libido, impotency, depression or tenderness in the breasts, you should consult your doctor. In some instances your doctor may recommend that your dosage is reduced or treatment stopped altogether. If you suffer an allergic reaction seek medical attention immediately.

If you are not seeing any effects 6 months to a year in, speak to your doctor to see if you are on the right dosage. For patients taking dutasteride three times a week, this may need to be increased to a daily dosage but wait for a prescriber to confirm if this is appropriate for you.

Conclusion: Is Dutasteride the Right Choice for You?

Dutasteride prevents hair loss by blocking the 5AR enzyme from converting one male sex hormone (testosterone) into DHT. Dutasteride was initially developed to treat BPH, a condition which can result in an enlarged prostate (a result of increased DHT). Researchers noticed the link between DHT and male pattern baldness/hair loss as a result of androgenetic alopecia and as a result, dutasteride has become a promising treatment for hair loss.

Dutasteride can be taken in conjunction with minoxidil for greater effect and can be used to improve results after a hair transplant procedure. Lifestyle changes such as quitting smoking, exercising regularly, eating well and sleeping better can improve hair health and enhance the effectiveness of dutasteride.

As dutasteride is a prescription-only medication it is important to speak to a medical professional before starting treatment. It is also important to understand the potential side effects and risks before taking this medication.

There are alternative and complementary treatments for hair loss, and it is important to take the time to understand these. Quick Meds offers free online hair loss consultations for people struggling with hair loss.