Hair Restoration Blog

Avodart (dutasteride) and Propecia (finasteride) have recently been in the news for the report of some studies regarding their role in increased or decreased risk of prostate cancer.  Avodart and Propecia are both 5-alpha reductase inhibitors (5-ARI), which help prevent production of DHT (dihydrotestosterone).  This class of medications is indicated for the treatment of benign prostate (BPH) hypertrophy.  These DHT blockers also help with the prevention of male patterned hair loss and have been recommended and prescribed for hair loss treatment, for many years.

On one hand, several studies have indicated that DHT blockers could decrease the rate of prostate cancer.  On the other hand,  there are some studies that indicate they may increase the incidence of high-grade prostate cancers.  Those studies performed on both finasteride (7 years study) and dutasteride (4 years study).  It has been concluded that the patients who take DHT blockers should have prior knowledge of whether they have a lower risk of prostate cancer.  However, if the patient gets prostate cancer it might be in a category which is more advanced.

Doctors should be aware DHT blockers can decrease the levels of PSA artificially, so a small increase in PSA levels might reflect a higher activity of prostate tissue in comparison to patients who are not on DHT blockers. Overall, it is good practice to make sure all patients age 50 and older have a baseline PSA reading before they get started on finasteride.  This will determine their PSA levels before they begin taking medications, and the doctor will be able to monitor changes in PSA with greater precision.

Q:

Hi Dr. Mohebi,

I am a male to female transgender patient of yours.  I was doing some research and I wondered if I should use Dutasteride in the form of Avodart instead of Finisteride in the form of Proscar. Here is the link I found: http://en.wikipedia.org/wiki/Dutasteride
This wikipedia artical inidicates that Dutasteride inhibits both isoforms of 5-alpha reductase, Type I and Type II, while finasteride only inhibits Type II.  Some early studies showed that Dutasteride is more effective.
I’m curious to know your opinion of taking this drug, and if it will have any effect of regenerating any of my lost hair?  While Finisteride seems to have mostly abated hair loss, I haven’t seen any kind of re-growth.

Thank you so much

A:

Dutasteride has been studied for its effect on hair loss prevention and prevention of miniaturization process.  The studies show that Dutasteride is more potent for hair loss treatment in comparison to finasteride.  Having said that, dutasteride (Avodart) has never been approved by FDA for hair loss treatment partially due to its side effects that are more commonly seen.

Dutasteride is FDA approved for Benign Prostate Hypertrophy (BPH) treatment.  It might become approved for hair loss in the future, but until then I do not prescribe it for my patients on a regular basis.
Since you are a transsexual person and you are going through medical treatments and sex reassignment surgeries and until you have your testosterone, you can use dutasteride instead of finasteride for a more complete male hormone blockage as long as you understand that you may have a higher risk of experiencing the sexual side effects.

Q:

Hi Dr. Mohebi,
I was at your hair restoration clinic a few months ago asking about hair loss. I was curious, have you heard of anything regarding Avodart (Dutasteride) causing significant thinning just in the front of the hairline? I got on it a month ago and I’m shedding a whole hell of a lot. Any idea how long the sheds last? I heard that the hair from the hairline actually does not grow back. Have you heard anything about that?

A:

Dutasteride (Avodart) although not FDA approved for hair loss treatment is prescribed by some physicians for treatment of male patterned baldness.  The effect of Dutasteride on slowing down the process of hair loss is documented through several studies.  Dutasteride blocks both isoenzymes (Type I and II) of 5 alpha reductase inhibitor and for that reason can help hair loss even more effectively than finasteride (Propecia).

Hair loss patients who start taking any dihydrotestosterone blockers may initially experience more hair shedding that is assumed to have to do with an increase in the turn over of miniaturized hair follicles.  The shedding and hair loss is usually temporary and new and stronger hair shafts will grow from the same follicles in a few months after the initial shedding.

Q:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you do not recommend Dutasteride for hair loss for obvious reasons, but based on available research findings on this medication, what do you think are the most likely possible side effects from using Dutasteride if worse come to worse. Would it be like multitude of finasteride side effects? Again, I know your view of non-FDA approved drugs.

A:

Dutasteride (Avodart) is one of the selective inhibitors of the type I and II of the enzyme 5-alpha-reductase, the enzyme that converts the male hormone testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison with dutasteride, finasteride (Propecia) acts as an inhibitor of just type II of the enzyme 5-alpha-reductase, which is more specific. Studies around dutasteride mechanism of action shows that, blocking both type I and type II enzyme can be more potent that only one in reducing the levels of DHT in the body.

If you are taking dutasteride for other indications, you may get some hair growth as a good side effect. As you may guess cannot recommend dutasteride solely for prevention of male patterned hair loss; not until it is approved for hair loss treatment by FDA. Other than not being FDA approved my other reasons are:

1. The optimum dose of dutasteride for hair loss prevention is not determined.
2. The side effects of dutasteride are much more prominent comparing to finasteride.  That include the negative effect of the medication on sex drive in men.
3. If you are considering the cost effectiveness of dutasteride, with new price reduction of finasteride that should not be in the picture any more.