Dutasteride isn't lowering my serum DHT??? (blood tests)

[rockhair]

I've been taking dutasteride for 9 months. I thought it was helping. I haven't been shedding really much at all the past 3-4 months.

However, I just got some bloodwork to check my hormone levels, and I was shocked to see my DHT does not seem to be suppressed at all. :shock:

Results were as follows. Normal range is in brackets.

DIHYDROTESTOSTERONE ______________ 2031 PMOL/L (860-3406)
SEX HORMONE BINDING GLOBULIN _____ 34.1 NMOL/L (10-70)
TESTOSTERONE _____________________ 16.9 NMOL/L (6.0-27.0)
TESTOSTERONE FREE ________________ 391 PMOL/L (196-636)
ESTRADIOL ________________________ 132 PMOL/L (0-172)
LH SERUM _________________________ 11.4 IU/L (1.2-8.6) A
FSH SERUM ________________________ 4.1 IU/L (1.3-19.3)


How on earth can my DHT be so high when I am taking 0.5 mg dutasteride daily? I get my dutasteride from a proper major chain pharmacy. I take it every day. I am on no other medications.

What does this mean? Am I resistant to the dutasteride? What do I do next?

I find this incredibly confusing and it's freaking me out since I was counting on dutasteride for stopping my hair loss, and now it looks like it's not doing anything. Thanks for any help.

 

[mpower]

what are the desirable DHT values when on Dutasteride?

 

[Dench57]

Thats crazy. I can only assume you had sky-high DHT before dutasteride? I take it you don't have baseline results?

 

[TinTon]

Thats crazy. I can only assume you had sky-high DHT before dutasteride? I take it you don't have baseline results?

You took the words right out of my mouth Dench lad!

Without baseline figures it's literally impossible to say 'factually' that a androgen inhibitor drug is not fulfilling its purpose.

It's doubtful that you had sky high DHT levels at baseline because dutasteride is supposed to inhibit 90% of serum DHT, so if your remaining 10% is 2031 pmol/l then I shudder to think what you were at 100% (20,310 pmol/l... surely impossible?).

Double check the figure and make sure you haven't misread it, sounds stupid but it happens to us all. Failing that, then you must either have some super high potency form of DHT that flicks off anti-androgen drugs like greenfly or some very dodgy dutasteride... what's the expiry on the tabs?

 

[Koga]

That's odd indeed. But as Dench said, you can't say anything without baseline results. You could take 1mg dutasteride a day, look up the charts and find out how much of a DHT reducing effect an extra 0.5 mg should have and then check out your bloodwork again and compare it with this one.

 

[Rudolphus]

Very odd indeed. All I can think of is that either your natural DHT levels are insanely high, or that your dutasteride pills are either fake or expired or damaged. As mentioned by an above poster, check the expiry date of the pills. Also, are you aware of any time that your pills may have been exposed to the air or to extreme temperatures, humidity, or direct sunlight?

Another possibility is that there was some error made when your bloodwork was being checked, although this seems unlikely.

Perhaps when you get your next batch of pills, get your bloodwork done again and see if your DHT still shows as abnormally high.

 

[rockhair]

Thanks for the replies guys. Yeah, it's really freaked me out. I've been despondent about it all day since I saw this. I can't get over it.

Unfortunately I don't have a pre dutasteride DHT level since I never had any reason to check. I presume my pre level was normal since there was no reason it wouldn't be. I didn't have any significant hormonal issues. I do have mild acne since I was a teenager which never went away, but nothing dramatic or unusual. As stated by some here, dutasteride is supposed to suppress DHT by >90%. That clearly is NOT remotely happening, no matter what my pre levels were. I looked up a graph of DHT on dutasteride in one study at it should be down to around the 300-800 PMOL/L range at most for sure (below the normal male range).

I also know my pills aren't expired or fake. I fill my prescriptions exclusively at busy locations of the largest chain pharmacy in my country. There is no realistic way they are giving out fake or expired dutasteride. I fill every 90 days so they don't sit long. I've got the lab results printed out in front of me and there's no typo/error evident either.

So far, I think there are three possible explanations:

1) I keep my dutasteride in my bathroom and I have HOT showers. This means the bathroom gets humid (foggy mirrors) and warm. As suggested in this thread, maybe the humidity is destroying/deactivating my dutasteride. This would be any easy one to fix if it's the issue. I'll feel dumb if that's been ruining the effect of the med for the past year, but glad knowing I can correct it.

2) finasteride/dutasteride are both metabolized through the CYP3A4 liver enzyme complex. It is known herbal supplements like St. John's Wort can increase the activity of this liver enzyme complex, which can then wipe the finasteride/dutasteride out of your system much faster and make them less effective. I'm not taking any St. John's Wort. However, I drink a lot of home made veggie and meal replacement shakes. I love them because they're extremely healthy (supposed to be anyway) and they're quick on the go for my busy life. However, I wonder if some unusual ingredients I use for these (eg. parsley, kasha, ceylon cinammon) or joint and skin supplements I use (eg. MSM, glucosamine, hyaluronic acid) could somehow be increasing the liver metabolism of dutasteride. I can't find any evidence for any of them being a problem, but who can know for sure.

3) Lastly, perhaps I am a rare individual who has 5-alpha reductase enzymes which are genetically variant and not inhibitable by dutasteride. This is something I've seen people online theorize as being possible, but I haven't seen any published studies on it. I'm going to look into it. This is obviously the worst explanation, since there's no fix for this. The only thing I could do is switch to topical anti-androgens like RU.

Here's my plan going forward:
- Stop all unusual dietary or nutritional supplements and eat a very simple/plain diet x1 month.
- Get new stock of dutasteride from pharmacy and keep the meds OUT of the bathroom.
- Retest DHT in 4 weeks.

Then I'll see what happens. I'll keep you guys posted. In the mean time, I'm going to keep researching this to find any other explanations. Any further suggestions in the interim are also very appreciated. This is a really messed up situation.

As an addendum, I should say that I have noticed a dramatic decrease in hair loss in the past few months (after about 5-6 months on dutasteride), to the extent that from what I can tell, I'm losing fewer hairs per day in the shower or around the house than when I was a teenager. Others in my family have noticed this as well. So maybe it's working either way. But still, I'd feel a hell of a lot better if the DHT levels made sense.

 

[zzzzz]

That is definitely bad dutasteride, or some error. If it was legitimate dutasteride it would be impossible for your DHT to be that high, unless you were on some sort of steroids too

 

[rockhair]

I just came back from the pharmacist. I explained the situation and asked her opinion. She said she doesn't think keeping it in the bathroom could explain the complete lack of effectiveness. She said even if the heat or humidity was damaging it, it would at most reduce it by a certain percent (eg. 20-30%) but not render it completely ineffective. From my own research on the heat stability of dutasteride, it is also implausible that bathroom temperatures (<30°C) could in any way destroy it. I also tested a capsule to make sure it hadn't leaked by popping it. Sure enough, it was difficult to pop and full of oil (indicating nothing leached out).

She explanation was that "maybe it just doesn't work" for me. She suggested the same two explanations I did. Either I am metabolizing the medication far too aggressively for it to function (though this again would only reduce its effectiveness by a certain percentage, as some would always still circulate), or maybe my 5-AR enzymes are a variant that cannot be inhibited by dutasteride.

I'm going to try filling the brand name Avodart for a few weeks, taking that, and then retesting DHT. Again, I'm cutting out unusual dietary intake that might theoretically induce liver enzymes (parsley, cinnamon). If that doesn't work, I'll try adding 5 mg finasteride daily to the dutasteride and test again in a few weeks. If the combo of finasteride 5 mg + dutasteride 0.5 mg doesn't do it, I'm basically screwed. I will switch to topical RU at that point and hope for the best.



- - - Updated - - -

Another possible explanation that I didn't mention is lab error. My DHT level test had to be sent out to a separate testing facility (because it's not a common test). It is possible, though very low probability that they could have mixed up my results with someone else's. There is no way to be sure of that though.

Lastly, to brainstorm further ideas, I am going to call GlaxoKlineSmith since they are the ones who first patented and released dutasteride. I will ask them if they are aware of any participants in their studies who similarly had no serum DHT response to the medication. This could be the most useful path to figuring out what's going on.

 

[rockhair]

I just got another serum DHT bloodwork taken at a different lab. It will take 2 weeks to come back (DHT is slow to test around here). I had it done to assess for the possibility of lab error on the first reading. Nothing has changed between the first reading in my OP and this one today. So we shall see.

I also e-mailed the lead research doctor for GlaxoKlineSmith on their dutasteride studies asking if any of his study participants during testing at any phase similarly showed a complete nonresponse to the medication. I'm curious if he will answer.

Lastly, I picked up some brand name Avodart 0.5 mg and started those today. I will recheck the DHT again in 2 weeks. If it remains elevated, I will add 5 mg finasteride daily and recheck one more time. If it still remains elevated after that, I will assume I am a genetic anomaly and close up shop.

- - - Updated - - -

I just found another guy on the forum who seems to be going through the exact same thing as me:

http://www.gourmetstylewellness.com/interact/showthread.php/93433-Yet-again-strange-DHT-results

He was on dutasteride for 1 year, checked his DHT, and found it was 499 pg/mL (= 1716 pmol/L). He then switched to finasteride 5 mg and rechecked. His DHT was then 596 pg/mL (=2050 pmol/L). To review, my DHT levels were 2031 pmol/L after 9 months on dutasteride. So similarly, for him, dutasteride and finasteride provided no useful DHT suppression.

I am betting there is a certain percent of the population for which these 5-alpha reductase inhibitors simply do not work. Our 5-AR enzymes are probably abnormally structured such that finasteride/dutasteride can't bind to them to block their action. So we just go on making DHT endlessly as if the med isn't even there.

I will find out for sure in around 4 weeks after a few more blood tests. After that, I might look around to see if I can find a geneticist interested in sequencing my 5-AR encoding DNA for research purposes and to document this phenomenon. It would be useful to know about, since most doctors are not routinely checking DHT levels for people on these meds. Perhaps they should be. They just assume the meds will work. That's likely a flawed assumption.

I'm ordering some RU58841 tonight. If my DHT can't be suppressed, that's the only viable option left.

(DHT unit conversion factor of 3.44 for pg/mL to pmol/L used as per: http://www.questdiagnostics.com/dms/Documents/test-center/si_units.pdf)

 

[RoyD]

Hi rockhair,

It's been months since I've come on this forum so you're lucky I arrived in time to answer your question. Anyways I'm not sure if I should be happy to find someone else with the same situation as me.

I think you read the post I made after I took the third test. I had initially taken a test while I was on dutasteride for over a year and you've seen the figure. I had also taken a PSA test since many people were saying that DHT tests can be inaccurate at times. The results for those were slightly abnormal (which it should be if I'm on anti androgens) but nothing which could ascertain that the meds were working or not.

I had actually though that the meds were of poor quality or fake because they were generic Indian meds so I decided to take the test on a different brand of Finasteride but the results were bad again.

Right now I'm still on the same Dutasteride and I'm not even sure why I'm still taking it. Hope I guess. I think the only way to surely find out is to stop taking any anti androgens for a few months and then getting tested. I'm too scared to do that because the last time I went from dutasteride to finasteride I shed badly.

I feel quite helpless right now because RU is not an option for me. dutasteride was my last resort. I may some day take another test while not on dutasteride but for now I don't see myself doing it. I do hope that we can get this figured out though.

 

[JDW]

I've been on different combinations of finasteride/dutasteride for years and currently on 0.5 dutasteride and 2.5 finasteride daily. Maybe it has slowed it down, we will never know because maybe I'd be in the exact same position without the drugs. What I know is that I have always shed a lot of hair and hair loss is progressing. Maybe this bears out your theory above that somehow these drugs just do not work for some in reducing DHT.

Again, without a parrallel universe where I never took any meds I will never know...

 

[TinTon]

Again, without a parrallel universe where I never took any meds I will never know...

Haha that's the one prospect of taking finasteride that annoys me the most.

I could be taking finasteride for 30 years and will never know 'if' or 'by how much' my balding would of progressed if I had never taken it, whilst at the same time being too scared to stop finasteride and find out.

With finasteride you're damed if you do and dammed if you don't. It's a cruel world for those of us who are going bald.

 

[OSWALD]

Every person has different genotypes for to produce alpha reductase enyzme system.

Some people who have high Xanthine Oxidase enzyme levels have naturally high alpha reductase and DHT levels.

Use allopurinol which is xanthine oxidase inhibitor and check it repeatly after 3 months..

 

[Illu2ion]

I've heard stories about people who have had finasteride working for them whereas dutasteride didn't. If, after your next bloodtest, your DHT-levels are still well within normal ranges, I would try getting on finasteride and testing your bloddlevels yet again after a few weeks.

 

[hope777]

However, I just got some bloodwork to check my hormone levels, and I was shocked to see my DHT does not seem to be suppressed at all. :shock:

Results were as follows. Normal range is in brackets.

DIHYDROTESTOSTERONE ______________ 2031 PMOL/L (860-3406)
SEX HORMONE BINDING GLOBULIN _____ 34.1 NMOL/L (10-70)
TESTOSTERONE _____________________ 16.9 NMOL/L (6.0-27.0)
TESTOSTERONE FREE ________________ 391 PMOL/L (196-636)
ESTRADIOL ________________________ 132 PMOL/L (0-172)
LH SERUM _________________________ 11.4 IU/L (1.2-8.6) A
FSH SERUM ________________________ 4.1 IU/L (1.3-19.3)

Your results worth nothing without having baseline results to compare it to.
It may be that you had beforehand 4000 PMOL/L (thus it helped alot) and it may be you had 2100 PMOL/L (thus it didn't help).
The only thing you can do right now in order to know what effect it has on you is stop using it for about 3 months - then check your DHT levels and see if it increased

Anyways, in case dutasteride doesn't have an effect on you - you may try finasteride since finasteride and dutasteride work on different genetic variation of the 5aR enzyme.

 

[Pequod]

I am getting back some blood tests myself and expect to see somewhat normal levels too. From what I have read testosterone testing is pretty accurate and DHT testing is not so accurate. Had you been tested prior to taking dutasteride you would be able to see if it was working by the testosterone levels as well as the DHT numbers.

You can go off of dutasteride for a couple months then get tested again by the same lab and see what the numbers are. That should tell you if it worked or not. I would not draw any conclusion based on this one test alone.

 

[mjg90]

Out of curiosity how has your testosterone changed? I get bloods twice a year since I was 18 (now 21) my normal test (total) is 450-550. My most recent test they came back at 1200. No complaints but I thought finasteride, if anything, would lower my testosterone... not more than double it