Unsure Whether To Start Dutasteride Treatment. Considering Topical And Microdosing.

[22&Balding]

So the dermatologist prescribed me avodart 0.5 mg three times a week, but I'm doubting whether I should start the treatment due to some things that I've read.

First, I'm concerned that dutasteride may have more severe side effects than finasteride because it inhibits a higher percentage of DHT. Sure, that's great for the hair, but probably not so much for the rest of the body. I've also read that, as opposed to finasteride, dutasteride inhibits the formation of certain neurosteroids and I'm concerned about how that may affect me in the long run. I was already quite worried about getting on finasteride, so dutasteride seems pretty hardcore for me. At least at the standard dosage.

I've found a chart that compares the effects of different doses of dutasteride, finasteride and placebo on DHT levels:

It appears that 0.5 mg of dutasteride reduce DHT levels by a greater margin than 5 mg of finasteride, but it also takes quite a long time for the DHT levels to go back to normal as compared to finasteride, and I'm not particularly fond of this.

On the other hand, 0.05 mg of dutasteride have almost the same effect on DHT levels 5 mg of finasteride have.

In spite of my concern, I was considering making my own topical dutasteride with a much smaller dosage than that prescribed to me, as it seems more reasonable and safer to me, but I'm not sure how to make it, as there doesn't seem to be information on the internet about this specific topic.

Can I just grind the dutasteride tablets and dissolve them in liquid Minoxidil? If so, I should dissolve six 0.5 mg tablets in a 60 ml Minoxidil bottle if I want to apply 0.05 mg of dutasteride with 1 ml of Minoxidil, right? Or should the dosage of topical dutasteride be lower than that of oral dutasteride?

Thank you, and excuse me if you struggle to understand some of the things I wrote, English is not my first language.

 

[Anatoly]

All your concerns and Qs are intuitive and have little to do with how these things work. Do your research of academic articles with proper statistics, start here: https://clinicaltrials.gov. There are solid p-values indicating that dutasteride is better tolerated despite being more potent.
Forget about % DHT inhibited, this does not directly translate into combating hair loss.
One cannot interpret this graph without the context of the trial (its goals...). It's about pharmacokinetics and pharmacodynamics, not about effectiveness or sides. Based on this graph, probably the most important thing you need to know is: in case you would like to become a farther, you'll have to wait longer after dutasteride discontinuation (6-12 month).

Using topical dutasteride won't prevent its systemic absorption - e.g. pregnant women are not allowed to touch a damaged capsule, as dutasteride will get through skin into the blood and affect their baby - it's in prescription info.
Dissolving it in minoxidil solutions is a bad idea.

 

[Hair-pun]

It's always difficult to know whether and when to start a new treatment for hair loss so I guess the best thing to do is read as much as you can on here about other people's experiences- but don't wait too long. I can tell you that for me dutasteride 0.5 every day was significantly more potent at the back of my head where i had some regrowth. However, I continued to lose at the front at the same rate as on finasteride. So, I would say have RU ready to go and if you notice this happening start using it at 3-5% in stemoxidine (it's easy to mix yourself) on the front. Many people suggest that it is just a shed from the front, but I can tell you that it cost me a great deal of hair believing this for 7 months, when I was already way past a hair density that I was happy with. I was also worried about dutasteride's impact on neurosteroids so I waited and waited until I became so desperate that I just didn't feel i had a choice any more, now I regret waiting because if I had taken dutasteride from the minute that finasteride stopped working I would probably still be a Norwood 1/2 and would have had time to stabilise at the front on another treatment. Now I am a 3 and looking in the mirror is hard. My advice is to take it because it's likely that at some point you will start it and the earlier you do the more hair you'll save. Also, dutasteride is not a miracle cure and may not stabilise you at the front. You need about 6 months to become aware of this, so the more hair you have when you start, the more time you have to add something else if it doesn't stabilise you. Also my derm, who is extremely cautious, is not worried about me being on dutasteride 0.5 every day so I don't think there is too much risk really. The real risk is losing so much hair that it significantly impacts on your quality of life. I have just lost almost a year to crippling depression caused by screwing up the transition to dutasteride, I don't want others to make the same mistake. Good luck!

 

[22&Balding]

Forget about % DHT inhibited, this does not directly translate into combating hair loss.

Can you explain this in more detail?

One cannot interpret this graph without the context of the trial (its goals...).

Excuse my ignorance, but why would it make any difference what the goals are? It wouldn't change the fact that a x dose of dutasteride decreases DHT levels by y%, or is there something else to understand that I'm missing?

It's about pharmacokinetics and pharmacodynamics, not about effectiveness or sides. Based on this graph, probably the most important thing you need to know is: in case you would like to become a farther, you'll have to wait longer after dutasteride discontinuation (6-12 month).

You make a good point here, but can you really lower the levels of a hormone by 90+% and expect no repercussions? If so, why does the hormone even exist? Maybe my intuition is seriously flawed, I don't know.

Using topical dutasteride won't prevent its systemic absorption - e.g. pregnant women are not allowed to touch a damaged capsule, as dutasteride will get through skin into the blood and affect their baby - it's in prescription info.

I have seen some studies before that show topical finasteride reduces dht in the scalp in a higher percentage than oral finasteride, while reducing in a lower percentage in the rest of the body.

Dissolving it in minoxidil solutions is a bad idea.

]

Really? I'm pretty sure people people do this with finasteride. Why is it a bad idea?

Thank you for your response.

 

[22&Balding]

It's always difficult to know whether and when to start a new treatment for hair loss so I guess the best thing to do is read as much as you can on here about other people's experiences- but don't wait too long.

The problem is the more I read the more undecided and confused I become lol

I can tell you that for me dutasteride 0.5 every day was significantly more potent at the back of my head where i had some regrowth. However, I continued to lose at the front at the same rate as on finasteride. So, I would say have RU ready to go and if you notice this happening start using it at 3-5% in stemoxidine (it's easy to mix yourself) on the front. Many people suggest that it is just a shed from the front, but I can tell you that it cost me a great deal of hair believing this for 7 months, when I was already way past a hair density that I was happy with.

I only have hair loss at the front, so we'll see. Does RU give you any sides?

I was also worried about dutasteride's impact on neurosteroids so I waited and waited until I became so desperate that I just didn't feel i had a choice any more, now I regret waiting because if I had taken dutasteride from the minute that finasteride stopped working I would probably still be a Norwood 1/2 and would have had time to stabilise at the front on another treatment. Now I am a 3 and looking in the mirror is hard. My advice is to take it because it's likely that at some point you will start it and the earlier you do the more hair you'll save. Also, dutasteride is not a miracle cure and may not stabilise you at the front. You need about 6 months to become aware of this, so the more hair you have when you start, the more time you have to add something else if it doesn't stabilise you.

You are probably right about this. There's just no choice.

Also my derm, who is extremely cautious, is not worried about me being on dutasteride 0.5 every day so I don't think there is too much risk really. The real risk is losing so much hair that it significantly impacts on your quality of life. I have just lost almost a year to crippling depression caused by screwing up the transition to dutasteride, I don't want others to make the same mistake. Good luck!

I hope your derm is right, but I don't know.
I'll try to avoid that the same thing happens to me.

Thank you.

 

[22&Balding]

Dutasteride has a half-life of 6 months. It will be in your system a long time after you quit. If you're only taking dutasteride 3 times a week then you're really only taking a .2mg dose.

Well, that's a bit concerning. But maybe I'm just being paranoid in a stupid way lol.

Topical finasteride has the same side effects as oral finasteride, in other words it goes systemic just like the oral version.

Sure, but according to some studies it lowers more DHT in the scalp and less in the rest of the body than oral finasteride. I guess that should translate to a more positive effect on hair loss while while lowering the side effects. But maybe I'm wrong, I'm not even remotely an expert.

There is no point in using it topically instead of orally. Dutasteride is a large molecule that isn't easily absorbed topically, the dose would have to be much higher than the oral dose in order to work. It's not a good idea if you actually want your hair back. Just swallow the pill.

Well, that's a problem if true. I don't know what to do. Is finasteride more easily absorbed through the skin than dutasteride?
Thank you.

 

[pegasus2]

Well, that's a bit concerning. But maybe I'm just being paranoid in a stupid way lol.


Sure, but according to some studies it lowers more DHT in the scalp and less in the rest of the body than oral finasteride. I guess that should translate to a more positive effect on hair loss while while lowering the side effects. But maybe I'm wrong, I'm not even remotely an expert.

I haven't seen that study? If that were the case then I would think that topical finasteride would give better results, but from what we see in this trial oral finasteride is more efficacious than topical, and the side effects are virtually identical.
https://clinicaltrials.gov/ct2/show/results/NCT03004469

Well, that's a problem if true. I don't know what to do. Is finasteride more easily absorbed through the skin than dutasteride?
Thank you.

Yes, finasteride is easily absorbed through the skin.

 

[22&Balding]

I haven't seen that study? If that were the case then I would think that topical finasteride would give better results, but from what we see in this trial oral finasteride is more efficacious than topical, and the side effects are virtually identical.
https://clinicaltrials.gov/ct2/show/results/NCT03004469



Yes, finasteride is easily absorbed through the skin.

There's a thread about one of the studies I mentioned: https://www.gourmetstylewellness.com/interact/threads/new-topical-finasteride-study-efficacy-sides.117896/

There was also a study that showed the scalp DHT levels were reduced by a greater percentage with topical than with oral. Will try to find it later.

It's weird how different studies about this subject can give completely different results. I don't know what to trust anymore, TBH.

 

[Hair-pun]

I have had no sides on RU but I must stress it isn’t a trialed drug so there is some risk involved in using it- I don’t know how much risk. All I know is that I’m out of approved options and if I lose any more hair its going to ruin my life, so I’m taking the gamble. I think try dutasteride first but be ready with RU or CB if it starts going south

 

[pegasus2]

There's a thread about one of the studies I mentioned: https://www.gourmetstylewellness.com/interact/threads/new-topical-finasteride-study-efficacy-sides.117896/

There was also a study that showed the scalp DHT levels were reduced by a greater percentage with topical than with oral. Will try to find it later.

It's weird how different studies about this subject can give completely different results. I don't know what to trust anymore, TBH.

This only compares minoxidil to minoxidil+topical finasteride. The hair count change here for topical finasteride + minoxidil is basically the same as for oral finasteride alone in this study:

The only thing the study in that thread proves is that topical finasteride/minoxidil is more efficacious than minoxidil alone. You don't need a study to tell you that. It doesn't say anything about inhibiting more scalp dht than oral finasteride. How could it when they didn't even test oral finasteride?

 

[Anatoly]

Can you explain this in more detail?
------- You can regularly measure your T and DHT (o finasteride, on dutasteride...). The fact that they are measurable does not make this analysis useful. This is just a surrogate marker and does not adequately predict hair regrowth - e.g. all things being equal, a guy may take an Avodart capsule once per week and see regrowth, another guy may take a capsule daily and see no regrowth - only slowing down hair loss progression. A lot depends not on relative changes in T and DHT, but on one's genetically determined androgen receptors sensitivity.
The only thing that worth of concern is that if your T level is substantially lower than the upper limit of the normal range; dutasteride raises T better than finasteride

Excuse my ignorance, but why would it make any difference what the goals are?
----- ---- A trial's design is everything, a long story to tell here.
It wouldn't change the fact that a x dose of dutasteride decreases DHT levels by y%, or is there something else to understand that I'm missing?
------- Dozens of other variables and dozens of conditions under which the changes in the values of these variables can be adequately compared...


----- ---- Ja, dutasteride at a certain dose decreases DHT by certain %, so what?.... These different doses of dutasteride were examined to determine the most effective one that is 0.5mg, as 5 mg does not give much additional benefit but bears higher risk of sides. Determining the best reasonable dose is a normal process of clinical trials (at a certain phase) of a new drug.

You make a good point here, but can you really lower the levels of a hormone by 90+% and expect no repercussions? If so, why does the hormone even exist?
What do u mean? Side effects? Dutasteride at 0.5mg has a better side effects profile that finasteride at 5mg daily - this runs against intuition.
Irreversible side effects? Dutasteride/finasteride effects are reversible, in case of dutasteride it takes longer. This is an advantage of these drugs - unlike things like Cyproterone (which blocks androgen receptors) and e.g. RU (that has never been approved for anything...) that lead to irreversible effects even long after discontinuation (incl. with respect to your ability to become a farther of a healthy child).

Maybe my intuition is seriously flawed, I don't know.
------- human body is extremely complex, and our intuition based on daily life experiences does not often work here

I have seen some studies before that show topical finasteride reduces dht in the scalp in a higher percentage than oral finasteride, while reducing in a lower percentage in the rest of the body.
------ It does not matter.
]

Really? I'm pretty sure people people do this with finasteride. Why is it a bad idea?

----- Yes, they do. And people also take crazy things like Cyproterone or RU. And do many other things that are not well science-based.

The logic of using it topically is understandable, but not reasonable unless you take it orally as well. Taking finasteride.dutastsride orally and its better systemic absorption allows better T increase (which is good) and better down regulates your AR sensitivity.

Thank you for your response.[/QUOTE]

 

[22&Balding]

This only compares minoxidil to minoxidil+topical finasteride. The hair count change here for topical finasteride + minoxidil is basically the same as for oral finasteride alone in this study:


View attachment 139989

The only thing the study in that thread proves is that topical finasteride/minoxidil is more efficacious than minoxidil alone. You don't need a study to tell you that. It doesn't say anything about inhibiting more scalp dht than oral finasteride. How could it when they didn't even test oral finasteride?

Yeah, but don't studies on oral finasteride show that it decreases serum DHT by 60-70%? This study shows topical finasteride decreases significantly less DHT than that, and you mention that it has the same results than oral in other studies, if I understood you correctly. That could be a good thing, at least theoretically.

 

[22&Balding]

You're forgetting that this is topical finasteride in combination with minoxidil vs the other study being oral finasteride alone. Combine oral finasteride with minoxidil and it blows topical out of the water. Combine oral finasteride with oral min for even better results.

You are right, but if the results of using topical finasteride are good enough and the decrease in serum DHT levels is much lower than with oral finasteride plus minoxidil it may be a good alternative, even if the results of oral finasteride+Minoxidil are better. I mean, oral finasteride alone has pretty good results in most people already, from what I read.

 

[22&Balding]

Can you explain this in more detail?
------- You can regularly measure your T and DHT (o finasteride, on dutasteride...). The fact that they are measurable does not make this analysis useful. This is just a surrogate marker and does not adequately predict hair regrowth - e.g. all things being equal, a guy may take an Avodart capsule once per week and see regrowth, another guy may take a capsule daily and see no regrowth - only slowing down hair loss progression. A lot depends not on relative changes in T and DHT, but on one's genetically determined androgen receptors sensitivity.
The only thing that worth of concern is that if your T level is substantially lower than the upper limit of the normal range; dutasteride raises T better than finasteride

Excuse my ignorance, but why would it make any difference what the goals are?
----- ---- A trial's design is everything, a long story to tell here.
It wouldn't change the fact that a x dose of dutasteride decreases DHT levels by y%, or is there something else to understand that I'm missing?
------- Dozens of other variables and dozens of conditions under which the changes in the values of these variables can be adequately compared...


----- ---- Ja, dutasteride at a certain dose decreases DHT by certain %, so what?.... These different doses of dutasteride were examined to determine the most effective one that is 0.5mg, as 5 mg does not give much additional benefit but bears higher risk of sides. Determining the best reasonable dose is a normal process of clinical trials (at a certain phase) of a new drug.

You make a good point here, but can you really lower the levels of a hormone by 90+% and expect no repercussions? If so, why does the hormone even exist?
What do u mean? Side effects? Dutasteride at 0.5mg has a better side effects profile that finasteride at 5mg daily - this runs against intuition.
Irreversible side effects? Dutasteride/finasteride effects are reversible, in case of dutasteride it takes longer. This is an advantage of these drugs - unlike things like Cyproterone (which blocks androgen receptors) and e.g. RU (that has never been approved for anything...) that lead to irreversible effects even long after discontinuation (incl. with respect to your ability to become a farther of a healthy child).

Maybe my intuition is seriously flawed, I don't know.
------- human body is extremely complex, and our intuition based on daily life experiences does not often work here

I have seen some studies before that show topical finasteride reduces dht in the scalp in a higher percentage than oral finasteride, while reducing in a lower percentage in the rest of the body.
------ It does not matter.
]

Really? I'm pretty sure people people do this with finasteride. Why is it a bad idea?

----- Yes, they do. And people also take crazy things like Cyproterone or RU. And do many other things that are not well science-based.

The logic of using it topically is understandable, but not reasonable unless you take it orally as well. Taking finasteride.dutastsride orally and its better systemic absorption allows better T increase (which is good) and better down regulates your AR sensitivity.

Thank you for your response.

[/QUOTE]

I don't know, man, I'm getting a bit out of my depth here. All I'm trying is to find a balance between effectiveness and side effects, and I think the lower dose of dutasteride I take, the better (surely larger doses can't have a positive impact on sides, can they?). As long as it gives me satisfying results.

How about taking 0.05 or 0.1 mg of oral dutasteride three times a week instead of 0.5 mg?

 

[22&Balding]

Well regardless of DHT levels the side effects reported in the trials are the same, so it doesn't appear to be any safer. Finasteride is such an ineffective treatment to begin with so why would anyone want to water it down? My advice is listen to your doctor and take the dutasteride he prescribed you. It's much more effective and has the same safety profile as finasteride. Most of the side effects are psychological anyways. If you tell someone they won't be able to get an erection if they take a pill they aren't going to be able to get an erection regardless of what is actually in the pill. It's completely in the head most of the time.

I still can't wrap my mind around the fact that decreasing the levels of a hormone by 90%, or even by 50% percent could have no impact on one's health whatsoever, as some studies seem to suggest.

 

[Anatoly]

All I'm trying is to find a balance between effectiveness and side effects, and I think the lower dose of dutasteride I take, the better (surely larger doses can't have a positive impact on sides, can they?). As long as it gives me satisfying results.

How about taking 0.05 or 0.1 mg of oral dutasteride three times a week instead of 0.5 mg?[/QUOTE]

I suspect it's too low. This is all too hypothetical. If you believe so strongly that you'll suffer from sides, you certainly will suffer - placebo is very powerful). I suggest taking Avodart capsule daily. You won't die. Generics vary in quality and may be less tolerable than Avodart (auxiliary substances, impurities etc). Take it for at least a month along with some stress-relieving medication (you're already stressed), ask your doctor for some antidepressant or alternatives to combat your fears of sides. In a month evaluate whether you can tolerate .5 mg daily. If not, reduce the dose to .5 mg every other day.
I've been taking a capsule daily for almost 8 months and experience nothing; this experience is not applicable to you of course, you need your trial. Although at the beginning when I was reading various creepy stories about sides I started to 'experience' them myself - this issue was resolved with some stress-reducing techniques.

 

[22&Balding]

DHT is just a metabolite of testosterone. You still have testosterone in your body doing everything that DHT did. The difference is DHT is more potent. Once your fully grown you don't need that extra potency anymore. It becomes mostly a negative thing with its main actions being body hair growth, male pattern baldness, and prostate enlargement.

I wish you were right, but I have my doubts.

There seems to be some evidence that DHT has a protective effect against diabetes and cognitive impairment, and according to this study, "treatment of benign prostatic hyperplasia (BPH) with the commonly prescribed Avodart (Dutsteride) may put men at an increased risk for diabetes, elevated cholesterol levels, non-alcoholic fatty liver disease (NAFLD) and worsening erectile dysfunction". I don't know if the later is directly related to the decrease of DHT levels caused by dutasteride, but it looks likely.

 

[22&Balding]

I Suspect it's too low. This is all too hypothetical. If you believe so strongly that you'll suffer from sides, you certainly will suffer - placebo is very powerful). I suggest taking Avodart capsule daily. You won't die. Generics vary in quality and may be less tolerable than Avodart (auxiliary substances, impurities etc). Take it for at least a month along with some stress-relieving medication (you're already stressed), ask your doctor for some antidepressant or alternatives to combat your fears of sides. In a month evaluate whether you can tolerate .5 mg daily. If not, reduce the dose to .5 mg every other day.
I've been taking a capsule daily for almost 8 months and experience nothing; this experience is not applicable to you of course, you need your trial. Although at the beginning when I was reading various creepy stories about sides I started to 'experience' them myself - this issue was resolved with some stress-reducing techniques.

Thanks for the advice, but I don't think I will need antidepressants.

I think my worries aren't unreasonable. As I said, I doubt suppressing a hormone can have no effects on the body, even if there aren't any immediate or noticeable symptoms. The hormone is unlikely to be there for no reason. I guess I'm more concerned about long term use (see the comment above).

 

[Here For the Lulz]

Just remember to slather a generous helping of the topical variety on your balls and good to go

 

[Anatoly]

Your logic is understandable, but insufficiently justified. Note again: dutasteride will raise your T, which is very important. DHT is not of much use when you're adult - to put it simply. Logic like yours is widespread when patients fear taking a drug that lowers/inhibits smith, assuming that 'smth' is actually needed. e.g. large numbers of people take different immunosuppressants - one can reasonably assume that suppressing your immune system is not a good thing, while immunosuppression can well raise your life expectancy (minus risk profile - e.g. infections etc). This logic is also widespread among those who deny statins - these drugs lower your cholesterol and CRP. They also argue that cholesterol is produced for a purpose and prefer to die of a heart attack or stroke. Human body is more complex that that. Do your research about sides in the long term - the data (types of events, frequency of adverse events etc) are abundant.

Long-term consequences of dutasteride have been well studied. A serious concern is erectile disfunction - this is rare and difficult to distinguish from a normal ageing process over e.g. a decade. Another concern is cancer: earlier accounts raised concerns about a slight increase in the incidence of prostate cancer. However, in 2020 it's quite established that long-term dutasteride use decreases the risk of prostate cancer.