Dutasteride Works when Finasteride Fails

In 2021, the single most important drug in the fight against hair loss remains Dutasteride (brand name Avodart). However, it is not approved for that use by the US FDA. I have written numerous past posts on Dutasteride to treat male pattern hair loss.

The most useful one remains my Avodart reviews for hair loss post due to the vast number of reader comments. Also see my posts on Dutasteride injections (also knows as mesotherapy).

Dutasteride v/s Finasteride Dosage and DHT Reduction
Dutasteride reduces more Dihydrotestosterone (DHT) than Finasteride.

Dutasteride more Potent than Finasteride

Every week I search PubMed for the latest papers on Dutasteride and hair loss. This week, I discovered an important new June 2021 study that was just published. It is titled:

“Change in hair growth-related gene expression profile in human
isolated hair follicles induced by 5-alpha reductase inhibitors: dutasteride and finasteride.”

The findings of this study are quite interesting and related to something similar that I published in 2014 (see old post at bottom). Note that this latest work was led by Japanese researchers and funded by GlaxoSmithKline (GSK), the manufacturer of Avodart.

It is encouraging to see GSK still interested in Avodart for hair loss. They will almost certainly not try to get the drug approved to treat hair loss in the US or EU. To date, Japan and South Korea remain the only countries where you can officially use Dutasteride to treat hair loss.

In the rest of the world, the drug is prescribed to treat enlarged prostates (BPH) in older men. For hair loss, you need off-label prescriptions. Also note that on average, side effects from Dutasteride are worse than from Finasteride.

Although GSK is headquartered in the UK, this particular research was affiliated with the company’s Singapore subsidiary. Professor Manabu Ohyama (who I have covered in the past) gave advice on the study protocol and methodology.

Key Findings

The key findings of this latest paper on Dutasteride (and Finasteride) include:

  • Dutasteride and Finasteride both suppressed the negative effects of testosterone on hair-related gene expression.
  • In particular, the gene expression for growth factors FGF7, IGF1 and WNT5a.
  • Dutasteride may have a stronger inhibitory potency to increase growth factor expression than Finasteride.
  • Dutasteride’s greater efficacy on hair growth in comparison to Finasteride is possibly due to the inhibition of 5α-reductase Type 1; or due to greater inhibition of 5α-reductase Type 2 by Dutasteride when compared to Finasteride. My note: most likely both issues are at play per next conclusion.
  • The authors claim that there results suggest that: “Type I 5 alpha reductase may play an important role in hair growth along with Type II 5 alpha reductase.

I forgot that this issue of the significance of Type 1 5α-reductase in relation to hair loss is still unresolved. My guess is that Type 1 is significant, but not quite as significant as Type 2. Dutasteride attacks both Type 1 and Type 2, while Finasteride only attacks the latter.

Make sure to also read my post on destroying androgen receptors on the scalp.

June 8, 2014

Dutasteride Works when Finasteride Fails

An interesting study by South Korean scientists was recently published in “The International Journal of Dermatology”.  It measured the effect of Dutasteride on men with androgenetic alopecia unresponsive to treatment with Finasteride.

They took 35 balding people who did not see any improvement while on Finasteride 1 mg/day for 6 months. They then put those same people on Dutasteride 0.5 mg/day for 6 months.  31 of those patients completed the 6 months of treatment.  Hopefully, the 4 who stopped treatment did not stop due to experiencing significant side effects.

Over three-quarters of these 31 patients saw at least some increase in hair count. Only 1 patient had a marked improvement, while 6 patients had a moderate improvement and 17 patients had a slight improvement. The remaining 7 patients did not see any improvement or worsening.

Side effects included transient sexual dysfunction in 6 patients (17.1%).

50 thoughts on “Dutasteride Works when Finasteride Fails”

    1. Does this mean that if Fin doesn’t work *at all* (as in, there is absolutely no slowing of hairloss, or possibly even an acceleration of hair loss perhaps due to upregulation) that Dutasteride may in fact at least temporarily reverse or halt the balding process?

      Reading over the article I wasn’t able to determine whether they defined Finasteride as “not working” simply by a lack of regrowth at 6 months, or a complete failure to halt miniaturization altogether.

      As someone who can literally take a six inch strand of hair and watch it thin from tip to root all the way down, I’m more than a little desperate for anything that could help.

  1. There are some fairly common side effects of Avodart:

    — Impotence.
    — Reduced sex drive.
    — Difficulty ejaculating.
    — Breast augmentation, discomfort or pain.

    Will my hair fall out again when I stop treatment for a year of effective results?

    Will my side effects return to normal after stopping treatment?

  2. I had the beginnings of gyno when I took Avodart every day (0.5mg). I stopped for a few months and then jumped back on but only took it once every 7 days. That was the sweet spot for me. It really saved my crown and vertex.

    1. Saved my crown too (for now). But I might have gained 10 lbs on the drug. Though can never be sure as my lifestyle changed a bit too over the years.

  3. Not risking those side effects – not worth it to me. I’ll transplant the hair from my backside first (joking – I’m not actually going to do that lol).

    But seriously, the best drugs they have available for hair loss have side effects (potentially) that are that horrible? It’s comical. Sure, grow your hair back….and retire your light sabers. No thanks. I’m going to need the saber for a good many years.

    1. Over 60 percent of adult Americans got the mRNA vaccines with no idea about potential long-term side effects. Even many infants and toddlers will get injected soon I am guessing. At least Avodart has 20 years of side effect data!

      1. I get what you’re saying. It was a risk of course taking the vaccine but the risk, for many, outweighed the risk of covid. I’d say this is a bit different. It’s hair loss, not a virus. Though I would bet the psychological damage for many is real when it comes to hair loss.

        I’d rather have unknown side effects to be honest than a light saber deficiency. Actually, I’d rather have my ear fall off than lose my light saber. Not worth it for me. Hard (pun intended) pass lol. But to each their own. It’s a personal decision. Just like the vaccine.

      2. I think you are wrong here. mRNA vaccines shouldn’t have any long term effect, they just build antibodies against covid, once they are built, the vaccine don’t play any role. So you can expect short term effects, but no long term effects.

      3. Admin did you see the story about mRNA vaccines causing heart inflammation? scary. If I already had heart problems I wouldn’t even get vaccinated. It’s literally still an experiment like you said, and just for the other people reading this I’m not anti vaccination I’ve been vaccinated my whole life I just choose not to do this one. And I don’t have any underlying health problems. 33million cases in the U.S. and 600k deaths give me a break. 183 million cases world wide of covid and only 4 million deaths.

    2. I have been taken 1mg Fin per day for nearly 2 years. All my hair has grown back. I have never experienced any side effects from taking Fin.

  4. If anyone isnt on any treatments and wants to participate in a hairloss trial, let me know. But you would have to be in the Philadelphia, Delaware, New York area. Topical applied daily. Have to pick up the topical on a weekly basis and the office is in NY. I cant go forward with it unless someone can take turns with me picking up the topical. I can’t drive up their every week. Male and female welcome. Please let me know your location and if interested? Thanks

    1. Hey Tom, can you elaborate if this is for a company or well known product? No worries if confidential info.

  5. That chart you posted is not encouraging. At 4 months (!) after ceasing the use of Avodart, DHT has STILL not returned to baseline.

    If you wind up getting side effects from 5ar reduction, you’re gonna have a reeaaal bad time on Avodart. Do we even know if it EVER returns to baseline?

    Not good.

  6. In like 90% of the cases i saw most of the ppl go for dut when fin failed!

    They almost always complain on worst shed without recovering.

    Its even hard to find positive review on dut compare to fin.

  7. That study seems accurate. I’ve been on dutasteride for about 6 years. It isn’t a perfect drug and I have gone below baseline. It has actually slowly given me side effects which, after 6 years, has now turned into me developing gyno issues and my free T is very low, thus now needing trt. My advice to anyone, if you don’t respond like me, try something like Ru58841 or even topical/oral minoxidil. I have a friend that won’t touch AA’s and he uses minoxidil. It’s working great for him.


  8. Admin, the trial is by Dr. Peter C. Friedman, President, The Skin Center Dermatology Group, New City, NY. The trial uses indirect cold physical plasma. They had success in the previous trial so they want to pursue it further. I’m really hoping a couple people (male or female) that live closer to me would take turns going to pick up the solution. It needs to be picked up weekly. I want all to know I’m professional, no worries about me disclosing your identity to anyone lol. I’m in the Philadelphia area. I need to think outside the box here in order for me to take advantage of such a nice opportunity! Admin if there is anyway you can assist, I’d appreciate it. Any other questions please let me know.

    1. I will post about it in our hair loss chat on Discord. If you want to join the chat, let me know too (but only if you plan to use Discord at least once or twice a month)!

  9. Sure I’ll join your discord. I have it on my phone but never used it before. How do I join your group?

  10. Lol. no kidding. Jesus, and we already know this back in the early 2000s . Problems are the tons of more side effects, including the metabolics one that Finasteride don’t have ( liver damage and diabetes ) .

  11. I was sitting with the cat today and looked at him thinking…his fur is pretty thick, eh? Cat fur to human head?

    I’m kidding. But man that would be soft lol

    1. Had the same though one time when I saw a male lion on a safari. And also whenever I see the MGM studio mascot on TV.

    1. FYI — I e-mailed Dr. Friedman in May and got a decent response. He mentioned how the treatment as yet was not meant for hair growth, but they were conducting a small pilot trial for that purpose.

  12. Has anyone heard anything lately about Dr Karl Koehler working on AGA after last year’s breakthrough published study? like others have said from listening to his interviews he didn’t seem like he really wanted to work on or wanted his breakthrough to help AGA he wants to fix burns and scars and other applications which i don’t have problem with obviously but at least show interest and work on AGA as well.

  13. I hate to burst everyone’s bubble, but stemson therapeutics is not going to come out with hair cloning until the next decade,and Dr tsuji is officially done and Dr junji is another Dr tsuji promising the world those are red flags! Right there, and tissuse is a complete and utter joke. Shiseido’s rich-01 isn’t much better than regular old minoxodil. We’re basically in the same spot we started in when I started reading this blog in 2014.Carl’s Jr sales cloned patties and were eating it but we just can’t clone a hair, and space x is not reaching mars with humans also until the next decade. In order for these new technologies to come out faster and better we need a fully working qountom computer to solve it .pfffff I bet the farm that elon musk is not reaching mars with humans on board not in this decade he has everyone fooled.

    1. buddy tell me who will fund the stemson research for so many years? If they don’t do it within 5 years, or at least they don’t make significant research, nobody will give them money, if they don’t succeed with pigs in 5 years, we won’t even remember Stemson

      1. Jan remember that link you sent me of fortunis capital in a vimeo conference video back in February . they said the pig trials were a success and they were hoping to start human trials later this year. So I don’t understand you saying if there pig trials are successful if you’re the one that showed me Video proof of fortunis capital saying it was successful,and there just waiting to start human trials. Jan bro by the way how did you find that video? I can’t find it anywhere anymore. I think Stemsons therapeutics might have taken down. But question is why you saying if they complete the pig trials when we already know the pig trials were a success? Thank you for your time Jan if you can reply back thanks.

  14. Happy Independance day to my bald/balding/battling/researching US friends. I’m sure at least some of you (like me) are envious of the guy(s) at the bbq with the good head of hair and gorgeous wife that you always desired as you sit there with your thumb up your you know what lol…yea I’ve had some drinks admin please give me a pass ha….everyone else happy Sunday!

  15. So, I switched to topical dutasteride due to sides from oral. I’m hoping it has the same effectiveness.

        1. @kiddoinc – great! I’ve been getting lots of Strut for topical dutasteride ads on my Instagram feed (along with HappyHead for topical minox).

  16. Hi Admin,

    May I know if Avodart works for frontal region as well? I am switch from Fin. And taking 5mg daily for 4 months.
    I am struggling if I should go for a transplant.


    1. Kintor is moving faster than Follica. By the time Follica’s device comes out nobody will use it cause hopefully we will have something better lol.

  17. I want to share some of my personal experiences with Fin. I went to a hair transplant doc about 2 years ago and was told that I should take Fin for a while before considering a hair transplant. My doc told me that Fin works on 70% of the population, but the result depends on each individual. I could at least see some results. I wasn’t so convinced at the very beginning, but also think there’s no harm to give it a try. So I have been taking Fin 1mg plus Menixcidol 5mg per day for nearly 2 years. The result is amazing. I got hair grew back all over my head, overall thicker, hair grows back on both the top of my head and the tempa area. I can see new hair keep growing out. At this stage, I can still have a hair transplant if I want my hairline to be perfect, but in reality, this is good enough. I just have to keep taking Fin. I have never experienced any sideaffects.

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