hair today gone tomorrow said:
BTW socks, I know youve been on oral spironolactone + finasteride for awhile and now you are just takin 5mg of finasteride E.O.D. What is your opinion on dutasteride?
Dutasteride looks good on paper and without a doubt works well for many men... I certainly would not discount Dutasteride as a possible treatment. However:
I think
every guy should try Finasteride first and give it a fair 1 - 2 yrs before considering Dutasteride. The reason?
1 - Cost. Finasteride is dirt cheap.
2- Finasteride is effective in the vast majority of men. There is not a need to jump to dutasteride if finasteride is going to do the job right?
3- The main cause for hairloss in genetically predisposed individuals is DHT produced via the Type II 5ar in the hair follicle cell itself. The Type I 5ar plays little to no role in male pattern baldness as demonstrated in pseudohermaphrodites (men born with the inability to produce the Type II 5ar but can produce the Type I 5ar) who never go bald as well as the studies done by Merck with MK386 (a Type I 5ar inhibitor that showed no or little effect on male pattern baldness).
The main reason dutasteride is more effective then finasteride is because it inhibits more Type II 5ar then 1mg of Finasteride. The inhibition of the Type I 5ar simple makes side-effects more probable as well as causing a higher upregulation of Testosterone (finasteride does too but not as much as dutasteride). Testosterone, like DHT, is an androgen and can contribute to hairloss just the same as DHT (though to less of an extend since it isnt as 'potent'). I personally think the reason why some men get frontal recession on dutasteride is because of this testosterone upregulation.
Lastly, DHT is not just some stupid hormone that does nothing but cause hairloss. IMO, it makes no sense to reduce DHT anymore then you absolutely -have- to. Again, if finasteride can do the job use finasteride.
So in summary, Dutasteride is a good drug and it works well for some men where Finasteride may not (perhaps due to pharmacogenetics or perhaps due to over-sensitivity to androgens like DHT). It is more expensive however, inhibits more DHT overall then is really needed, has a very long half-life once you build up a steady state of the drug into your system, and causes a higher degree of Testosterone upregulation.
Personally, Dutasteride has always been my last resort drug. I would personally sooner use finasteride and spironolactone over dutasteride... But that is just me. I have wrote a lot on this subject and this really is just a brief summary... But that's the 'just' of it.
