Shouldn't Dutasteride be more effective than it is?

[Dench57]

I know this has been talked about before. Just fancied getting some discussion going on why Dutasteride, which supposedly inhibits 95% of DHT, doesn't seem to work as well as it should. Of course it works very well for many people, but we still see plenty of people on here still losing ground with dutasteride, or saying "dutasteride destroyed my hairline" etc. Which is why people turn to RU and other experimental treatments.

If we ignore side effects, surely this should be pretty much a cure for everyone? We generally recognise that DHT attaching to the androgen receptor in the DP of the hair follicle is what sets off miniaturisation. How could a 95% reduction of DHT not stop male pattern baldness dead in its tracks for almost everyone? What other factors are there to consider? Could it be the upregulation caused by the drop in DHT, making our receptors much more sensitive to the remaining 5% DHT which means people continue to lose ground?

 

[Wolf Pack]

I think once male pattern baldness starts, DHT inhibition on it's own is not enough for some people. DHT is the first step, but much more happens after in terms of growth factors, prostaglandins e.t.c which lead to hair thinning.

Don't quote me on this but if you get castrated before puberty, male pattern baldness is not possible. But if someone is castrated after the onset of male pattern baldness, it may still continue but much slower. Once the "signal" has been given by DHT, the process can carry on without it.

 

[GoldenMane]

I would imagine that most people who choose dutasteride over finasteride have more aggressive cases, and most people who switch from finasteride to dutasteride do so because their case is becoming more aggressive.

Maybe dutasteride isn't destroying hairlines? Maybe it's just male pattern baldness becoming more aggressive and the coinciding switch to dutasteride isn't enough to prevent hairline hair loss?

DHT is only half the equation, follicle susceptibility is the other. A castrate with very low levels of DHT may still have very susceptible hair follicles and may eventually go bald, even under very low levels of DHT, same as we, even on drugs like dutasteride that greatly inhibit DHT, may also still go bald because our hair follicles are still susceptible to even low levels of DHT.

Ideally we should treat male pattern baldness by both inhibiting its production and introducing something that out competes it at follicle binding sites.