Testing Strut Health's Dutasteride Formula

[Pentanol]

I've stumbled upon a very interesting development.

As many of you may be aware, dutasteride is the active ingredient in the brand name, Avodart. This medication is prescribed off-label to combat androgenic alopecia and literature on its efficacy and tolerability make it an appealing option for individuals that are not content with finasteride or simply prefer the strongest, well-researched option. Recently, Strut Health, a relatively new telehealth provider, began prescribing compounded dutasteride with the option of a topical or oral version. I very much appreciate companies that are willing to go above and beyond the generic finasteride and minoxidil, so even though my current dutasteride option is cheaper, I wanted to support their efforts and began a consultation.

For those that do not want to browse the website, here is the information on it:

Strut Health is an interesting player in the hair loss telehealth industry. As far as I know, companies like Hims, Roman, Keeps and anything outside of the ancient MWC do not deal with dutasteride, so this is a promising step for those that would like an option to address hair loss outside of the FDA approved catalog. In addition to topical versions of dutasteride and finasteride, Strut incorporates tretinoin, which as been shown to increase the enzymatic activity that converts minoxidil to its active metabolite.

Strut obviously put a lot of thought to make their own formulation as opposed to selling a consultation that can be transferred to a local pharmacy, but there is nothing wrong with making their own formulation. Again, just to be clear, there is absolutely nothing wrong with prescribing a compounded formulation of a proven compound as this allows a company to make more money from their customers through their compounding pharmacy partner. To some, it may seem a little shady, but business is business and companies want to maximize profits.

Here's where the problem began:

When I read that dutasteride was compounded with biotin, I became a little suspicious as dutasteride is already susceptible to diminished bioavailability if the formulation is tweaked and adding biotin further complicates the formulation. Since an oil complex within a soft capsule is the go-to vehicle when preparing dutasteride since it has low aqueous solubility, my chemistry orientated brain became more interested in how the tablet/capsule would be prepared and the reasoning behind its preparation which can usually be found on the information sheet.

Strut Health offers:

.1mg Dutasteride + 500mcg Biotin
.4mg Dutasteride + 500mcg Biotin
.6mg Dutasteride + 500mcg Biotin

I chose the .06mg Dutasteride + 500mg Biotin option and waited for it to arrive. To my surprise, the information sheet that came with the medication was for a different product they offer, and the compound was inside a transparent capsule in the form of powder. Powder formulation of dutasteride has low dissociation when ingested, and since the buffers and compound modifier are not included, I could not even follow their reasoning as to why this would be the prepared formula. I messaged the doctor, who had otherwise been very responsive when asking if I knew the benefits and risks, but he has not replied.

How compound looks:

My messages:

As I previously mentioned, Dr. Patel had no issue responding to me when we were doing the routine consultation, but a question about the drug's pharmacokinetics, and it has been 10 days without a reply. To confirm my suspicions, I requested the formula from their partner compounding pharmacy and they decline sharing the formula with my laboratory. Just for context, labs share formulas all the time since there is nothing proprietary about generics and it is in everyone's best interest to formulate the most effective compounded pharmaceuticals. In my opinion, this is unethical and I, or anyone who is interested in the product deserves to know why they are using a delivery form that is counteractive to the compound's stability and at least a list of the inactive ingredients. This leads me to believe it is of lower quality than that of other providers, and possibly, not efficacious at all.

What I will be doing:

Regardless if Dr. Patel replies, which I think he won't, I will be using high-performance liquid chromatography with a reverse phase C18 column (UV detector ~ 240 nm) to test the concentration of their dutasteride. Then, I will test the aqueous solubility by testing the drug's pharmacokinetics on our lab rats. As a control, I will be comparing local dutasteride in a gelatin capsule as well as brand name Avodart, both sourced from a local pharmacy. This is going to take some of my time, but I think it is worth pointing out which providers are reliable and which are not. I will be updating this post frequently for those interested, and for any practicing chemists, I would like to compare thoughts on this, especially if you are in the field of pharmaceuticals.

 

[20YearsOnFin]

Hi, Im Interested in this topic, not only Strut Health's products though, but i would be interested to know why some people report different results depending on which brand of Dutasteride or finasteride they are using, there's a guy on this link talking about Dutasteride https://www.hairlosscure2020.com/category/generic-dutasteride/ and I have also posted about some of my experiences with finasteride.

I have 2 generic finasteride tablets in front of me, one give's me great results and the other causes my hair to shed endlessly, I would be interested to know if there is any measurable difference between tablets like these? or if its simply how they are compounded, whether purchasing finasteride or Dutasteride in its pure form, could theoretically lead to more consistent results.

 

[Pentanol]

I have 2 generic finasteride tablets in front of me, one give's me great results and the other causes my hair to shed endlessly, I would be interested to know if there is any measurable difference between tablets like these.

Describe the pills to me— both the shape and descriptive language on the surface. I will let you know if I have had experience with those brands in my lab.

 

[Derelict]

Hi, Im Interested in this topic, not only Strut Health's products though, but i would be interested to know why some people report different results depending on which brand of Dutasteride or finasteride they are using, there's a guy on this link talking about Dutasteride https://www.hairlosscure2020.com/category/generic-dutasteride/ and I have also posted about some of my experiences with finasteride.

I have 2 generic finasteride tablets in front of me, one give's me great results and the other causes my hair to shed endlessly, I would be interested to know if there is any measurable difference between tablets like these? or if its simply how they are compounded, whether purchasing finasteride or Dutasteride in its pure form, could theoretically lead to more consistent results.

I get generic dutasteride all the time, sometimes it has been dr reddys, sometimes milpharm, right now it is some manufacturer named crescent, i buy 6 months supply at a time so would know if there was any deterioration from switching brands, never had a problem. I guess you could always get GSK duta if you are really worried but i have never had any problems with generics.

 

[Ganked By DHT]

Thanks for doing this testing, I might try topical dutasteride in the future. Not surprised that a company that put biotin in their formula is shady.

 

[Pentanol]

lol. off to a good start! a slip of a decimal point to the left and missing the c on mcg... i'll delete this if you correct it...
(like this post to lmk)

no interest in strut. i use bulk powder topical and sides are apparent at 12mg/day. that's my gold standard pharmacokinetics on my lab rat.

I forgot to mention this in my post, but they actually don't offer 5000mcg biotin in their formulation despite what the website says, and they only give three options of dutasteride plus a maximum of 500mcg once you begin the consultation. I would mention this to the staff, but I have not been replied to since questioning their compound bioavailability and delivery method.

 

[BetaBoy]

that is a bit of a joke, I would have thought compounding labs have to follow the formulating guidelines for Dutasteride generics, maybe contact your countries medicines regulator?

 

[Pentanol]

that is a bit of a joke, I would have thought compounding labs have to follow the formulating guidelines for Dutasteride generics, maybe contact your countries medicines regulator?

I'm afraid it's a little more complicated than that. While manufactures of direct brand-to-generic compounds must utilize a similar formula to the original, compounding pharmacies are allow to be flexible with the rules since their entire purpose is to provide a different product that, theoretically, should be efficacious while providing a change based on the client's needs. For instance, many of the generics formulate finasteride with lactose; if a client requires finasteride without lactose, they must be sent to a compounding pharmacy to make a variant that does not include lactose.

In this case, Strut is using it's partner compounding pharmacy so their customers do not take the prescription and simply forward it to a local pharmacy, cutting Strut out of the profits. There is nothing wrong with this, they are a company trying to make money and have the right to take advantage of this loophole. For those familiar, a company called "BlueChew" does the same thing, except with ED medications. They put the AI in a candy-like tablet and require you to go through their compounding pharmacy so you do not simply transfer the medication to a local pharmacy.

Nevertheless, the issue with Strut is they are delivering Dutasteride using a vehicle that is inferior to that of generic or brand name Dutasteride. The lipid delivery in a gelatin capsule maximizes the bioavailability and allows proper compound dissolution in vivo.

Sidenote: For those that are buying powder formula of a compound, whether it be Dutasteride or even compounds that require explicit care in delivery, like Curcumin, the AI will not behave as desired if its vehicle is improper. It's like having a package delivered through the Sahara on a skateboard.

 

[20YearsOnFin]

I get generic dutasteride all the time, sometimes it has been dr reddys, sometimes milpharm, right now it is some manufacturer named crescent, i buy 6 months supply at a time so would know if there was any deterioration from switching brands, never had a problem. I guess you could always get GSK duta if you are really worried but i have never had any problems with generics.

Hi, thanks for the input, I'm more interested in this from a chemistry point of view, what any measurable differences are, do any of the inactive ingredients hinder absorption etc., and the reason that different brands cause different results in some users, I appreciate not everyone experiences this, for a comparison there are people who are able to maintain, simply by micro dosing, where as others require a full or increased dose to maintain.

 

[20YearsOnFin]

Describe the pills to me— both the shape and descriptive language on the surface. I will let you know if I have had experience with those brands in my lab.

Hi, the two I have in front of me are fairly obscure brands available only in South East Asia, so they are not that common, I have also had poor results (continued shedding/miniaturization) on more common brands ACCORD(1mg) , ACTIVIS ANADEEM (1mg) and Ricit. with regards to Dutasteride a brand that used to pop up alot with positive results was Breckenridge with CAMBER being less so.

there was a Dutasteride thread here talking about different brands.

https://www.hairlosstalk.com/interact/threads/generic-dutasteride-vs-avodart-any-efficacy-issues.122944/page-2

I would be interested to get the generic finasteride brand that I have had excellent results on tested, its no longer made but I still have some left, over the last 20 years I have tried several different brands of generic but have never been able to match the same results with another generic as I have had on this one obscure brand.

 

[20YearsOnFin]

Nevertheless, the issue with Strut is they are delivering Dutasteride using a vehicle that is inferior to that of generic or brand name Dutasteride. The lipid delivery in a gelatin capsule maximizes the bioavailability and allows proper compound dissolution in vivo.

Sidenote: For those that are buying power formula of a compound, whether it be Dutasteride or even compounds that require explicit care in delivery, like Curcumin, the AI will not behave as desired if its vehicle is improper. It's like having a package delivered through the sahara on a skateboard.

With Dutasteride powder is this simply because its insoluble in water? or is there more to it that that? and is there anything in a finasteride tablet that's essential to delivery or absorption or are the inactive ingredients primarily buking agents?... thanks

 

[Pentanol]

With Dutasteride powder is this simply because its insoluble in water? or is there more to it that that? and is there anything in a finasteride tablet that's essential to delivery or absorption or are the inactive ingredients primarily buking agents?... thanks

Dutasteride is not soluble in water, and direct oral ingestion of the pure powder state of Dutasteride delivers very low available quantities to the body. Dutasteride is soluble in ethanol (44 mg/mL), methanol (64 mg/mL), and polyethylene glycol 400 (3 mg/mL), but the oral version is made bioavailable with glycerin, and an oil, usually in the form of monoglycerides and diglycerides and a lipophilic compound such as BHT to assist in mobilizing the vehicle. Another thing to note is the preparation requires preservatives to ensure the compound remains stable over time. Medicines, like anything left in the open, are suspectable to chemical reactions from the environment, including elements such as light, humidity, and excessive temperature in either direction. For those that are making their own formulations, I highly recommend you compound with accurate ingredients and most of all, compose a small amount of the formula at a time.

When a large amount of a compound is made without the necessary preservatives, the compound is unstable after a short duration, due to a variety of chemical reactions that occur without an intermediate compound to preserve stability. Consider hydrolysis. When a carbon-based compound is left exposed, hydrolysis begins to take place very quickly. In the case of Dutasteride, or C27H30F6N2O2, chemical bonds are being broken due to the presence of H20 in the air since elements rearrange due to electron affinity and their current stability in relation to other elements, thus reducing the concentration of resolute Dutasteride and rendering the aggregate less useful to you.

The H20 in the air reacts with ALL of the compounds in the medication, from the delivery compounds to the actual AI. Consider this interaction with one molecule of H20 from the air and one molecule of triglyceride, a common very, very common lipid:

What happens to the triglyceride when it is exposed to H20? One of the bonds breaks down to form a DIglyceride and a mono fatty acid. Imagine these breakdowns happening all over the exposed medication, and having a 3 months supply of the medication renders the last month (at the very least) likely unusable. I say this not to be offensive or disparaging to those making their own formulations, rather to present awareness to chemical interactions that are often not considered and must be realized when forming an at-home solution.

 

[20YearsOnFin]

So in Laymen's terms.

Strut Health Dutasteride Summary

Dutasteride in Powdered form= FAIL
Clear Non Airtight Capsule= FAIL

Did it come in a nice box though?

 

[20YearsOnFin]

What about finasteride? is there anything that needs to be adhered to in its manufacture apart from being in a coated tablet or having preservatives included? You mentioned its commonly formulated with lactose? what's the purpose behind that?

 

[Pentanol]

The cloth case the medication comes in is very elegant and I believe the presentation had more consideration than the actual medicine.

As for finasteride, there are a number of manufactures in the U.S. that I've had experience with. These manufacturers are Accord, Ascend, and Aurobindo. Unlike dutasteride that is only a handful of inactive ingredients, generic manufactures of finasteride can be much more flexible with finasteride as the complementing ingredients have substitutes that should theoretically behave the same, in theory. In vivo after ingestion? Not all the time.

Here are the ingredients in Propecia:
Active ingredient: finasteride.
Inactive ingredients: lactose monohydrate, microcrystalline cellulose, pregelatinized starch, sodium starch glycolate, hydroxypropyl methylcellulose, hydroxypropyl cellulose, titanium dioxide, magnesium stearate, talc, docusate sodium, yellow ferric oxide, and red ferric oxide.

(For your curiosity, lactose monohydrate is a disaccharide that behaves as a stabilizer and a filler ingredient. This ingredient can be easily substituted without diminishing the efficacy of the compound)

In addition to 1mg of finasteride, these companies generic companies have the following inactives:

Ascend:
inactive:
lactose monohydrate, microcrystalline cellulose, pregelatinized starch, sodium starch glycolate, lauroylmacrogol 32 glycerides, magnesium stearate, Hypromellose, Titanium Dioxide, polyethylene glycol, Iron Oxide Red, and Iron Oxide Yellow.

Aurobindo:
inactive:
docusate sodium, hydroxypropyl cellulose, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch (maize), sodium starch glycolate, talc, and titanium dioxide.

Ascend:
lactose monohydrate, microcrystalline cellulose, pregelatinized starch, sodium starch glycolate, lauroylmacrogol 32 glycerides, magnesium stearate, hypromellose, titanium dioxide, polyethylene glycol, iron oxide red, and iron oxide yellow.

As you can see by the inactive ingredients, there is very little variation. Finasteride and its buffer ingredients are very cheap to produce, so deviating from Merck's ingredients to save money is not really useful. So why does Merck get to charge 100x more? Surely they're not selling the same product for 100x the cost unless the quality is better... right? Like almost every single patented drug available, Merck is selling the drug at a higher price to cover costs for Research and Development (R&D) like every company that has ever created and funded the testing of a drug. The FDA incentivizes companies to release efficacious treatments and they are rewarded through a patent that gives them exclusive selling rights for years. Once the patent is over, manufactures like Ascend can duplicate the formula and make small profits without having to spend ANY money on research and development.

This does not mean all generics are equivalent to their parent compounds as you'd have to consider certain factors that do not pertain to finasteride, like the isomer form, which becomes relevant in generics and brand names like Adderall vs the formula for generic amphetamine salts. The racemic compound in generics has different ratios of salts and is NOT the same as the brand, for better or worse.

I apologize if that is not the conclusion you wanted to hear. Chemically speaking, I can attest that the generics of Finasteride found in American pharmacies functions as well as the brand name, Propecia. If you would like to test this yourself, here is an experiment:

- Cease all treatment for one month, and get baseline blood levels
- Begin the generic you believe works for you, and begin treatment for 2 months, then test blood levels
- Cease treatment for one month, and begin the generic you feel is less efficacious, run for 2 months, and get blood work

If one of the generics does not suppress DHT levels, then you have your answer. It is my understanding that DHT levels will be inhibited by any of the FDA-approved generics as Finasteride is present and in a buffer vehicle that will allow competitive inhibition of types II and III 5-alpha-reductase isoenzyme, resulting in inhibition of the conversion of testosterone to dihydrotestosterone (DHT).

 

[20YearsOnFin]

I apologize if that is not the conclusion you wanted to hear. Chemically speaking, I can attest that the generics of Finasteride found in American pharmacies functions as well as the brand name, Propecia.

Hi, thanks for all the info, that's no problem I'm not looking for a conclusion, Many people can already attest that different brands of finasteride and dutasteride do seam to be having a different effect in some people, like the people in this link.

https://www.wolfhair.com/wp-content/uploads/2016/02/Brand-Name-vs-Generic-Finasteride-Jan-Feb-2016.pdf

I was mainly just interested if you have ever noticed anything in a lab setting when you have compared the drugs.

- Cease all treatment for one month, and get baseline blood levels
- Begin the generic you believe works for you, and begin treatment for 2 months, then test blood levels
- Cease treatment for one month, and begin the generic you feel is less efficacious, run for 2 months, and get blood work

If one of the generics does not suppress DHT levels, then you have your answer. It is my understanding that DHT levels will be inhibited by any of the FDA-approved generics as Finasteride is present and in a buffer vehicle that will allow competitive inhibition of types II and III 5-alpha-reductase isoenzyme, resulting in inhibition of the conversion of testosterone to dihydrotestosterone (DHT).

I can already assume all finasteride and dutasteride available would inhibit my DHT Levels. Would it be inhibited by the same amount? I don't know? But what I do Know is if I take Accord for 2 months all my hair starts falling into my cornflakes at breakfast, which is why I would never take it again.

The long term issue is the larger the Indian manufactures like Accord, Ascent, and Aurobindo get, the more favored brands like Breckenridge dutasteride get discontinued, Im starting to think Merck Proscar might also be in danger at some point as it seams to be less and less available in many regions.

I guess I could get what's left of the generic finasteride i had good results on tested locally, perhaps it was just a case of it being slightly stronger than advertised which amplified its effect.

 

[Pentanol]

I was mainly just interested if you have ever noticed anything in a lab setting when you have compared the drugs.

I have had experience with drugs that do not hold the concentrations stated on the label. As I mentioned, drugs can lose efficacy for a variety of reasons, but the biggest is exposure to moisture saturated environments that facilitate the breaking of bonds in the aggregate via hydrolysis.

As for you getting your finasteride tested, I think that is a good idea to give you reassurance. It is likely the finasteride you have is either normal in concentration or completely absent of it, entirely. Here is why:

Finasteride is unique in the sense that it does not increase in performance by a significant amount despite doubling or quadrupling the dosage. For this reason, .2mg of finasteride is the common dose in Japan because it is similar in efficacy to 1mg or even 5mg. This indicates it is unlikely that one of your generics is "stronger" or one is "weaker", rather one likely contains finasteride and one may be absent of it entirely. Even if your "weaker" generic is absent of .5mg of finasteride (leaving you with .5mg), it would still be effective at reducing DHT by an amount rivaling both 1mg and 5mg since .2 mg is nearly as effective as both 5mg and 1mg. Hope this helps!

 

[20YearsOnFin]

finasteride is unique in the sense that it does not increase in performance by a significant amount despite doubling or quadrupling the dosage. For this reason, .2mg of finasteride is the common dose in Japan because it is similar in efficacy to 1mg or even 5mg. This indicates it is unlikely that one of your generics is "stronger" or one is "weaker", rather one likely contains finasteride and one may be absent of it entirely. Even if your "weaker" generic is absent of .5mg of finasteride (leaving you with .5mg), it would still be effective at reducing DHT by an amount rivaling both 1mg and 5mg since .2 mg is nearly as effective as both 5mg and 1mg. Hope this helps!

Hi, interesting, I have heard this quite alot over the years and there seams to be some good articles about reducing the dosage to avoid side effect etc, for some individuals,

The only thing is every time I have ever switched brands I have staggered my switchover to phase out my old brand instead of making a straight switch, so for instance when I switched to Accord 1mg, I was still taking my original brand every third day (1/4 of a 5mg tablet), for many months after stating the Accord, but after about 6-10 weeks my hair always goes into a shedding phase that is only abated if I return back to my previous routine of a 1/4 of a 5mg tablet daily (good brand generic or Proscar) .

So in summary I have never gone off finasteride in the last 20 years, but my hair sheds like clockwork, if I swap out two/thirds of my finasteride dose with a different brand. If it's always the case the dose plays no part in anyone's results It's strange that I have always been able to notice a difference.

 

[Pentanol]

An update for those curious:

After work today, I spent some time analyzing Strut's Dutasteride. I was able to isolate the Dutasteride species from the capsule by simply mixing the collected powder in pure water. Since Biotin is soluble in water and Dutasteride is not dissolved in an aqueous solution, vigorous mixture of all powder content in 60 mL of pure water left me with weighted Dutasteride amassing .6 mg. Using Tandem Mass Spectrometry, I attempted to detect any buffer agents that would theoretically assist Dutasteride in becoming more bioavailable after digestion-- I was incorrect. There was NO detection of buffering or stabilizing agents and it is pure, powderized Dutasteride. I was hoping Strut's pharmacists were more sophisticated in their formula, and added supplementary inactive ingredients that I could test by administering the compound in lab rats and measuring their serum DHT over time to analyze bioavailability, as well as comparing the efficacy to traditional, lipid delivered Dutasteride, but this is not necessary. The pharmacodynamics of powderized Dutasteride are well established and indicate it is not readily bioavailable, which is precisely why GlaxoSmithKline and generics deliver the compound in a lipid-based vehicle that maximizes Dutasteride availability.

In addition to wrapping this up, over the weekend, I was contacted by the partner pharmacy of Strut Health after requesting their formula, and I was told by their pharmacist that their latest version of this compound was "under development" and it is to be expected that their oral Dutasteride formulation changes in the coming months.

For those interested in OD from Strut Health, I recommend waiting or finding a different source.

 

[TanDoc]

Bravo! Really appreciate these posts for elevating the discourse here. Appreciate reading from someone else with an actual science background, rather than the "bro-science"/youtube channels/cobbled-together crackpot theories from random pubmed abstracts. This is what we need.