Dutasteride

What is dutasteride?
Dutasteride is a prescription treatment that blocks the enzyme 5-alpha reductase type I and II. 5-alpha reductase turns testosterone into dihydrotestosterone (DHT).

Why is dutasteride part of my treatment plan?
Your genetics indicate that your steroid-reductase type I or type II activity is high. This will lead to increased levels of DHT, which impairs hair growth.

Are topical and oral dutasteride effective for alopecia?
Dutasteride has proven to increase hair counts, density, and personal assessment of hair growth. One study found that dutasteride is more effective for hair growth than finasteride. This is likely because finasteride only blocks type I of the steroid-reductase enzyme, while dutasteride blocks type I and type II. Dutasteride is three times more effective at blocking type II and 100 times more effective at blocking type I steroid-reductase enzymes.1  Topical dutasteride combined with microneedling was found to improve hair density and patient assessment of hair growth.2  Another study found significant hair growth with a topical product containing dutasteride, minoxidil, and finasteride.3

Why does Nimbus use low doses of oral dutasteride?
Oral dutasteride has the potential to cause significant side effects. By lowering systemic levels of DHT, you reduce the level of the most active form of testosterone. Unfortunately, this can lead to decreased libido, erectile dysfunction, adverse sexual experiences, nipple discharge, prostate cancer, and male breast cancer. Dutasteride is also associated with changes in mental health, such as depression, anxiety, and brain fog. Side effects usually resolve after medication discontinuation but may persist in rare cases. Stop taking dutasteride immediately and contact your physician if you experience any of these side effects. 

Dutasteride is category X in pregnancy as it causes birth defects in a male fetus. The use of dutasteride in pregnancy-eligible women is contraindicated unless reliable forms of contraception are used in conjunction. The risk of adverse effects can be lessened by using topical dutasteride. Blood DHT levels declined slightly in one trial, but the difference was not significant, and none of the participants reported adverse sexual issues.2  

Are there any adverse effects while using dutasteride?
Topical dutasteride is well tolerated. Itching has been reported at the application site.2 Other adverse events include low blood pressure, breast tenderness/enlargement, high-grade prostate cancer, allergic reactions, and leg swelling. 

Why do I need to keep taking dutasteride?
Dutasteride should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Dutasteride is not a cure for hair loss; it is a treatment.

Drug Summary: Dutasteride 

References
1) Zhou, Z., Song, S., Gao, Z., Wu, J., Ma, J., & Cui, Y. (2019). The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: A systematic review and meta-analysis. Clinical Interventions in Aging, Volume 14, 399-406. doi:10.2147/cia.s192435
2) Nada, Essam & Sharkawy, Reham & Abd Elmaged, Wafaa & Elmagd, Marwa. (2018). Topical dutasteride with microneedling in treatment of male androgenetic alopecia. Sohag Medical Journal. 22. 387-400. 10.21608/smj.2018.42083. 
3) Rafi AW, Katz RM. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatol. 2011;2011:241953. doi:10.5402/2011/241953