Question: I recently started taking finasteride but am not sure it’s working. I’ve been on it for just over 2 weeks and am thinking of adding in dutasteride. If I want to do this, how often should I take the dutasteride, assuming I continue to take the finasteride every day? I’m 24 with Male Pattern Baldness approx. NW3.
Answer: Hi, Ian. There's quite a lot to unpack here so, in order to answer your question fully, let's start with the mechanisms of finasteride and dutasteride.
Both finasteride 1mg and dutasteride are oral 5α-reductase inhibitors which decrease the formation of dihydrotestosterone (DHT) in the body. This is the hormone responsible for follicular miniaturisation in men with a genetic predisposition to Male Pattern Baldness(the process which causes gradually thinning hair and/or a receding hairline, a drop in hair density, shedding and can lead to eventual baldness).
Each of these medications was originally developed as a treatment for an enlarged prostate (Benign Prostatic Hyperplasia - BPH), and this remains the only authorised use for dutasteride in the UK at present.
The 5α-reductase enzyme, responsible for converting testosterone to DHT, exists in two forms: Type 1 and Type 2. Finasteride selectively inhibits Type 2 whereas dutasteride inhibits both forms.
Studies have been done which show that the two drugs used together have significant results. However, it is important to remember that both these medications also have significant potential side effects associated with them and, if both were used together, the side effects would likely be greater when combining finasteride and dutasteride together rather than using either alone.
Dutasteride is more potent and has a longer half life (this refers to the length of time it stays in the bloodstream). Therefore, users would be more prone to the occurrence of adverse effects, which would most probably also be more persistent due to the fact that the drug remains in the body for a longer period of time.
Finasteride 1mg is currently the only DHT-blocker that is licensed by the UK's medical regulatory board, the MHRA to treat male hair loss. It is also the only FDA-approved treatment of its kind in the USA.
Dutasteride is not authorised for this purpose in the UK or USA. As such, it is unlikely a medical professional in either country would prescribe this to you.
Given using it as a hair loss treatment is an off license use, and despite there being a greater potential for improved results using dutasteride and finasteride together, we do not recommend this combination due to dutasteride's use being off-licence and the increased potential for side effects.
If you are planning on acquiring dutasteride via an unauthorised supplier, such as a website, we must caution against this. There are many risks - from the hair loss products sold being counterfeit, mislabelled, or something other than they purport to be - an issue with potentially fatal consequences - to the medication being out of date and ineffective or simply a placebo.
The MHRA has been raising awareness of the growing problem of buying medication, including hair loss treatments, from unauthorised sources as this can have such serious ramifications.
We would advise you ensure your finasteride 1mg, which is widely available for prescription for male pattern hair loss in the UK, is also from a legitimate source. If it is not, then we recommend switching to a batch from an authorised, registered pharmacy so that you know what you are using is safe and should have little qualms about its efficacy given you know it has the requisite provenance.
With regards not seeing any effects from finasteride use so far, we consider it to be far too early on for you to be seeing results. Generally, it can take between three to six months from first starting the medication - assuming it is taken once per day, every day, as directed - to see progress. The more advanced the hair loss, the longer it can take, however.
In cases where the response to one form of treatment is not as expected, additional elements can be considered, depending upon the individual's medical suitability.
This ranges from adding in the only other MHRA-licensed and FDA-approved genetic hair loss treatment, high strength minoxidil, which is applied directly to the scalp to help stimulate hair growth, to using hair growth supporting products such as FDA-cleared low level laser therapy (LLLT) devices, the HairMax LaserBand or LaserComb for example.
If you would like personalised treatment recommendations and advice on your current situation, a consultation with a professional hair loss specialist may be advisable, even if you do decide to still 'go it alone' afterwards.
Whatever you decide, we must reiterate that self-medicating and procuring drugs from unauthorised sources can be dangerous and should be avoided.
The Belgravia Centre is a world-renowned group of a hair loss clinic in Central London, UK. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation from anywhere in the world for home-use treatment.
View our Hair Loss Success Stories, which includes the world's largest gallery of hair growth photos and demonstrates the level of success that so many of Belgravia's patients achieve.