There's a hair loss drug that blocks more DHT than finasteride. It is often more effective than finasteride. And yet, most doctors still don't start you on it. Why is that? I'm Dr. Gary Linkov, double board certified facial plastic surgeon and founder of Linkov Hair Surgery in New York City. I treat hair loss every single day. And today, we're tackling a simple but loaded question. Is dutasteride actually better than finasteride? Hair loss is progressive and every month of inaction can lead to more and more miniaturaturization. Finastride is the FDA approved first-line medication for preventing hair loss, but many patients still thin out on that medication. Dutastride is stronger, but it's not FDA approved for hair loss in the United States. So, should more people be taking it, or is finasteride still the smarter first move? Let's work our way to that answer. Both drugs inhibit five alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. Finasteride primarily inhibits the type 2 form of five alpha reductase and that leads to about a 70% reduction in serum DHT. Dutasteride on the other hand inhibits type 1 and type two forms of five alpha reductase and this leads to about a 90 to 98% reduction in DHT levels. Dutastasteride has a longer half-life of about 5 weeks. That means that it takes about 5 weeks for the amount of dutastride in your system to be reduced by half. In a 2024 systematic review of nine studies, dutastasteride was found to be superior to finasteride on the following parameters. Target area hair count, scalp photographic assessment, and subjects selfassessments. Currently, randomized control trials of oral dutastasteride for androgenetic alipcia are limited to about 24 weeks. Longer studies are of course needed, but so far it looks like dutastasteride is winning. But we haven't looked at the cost yet. And I'm not talking about money. When it comes to side effects, finasteride's incidence of erectile dysfunction is 1.3 to 2%. And decreased libido is at 1.8 to 2.6%. On the other hand, dutasteride's incidence of erectile dysfunction goes up to about 4 to 6% and decreased libido at about 3 to 4%. This difference may be due to dutasteride's greater DHT systemic suppression and its longer half-life. Most side effects from both medications appear within the first 3 to 6 months of use and are generally reversible. And reported side effects tend to decline with subsequent years of use. And these differences in side effect profiles are generally why doctors, including myself, tend to pause when it comes to starting dutasteride early in one's course of hair loss prevention medication. Another reason why dutasteride hits harder is because it's lipopilic. This means that it accumulates more in your skin and scalp tissue. So even after stopping, DHT suppression can continue for weeks. Finasteride clears quicker, so it's easier to adjust the dose of the medication. And if you're looking to stop the medication completely, it exits your system much faster. So, the longer half-life of dutastride might be good when it comes to hair loss prevention, but it's not great if you actually develop side effects. It's like putting something in motion that's harder to stop. Now, let's talk about how these medications are used in practice. Finasteride is FDA approved for male pattern hair loss at 1 milligram per day. Dutastride on the other hand is FDA approved for BPH at.5 mg per day and it's being used off label for hair loss in the United States. But keep in mind that dutastasteride is approved in certain countries for hair loss and that includes Japan, South Korea, and Taiwan. Many clinicians will use dutastasteride once a patient plateaus on finasteride or needs more aggressive intervention. Dutastasteride and finasteride both work to prevent further hair loss and may slightly improve your hair's appearance. Other treatments may help stimulate further hair growth and fullness. And that includes things like minoxidil, low-level laser therapy, exoome enhanced PRP, and nutritional optimization. And for additional support, I created the feel confident hair care line. Our shampoo, conditioner, and thickening foam are formulated to help complement other medical and surgical treatment without breaking the bank. And we have a scalp serum coming soon. So, make sure to subscribe to our newsletter for the latest updates. And here's what I actually do in my clinical practice when it comes to finasteride and dutestasteride. I start our male patients with androgenetic alopecia on 1 milligram a day of finasteride as a pill and that works for the majority of our patients at least 90%. If they continue to have hair loss but they're not experiencing any side effects. I will then switch them to oral dutastasteride at.5 mg a day. But first I give them at least 3 months on finasteride to see if that's enough to maintain their hair. And what's interesting is that so far I haven't had any patients develop side effects when they've done that switch. So if they were doing well on finasteride and we've switched them to dutastasteride, I haven't all of a sudden seen side effects develop. And that's quite promising, especially considering the reported literature incidence of side effects with dutastasteride being higher than finasteride. But I don't start anyone on dutastasteride from day one because we know from many studies that the side effect profile is a bit worse with dutastasteride compared to finasteride and people are already worried about side effects with these medications. So I don't want to subject someone to a stronger medication when they would otherwise do fine with the weaker medication which is finasteride in this case. And this is also why we don't have dutastasteride available on the feel confident website because I just don't want to confuse people when it comes to choosing the right medication for them. If people are looking to make that switch from finasteride to dutastride, I invite them to reach out to our office and we'll discuss the pros and cons and see if it makes sense for your specific clinical situation. Let's review some common questions that I get from my patients about dutasteride. Can I switch back to finasteride if needed? The answer is yes, but honestly that's rarely necessary. Once someone switches over to dutastasteride, I have found that they've done very well from a side effect profile and from an overall tolerance and results profile. So, they rarely then switch back to finasteride. Will 0.5 milligrams a day be enough? For most men, yes. But sometimes we do need to increase the dose. We can go as high as 2.5 milligrams per day if that's what it takes to control one's hair loss. Of course, the side effects will also be dose dependent. So, as we go up on the dose of oral dutestasteride, people will be at a higher likelihood of experiencing some side effects. It's always about balancing the efficacy of a medication with potential side effects. Can I use topical dutasteride? The issue is that dutastasteride is a larger molecule size than finasteride, which makes it harder for it to penetrate the scalp barrier effectively. Most compounded versions do not deliver enough drug into the follicle to meaningfully suppress DHT. Some formulations use specialized vehicles like liposomaal or DMSO based formulations, and some people will combine it with micro needling to improve absorption. Even misotherapy injections are currently being done with little to no systemic absorption reported. But unlike oral use, which is well documented, there are still no largecale clinical trials on topical or injected dutasteride for hair loss that would confirm its safety or efficacy. So in my practice I currently do not offer any topical or injected formulations of dutastasteride but I have spoken to some of my international colleagues at hair conferences around the world where they are starting to employ injected dutasteride and they're seeing overall very good results with limited safety issues and they're seeing very good clinical results with very few if any side effects. So I think that's something we just need more data on before we start offering it broadly. So why not just get hair transplant surgery and skip the medications whether it's finasteride or dutastride. Remember there's a limited donor supply in all of us when it comes to hair transplant surgery. We have to take the hair from somewhere to move it to the area that's deficient. But if we don't have enough to pull from, well then we're not going to be able to really have a significant outcome for the patient. Remember that the goal is always to protect your existing hair to confirm its stability before we go in with a hair transplant. The hair transplant is then used to build up density in a careful calculated way. Always trying to balance the donor and the recipient areas. And remember that with FUEE surgery, because we're harvesting from a broad area, some of that hair could still be DHT sensitive or in other words, susceptible to progressive loss over time, whether the hair is back here or now transplanted to the front. Let's say that hair if DHT sensitive will still fall out over time. So that again speaks to the importance of proper medical therapy to stabilize one's hair. Hair transplant surgery is very much synergistic with medications like finasteride or dutasteride. Without the meds, hair transplant surgery can be disappointing and is just less reliable over time. So, is dutasteride better than finasteride? It depends. For raw potency and hair preservation and potential for regrowth, yes. For safety, flexibility, and firsttime use, finasteride still wins. My current approach is to start conservatively and escalate if needed. If you're dealing with hair loss and you don't know where to start, or you're on meds, but they're not really helping, feel free to reach out to our team for advice. We offer full scalp analysis and a clear medical and surgical plan that's specifically tailored to you. And for women experiencing hair loss, medical therapy is equally as important. The medications are slightly different, and we've covered those in a few other videos. The contact info for my clinic is in the description below. Thanks for watching.