Hair Loss/Hairline


QUESTION: Doctor Panagotacos,

What is your experience with dutasteride on the hairline? I am a norwood 3 with thinning (only at the hairline) heading towards a norwood 4 and am in my mid twenties.  My hairloss started 2 years ago.  MPB runs in my family.  I have been on finasteride for 2 years as well as minoxidil and it completely filled in my crown and thickened the middle of my scalp.  My concern is the hairline that continues to recede and thin around my frontal forelock. I believe finasteride has really slowed things down and I would be much worse without it.

I would like to stick with a proven treatment that is FDA approved for hairloss (finasteride), but I am becoming desperate to stop the thinning and regain what I have lost. I am willing to take dutasteride if it is effective on the hairline.  Am i being too greedy by switching to dutasteride even though finasteride worked well in the crown and midscalp? From my research it seems that neither medications have a positive effect on the hairline.  In your experience what have you noticed from your patients taking the meidcations for the hairline?  Since finasteride didn't thicken my hairline would it be a fair educated guess to say dutasteride won't work either?  I am just hesitant to take a medication that is not FDA approved if there isn't a high percentage chance of reward specifically at the hairline.  Thanks for your time.

ANSWER: Just because the FDA has not approved a drug for something that doesn't mean that it does not work. Many drugs are prescribed by doctors for indications which will never get FDA approval because it costs hundreds of millions of dollars to get the approval. Propecia and Rogaine are classic examples of a company doing tests using a spot on the crown of the head to measure the increase in hair density after 6 months to two years of use. Everyone knows that those medications also helps prevent hair loss in the front hairline as well but it was easier to do the test on the back of the head on the crown and it was known there was a better chance at getting the hair to grow on the crown than the front. The FDA prevented the companies from advertising the fact that both of these medications do work on hairs in the front of the head and were told if they wanted to make that claim they would have to do another study.
 I am telling you I know that both of those products work on hairs on the front of the head but not as well as on the hairs on the back. The difference is the hairs on the back have more life cylces and when they go into their last life cycle they tend to stay in a coma just below the skin level for a lot longer than they do in front. Eventually these hairs in comas will die. The die off faster in front.
1mg Finasteride lowers your DHT by 66% -- 5mg Finasteride lowers your DHT 72% --.5mg dutasteride taken daily lowers your DHT 90%.
We know that young men with inherited patterns of extensive baldness do better by lowering their DHT as much as possible. The more you lower the DHT the less chance of having male pattern baldness. If the hairs in the front hairline have already been scarred and died rather than staying in the comatose state then there is no chance of getting them back. You won't know unless you do try lowering the DHT enough for six months to find out.

It is a simples equation  the amount of Bald Genes X the amount of DHT = the degree of Baldness

You can't change your genes but you can lower your DHT. You do not need the FDA's permission to lower your DHT . See your dermatologist and ask for a prescription for Avodart. I ask my patients to take it three times a week the first month or so and then every other day before going to daily use. That is so that they adjust to the change in increased Testosterone and decreased DHT gradually.

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QUESTION: I started taking dutasteride .5mg along with finasteride exactly 1 month ago.  I have been adding dutasteride .5mg 3 days a week and take finasteride 1mg. the other 4 days. I planned on now switching over to taking .5 mg of dutasteride every other day and taking a 1mg of finasteride the day I am not taking dutasteride.  I planned to do this for another month and then switch to .5mg dutasteride daily by itself.  Over the last month after switching to taking dutasteride I have noticed I am shedding more hairs from the front of my scalp and my hairline has started to recede and my hairline has gotten thinner in the last month.  The only thing I have done differently in my regime from 2 years ago is adding the dutasteride.  Should I discontinue the dutasteride or is this a sign it is working? Thanks for your advice.

You are gradually lowering your DHT just as I would have prescribed for one of my patients. If you are losing more hair in front, or anywhere else for that matter, it is not due to the dutasteride lowering your DHT more than it was before. It is most likely due to something which stressed your hair growth 4 weeks earlier and sent them into the resting phase. That could be a lack of sleep , a cold, worrying too much about whether you might not grow more hair-- etc.  
 We know it is DHT which caused male pattern baldness to show up. So the more you can decrease its formation the better. Have your doctor run a serum testosterone AND serum DHT level on you so you can see if it really is going down. Maybe you got a batch of counterfeit generic dutasteride instead of Avodart.

If your DHT is 15 or lower then I would seriously look for some other cause of your loss. Some other illness may be involved.

Hair Loss

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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