Hair Loss/Avodart and acne flare up
QUESTION: Dr. Panagotacos-
I've been slowly transitioning into Avodart per your recommendation. I'm up to roughly 2 pills per week (with finasteride alternated on the days in between). I've noticed the last month that my face has been breaking out quite badly on my cheeks. I've had limited acne in the past and I am nearly 30 years old so this moderate increase has been alarming. Can this be related to Avodart at all?
Secondly, I was planning on taking Avodart every other day and finasteride in between. Would it be detrimental in any way if I took finasteride daily in the morning and my avodart dosage at night (roughly 4 nights a week)?
Thanks in advance
ANSWER: Hi John,
I have not seen acne flares with patients on Avodart. Your testosterone will go up about 15% so I assume it is related. Acne flares are seen in men who take supplemental testosterone . Try washing with 4% PanOxyl Acne Wash twice a day to kill off the bacteria growing in the oil which leads to the acne flare. You may need to take an oral antibiotic for a short time to kill the bacteria causing this flare.
A friend of mine, a fellow dermatologist, has had very good results taking Avodart every other day and finasteride in between.
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QUESTION: Thanks for the advice Dr. Panagotacos. I'll see where I can order that benzoyl peroxide wash.
I have to apologize, I worded my second sentence badly. What I was asking is if it it ok to take finasteride 7 days a week in the morning while at the same time taking avodart every other day at night. Could this in any way be harmful to my health or hair?
That's great to hear that fellow derm is swing great results with that combo. Is he seeing cessation of loss or regrowth?
Thanks and take care
ANSWER: My friend is having good results with alternating Avodart and Fainasteride because it is lowering his DHT 85%. If he took Avodart daily it would lower the DHT by 90% and taking both every day would only lower it 91% . I can see no harm in taking it as you suggest. In a study done with patients taking 5 Dutasteride 0.5 mg =2.5mg daily the total decrease was 95%. I know of no one who prescribes this dosage.
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QUESTION: Dr. Panagotacos,
Those DHT numbers are quite interesting. Is there a study that you can reference that shows the 85% decrease by alternating finasteride and avodart?
The 6 month phase II studies for avodart showed that 2.5 mg/day increased hair counts by quite a bit more than .5 mg/day, so is it the 5% extra DHT inhibition the key player in that study?
The measurements of DHT suppression were done by me in my private office one year before the studies came out in the Journal of the American Academy of Dermatology. I shared that information with fellow dermatologists in an online chat group.
It would seem that 2.5mg is better than .5mg dutasteride. When you look at the figures as 90% suppression vs 95% it does not seem much different but if you look at there being 5% vs 10% of the original DHT it is a huge difference- twice as much. Nevertheless I know of no one prescribing 2.5mg daily.