Hair Loss/Dutasteride really better than finasteride?
I have a loaded question for you. Is dutasteride really better than finasteride in mpb?
Finasteride lowers 5 alpha reductase type two by 98%+ in the hair follicle. It has been shown in studies that type 2 5 alpha reductase is what is present in th hair follicle and creates the DHT that destroys hair.
Type 1 5 alpha reductase is found in other areas like organs, the brain, and oil glands.
Serum DHT levels are likely lower for dutasteride because the extra inhibition of 5 alpha reductase type 1.
In addition, the latest results from Japanese phase 3 FDA results for dutasteride for mpb shows less hair compared to finasteride in a one inch diameter circle measured by a trichogram at 1 year.
I would like your thoughts on this please.
Although the initial studies done would indicate it is 5-alpha reductaseType 2 is the enzyme responsible for MPB there have been studies done which indicate the Type 1 enzyme which is found primarily in the pilosebaceous unit " not only in the oil gland but also in the root sheath"
Article in Skin pharmacology: the official journal of the Skin Pharmacology Society 9(3):169-76 · February 1996
"not only sebaceous gland but also outer root sheath keratinocytes may contribute, through the activity of the steroid 5 alpha-reductase type 1, to the pathogenesis of androgen-dependent alopecia."
There are very good studies which show dutateride is more effective than finasteride- proving the importance of the Type 1 enzyme in the hair follicle--
Olsen EA, Hordinsky M, Whiting D, et al. The importance of dual 5-alpha reductase inhibition in the treatment of male pat- tern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride. J Am Acad Dermatol 2006;55: 1014–23.
And yet another study concludes "5 alpha - reductase – 1 (5 alpha R-l) has a broad pH optimum centered at pH 7.0, and a Km for testosterone that is twenty-five times that of 5 alpha -Reductase -2. The location of the gene for 5 alpha R-l is on chromosome 5 alpha. 5 alpha R-l has been observed to be more ubiquitously located in the skin, including the scalp. In the hair follicle, 5 alpha R-l appears to primarily concentrate in the sebaceous gland, but has been noted in other parts of the hair follicle including the dermal papillae.
I have observed both men and women get a better response to dustaeride than finasteride over the past 14 years in which I have prescribed dustateride for those who were not responding well to 5 mg finasteride.