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Hair Loss/Dutasteride really better than finasteride?


Hi Doctor,

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: 101423.
 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.  

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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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