How can dutasteride not work?

[davepeters3345]

I was reading up on the pharmacodynamics and kinetics of dutasteride, and it inhibits literally 99.9% of molecules that cause hair loss. So I was wondering how it scientifically possible that people STILL lose hair on dutasteride? Maybe I'm missing something..?

 

[bilboswaggins]

DHT is not the only thing that causes male pattern baldness

 

[Agustin Araujo]

Dutasteride will completely stop hair loss in over 99+ percent of men who take it. For those that still continue to lose hair on Dutasteride, the only conclusion that I can come up with is that they don't really respond to the 5-alpha-reductase inhibitor. You'd have to be extremely unlucky to be in the minority where Dutasteride doesn't work.

DHT is not the only thing that causes male pattern baldness

DHT is what causes male pattern baldness and is responsible for the miniaturization of the hair follicles. It's been thought if other androgens play any role in Androgenetic Alopecia, though none other one have been proven to do so.

 

[davepeters3345]

Dutasteride will completely stop hair loss in over 99+ percent of men who take it. For those that still continue to lose hair on Dutasteride, the only conclusion that I can come up with is that they don't really respond to the 5-alpha-reductase inhibitor. You'd have to be extremely unlucky to be in the minority where Dutasteride doesn't work.




DHT is what causes male pattern baldness and is responsible for the miniaturization of the hair follicles. It's been thought if other androgens play any role in Androgenetic Alopecia, though none other one have been proven to do so.

This is what I was thinking. I really want dutasteride. Its so hard to get a prescription in Canada

 

[zzzzz]

I don't think its possible to lose hair on dutasteride

 

[benjt]

Uneducated guess: Maybe dutasteride is not bioactive, but first needs to be converted into a bioactive metabolite by an enzyme. This is, for example, the reason why minoxidil doesn't work for some people - they lack the enzyme minoxidil-sulfotransferase.

If you lack the enzyme to convert dutasteride into its bioactive metabolite, then it will not work.

 

[davepeters3345]

That would make sense if dutasteride needed to be biotransformed before being an active medication. It is not however. Through my (limited) understanding of drugs and medication it is impossible to lose hair on dutasteride.

 

[xRedStaRx]

Uneducated guess: Maybe dutasteride is not bioactive, but first needs to be converted into a bioactive metabolite by an enzyme. This is, for example, the reason why minoxidil doesn't work for some people - they lack the enzyme minoxidil-sulfotransferase.

If you lack the enzyme to convert dutasteride into its bioactive metabolite, then it will not work.

Not completely. Some people have 5-AR II enzymes that cannot be 'targeted' by dutasteride, hence finasteride gives them the results they want instead.

But I guess it's quite rare.

 

[Wolf Pack]

Not completely. Some people have 5-AR II enzymes that cannot be 'targeted' by dutasteride, hence finasteride gives them the results they want instead.

But I guess it's quite rare.

I guess that's why there are anecdotal reports of people worsening their hair switching from finasteride to dutasteride. I saw a pharmacology report ages ago explaining how some enzymes are only targeted by finasteride, not dutasteride. This is rare though as u say, more likely dutasteride targets extra and plenty overlap between the two drugs.

Have you had any growth red?

 

[xRedStaRx]

I guess that's why there are anecdotal reports of people worsening their hair switching from finasteride to dutasteride. I saw a pharmacology report ages ago explaining how some enzymes are only targeted by finasteride, not dutasteride. This is rare though as u say, more likely dutasteride targets extra and plenty overlap between the two drugs.

Have you had any growth red?

There are several polymorphisms of steroid 5alpha-reductase type 1 and 2 genes, the former has specific polymorph sequences that are linked to prostate cancer and diabetes. Dutasteride supposedly cannot target certain morphs of the SRD5A2 gene. But I haven't seen studies of such, only remember some users couple of years back mentioning a test for the gene variant to gauge response.

My hair is noticeably better on finasteride more than a year in. Temples have stood still more or less. Crown and middle-front hair have gone back a couple of years. Now I'm somewhere between a Norwood 1-2. It won't be long until the temples go though.

 

[Koga]

There are several polymorphisms of steroid 5alpha-reductase type 1 and 2 genes, the former has specific polymorph sequences that are linked to prostate cancer and diabetes. Dutasteride supposedly cannot target certain morphs of the SRD5A2 gene. But I haven't seen studies of such, only remember some users couple of years back mentioning a test for the gene variant to gauge response.

My hair is noticeably better on finasteride more than a year in. Temples have stood still more or less. Crown and middle-front hair have gone back a couple of years. Now I'm somewhere between a Norwood 1-2. It won't be long until the temples go though.

You're losing your temples, I wouldn't call that 'noticeably better'? You might wanna add dutasteride or a topical anti-androgen? Or maybe you're just getting a more natural, male hairline?

 

[xRedStaRx]

You're losing your temples, I wouldn't call that 'noticeably better'? You might wanna add dutasteride or a topical anti-androgen? Or maybe you're just getting a more natural, male hairline?

If the temples fully go (the area that is currently mixed/thin) then I'll be a solid NW2.

I can live with that, the rest of my hair doesn't seem to be going soon. My father is a Norwood 5 at 50-something, my brother is a Norwood 1 at 27 (I guess he lucked out).

Here is my hair from Jan2015. I can't say if it's better or worse now, it's the first time I haven't taken monthly progress pictures in 15 months. But looks about the same.

Edit:
This is almost 2 years ago at age 23: (June 2013) for comparison.

 

[Ventures]

XredstarX

You have mediterranean origins, where are you from ?

I heard if your mother's side (maternal grandfather, uncle) started to loose hair early, than you are not happy at all, and you might start too. Of course, father's side plays role too, but if you inherit genes (apparently from your mother) which determine that your scalp hair is very sensitive to androgens then sooner, or latter you will start to develop male pattern baldness ?

To summarize: to start balding aggressively at young age you must inherit androgen sensitive scalp hair (which is probably inherited on X chromosome, so as from your mother's side) and medium or high levels of DHT (and other androgens) which are deposited inside scalp hair follicles (and this feature is inherited from your father, since I've read that hormonal profile is determined by your biological father)

Can you please answer this questions

1. What about your maternal grandfather. Are they bald, and at what age they started to loose hair?
2. Do you have body hair (on chest, arms, facial hair)? And did you have problems with acne vulgaris on your face during puberty?
3. Do you have brothers, are they balding too? And what about your mother, is her hair thinning?

 

[abcdefg]

Yeah I think propecia just isnt enough because there is still too much DHT left over and the temples/front are certainly most sensitive areas to androgens. With dutasteride not working what he said about the different enzymes not being affected in certain people makes sense or I think T still plays a role in male pattern baldness over the years. Its the most abundant male hormone and its hard for me to see how it doesnt affect hair when its an androgen no different than DHT except its weaker.
If someone used dutasteride and RU/CB to prevent both DHT and T from acting on hair I think you could maintain what you have possibly forever but we all know regrowing any hair is a whole different story

 

[DontWant2BeBald]

I don't think its possible to lose hair on dutasteride

I am losing hair on dutasteride. All angrogens cause hairloss for me so I need to get on a strong topical anti-androgen soon or I will lose more hair. Already on ru for 1 month but it has made no difference and i question how true its antiandrogenic qualities are

 

[xRedStaRx]

Yeah I think propecia just isnt enough because there is still too much DHT left over and the temples/front are certainly most sensitive areas to androgens. With dutasteride not working what he said about the different enzymes not being affected in certain people makes sense or I think T still plays a role in male pattern baldness over the years. Its the most abundant male hormone and its hard for me to see how it doesnt affect hair when its an androgen no different than DHT except its weaker.
If someone used dutasteride and RU/CB to prevent both DHT and T from acting on hair I think you could maintain what you have possibly forever but we all know regrowing any hair is a whole different story

Androgens aren't the problem!

Inhibiting DHT disrupts the biological male pattern baldness pathway, but it's not what actually causes hair to miniaturize, but it's an important step to reach that phase.

This is why testosterone does not cause male pattern baldness, if anything, testosterone is GOOD for hair. It's DHT itself that's the problem.

 

[Wolf Pack]

As Redstar says, DHT is basically only the initial trigger. It's obviously vital to lower it but for some people it's not enough as the cascade of events are already triggered and continue to develop with very little DHT. I think this is very rare though looking at the clinical trials. Think about it, even castration can still result in hair loss once the process has started, despite pretty much no test or DHT, usually it halts it though. Adrenals will still make some steroids though. T has nothing to do with hair loss, not even type 1 DHT. Just type 2.

 

[davepeters3345]

As Redstar says, DHT is basically only the initial trigger. It's obviously vital to lower it but for some people it's not enough as the cascade of events are already triggered and continue to develop with very little DHT. I think this is very rare though looking at the clinical trials. Think about it, even castration can still result in hair loss once the process has started, despite pretty much no test or DHT, usually it halts it though. Adrenals will still make some steroids though. T has nothing to do with hair loss, not even type 1 DHT. Just type 2.

Wait what... so I am pretty much ****ed? I thought finasteride/dutasteride would forsure stop it as it stops DHT.

 

[massa]

Wait what... so I am pretty much ****ed? I thought finasteride/dutasteride would forsure stop it as it stops DHT.

Yeah but its not about the amount of DHT its about your follicles sensitivity to DHT and possibly other androgens. In this case you use the kitchen sink approach is best


Mild Hair loss- Propecia
Moderate Hair Loss- dutasteride
Severe Hair Loss- dutasteride & RU

 

[Wolf Pack]

Wait what... so I am pretty much ****ed? I thought finasteride/dutasteride would forsure stop it as it stops DHT.

Don't be negative, you have barely commenced treatment. As massa highlights, there are a few weapons we can use. The clinical trials are a guide of success rate but no one can predict how you will do. Finasteride could bring it all back for you example, you just don't know. At the one year mark you will have a better idea.

- - - Updated - - -

Yeah but its not about the amount of DHT its about your follicles sensitivity to DHT and possibly other androgens. In this case you use the kitchen sink approach is best


Mild Hair loss- Propecia
Moderate Hair Loss- dutasteride
Severe Hair Loss- dutasteride & RU

Exactly, some people have low DHT to begin with, Zzzz for example had pretty low DHT (within normal range) yet his crown was going big time. This was before treatment. DHT must be lowered to below normal, but it's not the be all and end all.