Finasteride vs Dutasteride: Everything You Need to Know

‍Introduction

People of all ages and genders can suffer from alopecia, otherwise known as hair loss. Alopecia is characterized by a noticeable thinning or full loss of hair on the scalp or other parts of the body. For those who suffer from it, this illness is very concerning. It can significantly affect their quality of life and self-confidence. Fortunately, various treatments are available to deal with this issue. Finasteride and dutasteride are two drugs that have acquired popularity in the field of treating alopecia. These medications have proven in numerous clinical studies to halt hair loss and encourage hair growth in some patients.

Mechanism of Action of Dutasteride and Finasteride

Dutasteride and Finasteride belong to a class of drugs called 5-alpha reductase inhibitors, which target dihydrotestosterone (DHT). DHT leads to the induction of DKK1, a negative regulator in the Wnt pathway. This pathway is responsible for the stimulation of hair follicular growth. As a result of its inhibition, hair loss kicks in. In people who are genetically prone to male pattern baldness, DHT, a byproduct of testosterone, has been shown to shrink hair follicles. Dutasteride and Finasteride function by preventing the conversion of testosterone into DHT by blocking an enzyme known as 5-alpha-reductase. These drugs can halt or even reverse the advancement of male pattern baldness by lowering DHT levels in the scalp (Salisbury and Tadi, 2020).

Comparing the Efficacy of Dutasteride and Finasteride

Owing to its greater capacity to stop testosterone from turning into DHT, the data suggests dutasteride is a more effective treatment than finasteride. The key research findings regarding their efficacy include:

A 2004 study showed that dutasteride prevented a far larger amount of DHT. A daily dose of 5 mg dutasteride decreased DHT levels by around 98.4% in 399 patients, but a daily dose of the exact dosage of finasteride only decreased DHT levels by about 70.8%. That is a noteworthy distinction. Additionally, DHT was suppressed by 94.7% at the lowest maximally effective dose of dutasteride (0.5 mg) (Clark et al., 2004).

Another study conducted in 2017, focused on the comparison of Finasteride with Dutasteride. The study showed that dutasteride was more effective than finasteride in treating men with androgenic alopecia. The main variables of efficacy were hair counts in the targeted area (Clark et al., 2004). Based on the results, the dutasteride group showed a substantially larger increase in total hair count per cm² (baseline: 223 hair; at 24 weeks: 246 hair) reflecting new growth than the finasteride group (baseline: 227 hair; at 24 weeks: 231 hair). Moreover, In comparison to the finasteride group (baseline: 67 hair; at 24 weeks: 66 hair), the dutasteride group showed a considerably greater drop in thin hair count per cm² indicating of reversal of shrinkage (baseline: 65 hair; at 24 weeks: 57 hair).

Cost Comparison

It is crucial to take dosage, potency and treatment length into account when comparing the costs of these two therapies. Due to its higher potency, dutasteride might need smaller dosages, which could offset the price difference. Finasteride is available on the market in 1 mg strength and costs around $20-$40. Dutasteride 0.5 mg 30 capsules cost around $14. A study was conducted from June 2003 to June 2006 to assess the cost comparison of finasteride and dutasteride. Based on it, patients on dutasteride spent $51 less on medical bills per month ($122 vs. $173; P <.001) compared to those on finasteride (Naslund et al., 2008).

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Side Effects

There might be a difference between the efficacy of the two drugs but the side effects have emerged similar in both. Reported side effects of finasteride and dutasteride include (Fertig et al., 2017):

1. Erectile dysfunction
2. Decreased libido
3.  Impotency
4. Tenderness and breast enlargement
5.  Depression

A study assessed the side effects of the two drugs for six months. Between treatment groups, the overall incidence of adverse events was comparable. Altered libido was the most dominant side effect observed for the two. Dutasteride exhibited a 6.9% incidence rate for altered libido in comparison to finasteride which showed a 6.7% incidence rate. So we can say that both drugs exhibit almost similar adverse effect profiles. These adverse events tend to subside with time (Harcha et al., 2014).

Conclusion

The therapeutic decision between finasteride and dutasteride should be decided on a case-by-case basis. It depends on several considerations, including cost, the patient's response to the medicine and possible side effects. The research findings highlight dutasteride as the better therapeutic option based on the efficacy results. A marked difference in a decline in DHT levels was observed in the case of dutasteride compared to finasteride. The increased potency of dutasteride deems it better than Finasteride for treating alopecia. Moreover, the side effects profiles didn’t show a significant variation in the frequencies of adverse events assessed in the two drugs. So we can say that both finasteride and dutasteride result in almost similar side effects profile over prolonged use.

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REFERENCES

CLARK, R. V., HERMANN, D. J., CUNNINGHAM, G. R., WILSON, T. H., MORRILL, B. B. & HOBBS, S. 2004. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5α-reductase inhibitor. The journal of clinical endocrinology & metabolism, 89, 2179-2184.

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FERTIG, R. M., GAMRET, A. C., DARWIN, E. & GAUDI, S. 2017. Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: A comprehensive review. Dermatology Online Journal, 23.

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NASLUND, M., EADDY, M. T., KRUEP, E. J. & HOGUE, S. L. 2008. Cost comparison of finasteride and dutasteride for enlarged prostate in a managed care setting among Medicare-aged men. Am J Manag Care, 14, S167-71.

SALISBURY, B. H. & TADI, P. 2020. 5 Alpha reductase inhibitors.

HARCHA, W.G., MARTINEZ, J.B., TSAI, T.F., KATSUOKA, K., KAWASHIMA, M., TSUBOI, R., BARNES, A., FERRON-BRADY, G. and CHETTY, D. 2014. A randomized, active-and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. Journal of the American Academy of Dermatology, 70(3), pp.489-498.

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