Doctor of Pharmay – Dutasteride, Finasteride, or Minoxidil?


Which treatments for male pattern hair loss are scientifically proven to be the best in this video we’re going to be taking a look at this question by analyzing a study that identified and ranked the best hair loss treatments available and i think you might be surprised by the results so make sure to watch to the end now in the study authors compared the following

Treatments right we had the five alpha reductase inhibitors finasteride as well as dutasteride and then we also had topical and oral versions of minoxidil now these aren’t all of the evidence-based treatments for hair loss but these are the heavy hitters when it comes to the literature for sure now if you’re familiar with the literature you would know that there

Is no study directly comparing all of these different treatments together so how did the authors do this how did the authors compare all of these different treatments in terms of efficacy well what the authors did is they ran a type of study called a network meta-analysis and basically what they did is they took a whole bunch of different studies 23 studies to

Be exact and a lot of the studies were randomized control trials so they did have very high quality evidence and then the researchers used the magic of math statistics and the principles of evidence-based medicine to amalgamate all of these studies together to really get all that data together so that the researchers could essentially simulate a larger study that

Would have compared all of these different treatments now this method is not perfect it does have flaws especially considering that some studies were a lot better than other studies but the researchers did everything in their power to try and mitigate these flaws as best they could and what the researchers found is that this is how the treatments are ranked most

Likely now in first place we had dutasteride at the 0.5 milligram dose i don’t think this is too surprising for most people given that the rate of hair loss is believed to be proportional to the amount of dht and dutasteride tends to lower your dht more than finasteride does given that dutasteride inhibits more types of five alpha reductase compared to finasteride

I’m just going to show you some of the results from randomized control trials doing head-to-head comparisons between finasteride and dutasteride to really illustrate my point here now the thing that i want to mention with dutasteride and some of these other medications is that dutasteride is not approved for treating hair loss by the fda or by health canada or by

Most other regulatory bodies it is approved in certain asian countries but in the fda health canada it’s not approved what does that mean that means that the medication dutasteride has not been studied to the same extent as finasteride in young men with hair loss now it has been studied pretty extensively in older men for treating enlarged prostate but in the the

Population that we’re talking about here young men with hair loss it has not been looked at to the same extent it has not been exposed to the same level of scrutiny so there’s less safety data in the population that we’re talking about you would also need to find a provider who would feel comfortable prescribing due to asteroid to you off label now i personally

Know a lot of doctors who are very by the book people right if a drug is not approved by a health canada or the fda they’re just not going to prescribe it moving on to second place we had finasteride at five milligrams and this is also very interesting to me and it’s interesting because five milligrams is the high dose of finasteride that’s commonly prescribed

For prostate enlargement it’s not the one milligram dose which is usually used for hair loss now i think based on how one in five milligrams of finasteride are so similar in terms of five alpha reductase inhibition and also in terms of dht lowering we often assume that they have the same efficacy but the authors found that five milligrams of finasteride is likely

Better than the one milligram dose in the real world now again five milligrams of finasteride this is an off-label dose five milligrams is not indicated for hair loss so potentially less safety date up in young men with hair loss and you would also need to find a prescriber who would feel comfortable prescribing you this dose off label in third place we had oral

Minoxidil at five milligrams again very interesting now if you know anything about minoxidil you know that minoxidil was originally studied as a blood pressure pill and researchers found that they’d cause hair growth as a side effect and reformulated minoxidil into a topical version for hair loss and this is because topical drugs tend to be safer than oral drugs and

Also it turns out that oral minoxidil caused this very rare but life-threatening heart swelling type of side effect now that being said if you’re young healthy and you’re being monitored by a doctor you’re probably not going to run into this issue taking oral minoxidil but some people do get that issue especially sicker individuals and then obviously oral minoxidil

Not approved for treating hair loss so less safety data in young men with hair loss and you’d probably need to find a prescriber who is comfortable prescribing oral minoxidil off label now finally in fourth place we had finasteride at the one milligram dose this is the drug that myself and so many other people take for hair loss it is approved by health canada as

Well as the fda and it has an excellent safety profile it has hardly any drug interactions the amount that you would need to take to have an overdose is just absurd so very difficult to overdose on sexual side effects are very rare and reversible so overall very very good medication however i am a little bit disappointed with how low finasteride ranked in the

Study in terms of efficacy i think that finasteride with topical minoxidil is still a great treatment regiment but if i was only taking finasteride and i was looking to get some hair regrowth i would probably consider taking oral dutasteride rather than oral finasteride since then unsurprisingly in fifth and sixth place we had five percent and two percent topical

Minoxidil respectively same thing as rogaine right it’s good it’s it’s it’s fine it’s better than placebo but it’s not going to work any run uh wonders um and then in last place we had low dose oral minoxidil at the 0.25 milligram dose which makes me think what is even the point of taking low-dose oral minoxidil a drug that is not indicated for hair loss and also

Doesn’t seem to be very good for treating hair loss either so anyways that is all i’m talking about obviously based on the data from this study there are other possible rankings this video is a huge oversimplification of the study so i would encourage you to read it if you can now the result section is pretty confusing since the authors are talking about hair

Counts they’re using talking about statistics but in the conclusion of the study they did rank the treatments in the order that i presented this is how the researchers believe these drugs might rank all things considered anyways i want to thank you for watching this video it’s always much appreciated now i know that a lot of people are subscribed to my channel

Mainly for the hair loss content so here i decided to make a hair loss video about a study that i think is very important and very relevant and very actionable when it comes to treatments for hair loss and more more in depth so thanks again for watching and i’ll see you in the next video

Transcribed from video
Doctor of Pharmay – Dutasteride, Finasteride, or Minoxidil? By Isaac Wade PharmD