Switching From Finasteride To Dutasteride: Hair Loss Is Worse?!

Summary

Rob English discusses why some people notice increased hair shedding after switching from finasteride to dutasteride, despite studies he cites finding greater average hair regrowth with dutasteride. He says the worsening can have several explanations. In his view, most cases are likely due to temporary treatment-related shedding or a problem with how dutasteride was formulated, while other explanations remain hypothetical.

Key points and strategies

• How the medications differ: According to English, finasteride inhibits type 2 5-alpha reductase, while dutasteride inhibits both type 1 and type 2. He says studies find dutasteride produces about 30–40% more hair gains on average. However, dutasteride is not FDA-approved to treat hair loss and is used for enlarged prostate.
• Temporary shedding after a treatment change: English says some people experience increased shedding in the first few months after starting an effective hair-loss treatment. He describes this as potentially treatment-induced telogen effluvium: hairs shed as follicles move into a new cycle, and the shedding may precede thicker regrowth. This can be alarming, but is not necessarily a sign that treatment is failing.
• Check the dutasteride formulation: English raises concern that some compounded products may contain powdered dutasteride without the emulsifiers needed for absorption. He recounts a test in which one person’s DHT fell 13% after taking a powdered formulation, compared with the larger reduction he says would be expected from properly emulsified dutasteride. He recommends asking the prescriber or compounding pharmacy how the product is formulated; he says soft-gel versions are one way to ensure emulsification.
• Consider other explanations cautiously: English discusses genetic differences in drug response and a possible role for type 3 5-alpha reductase. He stresses that these possibilities are unproven and likely rare.
• Don’t change medication plans on your own: English mentions that some people combine finasteride and dutasteride on different days, hoping to address different enzyme types. He presents this as a speculative strategy, not an established solution. Discuss medication changes and persistent or severe shedding with a qualified clinician.
• Overall perspective: English estimates that temporary shedding and improperly formulated dutasteride explain most reported cases, while emphasizing that less common possibilities are not well understood. He encourages people to seek reliable information and compare treatment options.

This summary reflects the speaker’s claims and is not medical advice.

Presenters and sources

• Presenter: Rob English
• Sources discussed: Comparative clinical studies of finasteride and dutasteride; pharmacokinetic and pharmacogenetic studies; mRNA hair-follicle studies; an unnamed compounding pharmacy; and a single-person formulation test described by English.