
Rabbi
Tel Aviv, Israel
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The toughest pill to swallow is that dutasteride (and finasteride) while being the most effective drugs we currently have are still pretty shit at what they do.
People often point out that dutasteride nukes 90-95% of DHT but that’s a mistake. That’s serum DHT, if you are looking for anti balding effects what you’re really concerned about is scalp DHT, thinning of hair occurs locally at the scalp so systemic levels are secondary to local levels.
So how much does it reduce scalp DHT by?
Well it’s quite underwhelming.
pmc.ncbi.nlm.nih.gov
This goes to show why a topical anti-androgen that does not go systemic will mog AR inhibitor to Gandy heaven. Currently RU may do that but its long term safety profile is unknown due to never completing phase 3 trials. Pyrilutamide is the next major runner up but the previous study did not look so good hopefully the current trials running it at a higher dose yield something.
People often point out that dutasteride nukes 90-95% of DHT but that’s a mistake. That’s serum DHT, if you are looking for anti balding effects what you’re really concerned about is scalp DHT, thinning of hair occurs locally at the scalp so systemic levels are secondary to local levels.
So how much does it reduce scalp DHT by?
Well it’s quite underwhelming.
The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: a systematic review and meta-analysis - PMC
We performed a meta-analysis to evaluate the efficacy and safety of dutasteride and finasteride in treating men with androgenetic alopecia (AGA) during a 24-week treatment cycle. Randomized controlled trials of dutasteride and finasteride for ...

Barely 1/2 of scalp DHT at the cost of 90% of serum DHT is a pretty trash price if you ask me and I say this as someone who has been on Dut for a long time.A related clinical study stated that 0.5 mg/day of dutasteride could lower scalp DHT levels by more than 51%, and 5 mg/day of finasteride could lower scalp DHT levels by ~41%
This goes to show why a topical anti-androgen that does not go systemic will mog AR inhibitor to Gandy heaven. Currently RU may do that but its long term safety profile is unknown due to never completing phase 3 trials. Pyrilutamide is the next major runner up but the previous study did not look so good hopefully the current trials running it at a higher dose yield something.