A recent JAMA dermatology article published in February of 2022, did an excellent comparison of various available oral and topical medications for treatment of androgenetic alopecia. Overall, there are 3 commonly used prescriptions for male pattern baldness. These 3 medications are as follows (Dutasteride, Finasteride and Minoxidil).
These 3 medications fall into 2 different categories of treatment. Dutasteride and Finasteride fall into a category of medications called 5 alpha-reductase inhibitor. By inhibiting the enzyme 5 alpha-reductase, testosterone can not be converted to dihydrotestosterone (DHT). DHT is the main driver of male pattern baldness. Minoxidil on the other hand, is a blood pressure medication whose mechanism of action in treatment of androgenetic alopecia is not well understood. Let's discuss these 3 medications a bit further.
Dutasteride for treatment of hair loss
As stated above, dutasteride is a 5 alpha-reductase inhibitor and exerts its effect via inhibition of DHT formation. Dutasteride is actually used to treat prostate enlargement in men. Dutasteride does not have FDA clearance to treat male pattern baldness and is usually used "off label" to treat androgenetic alopecia. Dutasteride has a longer half life than Finasteride which means that the medication stays in your blood system longer and thus can be more effective.
Finasteride (Propecia) for treatment of hair loss
Finasteride is the only FDA approved oral medication for treatment of male pattern baldness or androgenetic alopecia. The original 1 mg per day dosage was approved under the brand name Propecia. As stated previously, finasteride is a 5 alpha-reductase inhibitor. Finasteride is often prescribed in a 5 mg per day dosage which is also considered "off label" usage. The half life of finasteride is about 6 hours which means that it is cleared through the body faster than dutasteride.
Minoxidil (Rogaine) for treatment of hair loss
Minoxidil is another common medication that is prescribed for treatment of alopecia. Minoxidil can be prescribed as a topical medication or as an oral medication. Minoxidil is the only FDA approved topical medication for treatment of hair loss. It was initially approved under the brand name Rogaine. Oral regimen of minoxidil on the other hand is a blood pressure medication and is again used "off label" to treat hair loss. The exact mechanism of Minoxidil for treatment of hair loss is not well understood.
Over all effectiveness of dutasteride vs finasteride vs minoxidil
This study looked at multiple endpoints in effectiveness of these 3 medications and their various dosage and routes of administration. In the end the overall ranking of prescription medications based on this study is as follows:
0.5 mg/day of oral Dutasteride
5 mg/day of oral finasteride
5 mg/day of oral minoxidil
1 mg/day of oral finasteride or Propecia
5% topical minoxidil (Rogaine)
2% topical minoxidil (Rogaine)
0.25 mg/day oral Minoxidil
In conclusion, oral dutasteride appears to be superior to other treatment methods, however, your specific treatment may depend entirely on you and thus you should speak with a hair transplant specialist today. To learn more, or to book a consultation, please visit us here. You can leave comments or ask questions below.