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HAIR LOSS TREATMENTS









illustration of male pattern hair loss

illustration of female pattern hair loss






Dutasteride vs Finasteride vs Placebo for Androgenetic Alopecia, J Am Acad Dermatol, (2014) [PubMed abstract]
  • The study enrolled 917 men with androgenetic alopecia
Main inclusion criteria
  • Age 20 - 50 years
  • Norwood-Hamilton Type III vertex, IV, or V hair loss (Illustration)
Main exclusion criteria
  • Other types of hair loss
  • Minoxidil within 6 months
  • Finasteride within 1 year
  • Dutasteride within 18 months
Baseline characteristics
  • Average age 39 years
  • Norwood-Hamilton Type: III - 43% | IV - 33% | V - 25%
Randomized treatment groups
  • Group 1 (181 patients): Placebo
  • Group 2 (184 patients): Dutasteride (Dut) 0.5 mg once daily
  • Group 3 (179 patients): Finasteride (Fin) 1 mg once daily
  • The study had two other dutasteride arms that used 0.02 mg and 0.1 mg dosing
Primary outcome: Change from baseline in target area hair count within a 2.54 centimeter diameter circle at the vertex at week 24, as assessed by macrophotographic technique
Results

Duration: 24 weeks
Outcome Placebo Dut Fin Comparisons
Primary outcome (change in hair count) -4.9 +89.6 +56.5 Dut or Fin vs placebo p<0.001 | Dut vs Fin p=0.002
Serum DHT levels at 24 weeks (nmol/L) 1.16 0.31 0.49 N/A
Decreased libido 1.10% 3.26% 5.03% N/A
Erectile dysfunction 3.87% 5.43% 5.59% N/A
  • In the other study arms, dutasteride 0.02 mg and 0.1 mg increased hair counts by 17 and 63, respectively. Both were significantly better than placebo.

Findings: Dutasteride increased hair growth and restoration in men with androgenetic alopecia and was relatively well tolerated.



  • Reference [3]
Finasteride sexual side effects during the first year of treatment
Side effect Finasteride 1 mg
(N=945)
Placebo
(N=934)
Decreased Libido 1.8% 1.3%
Erectile Dysfunction 1.3% 0.7%
Ejaculation disorder 1.2% 0.7%
Decreased volume of ejaculate 0.8% 0.4%
Stopped drug due to sexual side effects 1.2% 0.9%
  • Overall, 3.8% of finasteride-treated men reported ≥ 1 sexual adverse event compared to 2.1% of placebo-treated patients (p=0.04)
  • The incidence of sexual side effects did not increase with continued use up to 5 years
  • In a study of finasteride 1 mg daily in healthy men, a median decrease in ejaculate volume of 0.3 mL (-11%) compared with 0.2 mL (-8%) for placebo was observed after 48 weeks of treatment

  • Reference [8]
Dutateride sexual side effects during the first six months of BPH treatment
Side effect Dutasteride 0.5 mg
(N=2167)
Placebo
(N=2158)
Impotence 4.7% 1.7%
Decreased libido 3% 1.4%
Ejaculation disorder 1.4% 0.5%
  • The incidence of sexual side effects did not increase with continued use up to 2 years
  • In a 52-week study, dutasteride caused a mean reduction in total sperm count, semen volume, and sperm motility compared to placebo. Sperm concentration and sperm morphology were unaffected and mean values for all semen parameters remained within the normal range at all timepoints. The effects on total sperm count were not reversible after 24 weeks of follow-up.