Bernstein Medical - Center for Hair Restoration » DHT Blockers

What Hair Loss Medications are Effective DHT Blockers and are they Sold Over the Counter?

Robert M. Bernstein M.D. — Mon, 21 Apr 2008 06:49:00 +0000

Q: Are there DHT blockers that are sold in the pharmacy over the counter?

A: The only effective DHT blockers are finasteride (Propecia, Proscar) and dutasteride (Avodart).

These medications require a doctor’s prescription and are not sold OTC. Nizoral is a topical shampoo for seborrhea (a type of dandruff) that is sold over the counter, but it is not effective in treating hair loss.

Do You Recommend Avodart (Dutasteride) Hair Loss Medication?

Robert M. Bernstein M.D. — Mon, 25 Feb 2008 07:19:00 +0000

Q: I heard that there is a new drug on the market called Avodart for prostate enlargement which might help with hair loss as it blocks the conversion of testosterone to DHT better than Finasteride and is more effective than Propecia. Do you recommend taking it and if so what is the dose?

A: I am currently not recommending that patients take Dutasteride for hair loss, although it is more effective than Propecia, finasteride 1mg. (Dutasteride 0.5, the dose generally used for hair loss, seems to be slightly more effective than finasteride 5m in reversing miniaturization.)

The reasons that I am hesitant to prescribe it at present are outlined in the Hair Transplant Blog question Is Avodart Safe?

In addition to the reasons that I listed in that response, I would also consider that: Dutasteride, unlike finasteride, decreases sperm counts, it can result in persistent decreased sex drive and the incidence is greater than with finasteride. Finally there are a significant number of alpha-type 1 receptors in brain, those affected by dutasteride, but not finasteride.

However, since Dutasteride is approved for older men with prostatic disease, using it for hair loss in this age group (usually in a lower dose) is reasonable.

Does Propecia Hair Loss Medication Effect Beard Growth?

Robert M. Bernstein M.D. — Fri, 06 Jul 2007 12:48:00 +0000

Q: I am a 21 yrs old male having serious hair loss over the last few years. I also have very little facial hair. Since Propecia is a DHT blocker can it inhibit beard growth?

A: As you suggest, it would be reasonable to assume that since DHT stimulates beard growth, blocking DHT (with finasteride) would tend to inhibit its growth. In practice, this does not seem to be the case, i.e. we don’t find that Propecia has any affect on facial hair. The reason is not clear.

It is interesting to note that testosterone stimulates growth of axillary and pubic hair, but not scalp hair. Scalp hair growth is not androgen dependent, only scalp hair loss is.

DHT stimulates terminal hair growth of the beard, trunk and limbs, external ears and nostrils. Of course, it also is responsible for the bitemporal reshaping of hairline as one passes into adulthood and causes male patterned baldness (androgenetic alopecia).

Should One Use Multiple Hair Loss Medications, Such as Both Avodart and Propecia?

Robert M. Bernstein M.D. — Fri, 09 Feb 2007 09:15:48 +0000

Q: I’m 52 years old and have been taking Propecia (finasteride) for two years. It seems to maintain the status quo with no apparent regrowth. I am considering adding a dose of Avodart (dutasteride) once a week in conjunction with the daily Propecia. My question is twofold: (1) Since dutasteride blocks production of both enzymes (type I and II) that produce DHT from testosterone, is it redundant to take the finasteride that only blocks the type I enzyme?

A: It is redundant to take both.

However, you may not be taking the optimal dose of dutasteride which seems to be at least 0.5mg a day for hair loss.

Which is More Effective Hair Loss Treatment: Minoxidil (Rogaine) or Finasteride (Propecia)?

Robert M. Bernstein M.D. — Thu, 25 Jan 2007 04:26:26 +0000

Q: Will Propecia and Minoxidil reverse some of the miniaturization going on with someone with thinning hair? If I do need a hair transplant will I have to stay on these medications?

A: Yes, both minoxidil (Rogaine) and finasteride (Propecia, Proscar) affect the miniaturization of the hair follicles and help restore the shrunken follicles to cosmetically viable hair.

Minoxidil works by directly simulating miniaturized follicles to grow, whereas finasteride blocks DHT, the hormone that causes hair to miniaturize and eventually fall out.

Finasteride is much more effective than minoxidil in preventing or reversing the miniaturization process and it is so much more convenient to use that we generally suggest finasteride after a hair restoration procedure, but rarely recommend minoxidil.