How to get topical dutasteride for androgenetic alopecia?

Table of Content:
What is topical dutasteride? | How to get a prescription? | Side effects | How to apply it? | Additional tips | FAQs

What is topical dutasteride?

Dr. Alpana Mohta, board-certified dermatologist says that topical dutasteride is a medication used off-label to treat androgenetic alopecia (male and female pattern baldness) by applying it directly to the scalp. 

Unlike oral dutasteride, which is taken in pill form and has systemic effects, topical dutasteride was  designed to decrease side- effects by targeting the scalp area directly.

Does topical dutasteride work?

Clinical studies suggest that oral dutasteride is more effective than finasteride for increasing hair count and promoting hair growth. Besides dutasteride has a better safety profile than finasteride, as the incidence rate of adverse drug reactions of dutasteride is only 7.6%, finasteride 10.5%.¹

Although not enough research has been done, some clinical trials show that topical dutasteride is quite effective in treating androgenetic alopecia but with significantly lower systemic absorption and a reduced risk of systemic side effects like erectile dysfunction, low libido, and ejaculatory disturbances².

Topical dutasteride inhibits both 5-alpha reductase (5AR) enzymes and reduces dihydrotestosterone (DHT) levels locally in the scalp, which prevents hair follicle miniaturization and stimulates hair regrowth³.  

Dr. Mohta says that 5AR is the key enzyme involved in converting testosterone to dihydrotestosterone, the active form of hormone responsible for patterned hair loss. This enzyme is present in type 1 and type 2 isoenzyme forms. Type 1 5AR is found in the scalp, sebaceous glands and sweat glands; while type 2 is found in hair follicles and prostate. While finasteride only affects the type 2 5AR, Dutasteride affects both forms, making it more effective. 

Do you need a prescription for a topical dutasteride?

Yes, Dr. Mohta says that you need a prescription for topical dutasteride. This is because dutasteride can still have potential side-effects and there is also a slight risk of systemic absorption, therefore, its use needs to be monitored by a healthcare provider.

How to get a prescription for topical dutasteride?

You can get a prescription for topical dutasteride and topical minoxidil via Miiskin. The online consultation is $59 and it will include what the board-certified dermatologist considers will be the best treatment option for you. Medication refills are only $39.

What are the side effects of topical dutasteride?

Topical dutasteride is generally well-tolerated, but it can still cause minimal side-effects. However, since it is applied locally, the side effects are less common and less severe compared to oral dutasteride. 

• Headaches
• Itching
• Redness
• Irritation of the scalp
• Burning sensation
• Contact dermatitis (in some cases)

Although very rare due to much lower systemic absorption, topical dutasteride may cause decreased libido, erectile dysfunction, hormonal changes or mood changes⁴. 

Dr. Mohta says that topical dutasteride may cause birth defects, therefore it is not recommended for women who are pregnant, may become pregnant or nursing.

What is the dose of topical dutasteride for hair loss?

Dr. Mohta advises that you should always adhere to the instructions provided with the medication and those from your doctor. However, the typical dose prescribed for topical dutasteride is 1 ml twice per day. 

How to use topical dutasteride?

• Wash and dry your hair/scalp with a towel: Ensure your scalp is clean and dry before applying topical dutasteride. Use a mild shampoo to wash your hair and scalp, then towel dry.
• Apply evenly: Part your hair to expose the scalp and apply the measured dose evenly across the affected areas.  Most products also have the option of spraying. Usually 6 sprays will dispense 1 ml.
• Massage into the scalp: Gently massage the solution into your scalp to ensure absorption, avoiding vigorous rubbing to prevent scalp irritation.
• Wash your hands: Thoroughly wash your hands after applying the medication to remove any residual product.
• Allow to dry: Let the medication dry completely before using other hair products or going to bed.

Additional dermatologist tips

• Be consistent: Dr. Mohta advises using the medication consistently, typically twice a day, to maintain stable levels of the drug in your scalp.
• Do not overuse: Stick to the recommended dose, which is usually no more than 2 ml per day. Applying more than advised won’t enhance effectiveness and could increase the risk of side effects.
• Monitor for side-effects: Watch for potential side effects such as scalp irritation. If you notice any adverse effects, contact your healthcare provider immediately.
• Schedule regular check-ups: Regularly consult with your dermatologist to monitor your progress and make any necessary adjustments to your treatment plan.

Frequently asked questions about topical dutasteride

Is topical dutasteride better than topical finasteride?

Dr. Mohta says topical dutasteride and topical finasteride both treat hair loss by reducing dihydrotestosterone (DHT) levels, but dutasteride is generally more potent because it inhibits both Type I and Type II 5-alpha reductase enzymes, whereas finasteride only inhibits Type II. This makes dutasteride potentially more effective and with a similar rate of adverse reactions, especially with respect to sexual dysfunction. On the other hand, topical finasteride is more commonly available, the choice between the two should be made based on availability, individual response, side-effect tolerance, and guidance from a healthcare provider. Learn more about the differences between finasteride and dutasteride.

Can women use topical dutasteride?

Dr. Mohta says that dutasteride is usually not recommended for women of childbearing age due to the risk of birth defects. Dutasteride can be absorbed through the skin and could potentially harm a developing fetus. Instead, women with hair loss problems can use spironolactone and/or minoxidil.

Is topical dutasteride better than oral dutasteride?

Dr. Mohta says that topical dutasteride may be considered a better alternative to oral dutasteride for some individuals because it reduces the risk of systemic side effects. While both forms can be effective for treating androgenetic alopecia, topical application may offer a safer profile by minimizing the impact on the rest of the body. However, the effectiveness of topical versus oral dutasteride can vary based on individual responses and specific circumstances. It mostly comes down to the risk benefit ratio for the patient’s sexual side effects. If the patient has pre-existing sexual dysfunction or is aversive to oral therapy due to the risk of adverse side effects, Dr. Mohta prescribes topical dutasteride.

Can dutasteride be absorbed through the skin?

Dr. Mohta says that dutasteride can be absorbed through the skin. When applied topically, the medication penetrates the scalp and reaches the hair follicles, where it inhibits the enzyme 5-alpha reductase, reducing DHT levels locally. This localized absorption is intended to treat hair loss with fewer systemic effects compared to oral administration.

Is topical dutasteride a DHT blocker?

Yes, topical dutasteride is a DHT blocker. It inhibits the 5-alpha reductase enzyme in the scalp, which converts testosterone to dihydrotestosterone (DHT), a hormone that contributes to hair follicle miniaturization and hair loss.

Can I switch from oral to topical dutasteride?

Yes, Dr. Mohta says that you can switch from oral to topical dutasteride, but it should be done under the guidance of a healthcare provider. They can help determine the appropriate dosage and monitor for any changes in effectiveness or side effects.

Is topical dutasteride better than topical minoxidil?

Dr. Mohta says that topical dutasteride and minoxidil work through completely different mechanisms. Dutasteride reduces DHT levels, while minoxidil increases blood flow to hair follicles and extends the hair growth phase. Individuals may benefit from using a combined dutasteride and minoxidil solution for a synergistic effect.

Can you combine topical dutasteride and topical minoxidil together?

Yes, Dr. Mohta says you can indeed combine topical dutasteride and topical minoxidil. Using both treatments together can address hair loss through different mechanisms, potentially enhancing overall effectiveness. However, this combination should be used under the supervision of a healthcare provider to monitor for side effects and ensure proper usage.

Can topical dutasteride be applied to dirty hair?

For best results, Dr. Mohta says topical dutasteride should be applied to a clean scalp. Washing your hair and scalp with a mild shampoo before application ensures that dirt, oil, and product buildup do not interfere with the medication’s absorption. Applying it to a clean scalp helps maximize its effectiveness.

Article References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9561294/
https://www.americanhairloss.org/hair-loss-treatment/drug-therapy/topical-dutasteride/
https://www.researchgate.net/publication/334740272_Topical_dutasteride_with_microneedling_in_treatment_of_male_androgenetic_alopecia
https://pubmed.ncbi.nlm.nih.gov/35238144/