sup choose how y'all living hope everything is Nova and you're all having a pream week so if you guys know me and follow my channel then you'll know that I'm obviously a very big fan of using five air Inhibitors to stop hair loss that is for good reason of course and that is because five air Inhibitors are the most effective means of stopping hair loss that currently exists today usually when I recommend people start a five air inhibitor I will tell them to start with finasteride after all finasteride is the five air inhibitor which is FDA approved for treating hair loss and is the one I personally use myself specifically what I'll do is that I'll use generic proscar and I'll cut it into quarters and use it at 1. 25 milligrams per day since that is the cheapest way to take finasteride my experience with finasteride has been an extremely positive one and the science backing finasteride safety and efficacy as a hair loss treatment is overwhelming indeed accepting the fact that you need finasteride to stop your hair loss is taking the red pill of course even though I am on team finasteride I haven't forgot about my friends who are part of or thinking about joining the dutasteride master race dutasteride has the well-earned reputation of being more efficacious than finasteride as stopping hair loss but does that increase efficacy come at the price of a higher risk of side effects well surprisingly the answer seems to be no dutasteride does not have a greater chance of causing side effects than finasteride in fact if anything it is possible that the risk of side effects from dutasteride is even lower than from finasteride believe it or not I know that sounds crazy and I'm sure people are about to ask me things like oh yeah Kevin well what about the neurological side effects like brain fog or depression you say that the risk of neurological side effects from finasteride is low because it blocks the type 2 5-hour ISO enzyme and the Brain contains the type 1 5 Air isoenzyme I can accept that but through testeride blocks both ISO enzymes in fact it is 100 times stronger than finasteride at blocking the type 1 isoenzyme and it is three times stronger than finasteride of blocking the type 2 ISO enzyme so do test right has got to affect our brains and overall it is stronger than finasteride so it has got to cause more side effects so clearly dutasteride can't be safe so haha so all that is true about dutasteride being stronger than finasteride and suppressing both the type 1 and type 2 5 Air isoenzymes do testerite is stronger than finasteride and that it lowers both serum DHT and scalp DHT more than finasteride does besides this point though finasteride also has a very short serum half-life of only five to seven hours while dutasteride has a very long serum half-life of five weeks so if you develop side effects while on finasteride you can stop the drug and it will be out of the system in just a few days whereas with the case of detasteride it can take months to clear out the system entirely yet even though dutasteride is more powerful and longer acting than finasteride it is rather strange that it is primarily finasteride and not do tasteride that gets most of the bad press including claims that its side effects don't go away over time even though its serum Half-Life is measured in hours not weeks it's finasteride and not do testeride that has depression listed as an adverse side effect in its package insert even though finasteride doesn't have any notable effects on brain neurosteroid levels which are synthesized by the type 1-5 air ISO enzyme do testeride on the other hand does block the type 1-5 air isoenzyme that is present in the brain yet it doesn't even have depression listed as a possible side effect in its package insert so how in the hell is it that finasteride supposedly causes depression but do testerite doesn't cause depression even though do testeride suppresses a type 1-5 air isoenzyme with finasteride doesn't and how is it possible that dutasterac has a similar or even lower incidence of side effects when it suppresses the type 1 isoenzyme and more of the type 2-5 air isoenzyme compared to finasteride does dutasteride have more side effects than finasteride or doesn't it and if it doesn't why even bother using finasteride to begin with if dutasteride is safer and more effective than finasteride does the dutasteride master race have a point here well let's go balls deep into the data and find out once and for all Chums here is one of the first studies to compare to test ride with finasteride it is this article here titled quote Market suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride a dual five Alpha reductase inhibitor unquote in this study 399 men with benign prostatic hyperplasia also known as BPH were randomized to receive five milligrams daily a finasteride or dutasteride different doses of dutasteride were tested ranging from 0. 01 milligrams per day to five milligrams per day these drugs were compared to a placebo control group this graph here shows the effects on serum DHT levels after 24 weeks of treatment five milligrams daily of finasteride decrease serum DHT by 70 percent with dutasteride 0.
01 milligrams daily had a minimal effect and 0. 05 milligrams daily decreased serum DHT Levels by 53 so still less than finasteride at one milligram however keep in mind that the standard dose of dutasteride is 0. 5 milligrams per day this standard dose decreased serum DHT by 95 percent while 2.
5 milligrams daily of dutasteride decreased it by 98 going up even higher to five milligrams daily of dutasteride didn't have much of an additional effect which suggests that do castorite hits its peak at 2. 5 milligrams per day so based on all this data 2. 5 milligrams daily do test drive is the strongest five error Blocker in existence for treating both hair loss and BPH keep in mind though that this was just a study for enlarged prostate so they didn't look at Scout DHT levels this is important because serum DHT doesn't always correlate with scalp DHT but we have other data on that coming up very soon so keep watching but getting back to this BPH study here is the same data on serum DHT suppression in table form this table also shows that the two drugs increase serum testosterone levels which we would expect since blocking the 5 Air enzyme converts the alpha Chad hormone testosterone into the beta version trash hormone DHT 5ar metabolizes testosterone so by blocking 5 AR with dutasteride or finasteride we are slowing this metabolism and therefore preserving more of our testosterone levels this is probably why a lot of people actually report an increase in libido while they're using finasteride or dutasteride this study also looked at how long it took for serum DHT levels to return back to normal after stopping finasteride right and dutasteride in this graph finasteride at a dose of 5 milligrams per day is represented by black squares after stopping finasteride serum DHT levels were returned back to normal within four weeks with dutasteride at 0.
5 milligrams represented by gray squares here serum DHT levels were almost backed up Baseline after 16 weeks however with doses of dutasteride at 2. 5 milligrams or 5 milligrams daily which is represented by the white circles and white diamonds the serum DHT was still about 90 percent suppressed after 16 weeks so this data confirms that dutasteride has a much longer Half-Life than finasteride which means that side effects could possibly persist for several weeks after stopping the drug particularly if you are taking 2. 5 milligrams of dutasteride now looking at side effects in this study it is interesting that despite the much greater reduction in syrup DHT levels from dutasteride the investigators found that quote dutasteride was well tolerated and generally had an adverse event profile similar to Placebo unquote this figure shows that the incidence of drug-related side effects was similar between finasteride and the different doses of dutasteride and in fact there was no statistical difference in the incidence of side effects in the drug groups versus placebo now this first study looked at the people with BPH but the next study specifically this one here looked at finasteride versus dutasteride for treating hair loss so finally we're looking at an actual hair loss study in this study 416 men were randomized to receive either five milligrams daily of finasteride or doses of dutasteride ranging from 0.
05 milligrams daily to 2. 5 milligrams daily just like in the last study these treatment groups were compared to a placebo control group so conveniently this study design is very similar to the previous study with the only big difference being that the investigators were looking at hair growth and not BPH because of this they looked at the effects of the drugs on scalp DHT as well as serum DHT which is good since we know that scalp DHT is more important than serum DHT when we're talking about androgenic alopecia so first looking at the effects on hair counts after 24 weeks of treatment you can see that both finasteride and dutasteride were effective though 0. 5 milligrams and 2.
5 milligrams daily of dutasteride were more effective than five milligrams of finasteride if you're wondering how five milligrams of finasteride Compares with one milligram of finasteride for hair growth remember that both doses have nearly the same effect on serum DHT levels and that's because finasteride's dose response curve is relatively flat what this means is that finasteride Peaks at one milligram so using five milligrams of finasteride will have the same effect on your hair as using one milligram of finasteride you can see this in a figure from a study from 1999 where the effects of different doses of finasteride on scalp DHT are shown in the left hand graph and the effects on serum DHT are shown in the right hand graph I talk about this in my optimal dose of finasteride video which I'll link below do testosterone on the other hand does not Peak at its standard 0. 5 milligram dose and it can be safely stacked all the way up to 2. 5 milligrams daily which will suppress about 30 percent more scalp DHT than 0.
5 milligrams of dutasteride and 40 percent more scalp DHT than one milligram of finasteride I talk about this in my perfect dose of dutasteride video which is also linked below anyways looking at serum DHT levels and testosterone levels with the different drugs we see curves very similar to the previous study the next graph shows the scalp DHT suppression with each drug to put this graph into real numbers five milligrams of finasteride suppress scalp DHT by 41 while 0. 5 milligrams of dutasteride suppressed it by 51 and 2. 5 milligrams of dutasteride daily suppress scalp DHT by a whopping 79 percent like in the previous study the drugs were discontinued after 24 weeks in this study the serum DHC levels were re-evaluated 12 weeks after discontinuing the drugs you can see that the DHT levels have returned to Baseline 12 weeks after stopping the drugs for both finasteride and dutasteride 0.
5 milligrams daily the levels may have returned much more quickly than this especially for finasteride since it has a much shorter Half-Life but the investigators only check the blood levels at 24 weeks and 36 weeks into the study with a dose of 2. 5 milligrams daily of dutasteride the serum DHC levels are not back to Baseline after 12 weeks much like with the previous study so what this all means is that even if you do get side effects from dutasteride at a dose of 0. 5 milligrams per day at the very worst it may take up to three months for the side effects to subside completely however if you're on 2.
5 milligrams of testosterone per day it will take longer because the drug is still active in your bloodstream three months after stopping it how much longer will the side effects last you may ask well we don't know for sure because the study design didn't have a long enough follow-up period but it certainly wouldn't ever be permanent because the blood levels do eventually normalize over the time as they would with any other drug you're using with finasteride on the other hand this isn't a concern at all since based on its Half-Life it should be completely out of your system in just a few days so we know that side effects from dutasteride can last longer than finasteride side effects so that is one clear Advantage finasteride has over dutasteride but is the risk of getting side effects from dutasteride higher than it is with finasteride well this study here also looked at side effects from both drugs like the previous study there was no difference in the incidence of side effects in the drug groups versus the placebo group this is despite the fact that dutasteride is a more powerful suppressor of DHT than finasteride as well as having effects on the type 1 5 Arab ISO enzyme that finasteride doesn't have the study's conclusion seem a bit hard to believe however and that's not because finasteride and dutasteride had a similar incidence of side effects but rather because in this study like the previous study the drug showed the same incidence of side effects as the placebo group we know from the large clinical studies that both finasteride and dutasteride have a low but real incidence of side effects compared to Placebo these are relatively short-term studies and the number of subjects while in the hundreds is still relatively low in trying to assess the incidence of side effects from drugs when a drug has a low risk of side effects like finasteride and dutasteride you need a larger number of subjects to get an accurate idea of how common the side effects really are if a drug has only a two percent risk of side effects for instance then you could have a study with 200 subjects that still shows a zero percent risk of side effects due to Pure chance it would be like flipping a coin and getting Tails two times in a row not a big deal and totally plausible you can determine efficacy with a small study but to determine the safety of a drug you need a large study well fortunately there are much larger trials comparing these two drugs so let's see what they tell us about the incidence of side effects from finasteride versus dutasteride in this article from 2011 1630 men with BPH were randomized to get either five milligrams per day of finasteride or 0. 5 milligrams per day of dutasteride the study results showed that the incidence of side effects and finasteride versus dutasteride was comparable the authors say quote the incidence of sexual Adverse Events such as impotence decreased libido ejaculation disorders and sexual function disorders as well as gynecomastia was also similar in each treatment group unquote going against this conclusion though is the next study published in 2012. this was a retrospective study of 378 men treated with either finasteride or dutasteride for BPH this study found a greater incidence of sexual side effects and gynecomastia with dutasteride versus finasteride however this study is really an outlier because as we'll see the majority of studies looking at both drugs did not find a difference between the two drugs and the incidence of side effects and some even seem to show that dutasteride has fewer side effects than finasteride but unlike the previous study this was a smaller study and was not a prospective randomized clinical trial the authors of this study recognized this and pointed out that quote Although our results suggest safety profile differences between finasteride and dutasteride the interpretation of these results is limited by the retrospective non-randomized nature of the study unquote in the next study from 2014 917 men with androgenic alopecia were randomized to get either finasteride at one milligram per day dutasteride at doses of 0.
02 to 0. 5 milligrams per day or Placebo both drugs were effective in increasing hair counts and hair diameter though as expected dutasteride at 0. 5 milligrams per day was more effective than finasteride at one milligram per day but looking at adverse effects the overall incidence of side effects was similar between the treatment groups and control groups this table here shows the incidence of adverse effects in the different groups this table also shows why it is important to have a control group in these kind of studies which the last study I just showed didn't have unfortunately the reason that a placebo control group is so important is that there was a significant incidence of side effects in the placebo control group itself in fact the incidence of side effects in the placebo control group was almost the same as the incidence of side effects and the actual treatment groups if you look at the second row of this table here it shows the incidence of any drug related adverse effect the next to last column shows to test right at 0.
5 milligrams daily and with dutasteride the incidence of Adverse Events was 16 however if you look at the First Column which is the placebo group the incidence was 15 if you didn't have a placebo group you'd think that dutasteride at 0. 5 milligram daily was causing a 16 incidence of side effects whereas in reality it is only increasing the incidence of Side Effects by one percentage point it turns out that the researchers agree with this conclusion by saying quote there were no statistically significant differences between active treatment groups and Placebo in the incidence of Adverse Events drug related Adverse Events serious Adverse Events or adverse event withdrawals from the study or study drug unquote looking specifically at sexual side effects such as low libido and erectile dysfunction the authors say quote the incidence of Adverse Events of special interest related to sexual functioning and breast disorders was similar in the active treatment groups and lower with Placebo with the composit adverse event altered libido being the main cause for the difference between Placebo and active treatments unquote so in this study the incidence of side effects from dutasteride and finasteride was similar and the only type of side effect that was more common with the drugs than with Placebo was sexual side effects there are more studies like these that show a similar incidence of side effects between the two drugs for example this study from India randomized 90 band with androgenic alopecia to receive either dutasteride at 0. 5 milligrams daily or finasteride at one milligram per day this study also found that dutasteride was Superior to finasteride in terms of hair growth once again the incidence of side effects was comparable between the two drugs the investigators conclude quote both the group showed a similar side effect profile with sexual dysfunction being the most common and reversible side effect unquote so when there are multiple studies available comparing these two drugs together one strategy you can use to come up with a stronger conclusion is to do a meta-analysis in a meta-analysis the results of similar studies are combined into one big study by combining the these results you get more subjects and the statistics become stronger as a consequence so DrZhao from China has published two meta-analyzes comparing to test drive with finasteride one was published in 2019 and included 576 men being treated with dutasteride versus finasteride for androgenic Alopecia as expected dutasteride was more effective than finasteride but that isn't contentious we are most interested in side effects here after all these Force plots summarize the data what a forest plot is well it isn't a Horticultural term rather it is just a way to graph the relative risk of a treatment versus placebo points to the right of the zero line show increased risk and points to the left show decreased risk in case you're having trouble interpreting these graphs DrZhao summarizes the data in the results section of his paper he states that there was no difference in the incidence of altered libido erectile dysfunction or ejaculation disorders between the two drugs so simply put the side effect profile between finasteride and dutasteride is about the same the second meta-analysis from DrZhao was published in 2020 and this time he looked at men with prostate problems who were given either finasteride or dutasteride this time there were 2041 subjects once again there was no difference in the risk of any adverse offense decreased libido or impotence between the two drugs as shown here in fact if anything there was a trend towards dutasteride being the safer drug which you wouldn't think makes any sense given that dutasteride is also the more potent drug and usually the more powerful the drug the more risk there is of side effects however these differences weren't statistically significant so DrZhao once again concluded that there was no significant difference in the risk of side effects between finasteride versus dutasteride there are two other meta-analyzes that I found that compare the incidence of side effects for dutasteride versus finasteride this one published in 2019 looked at 15 randomized controlled studies including 4495 subjects that compared to test right at 0.
5 milligrams daily to finasteride at one milligram daily the article specifically looked at the risk of sexual side effects like erectile dysfunction or reduce libido and problems with ejaculation this figure shows the overall effect of these drugs on the risk of getting these side effects not surprisingly finasteride does increase the risk of having sexual side effects with a risk ratio of 1. 66 and this was a statistically significant finding dutasteride also increased the risk although the risk ratio was less at just 1. 33 and this result was not statistically significant the authors concluded that both drugs increase the risk of sexual side effects they propose The increased risk with dutasteride was not statistically significant because there were fewer subjects taking to test ride versus finasteride but this isn't the only study showing a decreased risk of side effects with dutasteride compared to finasteride we have yet another meta-analysis that showed similar results when dutasteride was compared to finasteride this last meta-analysis is from our friends in good Korea the analysis included 600 men half of whom took finasteride and the other half were on dutasteride like all the studies comparing the two drugs due asteroid was more effective than finasteride in promoting hair growth when the incidence of side effects was compared between the two drugs statistically this incidence was similar between the two drugs though as you can see here there was once again a trend towards dutasteride having fewer side effects The Only Exception is what the authors call Adverse Events of Interest which were sexual side effects and look and it looks like there was a slight Trend favoring finasteride over dutasteride in this type of side effect the authors conclude by saying quote the rate of adverse offense overall was low in both treatment groups though the calculated incidence rate of Adverse Events were numerically higher among finasteride treated patients compared with dutasteride treated patients unquote well all these studies talking about side effects are interesting but have you chooms noticed a common Trend yet it's the fact that none of these studies mention anything about depression or any other cognitive side effects whatsoever that's especially odd because like I said dutasteride is a powerful type 1 5ar blocker which unlike finasteride you might think would affect more my neurosteroids well fortunately the last article comparing the two drugs together which was just published this year looks at this very question this article is from France and it used the French national Healthcare database to identify 69 786 finasteride users and 217 577 do test ride users all of whom were taking the drugs for BPH not androgenic alopecia so it is interesting that this is one of the few studies with a lot more dutasteride users than finasteride users you know maybe that's because dutasteride is more commonly prescribed in France especially if the indication is for BPH anyways the authors compare the risk of suicide in these subjects it turns out the risk of suicide was low and not any different between the two drugs the authors say quote suicidal events occurred for 52 individuals 0.
07 exposed to finasteride including 18 deaths 0. 03 and 34 for self-harm hospitalization 0. 05 and for 133 individuals 0.
06 percent exposed to dutasteride including 47 deaths 0. 02 and 87 first self-harm hospitalization 0. 04 percent unquote as to why do test drive doesn't seem to increase the risk of depression or suicide the authors point out that quote it is not currently clear to what extent do testerite also crosses the blood brain barrier and further biological investigations are needed to address this issue as such a difference could explain the difference observed in our study between two drugs of the same pharmacological class unquote now I have read articles that claim that dutasteride does cross the blood brain barrier and others that claim that it doesn't the issue is that dutasteride is a larger molecule than finasteride and that might be too large across the blood-brain barrier I think this article statement that it is not clear to what extent do castoride crosses the blood-brain barrier is an accurate one because I don't think the research has been done to clear up this issue one way or the other it may be that dutasteroid crosses the blood-brain barrier partially and so that the actual concentrations of the brain are lower than in serum levels however I don't think this is something that needs be research any further because if the testerite did cause problems we'd see it in the outcome data we don't always need to fully understand the mechanism of drug in order to know that it is safe if detestroid had any of these major issues people worry about we would have seen them by now in the clinical trials as well as in the follow-up data I mean the drug has after all been out for decades now so what's especially bizarre about all of this data is that unlike what you would predict dot asteroid has the same incidence of side effects as finasteride despite it being a stronger type 1 and type 2 isoenzyme blocker than finasteride and despite it lowering DHT significantly more than finasteride in fact if five AR side effects are due to the lowering of DHT levels you would expect you test right to cause a lot more side effects than finasteride also if the effects on neurosteroid levels were important again dutasteride would cause more side effects than finasteride since it is 100 times stronger at inhibiting the type 1 5 Air ISO enzyme compared to finasteride remember the type 1 isoenzyme is the iso enzyme that is present in the brain now like I said it is possible that dutasteride doesn't cross the blood brain barrier well enough and maybe that is why it doesn't cause any neurological side effects but you would expect finasteride to cause even fewer neurological side effects because it only has a negligible effect on the type 1 isoenzyme so we can easily conclude from all this that the two drugs are pretty equal in the risk of side effects although the most important thing to remember is that the risk of side effects from both drugs is low and side effects are not persistent at least not for any longer than a few days in the case of finasteride or a few weeks in the case of dutasteride since do testosterone has a longer Half-Life than finasteride so you may be wondering if dutasteride is more powerful than finasteride and has about the same incidence of side effects then why should anyone bother using finasteride at all why not just use dutasteride well as the finasteride peasant let me try to give my rationale for this to the dutasteride master race you see you can describe me as kind of uh if it ain't broke don't fix it kind of guy finasteride has been my go-to hair loss treatment for over a decade and it works extremely well for me as such I just don't feel much of a desire to change treatments when I'm already using something that works very well also as a vegan I don't like how detasteride comes in a soft gel capsule since soft gels are made out of gelatin which is an animal byproduct yes before you ask I know that finasteride contains a trace amount of lactose but the amount of lactose found in finasteride is beyond trivial I'm talking about having to consume years worth of finasteride to get the amount of lactose you'd find in just a single eight ounce glass of milk and I talk about that a bit in my mic the vegan video which I'll link below as far as giving a more scientific rationale for preferring finasteride over dutasteride finasteride does have the advantage of being the original five air inhibiting hair loss drug and as such it has more long-term follow-up data including studies showing it maintains its efficacy even after 10 years of usage I actually have a video where I go over that 10-year follow-up data link below so be sure to check that out and my wife and asteroid stops hair loss video if you want to know more about why finasteride never stops working another advantage of finasteride is that it is easier to titrate down if you do get side effects since finasteride is a tablet you can cut the one milligram pill into smaller Doses and research shows finasteride even in doses as low as just 0.
1 milligrams per day can be effective and that is discussed in my optimal dose of finasteride video which is linked below do testosterone on the other hand cannot conveniently be titrated below its standard 0. 5 milligram dose since it is a soft gel so if you get side effects on 0. 5 milligrams of dutasteride you can't practically scale down any lower than that however unlike with finasteride you can titrate up with your task Drid to make it more effective finasteride Peaks at one milligram per day but dutasteride can be used safely in doses as high as 2.
5 milligrams per day which will suppress twice as much scallop DHT as one milligram of finasteride bottom line though is that both finasteride and dutasteride are fantastic drugs and they both will work to stop hair loss forever most people who say finasteride isn't strong enough for them are usually just misinterpreting a treatment shed as a sign that the drug isn't working when the reality is that the opposite is true and I'll post my shedding video below if you want an explanation on that the bottom line though is that you need to stick to treatment through the shedding periods because if you stop treatment you're going to end up not having any hair left to shed yes shedding is normal and no shedding doesn't mean the treatment isn't working the opposite is true again please watch my sharing video link below however if you are convinced that finasteride isn't enough let's say you've been on finasteride for about two years and you're still losing ground then at that point it might be a good idea to switch to dutasteride and if you do make that switch then you shouldn't worry that you'll get more side effects all the existing data suggest that the chances of side effects from dutasteride are about the same as finasteride so if you are a good responder to finasteride you should assume you'll also be a good responder to detached right whatever the case you shouldn't fret over which five air inhibitor to use just get on one of them and you will be fine I promise if you want a little more Assurance of efficacy you can try to test drive or even 2.
