Dutasteride, branded as Avodart, has a similar mechanism as finasteride. The drug is primarily prescribed to treat an enlarged prostate. As for treating hair loss, it is approved in Japan1 and South Korea,2 but not in the United States, United Kingdom nor (apparently) European Union countries. Dutasteride may be prescribed off-label for hair loss in the United States.
Dutasteride has differences in pharmacology compared to finasteride. It has a much longer half-life of about five weeks, whereas finasteride’s half-life is 5–6 hours. Dutasteride inhibits all three types of the 5-alpha reductase enzyme, whereas finasteride primarily inhibits types 2 and 3.
Along with finasteride and saw palmetto, dutasteride has been linked a post-drug disorder in some men. There are comparatively few reports of the disorder online, which could be due to several factors: differences in pharmacology, limited prescriptions for hair loss, lower awareness of the disorder among patients and physicians, and hesitancy to report adverse events for off-label prescriptions (these factors are further discussed in section 3 of this post).
Following are firsthand reports of lasting dysfunctions after discontinuing dutasteride with links to sources.
User review
Destroyed my penis. Destroyed my self- confidence. Destroyed my wife’s happiness. How come these people have not found a safe way to reduce the prostate.
Review by Michael on Drugs.com, May 14, 2018
Destroyed my wife’s happiness.
User review
Wouldn’t recommend dutasteride as it effects sex response and this effect remains with me after stopping the drug. Pity my prescriber didn’t mention this.
Review by Rick on Drugs.com, Jul 25, 2020
i never ever had libido issues in my life. Im healthy, i lift 4 times a week. Im a happy person. I was never stressed out about my libido and never worried about side effects (for the people who would claim “placebo”). And i still experienced such severe side effects.
Post-finasteride/dutasteride-syndrome Exists (my Experience)
I just want to say that personally i believe in temporary Post-Finasteride-Syndrom (PFS) by now. I was one of the people who made fun of it, and i even made fun of the idea that finasteride could even create side effects in the first place. Now this anecdotal experience from me is with dutasteride, but this might apply to finasteride for some people who are even more sensitive than me.
I took dutasteride for 10 months. During those months, my libido was non-existant. A woman could be fondling me and i wouldnt be able to get hard. No issue for me. I just wanted to get some of my hair back and then stop the drug. The dutasteride did work. Not to the extent i expected, but it worked. I stopped the dutasteride and waited for my libido to come back. 1 months – > nothing. 2 months -> nothing. To be expected considering the drugs half life. But then, this pattern continues. 3 months, 4 months. 5 months. My libido is still gone. As i planned to start my long, low dose steroid cruise soon anyways, i decided to start with it earlier than planned to see if it would help me. 250mg of test decanoate per week. Fast forward 2 months, i can feel improvements in my libido. But it basically went from 0% to 20-30%, which is obviously not enough. I waited another 2 months. 40% libido now, which is still laughable compared to before.
I want to point out i never had libido issues in my life. During my cycles, during my PCT’s when my Testosterone was low. Never.
So researched the topic to find out whats wrong. Why is my dick not working, despite getting bombarded with so much testosterone and DHT?
Your penis is made up of smooth muscle which contracts or relaxed to control the blood flow rushing into your penis. DHT is the primary androgen in this smooth muscle. Its one of the only muscles in the body that relies on DHT. Or should i say, androgenicity. Based on your genetic suspectability, people require different DHT levels (or androgen activity) to maintain this smooth muscle. If you are sensitive to low androgenic activity in your genitalia, the muscles will atrophy and literally lose size and strength. Its the primary reason why PFS as a topic exists at all. When this muscle atrophies, it needs DHT and literal training to get back to its old form. Which is fapping, as stupid as that sounds.
Again, i want to point out, i never ever had libido issues in my life. Im healthy, i lift 4 times a week. Im a happy person. I was never stressed out about my libido and never worried about side effects (for the people who would claim “placebo”). And i still experienced such severe side effects.
Now look at the extent i had to go and the timeframe to recover just a tiny bit. The amount of hormones and medications im using to create the perfect [environment] for libido.
Imagine what happens to people who dont have access to these things, or are simply not ready to go to this extent. I can understand how someone claims Post-Finasteride-Syndrome when he still has libido issues 2 years after discontinuation.Yes, this happened with dutasteride. But there might be people who are even more sensitive than me and get these issues on finasteride.
The big mistake for me was taking dutasteride and thinking i would recover on my own. The half life is too long. Take finasteride instead. When you notice severe side effects, the drug will be out of your system in mere days when you stop. It also not nearly as strong as dutasteride.
I know some people are going to call me a beta or something, or tell me i didnt drink enough water, or that i didnt sleep enough or some other kind of excuse to give a reasoning for my side effects other than dutasteride. I should have been one of the last people to get side effects but i still got them.
I know this goes against research data but i can only share my experience and tell you what happened in my case. Some people are just very unlucky. Some people are immune to finasteride. Some people are immune to libido issues. Some people watch p**rn and their dicks stop working. Some people take pro-level amounts of steroids for 20 years and dont lose hair. All these things seem impossible but they seem to exist.
Post by Moo*** on HairLossTalk, Feb 27, 2020
Stopped dutasteride after 2 years
Now out of nowhere complete libido loss and ED I’m a mess right now and don’t know why I post this here not that anyone cares, but feels like I’m back to square one idk what to do I hope to god switching to finasteride will make the side effects disappear otherwise idk man
I’m stressed because of this but this isn’t in my head it’s been going on for months but I just told myself my libido will return I’m the opposite of someone who talks himself into side effects, but I can’t keep walking away from it I have legitimate side effects that need to be addressed fast
I’m the opposite of giving myself sides I’ve put the issue away for months thinking it would return but my libido is dead man I can’t deny it anymore. I’ve had almost 2 years of no sides but it’s completely dead right now
Post and two comments (comment 1 | comment 2) by Bra* on r/tressless, 7 Sep 2021
I’m honestly baffled that knowledge about this condition readily exists and NOTHING is happening to help those people who are suffering from it. My life ended when I developed PFS and I have been left to rot by the medical community.
POST DUTASTERIDE SYNDROME SUFFER SPEAKS HIS MIND
3 years ago, we exchanged a friendly conversation on my troubles with Post-Finasteride Syndrome [This author apparently took dutasteride but refers to the condition as post-finasteride syndrome]. I followed your advice back then and went to several specialists, who couldn’t help. Since then, I am still suffering tremendously (numb deformed genitals, zero arousal, severe ED, other physical symptoms such as a thinning beard…) after exposure to 5ARi treatment.
I’m honestly baffled that knowledge about this condition readily exists and NOTHING is happening to help those people who are suffering from it. My life ended when I developed PFS and I have been left to rot by the medical community.
Would you be willing to raise awareness about this rare iatrogenic condition in the medical/dermatological community or publish a case report as to bring PFS in the medical literature? I don’t think this would damage reputation anymore since some credible studies have been published since, and, sorry for being so candid, I personally believe it’s your responsibility to help those who’ve been harmed by a drug you are promoting online.
I don’t mean any offense or disrespect. But I’m only trying to give a voice to thousands of young man who have been severely harmed by this drug and have lost all hope. Last year, we lost a young man to suicide, because he couldn’t bear the bodily destruction anymore that PFS has wrought.
Please, consider helping us bringing awareness to this rare iatrogenic disease. We have a moral obligation to not turn a blind eye to those in need.
Thank you
Letter to BaldingBlog (sender not specified), Mar 21, 2023. Blog is maintained by Dr. William Rassman, hair transplant surgeon. A response from Dr. Rassman is on the website.
A bigger concern for me now is that the ED drugs aren’t working for me anymore.
The next user describes taking dutasteride and finasteride concurrently, but the title attributes his lasting dysfunctions to dutasteride. It is of course possible that either finasteride or dutasteride, or a combination of the two, contributed to these experiences.
Suffering from intense sides from dutasteride
I’m in my late 20s and suffering from intense sexual sides after taking dutasteride, including almost complete loss of libido and impotence.
I began taking finasteride (doctor prescribed) in 2012 and added 0.5 mg of dutasteride (ordered from an online pharmacy) in 2015. I don’t think this was a wise move by any measure, but I went ahead with the combo to combat hair loss. The results weren’t dramatic as my hairline continued to recede as well as general density and hair thinned, but I had a peace of mind knowing that I was doing all I could do.
[…] [M]y daily regimen became 1 mg of finasteride, 0.5 mg of Indian pharmacy dutasteride, and 0.5 mg of prescribed generic dutasteride from a local pharmacy.
One obvious change that I noticed was crazy shedding which started in the second month and lasted for a couple of months. Hair started falling like I was going to go bald by the end of the year. At the same time, however, I had a strange feeling of hopefulness believing that the doctor-prescribed dutasteride was actually working […] and once shed phase passes, new and stronger hair will grow back. […] [H]airline recession continued and reduced density from shedding never recovered.
About at third month, though I didn’t realize at the time as one of the sides from dutasteride, my libido was significantly reduced. However, I still had urges and I had no difficulty getting aroused so I didn’t think of it much. In late October, I began to realize the erection quality was not as good, but I merely thought fatigue was causing it and I had no problem finishing a sexual intercourse. Then in the middle of November, while having an intercourse the second time, I suddenly lost the erection and no stimulation could make my penis hard or gather any blood flow. It felt numb, and when the feeling did not go away until the next morning, I knew something had gone seriously wrong and I learned I was suffering from intense side effects from dutasteride.
I immediately began taking Cialis to hide my sexual dysfunctions from my girlfriend, but even with the help of Cialis, I was only able to have intercourse just once. I would need at least 12 hours of a lapse in order to perform again.
At the same time, I began to exercise my lower body including squatting and running, as well as kegels, and taking l-arginine, pycnogenol, and maca tablets. Of course, I stopped taking all hair loss drugs.
Then about a couple of weeks ago, I felt a complete loss of libido and Cialis, even at 20 mg dosage, stopped working for me. I could only achieve semi-erection, enough to penetrate after physical stimulation, but would soon become flaccid, unable to complete intercourse. I tried Viagra at varying dosages, from 25 mg to 100 mg, but had even less success.
Now, I am severely depressed and don’t know what to do. I’ve done a massive amount of researching online, but there is no known cause for the side effects (other than they just happen when dutasteride is taken) and therefore no cure. Those who recovered from cases like mine came naturally, and the time frame of recovery, if any, varies from a few weeks to a few years. A bigger concern for me now is that the ED drugs aren’t working for me anymore. Previously, I was going to let my body heal itself and wait for it, which is the only course of action I can take, and meanwhile, I would use ED drugs to have intercourse. However, I can’t have a proper intercourse with even with the ED drugs, both Viagra and Cialis. Now, I am wishing I hadn’t been born…
Post by mlb*** on r/tressless, Jan 10, 2018
References
- Ji-young S. Generics to challenge GSK’s prostate, hair loss drug in Korea. Korea Herald. 2016 Jan 22. http://www.koreaherald.com/view.php?ud=20160122000522
- PMDA Japan. Review Reports: Drugs. https://www.pmda.go.jp/english/review-services/reviews/approved-information/drugs/0001.html