Efficacy and Systemic DHT Suppression of Topical Finasteride vs Dutasteride

General
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Dear fellow derma nerds, I’ve run into a bit of a logical conundrum.

Dutasteride offers stronger suppression of 5-alpha reductase than finasteride and is therefore more effective in slowing the progression of androgenic alopecia when taken orally. However, when it comes to topical application, things get murkier.

Dutasteride has a significantly higher molecular mass (528.53 g/mol) compared to finasteride (372.55 g/mol), which likely means reduced passive absorption through the skin. So here’s the question:

Does dutasteride’s limited absorbency as a topical treatment outweigh its greater DHT suppression?

This led me to wonder — what if you microneedle prior to applying the dutasteride to increase absorption?

  1. Could this allow enough penetration for dutasteride to achieve greater local DHT suppression than topical finasteride?
  2. Since dutasteride’s molecular mass exceeds 500 Da, would this reduce systemic absorption compared to finasteride — potentially yielding stronger localized suppression with fewer systemic effects?

Looking for evidence-based opinions, theories, or any relevant research you’ve come across.

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Maybe our resident dut expert @Fuzzasteride has an opinion here

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Kwrx has some nice videos on this exact subject. There are ways to get around the 500 dalton rule, including microneedling. But currently we don’t have enough data to suggest topical dutasteride as a real treatment option. @Henryk thanks but I am by no means an expert on this drug haha

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Paging @nkrata, second dut expert

@dermanerd there’s some content on mesotherapy you should check out:

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