Many threads exist on Propecia (Finasteride) and Avodart (Duasteride) so I hope this isn't a duplicate. In my search to decide which I will use, I came across a very interested article(there is not date on it) by Dr. Epstein. I hope it's not against the rules to post a link, here it is:

http://www.stuartmed.com/whatsnew/dutasteride.asp

This is a quote from the article (I strongly suggest you read it if you take Avodart) discussing the existence of 5AR-1 in the human brain (which Avodart reduces). Please read the following quote by Dr. Epstein for detail:

"Finasteride has a biological model and dutasteride does not. This quite simply means that there is much more safety data on Propecia than Avodart right now. The effects of 5AR type 2 deficiency, (the same environment Propecia creates) have been thoroughly studied for over 25 years in a group of patients in the Dominican Republic. The long-term "side effects" are no hair loss, and no prostate cancer. Patients with genetic 5AR-2 deficiency have no life-threatening disorders and there is no 5AR-2 present in their brain tissue. Conversely, there is no biological model for 5AR type 1 deficiency, which Avodart creates, and there are measurable levels of 5AR-1 in the human brain. Conclusion -- the blockage of 5AR-1 may have yet unknown neurological implications."

"Measurable levels of 5AR -1 in the human brain"! Many of you may know this but I did not. Has there been any discussion on this in the past? It disturbs me to think I was considering a medication which may reduce the level of something existing in my brain and this is the first I've seen it mentioned after reading several articles regarding Avodart.

Those of you taking Avodart, or contemplating it (as I was), have you heard of this before? Has there been resolution to the concern?

Thanks,

hairbank,

Good find. I did know this and I think I may have put it in the article I wrote a few months ago posted somewhere in this forum.

Strangely enough, I had a *minor* side-effect while on Proscar that I do not have on Avodart: I had trouble concentrating. Seems impossible since finasteride does not inhibit Type 1 and Type 1 is the one that is present in the brain. SInce I started Avodart (in November '04) I have not had the problem as severely.

Now, my situation is not common and I admit, it may be something akin to the placebo effect since I was expecting difficulty concentrating upon starting Avodart. However, when you expect something to happen, usually that is when it does... you psyche yourself out and since your mind expects it, it's there. Just the opposite happened with me.

At any rate, it is true that there is not anywhere near the amount of information available on dutasteride as there is for finasteride, however I have had no adverse effects thus far with only positives to report (albeit slow progress). Avodart is definitely not for someone that cannot handle the potential shedding and is not in it for the long haul. Heck, it was at least 13 months (this past December) when I looked in the mirror and could definitely tell a real, no bunk, postive improvement in the crown. It takes a while. THe way I figure it, though, is that it took years to lose my hair so its going to take some time for it to grow back.

I am 99% sure that there is no resolution to the concern yet, but your best bet is to find others that have used the drug for 18+ months (at least!) to get their experiences. I have noticed that people under 8 or so months are still in that "under 12 months shedding crisis mode" a lot of the time.

-Robert

Robert, I much appreicate all of the advice you have given on this board. Speak for myself, I am using Propecia but only reluctantly at this time because although it has a long history and is deemed safe by the medical community, you never really knnow (i.e., celebrex, vioxx, etc.) I would never-ever use any drug long term that did not have a good track record for safety. If it works for you great, but at what risk?

This might help shed some light on this issue.

There was a recent European study looking at the long term affects of dutasteride. It consisted of 2340 patients who were followed for four years. The investigators concluded that the adverse side effects were similar to those of finasteride. The study, however, did not address the efficacy of the drug in the treatment of androgenic allopecia, since its only official use is for benign prostatic hypertrophy.

Here is the reference if anyone is interested in reading further:
BJU Int. 2006 Jan;97(1):73-9; discussion 79-80

OneMission06,

I'm aware that the effects of duasteride seem similar to finasteride. But, as posted above, what about long-term effects of blocking DHT 5AR-1 which is present in brain tissue?

Everyone has their decision to make regarding whether or not to take meds to aid in preventing hairloss. For me, I've finally made the jump to start on finasteride due to the long term studies that have been done. For me, duasteride is too risky.