Moving from Finasteride to Dutasteride

[Richenda]

Hi everyone,

Whilst I await my GnRH analogue in c. 2 to 4 months I'm switching from Finasteride to Dutasteride. This is partly driven by cost and partly that I think it's better for DHT suppression.

I've been on hormone treatment for c. 14 months and have all-clears from blood tests. My Finasteride quantity gradually increased to the same you would use to treat benign prostate enlargement. Am I right in assuming that I would switch to Dutasteride at the standard daily amount? I realise that we cannot discuss dosages so for a newbie to this drug I'm assuming it's the normal amount at which Dutasteride appears?

[SamKelley]

Finasteride and Dutasteride are similar but different. Dutasteride works on 5 alpha reductase I and II whereas Finasteride only works on I.

Dutasteride is more potent, so dosages won't be the same.

I'd be very careful with both medications, due to Post-Finasteride Syndrome, to which there is no accepted cure. Dutasteride is a newer drug however I'm certain it will also have similar or worse consequences in some people.

These are drugs that require informed and knowledgeable medical advice because of their unintended and potentially life-changing side-effects.

On a lighter note, pumpkin seed oil is being shown to be effective in inhibiting testosterone conversion to DHT, a study was done recently on it which was shown to significantly reduce or reverse male pattern balding and it is also being studied for benign prostate hyperplasia.

xox
Sami

[Richenda]

Hi Sami,

Thanks for this.

My use of 5 alpha reductase has been approved and I've been using F for 14 months. I'm interested in what you say about the post-F Syndrome. Can you tell me more, because I've never heard of it? The only side effect I really notice with it is some brain fog, which I don't much care for. As you may know, when used for prostatic enlargement they prescribe 5mg a day.

Dutasteride isn't yet approved for either male pattern baldness or MtF therapy but it is approved for benign prostatic enlargement at a typical standard figure which can be seen in places like this http://reference.medscape.com/drug/avodart-dutasteride-342823

I'm guessing that's what people do on here?

Chen xx

[Emily.P]

I always thought Dutasteride was actually more expensive than Finasteride . I cannot comment about FInasteride, I have been on Dutasteride for a bit more than one year, and Iit looks there has been regrowth in the area of 5mm-1cm wide, at least my temples have come back completely. Not that I have had much loss beforehands (in our family MPB was not an issue - instead we were turning salt-and-pepper by age of 26-30).
Another thing - in combination with androcur and estrogen, Dutasteride is very powerful castration drug which can kill your sex drive completely. I wonder if that is something which happened to me (and a reason for my asexuality, cause currently I am just not being attracted to anyone), and whether this is temporary or permanent .

[Richenda]

That's really interesting Emily. I'm likely to be put on a GnRH analogue before too long so I won't use androcur for now.

Re. costs, in the hypothetical event of, say, 4mg finasteride vs 0.5mg dutasteride the latter would be cheaper day by day for generic products ... I think?

[Emily.P]

Speaking of costs, Dutasteride is more modern product and package per package is more expensive. But, as You correctly noted, it is just the "basic" cost per se, and it will change in Your individual case, based on Your daily dosage and other factors. Personally, when I got first prescription for 4 boxes of Avodart (Dutasteride) I was surprised at how expensive it was (altogether after pharmacy discounts ended about 120 EUR), but then I realised that this amount will last for the whole year (I switch between Avodart and Androcur on daily basis, because when taken together they make my liver not very happy) so 120 EUR for one year was not that much .

[KayXo]

I'd be very careful with both medications, due to Post-Finasteride Syndrome

I'd also be interested to hear the details as I've taken it in the past and now NEED to take progesterone as it increases allopregnanolone concentrations. Apparently, some of the symptoms include anxiety and depression.

http://www.ncbi.nlm.nih.gov/pubmed/24717976

On a lighter note, pumpkin seed oil is being shown to be effective in inhibiting testosterone conversion to DHT, a study was done recently on it which was shown to significantly reduce or reverse male pattern balding and it is also being studied for benign prostate hyperplasia.

I only read studies on rats, not on humans. How findings on rats translate to humans needs to further elucidated unless there have been studies on humans I am unaware of.

I always thought Dutasteride was actually more expensive than Finasteride

It is. Sometimes way more expensive depending on where you buy it from , generic vs brand and if insured.

Another thing - in combination with androcur and estrogen, Dutasteride is very powerful castration drug which can kill your sex drive completely.

Dutasteride only reduces DHT levels. If it were a powerful castration drug, it would not be prescribed to males for prostate enlargement. I know you stated WITH Androcur and estrogen but I think you are still OVERestimating dutasteride's effects. I think Androcur has more to do with killing sex drive because it reduces dopamine levels, hence increasing prolactin levels in the process.

I'm post-op, have very little T (below female range), plenty of E and yet have a healthy sex drive.

[SamKelley]

My use of 5 alpha reductase has been approved and I've been using F for 14 months. I'm interested in what you say about the post-F Syndrome. Can you tell me more, because I've never heard of it? The only side effect I really notice with it is some brain fog, which I don't much care for. As you may know, when used for prostatic enlargement they prescribe 5mg a day.

Dutasteride isn't yet approved for either male pattern baldness or MtF therapy but it is approved for benign prostatic enlargement at a typical standard figure which can be seen in places like this http://reference.medscape.com/drug/avodart-dutasteride-342823

I'm guessing that's what people do on here?

I'm aware that some people take Dutasteride as part of their regimen. I don't think it's a lot of people though, most seem to stick with the main anti-androgens (cyproterone acetate or spironolactone). However transgendercare recommends finasteride, for example.

The problem with finasteride is that it does inhibit conversion of testosterone into DHT, however the exact process by which it does this is unknown. 5-alpha reductase is used in many functions in the brain, and the brain runs on steroids (among other things). My point being for me personally the potentially life-altering risk of finasteride/dutasteride - though probably small - seems to be a point of great ongoing debate right now, so I just wanted to make you aware of it.

I'd suggest searching on scholar (and non-scholar) articles on "post finasteride syndrome", and discuss any concerns with your endo.

I guess I might be a bit different from most in that I trust my doctors, however I do my own research as well and challenge them until I feel comfortable with what I'm doing to myself ... especially long-term 

xx Sami

[Richenda]

It is. Sometimes way more expensive depending on where you buy it from , generic vs brand and if insured.

Dutasteride only reduces DHT levels. If it were a powerful castration drug, it would not be prescribed to males for prostate enlargement. I know you stated WITH Androcur and estrogen but I think you are still OVERestimating dutasteride's effects. I think Androcur has more to do with killing sex drive because it reduces dopamine levels, hence increasing prolactin levels in the process.

But in what would be considered standard dosage my Dutasteride is 78p a day compared with £1.13 for Finasteride, so I don't think it is more expensive. That's also sourcing from cheapest available but trustworthy generics.

Re. both F and D they do have a medical castration effect I believe, evidenced in two ways. First, both drugs contain warnings about decreasing sperm count and efficacy. Second, there are incredibly strict warnings about women handling Dutasteride because it is present in what sperm are left and it can therefore cause big deformities in a male unborn foetus. Indeed, anyone taking Dutasteride is advised to use a condom, but it even permeates through the skin.

[Richenda]

I'm aware that some people take Dutasteride as part of their regimen. I don't think it's a lot of people though, most seem to stick with the main anti-androgens (cyproterone acetate or spironolactone). However transgendercare recommends finasteride, for example.

The problem with finasteride is that it does inhibit conversion of testosterone into DHT, however the exact process by which it does this is unknown. 5-alpha reductase is used in many functions in the brain, and the brain runs on steroids (among other things). My point being for me personally the potentially life-altering risk of finasteride/dutasteride - though probably small - seems to be a point of great ongoing debate right now, so I just wanted to make you aware of it.

I'd suggest searching on scholar (and non-scholar) articles on "post finasteride syndrome", and discuss any concerns with your endo.

I guess I might be a bit different from most in that I trust my doctors, however I do my own research as well and challenge them until I feel comfortable with what I'm doing to myself ... especially long-term 

xx Sami

Hi Sami,

My Finasteride and Dutasteride are approved by my endocrinologist pending GnRH analogue insertion. I definitely think Finasteride makes me a bit foggy. It's one of those toss-ups though: which is worse, that or the horrendous dysphoria I get from not taking a T-blocker? I know the answer for myself.

I had a lot of trouble with Spiro and it's getting a bad name in the UK. It's the drug I would no longer touch with a bargepole.

xx

[SamKelley]

Yes I hear you ... we do what we need to do ...

I'm hoping to get an orchi as soon as possible to avoid the anti-androgens us much as possible...

[Richenda]

I'm with you 100%: I brought this up at my GIC meeting. If there's a big delay on SRS I'll go for an orchi. Can't wait to chop the buggers out the system

[KayXo]

The problem with finasteride is that it does inhibit conversion of testosterone into DHT, however the exact process by which it does this is unknown.

Finasteride binds Type 2 Alpha-reductase enzyme, disabling it and not allowing it to convert T to DHT. But...

5-alpha reductase is used in many functions in the brain, and the brain runs on steroids (among other things).

This enzyme is also needed for the production of allopregnanolone (from progesterone to dihydroprogesterone to allo), a neurosteroid found in the brain responsible for reducing anxiety and having anti-depressant effects.  Hence, finasteride may reduce allopregnanolone concentrations in the brain as well, resulting in increased anxiety and depression. These effects may apparently persist after discontinuing the drug.

Re. both F and D they do have a medical castration effect I believe, evidenced in two ways. First, both drugs contain warnings about decreasing sperm count and efficacy. Second, there are incredibly strict warnings about women handling Dutasteride because it is present in what sperm are left and it can therefore cause big deformities in a male unborn foetus. Indeed, anyone taking Dutasteride is advised to use a condom, but it even permeates through the skin.

Castration for me equals cessation of gonads' production of male hormones. This is not the case with both drugs as they only reduce DHT, not T.

Yes I hear you ... we do what we need to do ...

I'm hoping to get an orchi as soon as possible to avoid the anti-androgens us much as possible...

I'm with you 100%: I brought this up at my GIC meeting. If there's a big delay on SRS I'll go for an orchi. Can't wait to chop the buggers out the system

It's too bad doctors don't condone E injections or pellets as these both suffice to reduce T to post-SRS levels without the need for anti-androgens and without putting at risk the health of the patients.

[SamKelley]

Hello again KayXo

Yes, if there's sufficiently low T, then there is also less to convert to DHT - without disrupting other important neurosteroids and transmitters.

Both cis male and cis females need basic levels of testosterone and dihydrotestosterone to be healthy. They're important neurosteroids for all genders. The difference is the balance.

I agree with KayXo that a sufficiently high dose of estradiol should in itself be enough to suppress T (and hence DHT) - however most doctors will disagree. Some doctors may be persuaded if you show them the appropriate peer reviewed papers... There is a wealth of research and information collected on the FaceBook group GENDER RESEARCH for ALL GENDERS.

xox
sami

[KayXo]

Both cis male and cis females need basic levels of testosterone and dihydrotestosterone to be healthy. They're important neurosteroids for all genders. The difference is the balance.

I would even question this because take CAIS (complete androgen insensitive) individuals in whom testosterone and DHT are unable to affect the body. Are they unhealthy, more prone to health risks due to having no T or DHT? They don't seem to be, as far as I can see. They do however produce enough E (through aromatization of T) and eventually get enough of it exogenously to compensate for the lack of androgen.

[Richenda]

Well ... I'm in a state of some astonishment at the effects of Dutasteride (Avodart)

I hadn't expected such a big impact in the switch over from Finasteride to Dutasteride. Within 24 hours I noticed my nipples were way more sensitive. Within 48-72 hours they were noticeably growing, both in height and width. And as for my breasts, which admittedly were already doing well, it's like they have a pump blowing them up.

None of the above can be taken as scientific proof. And, although Dutasteride is considered a relatively safe drug, I am not advocating self-med to anyone who reads this anecdotal report.

But I'm pretty gobsmacked tbh.

[SamKelley]

It's supposed to stop 99% of T converting to DHT so I'd believe it. Keep us up to date?

How do you feel otherwise mentally and physically?

[Richenda]

Hi Sam, Really good actually. At the moment I feel less foggy than under Finasteride

[KayXo]

It's supposed to stop 99% of T converting to DHT

Studies have shown low dosage dutasteride to reduce DHT by about 93-95 %, higher dosages by about 98%. T levels also slightly increase as a result because more T is available, T can convert to E.

[SamKelley]

Hi Sam, Really good actually. At the moment I feel less foggy than under Finasteride

That's great!

Hmm!