Dutasteride Mesotherapy: An In-Depth Look
Since genetic hair loss is a progressive condition, medications aimed at slowing and preventing further loss are an important part of any hair restoration regimen. Despite the potential importance of effective hair loss drugs, however, only two medications have ever been reviewed and approved by the US FDA and similar organizations: oral finasteride (1mg “Propecia”) and topical minoxidil (5% “Rogaine”). While these medications have helped millions of hair loss sufferers, for many they are insufficient, impractical, or cause intolerable side effects. Because of this, many patients seek other hair loss drug options. One of the most popular of these “off label” hair loss medication options is the drug dutasteride (0.5mg “Avodart”). But what is dutasteride? How does it work and is it effective? Finally, how can it be utilized? In an oral form, topical form, or even an injectable form (mesotherapy)? Read on to find out!
What is Dutasteride (“Avodart”)?
Dutasteride is a medication very similar to the FDA approved finasteride. Both drugs block the enzyme 5-alpha-reductase, which converts the male hormone testosterone to dihydrotestosterone or “DHT.” In patients with a genetic predisposition, DHT is the hormone which actually attacks the hair follicles and causes genetic male hair loss (male pattern baldness) and many cases of genetic female hair loss (female pattern hair loss). By blocking the conversion of testosterone to DHT, patients have a lower level of DHT in the blood and less reaches the hair follicles.
The lower the level of DHT near genetically susceptible follicles, the less interaction there is between the two (DHT and hair follicles), and the less hair that “miniaturizes” and eventually “falls out.” But if finasteride and dutasteride work in similar ways and finasteride is FDA approved, why would any patient want to use dutasteride instead?
While both finasteride and dutasteride work in the same manner, dutasteride blocks a wider variety of the 5-alpha-reducatase enzymes and this results in a greater reduction in DHT levels. Specifically, dutasteride lowers blood DHT levels by 90% whereas finasteride lowers levels by 70% (Estill et. al., 2023). This lower level means less interaction between DHT and the hair follicles and less hair loss.
If dutasteride works in the same manner as the FDA approved finasteride with an even greater efficacy, why wouldn’t all patients simply take this daily pill? Unfortunately, a number of hair loss patients report adverse side effects from taking oral “anti-androgen” pills like finasteride and dutasteride. Side effects range from sexual dysfunction (erectile dysfunction, decreased libido, etc) to fat redistribution (gynecomastia) to generalized “brain fog,” and reports have shown upwards of 17-20% patients experiencing these issues (Nickel, 2004).
Most believe these side effects occur because oral administration of anti-androgen medications releases the drug throughout the entire body (“systemic” distribution) and allows it to affect the entire body. But since anti-androgen medications are proven to be effective, patients still want the medication. So, is there a way to get the medication into the scalp in a more specific manner and reduce the amount going into the general system? The answer is yes! And this is where dutasteride mesotherapy comes into play.
What is Mesotherapy?
Mesotherapy simply refers to the injection of medications directly into specific areas of the body. It has been used in a range of applications from vascular disorders to pain treatment to skin rejuvenation, and has now gained attention as a potential treatment for hair loss; particularly for those seeking alternatives to oral medications. One of the most popular mesotherapy-based hair loss treatments is dutasteride scalp injections. But is it effective? Does it circumvent the side effects? How does it compare to oral dutasteride? How long does it last and, importantly, what does it cost?
Is Dutasteride Mesotherapy Effective?
Dutasteride mesotherapy involves injecting low-dose dutasteride (typically 0.005% to 0.01% dutasteride solutions) directly into the scalp to target hair follicles. This localized delivery method is believed to provide a low dose directly to the affected areas, potentially creating an effective approach while reducing systemic distribution (Rodriguez-Cuadrado et. al., 2023).
Clinical studies have shown that dutasteride (0.5mg), when used orally, is effective in reducing hair loss and improving the appearance of hair in upwards of 80% of patients with androgenic alopecia – genetic male hair loss (Choi et. al., 2022).
The effectiveness of dutasteride mesotherapy specifically is still under investigation. However, anecdotal reports and small-scale studies suggest positive outcomes, with many patients experiencing a noticeable reduction in hair loss and some regrowth. Between 2009 and 2013, three published controlled studies showed efficacy and overall improvement using 0.005% to 0.05% dutasteride mesotherapy (Rodriguez-Cuadrado et. al., 2023). A 2017 study published in the International Journal of Trichology showed improvement in hair density and hair diameter in all patients (6) treated with 0.01% dutasteride mesotherapy (Saceda-Corralo et. al., 2017). A 2022 retrospective review of a large number of patients (541) with androgenic alopecia showed a marked improvement in the majority of patients, with nearly 40% (38.4%) of patients showing a significant improvement (Saceda-Corralo et. al., 2022). While more research is needed, dutasteride mesotherapy shows promise as an effective treatment for slowing and improving genetic hair loss.
But remember that the goal of direct injection administration of dutasteride is to prevent the systemic absorption and side effects of the oral pill. So, what do these studies tell us about the side effects associated with dutasteride mesotherapy?
Dr. Blake Bloxham, Hair Transplant Surgeon
"Oral dutasteride has a proven track record for treating hair loss, with consistent results across studies. As previously stated, it decreases serum (blood) DHT levels by 90% and provides improvement in over 80% of patients. Mesotherapy has also shown broad improvement in patients with “marked” improvement in over 40%. It also does so without systemic involvement, showing no change in systemic hormone levels".
Consult With Dr. BloxhamWhat Are the Side Effects of Dutasteride Mesotherapy Injections?
Like any medical procedure, dutasteride mesotherapy is not without potential side effects. Some of the most common side effects reported include:
1. Localized Reactions:
Redness, swelling, and pain at the injection sites are common but typically mild and temporary. The 2022 retrospective data review showed this was the most common side effect, appearing in over 45% of patients (Saceda-Corrado et. al., 2022). However, it was reported as not severe and temporary.
2. Scalp Irritation:
Some patients experience itching or sensitivity in the treated areas.
3. Infection:
As with any injection, there is a risk of infection if the procedure is not performed under clean conditions.
But what about adverse system effects? Although mesotherapy targets specific areas, there is still a possibility that small amounts of dutasteride can enter the bloodstream, potentially leading to systemic side effects similar to those seen with oral dutasteride, such as sexual dysfunction, changes in libido, and hormonal imbalances. However, this is not what was observed in the limited clinical studies. The 2017 International Journal of Trichology study showed no adverse system side effects and no change in blood DHT levels (Saceda-Corralo et. al., 2017). This implies that the injected dutasteride was staying locally in the scalp and was not becoming absorbed systemically and causing negative side effects.
The 2022 large, retrospective data review also showed no serious or adverse sexual side effects reported (Saceda-Corralo et. al., 2022). While, again, more data is needed, dutasteride mesotherapy does appear to significantly reduce or eliminate the potential for adverse side effects seen with oral dutasteride.
What is the Half-Life of Dutasteride Mesotherapy?
The half-life of a drug refers to the time it takes for its concentration in the body to reduce by half. In simpler terms: How long does the drug last or how long does it take to “leave your system”? For oral dutasteride, the half-life is quite long—approximately 5 weeks, which means it stays in the system for an extended period even after discontinuation.
The half-life of dutasteride when administered via mesotherapy is less well defined and may differ due to the localized nature of the treatment. Some believe it may be shorter than the oral form, as the drug is delivered directly to the target area and may not circulate throughout the body as extensively.
However, the 2017 study published in the International Journal of Trichology shows that the half-life of dutasteride mesotherapy is still quite long; they estimated it at 4 weeks (Saceda-Corrado et. al., 2017). Drugs with
short half-lives are impractical to utilize via mesotherapy; this is because they would need to be injected daily or even multiple times per day! No patient would want this nor would any doctor recommend this. What makes dutasteride a good drug to use in a mesotherapy treatment, however, is its long half-life. A half-life of 4-5 weeks means the medication only needs to be injected – theoretically – every few months.
In fact, the study published in the International Journal of Trichology in 2017 showed efficacy injecting dutasteride once every 3 months (Saceda-Corrado et. al., 2017). Several injection appointments per year make dutasteride a very reasonable choice for mesotherapy treatment, especially for those seeing to avoid the “hassle” of taking a daily pill or in those worried about potential system side effects from taking the oral form.
Dutasteride Mesotherapy vs. Oral Dutasteride
So, how do these two methods of administration compare? When comparing dutasteride mesotherapy to oral dutasteride, several factors need to be considered:
1. Efficacy: Oral dutasteride has a proven track record for treating hair loss, with consistent results across studies. As previously stated, it decreases serum (blood) DHT levels by 90% and provides improvement in over 80% of patients. Mesotherapy has also shown broad improvement in patients with “marked” improvement in over 40%. It also does so without systemic involvement, showing no change in systemic hormone levels.
2. Side Effects: Oral administration can lead to systemic side effects in up to 20% of patients. These include sexual side effects like erectile dysfunction and loss of libido (Nickel, 2004). Mesotherapy, on the other hand, seems to eliminate these risks by targeting the treatment area and keeping the medication localized. However, localized side effects at the injection site are more common with mesotherapy – with mild pain being reported in 45% of patients (Saceda-Corrado et. al., 2022).
3. Convenience: Oral dutasteride is taken daily and is easy to administer. Mesotherapy requires visits to a clinic for injections, which might be less convenient for some patients.
4. Cost: Mesotherapy tends to be more expensive due to the need for repeated clinical sessions, disposable medical supplies, and the injector’s time. Whereas oral dutasteride is generic and widely available, meaning it’s typically quite cost-effective.
Dutasteride Mesotherapy Cost
We know oral dutasteride is very reasonably priced and cost-effective, but just how much does dutasteride mesotherapy cost? The cost of dutasteride mesotherapy can vary widely depending on factors such as the practitioner’s expertise, location, and the number of sessions required. On average, each session can range from $200 to $500. Since multiple sessions are often necessary to achieve and maintain results, the total cost can add up over time – especially when compared to generic oral dutasteride. For some patients, however, not taking a daily pill and avoiding the risk of systemic side effects make the additional cost worth it.
Is Dutasteride Mesotherapy Permanent?
The effects of dutasteride mesotherapy are not permanent, and the duration of its efficacy can vary from person to person. Typically, patients may notice results after a few sessions, with the effects lasting several months. To maintain hair growth and slow further loss, ongoing maintenance sessions are usually required every 3 months, depending on the individual’s response to the treatment.
Summary
Dutasteride mesotherapy presents a promising alternative to oral treatments for hair loss, offering a targeted approach that seems to reduce systemic side effects. However, its effectiveness and long-term benefits require further research. Patients considering this treatment should weigh the costs, potential side effects, and the need for ongoing sessions against the convenience and established efficacy of oral dutasteride. Consulting with a qualified healthcare provider is essential to determine the best course of action for managing hair loss.
Author:
Dr. Blake Bloxham, New York Hair Transplant Surgeon
References:
Choi, G-S., et. al. (2022). Long-Term Effectiveness and Safety of Dutasteride versus Finasteride in Patients with Male Androgenic Alopecia in South Korea: A Multicentre Chart Review Study. Ann Dermatol. 2022 Oct; 34(5): 349–359.
Estill, M.C., et. al. (2023). Finasteride and Dutasteride for the Treatment of Male Androgenetic Alopecia: A Review of Efficacy and Reproductive Adverse Effects. Georgetown Medical Review. 7(1)
Nickel, J.C. (2004). Comparison of Clinical Trials With Finasteride and Dutasteride. Rev Urol. 6(Suppl 9): S31–S39.
Rodriguez-Cuadrado, F.J., et. al. (2023). Mesotherapy with dutasteride for androgenetic alopecia: a concise review of the literature. EJD. Vol. 33, n° 1, January-February 2023. 72.
Saceda-Corralo, D., et. al. (2017). Mesotherapy with Dutasteride in the Treatment of Androgenetic Alopecia. Int J Trichology. 2017 Jul-Sep; 9(3): 143–145.
Saceda-Corralo, D., et. al. (2022). Mesotherapy With Dutasteride for Androgenetic Alopecia: A Retrospective Study in Real Clinical Practice. J Drugs Dermatol. 2022 Jul 1;21(7):742-747.
