Efficacy and safety of dutasteride in the treatment of alopecia: a comprehensive review

INTRODUCTION: Alopecia affects many individuals, with androgenetic alopecia (AGA) being the most common form in both men and women. The exact etiology of AGA is unclear. The systemic treatments of AGA include 5-alpha reductase inhibitors (finasteride, dutasteride) and low-dose oral minoxidil. AREAS COVERED: The article comprehensively reviews dutasteride's pharmacokinetics, pharmacodynamics, clinical efficacy, and side effects to support clinicians in prescribing it for alopecia. EXPERT OPINION: Studies show dutasteride to be more effective than finasteride for AGA, with both drugs having similar safety profiles. In our view, clinicians should consider topical minoxidil and oral finasteride as first-line treatments, as they are well-studied for male and female AGA (finasteride is off label in females and should only be considered in post-menopausal females). If these options are ineffective, oral dutasteride may be considered off-label for greater efficacy in males and post-menopausal females. However, dutasteride can reduce sperm count and motility, potentially affecting fertility in men with preexisting fertility issues. Men whose partners are pregnant should avoid dutasteride.