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Dutasteride for transseual women


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This is my first ever post on this forum, so I apologise if it lacks the polish of an expert blogger or forum-user.



I will make clear from the start that I am what is called a transsexual woman, although I do not consider myself to be trans-anything – I am just a woman. Normally I go about my everyday life as a regular woman, with no questions asked and (generally) no-one is any the wiser, but I need to ‘out’ myself here for the purposes of asking my question and requesting the help of others on the forum.



My questions relate to the use of Dutasteride, which my doctor prescribes and has done for 3 years, since I began my transition at the age of 57 – very late by comparison with many. I had my sex reassignment surgery two years ago and thus have no conventional testosterone, although I know that a small amount is still produced by the adrenal gland, and it is this which I hope to target with the Dutasteride. From my limited understanding of medical matters, I believe that it is this adrenal gland-produced Dihydroxytestosterone which has a negative effect on follicle development and which, importantly, is more effectively inhibited by Dutasteride than by Finasteride. Does anyone know if this is correct?




As background information I will add that I (fortunately) have longer and denser hair than most men of my age would expect to have, although each hair is very fine. I do not have the classic male pattern baldness, but in recent months (almost exactly since my 60th birthday, it seems) I am conscious that overall density is becoming less and the daily loss into my hairbrush is becoming greater.



I would be glad to hear from anyone who has long-term experience of taking Dutasteride, especially any other transwomen (please forgive the term) on this site. I am interested in any information about long-term use as I envisage taking it for the next 20 years/ rest of my life, given that I am sixty now, and subject to my doctor continuing to prescribe it.



I am also keen to learn if anyone has news of the relative efficiency (or otherwise) of Dutasteride compared with Finasteride. In particular I am talking about prescription drugs, rather than the commercially available products such as Rogaine. I fear that my doctor may at some stage question the continued use of Dutasteride, either on grounds of cost or efficacy, and I would like to be prepared in advance with some counter-arguments.




All helpful suggestions gratefully received :- )




Apologies for the typo in the headline and for my subsequent inadequate proof-reading - my keyboard is not very good with the letter 'x', but I should have spotted the missing 'x' in 'transsexual'

Edited by Inconnue
Typing error
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Hi Inconnue,


Welcome to the forums and thank you for sharing your story. I know these types of issues are sensitive for transgender individuals, so hopefully our community can help.


First, and foremost, I recommend discussing these issues with the physician managing your hormone therapy (hopefully an endocrinologist). Because the doctor is familiar with your replacement therapy and hormone profile, he/she will likely be able to offer the most accurate advice.


You are correct about the small amount of androgen hormone being produced by the adrenal gland (specifically the deepest layer of the adrenal cortex). These hormones are not pure DHT (dihydrotestosterone) or testosterone, but are precursors to androgen (testosterone) hormones, which can be converted to DHT in the body and cause progressive hair loss. This means it is important to halt this conversion if you are genetically prone to hair loss (androgenic alopecia).


You are also correct about the "increased" efficacy of dutasteride compared to finasteride. Finasteride halts the conversion of testosterone to DHT by blocking the type II 5-alpha-reductase enzyme; only one of the enzymes responsible for creating DHT. Dutasteride, on the other hand, blocks both type I and type II 5-alpha-reductase. While it probably sounds like this makes dutasteride a more effective hair loss medication, studies have shown that both drugs are essentially equally effective. One isolated case study demonstrated greater effect when combining dutasteride and finasteride, but the results haven't been reproduced.


If you are concerned about further thinning on dutasteride, speaking to your doctor about minoxidil (Rogaine) may be helpful. Unfortunately, I don't think you will find many members on the forums with long-term (20 year) dutasteride experience. However, many members have taken finasteride for a number of years with solid results and minimal side effects, so maybe they will chime in.


I hope this helps! Please feel free to ask any additional questions (either here or via private message).

Edited by Future_HT_Doc

"Doc" Blake Bloxham - formerly "Future_HT_Doc"


Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum


All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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Thank you Blake. I very much appreciate your detailed and helpful reply. I have indeed discussed my concerns with the endocrinologist who, in turn, guides my General Practitioner as to my hormone medication. I don't know the system in the USA but here in England a hospital specialist can make recommendations, but the patient receives her/his medication from the GP. I use a transdermal hormone replacement therapy gel daily (there's that prefix 'trans' again!).


The endocrinologist was moderately sympathetic, and agreed (for now) to the continued use of Dutasteride. However, the usual response from medical staff, who are mostly men, is that I should be pleased with the amount of hair I still have. One even pointed to his own thinning scalp and said I should count myself lucky as I had more hair than him, despite being 20 years older. They all seem to consider it from a very male perspective (Sorry!), taking it as inevitable. Yet the impact of hair loss for a woman cannot be overestimated. I was very lucky to have a female GP at the time of my transition 3 years ago, who gave me the first prescription for Dutasteride. My present GP simply continued my regime, but questions the cost; so the support of the endocrinologist, whose 'senior' opinion he respects, is vital, but I will be taken off the endocrinologist's register by June this year, as my transition is considered complete (which it is - I fully understand that his resources/time must be given to newer patients).


Your answer, giving details of the difference between the two drugs' impact on type I and type II 5-Alpha-reductase enzymes is therefore very useful, although I am clearly not equipped to enter a technical debate with a doctor.


Any further information or experiences, either from transwomen or perhaps friends or relatives of such women (with respect to their annonymity), would be greatly appreciated.

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