Criteria for Prescribing Dutasteride?

Good day Dr. Rassman, Great forum with lots of useful info. What is your position on prescribing Dutasteride? I believe in the past you’ve stated you wouldn’t, but I also thought I remembered reading a post where you said you might under certain circumstances. I’m 45 years old and have been on Finasteride for 7 years and have noticed the diminishing returns over the last year or so. I would like to try Duasteride but not without talking with a professional such as yourself first. I guess what I’m asking is, provided I meet your criteria, are you open to prescribing Duasteride? I would like to schedule an office visit with you so I could get your analysis of my particular situation. Great excuse to go to a Laker game.

Under the following circumstances, I would consider prescribing dutasteride before it is FDA approved to treat hair loss, but see the qualifier below:

1. It is a man over 40 years old and has had all of the children he expects to have.
2. Even better for me is if the patient had a vasectomy done to ensure that there will be no more children.
3. At least a year on finasteride with poor results or slipping backwards.

The qualifier is — realistic expectations, such that we develop a good doctor/patient relationship. It is important to note that your question itself is a problem, as I do not create rules for prescribing something that the FDA has not approved of. I created this above list under stimulus of this question. Some of you might think I’m crazy for the 2nd item in the list (vasectomy), but honestly, it is just a way to highlight to the patient that we’re not fully aware of all risks when it comes to this medication. The drug was FDA approved to treat the prostate, and while it may treat hair loss, the dosing and age criteria haven’t been established for prescribing it off-label. This is a powerful medication and it has been shown that the half-life of dutasteride is far greater than the current hair loss treatment of choice, finasteride (Propecia), thus the side effect risk is possibly also greater.

I’ll go into a little greater detail about this tomorrow… so please check back.