If you want to treat androgenic alopecia, there’s a strong argument for addressing DHT.

DHT is the hormone causally linked to pattern hair loss. In genetically susceptible hair follicles, it gradually shortens the growth cycle, miniaturizes hairs, and leads to progressive hair loss.

For decades, the prescription approach to lowering DHT was pretty straightforward:

Take 1 mg of finasteride.

Today?

There are a lot more options.

You can use finasteride or dutasteride. Oral or topical. Low-dose or full-strength. You can prioritize scalp localization, systemic DHT suppression, convenience, or maximum efficacy.

More choice is a good thing. It allows you to construct the right approach to addressing your hair loss, tailored exactly to your goals and preferences.

But it also makes choosing a DHT reducer a lot more confusing.

So today, I want to simplify things.

Here’s how I currently think about seven DHT-reducing options for men with androgenic alopecia: what we know about them, what we don’t know, and who might be the best candidate for each.

First: finasteride vs. dutasteride

Both medications work by inhibiting 5-alpha reductase, the enzyme responsible for converting testosterone into DHT.

The major difference?

Finasteride primarily inhibits type II 5-alpha reductase. Dutasteride inhibits both type I and type II.

That means, pound-for-pound, that oral dutasteride suppresses more DHT than finasteride. And as doses increase, we tend to see greater DHT suppression, and often greater improvements in hair gains.

But stronger isn't automatically better. Because when crafting a long-term regrowth regimen, what works best must be balanced against other factors, like evidence quality and safety.

Then you’ve got to account for delivery methods: system (via pills) versus local (via topicals).

The former comes with far more convenience. The latter, depending on the dose, may come with better safety.

All in, this makes selecting the right DHT-reducing drug, dose, and formulation more complicated than it really should be.

So here’s a table to help you make a choice, based on the evidence:

For more information on these doses, feel free to watch this breakdown on topical finasteride and this breakdown on topical finasteride versus dutasteride.

And for those interested in a high-level summary, keep reading.

1. Low-dose topical finasteride: 0.005% x 1-2 mL daily

According to clinical research, the minimum viable dose for topical finasteride appears to be 0.005% x 1-2 mL daily.

This also happens to be a dose where, in one 16-month study, men and women saw hair parameter improvements but without any impact on serum DHT.

In other words: a dose this low may allow finasteride to better localize to the scalp - so you can still preserve DHT elsewhere - and also improve hair growth.

But whether that localization is 100% perfect in every person - and whether those hair gains are comparable to bigger doses of topical finasteride - is an entirely different story.

For more information, please see this video. Otherwise, here’s who this formulation might best fit:

Best candidate: someone who’s looking for hair gains, who wants to better localize finasteride to the scalp, and who’s willing to potentially trade some maximum efficacy for what might be a lower dose with potentially fewer side effects.

View Ulo's low-dose topical finasteride →

2. Low-dose topical dutasteride: 0.02% x 1-2 mL daily

This follows a similar philosophy - but uses a more potent 5-alpha reductase inhibitor.

Small studies of low-dose topical dutasteride have generally shown very little impact on serum DHT. We even covered one recent study in this video.

Having said that, our anecdotal experience is that low-dose topical dutasteride is best reserved for those who are looking for hair stabilization, rather than hair regrowth.

It’s currently our opinion that low-dose dutasteride localizes very well to the scalp - possibly even better than topical finasteride. There are many arguments for why, and we explore several of them here.

But just because dutasteride is more effective than finasteride orally - we cannot automatically presume the same exact relationship for topical applications, or all doses! And with such limited evidence currently, all we have our anecdotal trends to lean on with respect to low-dose topical dutasteride: it tends to localize very well. But it seems more relegated to stopping hair loss, not producing appreciable hair gains.

Best candidate: someone whose primary goal is maintaining hair while minimizing systemic DHT suppression.

View Ulo's low-dose topical dutasteride →

3. Full-strength topical finasteride: 0.2% x 1-2 mL daily

In a large randomized clinical trial, higher-concentration topical finasteride significantly improved hair counts versus placebo, with hair count improvements that were numerically similar to oral finasteride.

In other words: full-strength topical finasteride was non-inferior to oral finasteride; they both regrew hair comparably! But what about localization?

This is where the picture gets a bit more nuanced.

On the one hand, higher concentrations of topical finasteride (0.1-0.3% x 0.5-2.0 mL daily) do tend to slightly leak from the scalp, and they do tend to lower blood levels of DHT - our best proxy for systemic DHT reductions.

On the other hand, DHT reductions from full-strength topical finasteride appear slightly milder than that of the oral 1 mg finasteride formulations.

Moreover, research also directionally shows a reduced risk of side effects from these higher concentrations of topical finasteride versus 1 mg of oral finasteride, at least in comparative clinical studies.

This is good news! And the question should be: why?

Some researchers currently attribute this to the fact that topical finasteride, despite going systemic, is only found in circulating levels just 1/100th to 1/200th that of oral finasteride. This is totally possible.

Other researchers actually just attribute this to the placebo effect - meaning that men using full-trength topical finasteride simply just believe it isn’t going systemic, which reduces their odds of attributing side effects to the medication.

I think both arguments might be true. We cover more in this video.

All in, if someone wants a topical DHT reducer with a relatively mature evidence base - including strong regrowth evidence and a potential reduction in side effect risks versus oral DHT reducers - this formulation is probably where I'd start.

Best candidate: someone who wants meaningful regrowth potential but prefers a topical treatment over systemic therapy.

View Ulo's standard topical finasteride →

4. Full-strength topical dutasteride: 0.2% x 1-2 mL daily

You’d think that as you increase your strength of topical dutasteride, the higher scalp exposure would increase the amount of medication reaching both the scalp and systemic circulation.

In other words: better regrowth at the expense of more side effect risks.

But based on the real-world experiences we've tracked, we tend to see a different relationship:

Full-strength topical dutasteride tends to produce hair gains, with no clarity (yet) on whether those hair gains are better, worse, or the same as full-strength topical finasteride.

But those using topical dutasteride also tend to note better localization: as in, less systemic DHT reductions.

Again, this is just the anecdotal trend we’ve observed over the last several years. And I want to emphasize the word anecdotal, again, because there's an important caveat:

The evidence base for topical dutasteride is nowhere near as mature as the evidence base for topical finasteride.

This is also something we note in our comparative video.

Nonetheless, full-strength topical dutasteride seems to help - particularly for those looking for hair gains alongside some degree of drug localization.

Whether it works better than full-strength topical finasteride - or oral finasteride - remains to be seen.

Best candidate: someone who wants stronger local DHT inhibition than lower-dose topicals and accepts a greater likelihood of systemic exposure.

View Ulo's standard topical dutasteride →

5. Oral finasteride: 1 mg daily

Oral finasteride is the FDA-approved treatment for male pattern hair loss.

As it stands, decades of clinical studies showing that 1 mg finasteride can slow, stop, or partially reverse androgenic alopecia in 80-90% of the men who use it - with the typical user noting terminal hair count improvements of ~10% and hair volume improvements much greater.

On average, this tends to mean “rewinding” the clock on how your hair looks by 6-36 months. Which is quite impactful, especially for those catching hair loss early.

It's also incredibly simple: one pill, once per day. And simplicity matters when you’re considering committing to something for the long-haul. For more information, check out this video.

But like all oral DHT reducers, it reduces systemic DHT levels. And at 1 mg daily, finasteride reduces DHT to the tune of about 70%. And while the risk of side effects - at this dose - is relatively low, side effects can and do still happen.

On the one hand, many side effects may be easily managed with dose titrations and formulation adjustments. For more information, see this video.

On the other hand, those who want to minimize these risks may choose to forgo the convenience of oral delivery, and instead, take their chances with a topical formulation.

But that can be true, and simultaneously, it can be true that oral finasteride at 1 mg daily currently stands as the world’s best-studied, FDA-approved hair loss treatment. And for those really looking to “one-shot” their hair loss, this pill - if started early enough - is often all you need.

Best candidate: someone who wants a convenient, extensively studied treatment and isn't specifically trying to minimize systemic DHT suppression.

View Ulo's 1 mg oral finasteride →

6. Oral dutasteride: 0.5 mg daily

If 1 mg finasteride is the benchmark, 0.5 mg dutasteride is probably the most established step up in hair growth efficacy.

Unlike finasteride, dutasteride inhibits both major forms of 5-alpha reductase (type I and type II). As a result, it inhibits DHT by significantly more: 95% or higher (depending on the dose).

And this generally seems to produce better results. Head-to-head studies generally favor 0.5 mg dutasteride for measures like hair count, hair thickness, and reversal of miniaturization.

We discuss many of these studies in this video.

The bottom line: 0.5 mg dutasteride might be a great option for men who have more aggressive hair loss, or for those who've already tried finasteride, but who still want better results.

Moreover, at a DHT reduction rate of 95% or higher, you’d expect worse side effects on dutasteride than finasteride.

But ironically, this doesn’t seem to be the case - at least for sexual side effects. Head-to-head clinical studies currently suggest 0.5 mg of dutasteride produces similar or lower risks of sexual side effects than 1-5 mg of finasteride, even despite the added DHT reductions!

But the nuance that gets lost online is that this is just one class of side effects! There are other classes whereby dutasteride may actually carry a higher risk versus finasteride. For more information, see this comparative video.

So all in, who might benefit from 0.5 mg dutasteride?

Best candidate: someone prioritizing greater efficacy than standard finasteride - particularly someone who has responded inadequately to finasteride.

View Ulo's 0.5 mg oral dutasteride →

7. Oral dutasteride: 2.5 mg daily (nuclear option)

Finally, we have the most aggressive option on this list.

In one randomized dose-ranging study, researchers compared several doses of dutasteride with finasteride and placebo for hair gains.

Hair growth improved as the dutasteride dose increased. And 2.5 mg dutasteride produced the strongest hair growth results, outperforming both 0.5 mg dutasteride and 5 mg finasteride.

We made a video deep-diving into this topic, which you can view here.

That makes 2.5 mg dutasteride a worthy candidate for someone whose priority is straightforward: nuke DHT, maximize hair growth potential.

Having said that, there is substantially less data - both for efficacy and safety - on 2.5 mg dutasteride than there is on 1 mg finasteride or 0.5 mg dutasteride. And anyone trying this dose needs to be aware of this.

This doesn’t mean it’s not effective (see this guy’s progress)...

…or that it comes with unprecedented risk (multiple 6-12 month studies have found that dutasteride doses from 0.5 to 5 mg were generally well tolerated and all produced statistically similar rates of total side effects)...

…just that there is less evidence to support its use. And at least across the current clinical landscape, the higher doses may also come with a slightly increased risk of sexual side effects.

Best candidate: someone who’s truly looking for a nuclear hair growth stack, who’s previously tried (and tolerated) 0.5 mg oral dutasteride, and who’s comfortable with the trade-offs mentioned above.

View Ulo's 2.5 mg oral dutasteride →

So... which DHT reducer is "best"?

I don't think there is one. And that's really the point.

If your #1 goal is minimizing systemic exposure, your answer might be a low-dose topical.

If you want the strongest clinical evidence for a topical, you might gravitate toward topical finasteride.

If convenience matters most, an oral medication might make more sense.

If you've already tried finasteride and need something stronger, 0.5 mg dutasteride might be the logical next step.

And if you're trying to maximize efficacy above virtually everything else, 2.5 mg dutasteride might be the right fit.

Different treatments fit different journeys.

And that's one of the reasons I've taken the position - for years - that hair loss treatments should never be one-size-fits-all.

It's also a big part of why I helped cofound Ulo.

Ulo is a telehealth hair-loss platform built around personalization. It offers all of the DHT reducers discussed above –– alongside additional hair-growth treatments –– and allows you to tell the medical team what matters most to you.

Save up to 30% on 3-, 6-, and 12-month Ulo packages →

Topical versus oral. Finasteride versus dutasteride. Low-dose versus full-strength.

And the option to customize your formulations with add-ons like minoxidil, retinoic acid (tretinoin), and other high-impact ingredients.

Ultimately, the "best" treatment is rarely just the one that produces the biggest average improvement in a clinical trial.

It's the treatment that gets you the results you're looking for, in a way you're comfortable enough with to actually stick with.

And when it comes to treating hair loss, consistency is the most important variable of all.

Currently, Ulo is offering up to 30% off with our new 3-, 6-, and 12-month packages. It’s one of the ways we’re passing on more cost savings to you.

If you have any questions about Ulo, don’t hesitate to reach out. Just reply to this email.

That's all for now.

All my best,

Rob

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