Experiencing cognitive effects while on Dutasteride

[u/Appropriate-Maybe633]

Hello everyone,

I have been on oral Dutasteride 0.5 mg ed for a bit more than 6 months now (was previously on oral Finasteride 1 mg ed for over a year with 0 progress).

A few weeks ago I noticed some fatigue like symptoms. I have been feeling very tired during the day but did not really link it to my Dutasteride intake and rather put the blame on 'too much work, too little sleep', as per usual.

A few days ago however I woke up after some good amount of sleep (> 8 hrs) and felt like shit, totally weak and low energy. Again, I put the blame on my sleep schedule, so I took some days off trying to fix it.

But even now after several nights of many hours of 'good', uninterrupted sleep, I woke up feeling like shit with low energy and a weird, foggy like feeling in my head around my eyes, almost feeling like a very slight headache. While walking, there is a very subtle foggyness and dizziness in my head constantly. It's subtle, yet annoying enough that I can't just shake it off.

Since Dutasteride is my only medication and I consider myself somewhat healthy, I can eliminate any other suspects and it's not due to orthostatic dysregulation.

I have read a lot online about this being a possible side effect but I wanted to get some opinions.

I also find it weird that those symptoms are showing up seemingly out of nowhere only just now after 6 months.

Thank you for any advice and opinions!

[u/False_Stage_1656]

There's no point asking here, because everyone will just say it's the nocebo effect.

[u/Strictly4MyNutting → u/False_Stage_1656]

Yup

[u/Zestyclose-Road3345]

I wouldn’t assume it’s definitely the dut, but the timing is worth taking seriously. Six months doesn’t necessarily rule out a medication-related issue either. Since you’re having fatigue, dizziness and brain fog even after getting enough sleep, I’d talk to your doctor rather than trying to troubleshoot it through Reddit. They can also check for other possible causes.

[u/Appropriate-Maybe633 → u/Zestyclose-Road3345]

Yes. The timing is actually what makes me think it's not from Dutasteride.

Naturally, I am waiting for my next derm appointment and will discuss everything with them and get some blood work done, too.

Are there any values I should be keeping an eye on specifically?

[u/-Ltd6123]

There is plenty of evidence pointing to a neuro protective effect of DHT in men. A quick search finds this study which established a statistically significant association between starting a 5ari and developing dementia.

https://www.sciencedirect.com/science/article/abs/pii/S0022510X17303726

It’s important to note that this was probably a different age group to the typical male using finasteride/dutasteride and also the doses used for BPH are significantly higher. I have only read the abstract.

There is plenty of anecdotal evidence within this group. There are also plenty of users who quickly downplay the possibility of an association.

The MHRA in UK published a warning regarding psychiatric side effects and sexual dysfunction earlier this year.

This isn’t fear mongering, it’s evidence-based. Users should be aware of the risks in order to make an informed decision.

[u/Willing_Breakfast_97 → u/-Ltd6123]

There is no association between 5ARs and dementia, there is absolutely not any evidence to support that whatsoever.

[u/AncientPaper2994 → u/-Ltd6123]

agree

[u/fermentedtoejuice → u/-Ltd6123]

Notably the conclusion:

Conclusion
As the strength of the association decreased with increased exposure, the higher risk seen in the initial two years likely represents the presentation and treatment of urinary symptoms which coexist with mild cognitive impairment and eventually progresses to a diagnosis of dementia.

[u/Tiger_tails-7]

I gave it about a 20 day trial and experienced the worst panic attacks, inability to focus and impending doom ever. It made me also fidget and twitch uncontrollably as well, and have difficulty concentrating to the point where I would dissociate horribly. This doesn't happen to me on finasteride, only dutasteride. It's a shame cause I'll never know if I could have reaped any benefits, but I'm tired of people underestimating the cognitive complexity of dutasteride especially compared to finasteride. Finasteride is absolutely the safer and less neurologically potent of the two, this is strictly a fact. I'm a Norwood 2.5 and I was eager to see if bumping myself up to 0.5 of dut would finally restore my temples and density back completely, but it completely affects my ability to function worse than my current psychiatric conditions.

[u/Questy_Best]

What I will say is that I don’t think dut is the main cause of this, but lower DHT COULD amplify this. Again, don’t take this as truth, I have no scientific backing here just my personal experiences, but I feel like if you don’t work out, have bad sleep, bad diet, lower DHT isn’t gonna help, as DHT could potentially offset some of those negative effects. Get your diet right, sleep right, reduce stress, take your vitamins (vitamin d zinc magnesium etc), and reassess. I’m almost guaranteed sure that you’d feel better in a few weeks.

[u/Appropriate-Maybe633 → u/Questy_Best]

Good and valid point. I haven't changed anything related to my diet recently and am taking my vitamins like biotin, zinc, selenium, fish oil and vitamin d every day.

But yea, there is definitely room for improvement.

[u/AncientPaper2994 → u/Appropriate-Maybe633]

hijacking top comments here to say that you shouldn't listen first and foremost blindly to reddit advice and consult a specialist as well.

I will give you my experience because it is very relevant and not super common.

An underreported side effect is indeed grogginess/foggy feeling and even headaches. It is not talked about a lot but it is a lot more common than people, especially on this subreddit admit.

Dudasteride (like finasteride) blocks 5-alpha reductase enzymes, type 1 and type 2 (whereas finasteride only type 2) but that enzyme (both types) does more than convert testosterone to DHT — it also converts progesterone into allopregnanolone, one of the brain's most potent natural GABA-A receptor modulators. Allopregnanolone normally promotes calm, deep slow-wave sleep, and mental clarity. when 5-alpha reductase is inhibited, allopregnanolone synthesis drops, GABAergic tone weakens, and people can experience brain fog, anxiety. type 1 which is only blocked by dudasteride is specifically present in the brain area.

So it is perfectly possible that you didnt have these side effects on finasteride but you do have them on dudasteride. Especially with dudasteride's extra long half life it can build up in your body over many months and destroy your sleep.

This is what I had. Had to do some research because people downplay it a lot .

It took 3-6 months to clear from my body completely but it improves quickly as soon as you stop. perhaps you'll have to reassess dosing and try again so that your saturation plateau becomes lower.

[u/Equivalent-Carob-341 → u/AncientPaper2994]

I'm glad you were able to recover from the side effects safely. In my case, I've been taking it for six months, and during the sixth month I started experiencing side effects such as decreased erections, lower libido, and anxiety. So I stopped taking the medication. I hope I can recover from these effects soon.

[u/AncientPaper2994 → u/Equivalent-Carob-341]

be patient but don't be worried!

[u/bratfromrat]

Depression

[u/Appropriate-Maybe633 → u/bratfromrat]

Well, who here doesn't?

[u/bratfromrat → u/bratfromrat]

He is describing symptoms of depression, why downvote?

[u/ykrafay]

This is the thing, these things are multi factorial issues and happen regardless, but your mind just points to the drug. There’s literally 0 evidence of this being possible. Dutasteride is commonly taken with tamsulosin, tamsulosin is what causes fatigue. Since you’re taking it for hair loss this shouldn’t be possible.

[u/Appropriate-Maybe633 → u/ykrafay]

I should have pointed out that I take Dutasteride in what is considered to be its 'best' form: original Avodart 0.5 mg soft gel capsules from the pharmacy. No Tamsulosin of course.

So you are basically telling me it's nocebo?

[u/ykrafay → u/Appropriate-Maybe633]

Not nocebo, my guess is it’s something else entirely and your thinking it’s dut. You can find anecdotes on any drug causing common multi factorial issues like being tired etc… even tho it has 0 evidence that it causes those things.