Androgenetic Alopecia Treatment in Asian Men

by Yohei Tanaka, MD, PhD; Toru Aso, MD, PhD; Jumpei Ono, MD; Ryu Hosoi, MD; and Takuto Kaneko, MD

Dr. Tanaka is with Clinica Tanaka Plastic, Reconstructive Surgery and Anti-aging Center in Matsumoto, Nagano, Japan, and the AGA Skin Clinic in Tokyo, Japan. Drs. Aso, Ono, Hosoi, and Kaneko are also with the AGA Skin Clinic in Tokyo, Japan.

Funding: No funding was provided.

Disclosures: The authors have no conflicts of interest relevant to the content of this article.

Abstract: Background. Androgenetic alopecia (AGA) is a common form of hair loss in Asian men. Although AGA is often regarded as a relatively minor dermatological condition, hair loss can impact self-image and is a main cause for anxiety and depression in some men. We have treated patients with AGA for seven years. Objective. The goal of this study was to evaluate the effectiveness of our combination therapy in Asian men with AGA. Participants. Between the years 2011 and 2017, 18,918 male patients were treated in our center. Our combination therapy consists of oral finasteride once daily, oral and topical minoxidil twice daily, and an injectable treatment of lidocaine and an AGA treatment solution comprising minoxidil, arginine, aspartic acid, caffeine, copper tripeptide, lysine, niacin, panthenol, propanediol, propylen glycol, retinyl palmitate, pyridoxine, sodium hyaluronate, and ubiquinone once monthly for more than six months. Measurements. Digital photographs were taken pre- and post-treatment, and patient assessments were recorded after six and 12 months post-treatment. Results. Significant improvement was observed in all patients in the digital photographs. Ninety-six and 80 percent of the patients reported satisfaction with the results of the treatment after six and 12 months post-treatment. Minor complications were observed in 802 (4.2%) patients, characterized by slight pain and bleeding due to injection, swelling, dizziness, itching, and erythema of the scalp. Slight pain was reported in 651 patients (3.4%), and slight bleeding was reported in 56 patients (0.3%). Sexual dysfunctions were uncommon. These minor complications resolved spontaneously. No treatment-related adverse events were observed. Conclusion. A combination of these therapeutic options offers safe and highly efficacious treatment for AGA with minimal complications.

Keywords: Androgenetic alopecia (AGA), Combination therapy, Finasteride, Hair loss, Minoxidil

J Clin Aesthet Dermatol. 2018;11(7):32–35

William Rassman, M.D. Comments: This is an impressive series of 18,000 Asian men where genetic patterned balding was treated. The general satisfaction rate is clearly defined and it is high. The article is easy to scan.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622412/

The paper is interesting. Many people pre test platelet counts and then do platelet counts on the PRP obtained after it is spun down. If one were to take an average of perhaps 130cc of blood and spin it down, they would wind up with usually 6 or so cc of PRP. Platelet counts are usually 4-8 times the original platelet count. Sometimes maybe as high 10x the platelet count. These numbers may not correlate. I would want to know how many cc of prp did they get and did they dilute that with each patient. It is not clear why they compared different platelet concentrations for hair growth from the data presented here as these conclusions are not statistically significant based upon the data collected. There are no controls used in this study which by itself, disclaims many of the validity of the claims. I still remain skeptical

I always tell my patients that the risk of sexual dysfunction or loss of libido was between 2-4% but this article suggests that these side effects were not seen in their study of over 600 men from all age groups. This suggests a strong psychological impact that could be the cause of the sexual complaints reporting “there is evidence of a nocebo effect (an adverse side-effect that is not a direct result of the specific pharmacological action of the drug)“. The link below is a copy of the article which should be read by our audience. The main thrust of the article, however, was that “recent research … suggests that men with alopecia may be inherently more susceptible to sexual dysfunction regardless of treatment and that sexual dysfunction is not uncommon in the general population regardless of alopecia status.” I personally know the first author, Dr. Robert Haber and he is an honest and diligent clinician who I trust.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.15548?author_access_token=D24c_h79HLymV8uMhMZjRIta6bR2k8jH0KrdpFOxC64P8g8jjA3oxKEtIH6uG2i3wzguPsCnGEXe1jO-tZhF84ZrGEXnIpW-Wt9_oexeaNFlCp1ZbNfymVRdrP5xtRuy&

From the New York Times, this article discusses verteporfin, a new miracle drug for preventing scars: https://www.nytimes.com/2021/04/22/health/surgery-scar.html

According to the article, this drug is not yet FDA approved for use in humans for the prevention of scarring.

Just saw some ad about Just For Men “revolutionary” product (“Just For Men Control GX Grey Reducing”) which claims to reduce graying gradually. I was wondering if you believe it is safe to use and would not trigger hair loss with all the chemical that the product must have.

I don’t have specific knowledge of the Just for Men product other than to say that any claims made by such a company concerning safety and effectiveness comes under FDA supervision. I recommend looking at the product’s packaging for the FDA certification.

No, finasteride does not produce miniaturized hairs. It may cause new hair to grow or make miniaturized hairs thicker.