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.

I’ve been on the finasteride and minoxidil stacked for a little over a year now, and I’ve had great results with minimal sides.

I just recently got into styling my hair. I’ve been using pomade daily, and I’m concerned about the amount of hair I’ve been seeing on my hands and comb/brush when styling.

I’m wondering if this is indeed increased shedding from the styling product, or if I’m just catching “sticky clumps” of hair from the pomade.

Dear Doctor Rassman,

I am a 25 year old male. I have a Norwood 1, so no thinning at the crown or at the temples. My hairline is about the same as when i was 17. My hairdresser always tells me I have very thick hair (she even thins it out sometimes) I lose about ten hairs a day when brushing and in the shower. My father and grandfather mothers side are not bald and neither are my other male family members.

You might wonder, why is he writing?

I’m really curious. When my long (well medium length) brown hair gets wet, I can see some skin. No bald spots, but dependent on the way the hair falls, I can see my scalp. Well, not eveywhere, but small lines.

How is this posible? (couldn’t find the answer anywhere on the internet)

(I have light skin btw)

Thanks in advance for your answer.

P.S.Great site, interesting and helpfull 🙂

This type of question has been addressed here before. Thinning differs in people. Those with coarse hair can lose more hair than those with fine hair and not show thinning. Those who have miniaturized hairs will show thinner and thinner as the miniaturization increases. The loss of 10 hairs per day only reflects about 10% of what a typical person loses throughout the day. Most people see more hair loss in the shower, because they can not see what blows away on a windy day — but just because they do not see it, does not mean that it does not happen. We lose some of the 100 or so hairs on a 24 hour basis. Everyone can see their scalp, unless the skin is dark and the hair is dark as well, has a high density, or it mats together with a good, tight afro.

Assuming that you are a Norwood Class 3 at this time and do not have a crown component, it is likely that you will not advance to a significant Norwood Class compared to most people your age. If you take the drug Finasteride, it will not advance the balding pattern. With these factors, it is possible to restore the balding area to a “full level,” provided that your donor area has at least average donor density (which could be a limiting factor). You are asking to restore your recipient site density to near normal in order to cut your hair very short; I think this is worth discussing with your hair transplant surgeon.

Are hair systems really unnoticeable? I am considering gluing the system on, is this the best way to apply ? What’s the best shampoo/ conditioner to use? Do you think that I should just rock the bald? (Devil’s advocate) Any tips/advice? I am planning on going scuba diving in September, will I be able to do this with the system in place ? For those that have used a system before, what was the first time after like? Has it ever came off at an inopportune time? How long do the pieces actually last? I’m hoping for it to last about a year, is this a reasonable expectation?

Hair systems or wigs are expensive over the long haul, running in the thousands of dollars forever. They are usually detectable and hard to keep in place unless they are heavily glued and with long term use they tend to develop an odor from your sweat. You can’t scuba dive or swim freely and you always look at people’s reaction trying to see if they can detect that you have a wig on. They do have challenges when you are with a woman who might want to grab you by your hair, not good. The average hair system last 2-3 years and then must be replaced. The less expensive ones last a year or so before they fall apart. The advantage of a hair system is it almost looks like real hair but most people can tell it is a wig.

The Scalp MicroPigmentation alternative: https://scalpmicropigmentation.com/bold-shaved-look/.

Scalp MicroPigmentation gives you absolute freedom from your extreme balding and freedom to do whatever you want to do, swim, scuba, make-out with a lady as she grabs your head.

Go to https://scalpmicropigmentation.com/ and go down to the second man on the front page which has a video where the man tells his very interesting and funny story about his experience with Scalp Micropigmentation (SMP).