Standard Treatment for AGA– Treatments for AGA –

Standard Treatment for AGA

The AGA standard treatment at our clinic uses “finasteride” as a medicine to prevent hair loss and “minoxidil topical medicine” as a hair growth medicine. In other words, it is a treatment that prevents hair loss with the drinking medicine finasteride and grows hair with the ointment minoxidil lotion to increase the overall hair volume.

The basis of treatment is “to prevent hair loss” and “to cause hair growth”, and finasteride and ketoconazole prevent hair loss from the inside and outside, and minoxidil causes hair growth, so it is prescribed with the expectation of a synergistic effect.

As it is not a strong treatment, it is not effective enough for patients with fast thinning hair, moderate or severe hair loss, or AGA mainly in the M-head or frontal area, but it is recommended for patients with mild hair loss or AGA mainly in the parietal area, as it can be expected to maintain or mildly improve the status quo.

Overseas finasteride products, minoxidil lotion, ninazole shampoo, ketoconazole lotion, etc. prescribed at our clinic are not approved for AGA in Japan, so they are not covered by the Pharmaceutical Side Effect Damage Relief System.

In mild cases, it may be done with treatment with minoxidil lotion and topical preparations of ketoconazole, but the improvement rate is not so high, so if the effect is poor after about half a year, it is better to add finasteride.

During the period of about one month after starting standard treatment, a phenomenon called “initial hair loss” may occur, in which hair grows and regrows with hair growth. Hair that falls out due to early hair loss is hair in the resting phase, so it is originally hair that falls out sooner or later. It is also evidence that the effect of the treatment is coming out, so let’s not worry about it.

As hair grows at a slower rate, the effectiveness of the treatment is determined after 6 months. At the latest, the effect will be seen in about one year, so if there is sufficient hair growth at that point, the medication will be continued. If the effect is not sufficient, the treatment can be changed to a stronger treatment if desired.

Finasteride

Finasteride suppresses DHT (dihydrotestosterone) production by inhibiting 5α-reductase 2 enzyme which is necessary to produce DHT, the cause of AGA.

In clinical trials in Japan, finasteride 1mg for 1 year resulted in 58% improvement, 68% for 2 years, and 78% for 3 years, and maintenance of the current condition was observed in 40% of patients after 1 year, 31% after 2 years, and 20% after 3 years. For patients between the ages of 20 and 50, 98% of patients showed improvement and maintenance.

However, looking at the rate of remarkable efficiency alone, 2% in the frontal area and 6% on the crown of the head, the effect of the treatment alone is not that significant. As with other AGA medicines, even if hair growth increases and hair loss decreases, it will return to normal when discontinued; it is necessary to bear in mind from the outset that AGA medicines are only effective for as long as you are taking them.

For detailed information on the efficacy and mechanism of action of finasteride, please refer to the AGA blog “Efficacy of finasteride“.

Precautions of finasteride treatment

1. It is not indicated for hair loss under 20 years old, female alopecia, alopecia areata, and alopecia due to anticancer drugs, etc.
2. Pregnant women, women who may become pregnant or women who are breastfeeding cannot use finasteride
3. Although the possibility of effects to fetus by finasteride is very low, we still recommend contraception should be used while taking finasteride and until one month after discontinuation of the treatment to ensure that transfer of finasteride to semen has been completely eliminated.
4. Please avoid blood donation during taking finasteride until one month after discontinuation of the treatment.
5. It usually takes at least 6 months to see the effect of finasteride treatment.
6. If finasteride is discontinued, the treatment effect will be lost and the symptoms of AGA will gradually progress again.
7. Please be sure to inform your doctor that you are taking finasteride when undergoing prostate cancer screening. Finasteride lowers PSA levels by approximately 50% and should be twice the measured PSA level.
8. Initial hair loss may occur during the first month of finasteride treatment.

	1~5%	Less than 1%	Frequency unknown
Allergy			Pruritus, urticaria, rash, angioedema (including lip, tongue, throat, and facial swelling)
Genital system	decrease in sexual desire1	Erectile dysfunction1, ejaculatory ysfunction1, decreased semen volume	Testicular pain, male infertility, Blood in semen, low quality of semen (reduced sperm concentration, azoospermia, Iow sperm motility, abnormal sperm morphology, etc.)2
Liver			Increased level of AST(GOT)、ALT(GPT)、γ-GTP3
Others			Breast tenderness, breast enlargement, depression, dizziness

1. Some of post-marketing reports showed persistence symptoms after discontinuation of finasteride.
2. There have been reports of normalization or improvement in semen quality after discontinuation of finasteride.
3. Blood tests are recommended every 6-12 months because liver dysfunction may occur.

• In an overseas clinical study of 18,882 healthy men (mean age: 63 years) treated with 5mg finasteride (5 to 25 times the approved dose) or placebo for 7 years, the incidence of high-grade prostate cancer with a Modified Gleason Score 8 to 10 was higher in the 5 mg finasteride group (1.8%) than in the placebo group (1.1%) (relative risk 1.70 [95% confidence interval: 1.23-2.34]). (*For reference: the cumulative lifetime risk of prostate cancer in general is 9.7%, or about 1 in 10, according to 2015 statistics.)
• There were post-marketing reports showed male breast cancer in patients treated with finasteride. The causal relationship between long-term finasteride treatment and the development of male breast cancer is unknown.
• Decreased prostate volume has been reported overseas.

No interactions between finasteride and other drugs have been reported.

The risk of side effects and efficacy are the same in both products, but the price is lower for oversea-made drugs. In addition, while products of Japan are covered by Relief Systems for Adverse Drug Reactions if there are any severe side effects that occur after treatment, oversea-made products are not covered by the system because they are unapproved drugs in Japan.

Fees

	Price (Tax included)
Finasteride 1mg (Overseas Products)	30 tablets ¥2,970
Finasteride 1mg (Products of Japan)	28 tablets ¥4,312
Blood tests (only when necessary)	¥2,948

• A consultation fee (¥3,850 for initial visit, ¥1,650 for repeated visit) will be charged for prescriptions.
• A maximum of six-month prescription is available.
• Since finasteride is a pharmaceutical product, please note that we do not accept returns or refunds after prescription, even in the case of side effects occurrence, etc.
• We recommend a blood test every 6 to 12 months, but it is not necessary if you have already had a blood test from other hospitals or routine health check.

Minoxidil Hair Tonic Lotion

How to use Minoxidil Hair Tonic

Twice a day (morning and evening), with the bottle upright, apply 5~6 pushes (approx. 1 mL) each time to the scalp where hair loss is occurring, and massage with the belly of your fingers.

When showering or bathing, use Minoxidil hair tonic after washing and drying your hair with a hair dryer. In the morning, use this product before hair styling products.

• Avoid contact with eyes. In case of contact with eyes, rinse immediately with water or lukewarm water. If symptoms are severe, please consult an ophthalmologist
• Contact of mucous membranes such as touching eyes with Minoxidil on hands may cause irritation. Please be sure to wash off the solution on hands after topical use.
• Avoid contact with items that may dissolve in alcohol (glasses, synthetic fibers, etc.).
• When using hair dye (hair color, hair dye, gray hair dye, etc.), use Minoxidil after the hair has been completely dyed.

Who may not eligible for using Minoxidil Hair Tonic

Please consult your doctor if you are

1. Those who are allergic to Minoxidil or alcohol
2. Those who are under 20 years old
3. Those with hair loss other than androgenetic alopecia (e.g., alopecia areata, alopecia due to thyroid disease, etc.), or those with alopecia of unknown cause
4. Those with high or low blood pressure
5. Those with heart or kidney disease
6. Those with severe swelling
7. Those who are over 65 years old
8. Those who are pregnant or breastfeeding

• The nozzle of bottle may become hardened by the chemical solution and become difficult to eject. If the nozzle becomes completely hardened, clean the nozzle outlet with a toothpick and wash it with warm water or ethanol to make it easier to eject.
• Store away from direct sunlight, high temperatures, and cold temperatures below 5℃.
• Do not store in a refrigerator. Crystals will precipitate and harden when cold.
• Keep out of reach of children.
• To avoid misuse and to maintain quality, do not replace the container with another one.
• Keep away from fire.
• Do not use products after their expiration date. Expiration date is 6 months from the date of prescription.

• Redness, itching, irritation, rash on scalp or body
• Headache, feeling faint, dizziness
• Chest pain, rapid heartbeat, palpitations, shortness of breath
• Sudden unexplained weight gain, swelling of limbs
• Theoretically, any ingredient can cause anaphylaxis or other serious allergic symptoms although there has never been a case in our clinic in the past.

• It takes time for hair to grow. The efficacy of Minoxidil will be observed after using daily for at least 6 months.
• Because of its short-lasting effect, it is important to use it twice a day.
• Hair growth varies from person to person, and this product may not be effective for everyone.
• Continued use is required. The hair will gradually return to the status before treatment after Minoxidil is discontinued.
• Initial hair loss may occur during the first month of use.

Fees

	Price (Tax included)
Minoxidil 2% Hair Tonic Lotion 55ml	1 bottle ¥3,234
Minoxidil 5% Hair Tonic Lotion 55ml	1 bottle ¥4,246
Minoxidil 10% Hair Tonic Lotion 55ml	1 bottle ¥5,478

• A consultation fee (¥3,850 for initial visit, ¥1,650 for repeated visit) will be charged for prescriptions.
• After the second visit, no consultation fee will be charged if only topical medications are prescribed.
• A maximum of six-month prescription is available.
• Since Minoxidil hair tonic lotion is a pharmaceutical product, please note that we do not accept returns or refunds after prescription, even in the case of side effects occurrence, etc.

Ketoconazole 2% Topical Preparation

Ninazol shampoo contains 2% ketoconazole, an antifungal medicine. Ketoconazole has been reported to reduce dandruff and sebum, as well as inhibit male hormones (DHT), which cause AGA.

Although overseas guidelines have a level of recommendation of C1 (may be used), it has been shown to be effective in several trials with AGA patients and is recommended as an adjunctive hair growth treatment.

Use ketoconazole lotion if you do not like the smell of shampoo or if you do not like the way your hair creaks.

How to use Ketoconazole 2% Topical Preparation

Ninazol Shampoo

After wetting the hair, take a 100 yen coin ~ 500 yen coin sized amount onto the palm of your hand. Lather lightly in the palm of your hand, apply to the thinning hair area and surrounding area and massage lightly with your fingers. You may also apply it to the entire scalp. Then leave on for five minutes and rinse well with lukewarm water.

Use three times a week is sufficient, but if you are concerned about scalp dirt, you can use it daily. In such cases, use the shampoo as you would a normal shampoo, without leaving it on for five minutes.

The right amount of NINASOL shampoo is enough to make a light lather when applied to the hair; the amount to be used at one time varies from person to person depending on the amount of hair and sebum on the head, so increase or decrease accordingly.

Each bottle lasts approximately 2 months.

Ketoconazole Lotion

Apply approximately 0.5 mL (half a 10 yen coin) twice daily to the scalp and massage gently.

If you are using minoxidil lotion, we recommend using it before minoxidil lotion. In fact, the effect will be the same whichever comes first, but if you use minoxidil first, more of the minoxidil ingredients will stick to your hair, causing it to become powdery and dry.

Each bottle lasts approximately 7-10 days.

Who may not eligible for using Ketoconazole 2% Topical Preparation

• Those who are allergic to Ketoconazole
• Those who are pregnant or breastfeeding

Side effects are rare, but include:

• Skin side effects (frequency unknown)
  skin burning, rash, dermabrasion, sticky feeling of skin, urticaria, erosion, cracks, pain, irritation, pruritus, contact dermatitis, erythema, blisters
• Systemic disorders and side effects of administration locally (frequency unknown)
  Application site reactions (bleeding, discomfort, dryness, inflammation, confusion, edema)
• Side effects of the immune system (frequency unknown)
  hypersensitivity
• Other side effects (frequency unknown)
  urine protein positive

If symptoms of side effects appear, discontinue use and consult a doctor.

Fees

	Price (Tax included)
Ninazol Shampoo 100ml	1 bottle ¥2,178
Ketoconazole Lotion 10g	1 bottle ¥660

AGA Standard Treatment Fees (tax included)

Example of fees for an initial visit [2 months’ worth]

Initial consultation fee	¥3,850
Finasteride 1mg (Overseas Products) [60 tablets]	¥2,970
Minoxidil 5% or 10% Hair Tonic Lotion 55ml [2 bottles]	¥8,492 ~ ¥10,956
Ninazol Shampoo 100ml [1 bottle]	¥2,178
Total fees	¥20,460 ~ ¥22,924

Example of fees for an repeated visit [4 months’ worth]

repeated consultation fee	¥1,650
Finasteride 1mg (Overseas Products) [120 tablets]	¥11,880
Minoxidil 5% or 10% Hair Tonic Lotion 55ml [4 bottles]	¥16,984 ~ ¥21,912
Ninazol Shampoo 100ml [2 bottles]	¥4,356
Total fees	¥34,870 ~ ¥39,798

• For return visits, ‘telemedicine‘ is also available.
• A consultation fee is charged for prescribing oral medication. If you only require a prescription for topical medication, no appointment or consultation is required after the second visit.
• Medicine prices vary depending on the type of medicine (domestic or foreign) and dosage.
• At the first visit, the patient is prescribed a two-month supply to observe side effects, followed by a four-month prescription if there are no problems at the second visit, and a visit every three months thereafter. On request, up to six months’ worth of medication can be prescribed.

Convenient telemedicine

Our clinic is the first in the country to prescribe AGA medication via telemedicine. Initial consultations require a face-to-face consultation, but for those who live too far away to visit the clinic or are too busy with work to spare the time, we offer online consultations and prescriptions, and deliver the medication to your home.

To use remote consultation, you need to fill in the ‘Agreement for Telemedicine’. For more information, please see ‘Telemedicine‘ and contact our reception if you wish to use this service.