Standard Treatments for AGA
At our clinic, the standard treatment for androgenetic alopecia (AGA) involves a combination of the hair loss inhibitor “Finasteride” and the hair growth medication “Topical Minoxidil”.
Finasteride helps prevent hair loss and slows down the progression of AGA, while Topical Minoxidil promotes hair growth and strengthens existing hair, gradually increasing overall hair volume.
The standard treatment provides mild effects, so it may not lead to a dramatic increase in hair growth. However, it can help maintain the current hair status and achieve mild improvements in hair thinning.
This treatment is recommended for individuals with mild AGA or patients experiencing hair loss specifically in the crown area of the scalp.
The fee for the standard treatment
Example of Initial Consultation Fee (2 months’ worth)
| Item | Fee（tax included） |
|---|---|
| Consultation Fee | First visit ¥3,850 |
| Medication Cost | Finasteride1mg 60 Tabs ¥5,940 Minoxidil topical （5% or 10%） 2 bottles ¥8,492～¥10,956 NINAZOL Shampoo 1 bottle ¥2,178 |
| Total fees / 2 months | ¥20,460～¥22,924 |
| Cost per month | ¥10,230～¥11,462 |
Example of Follow-up Consultation Fee (4 months’ worth)
| Item | Fee（tax included） |
|---|---|
| Consultation Fee | Revisit ¥1,650 |
| Medication Cost | Finasteride1mg 120 Tabs ¥11,880 Minoxidil topical （5% or 10%） 4 bottles ¥16,984～¥21,912 NINAZOL Shampoo 2 bottles ¥4,356 |
| Total fees / 4 months | ¥34,870～¥39,798 |
| Cost per month | ¥8,717～¥9,949 |
- For prescribing oral medication, a consultation fee is applicable. However, for those who only require prescription of topical medication, no further appointments or consultations are necessary from the second visit onwards.
- During the initial consultation, a two-month supply is prescribed to monitor any potential side effects. In subsequent follow-up visits, if there are no issues, a four-month supply is prescribed. Afterward, a regular consultation every three months is recommended. Depending on your preference, we can prescribe a maximum of six months’ worth of medication.
Aggressive Treatments for AGA
In aggressive treatment for androgenetic alopecia (AGA), dutasteride is used, which is approximately 1.6 times more effective than finasteride in preventing hair loss.We also prescribe “minoxidil tablets” to stimulate hair growth.
Aggressive treatment is suitable for individuals with AGA of the frontal type, those in their 20s and 30s experiencing rapid hair loss progression, and individuals with moderate to severe AGA.
It is recommended to first undergo standard treatment for a period of at least 6 months. If there is no improvement and hair loss continues to progress, it is advisable to consider aggressive treatment.
The fee for the Aggressive treatment
Example of treatment 1
The combination of finasteride and minoxidil tablets is a commonly used treatment pattern in many specialized clinics for androgenetic alopecia (AGA). This treatment approach offers significant improvement for individuals with moderate hair loss progression or those with vertex-pattern hair loss.
Initial Consultation Fee (2 months’ worth)
| Item | Fee（tax included） |
|---|---|
| Consultation Fee | First visit ¥3,850 |
| Medication Cost | Finasteride1mg 60 Tabs ¥5,940 Minoxidil oral 5mg 60 Tabs ¥8,580 NINAZOL Shampoo 1 bottle ¥2,178 |
Examination Fee | Blood test ¥5,148 ECG ¥2,706 Urine test ¥1,848 |
| Total fees / 2 months | ¥30,250 |
| Cost per month | ¥15,125 |
Follow-up Consultation Fee (4 months’ worth)
| Item | Fee（tax included） |
|---|---|
| Consultation Fee | Revisit ¥1,650 |
| Medication Cost | Finasteride1mg 120 Tabs ¥11,880 Minoxidil oral 5mg 120 Tabs ¥17,160 NINAZOL Shampoo 2 bottles ¥4,356 |
| Total fees / 4 months | ¥35,046 |
| Cost per month | ¥8,761 |
Example of treatment 2
The combination treatment of dutasteride and minoxidil tablets is the most effective for hair loss.
Initial Consultation Fee (2 months’ worth)
| Item | Fee（tax included） |
|---|---|
| Consultation Fee | First visit ¥3,850 |
| Medication Cost | Dutasteride AV 0.5mg 60 Caps ¥10,560 Minoxidil oral 5mg 60 Tabs ¥8,580 NINAZOL Shampoo 1 bottle ¥2,178 |
| Examination Fee | Blood test ¥5,148 ECG ¥2,706 Urine test ¥1,848 |
| Total fees / 2 months | ¥34,870 |
| Cost per month | ¥17,435 |
Follow-up Consultation Fee (4 months’ worth)
| Item | Fee（tax included） |
|---|---|
| Consultation Fee | Revisit ¥1,650 |
| Medication Cost | Dutasteride AV 0.5mg 120 Caps ¥21,120 Minoxidil oral 5mg 120 Tabs ¥17,160 NINAZOL Shampoo 2 bottles ¥4,356 |
| Total fees / 4 months | ¥44,286 |
| Cost per month | ¥11,071円 |
- For prescribing oral medication, a consultation fee is applicable. However, for those who only require prescription of topical medication, no further appointments or consultations are necessary from the second visit onwards.
- For prescribing minoxidil tablets, it is necessary to undergo blood tests, an electrocardiogram (ECG), and urine tests during the initial consultation and every 6 months thereafter.
- During the initial consultation, a two-month supply is prescribed to monitor any potential side effects. In subsequent follow-up visits, if there are no issues, a four-month supply is prescribed. Afterward, a regular consultation every three months is recommended. Depending on your preference, we can prescribe a maximum of six months’ worth of medication.
Case Study: Treatment of Male Pattern Baldness
Here are the before and 7-month after photos of a patient who underwent aggressive treatment for AGA at our clinic. The effects typically start to become noticeable within 3 to 6 months and reach their peak at around 1 year. Continued use of the medication is necessary to maintain the results.
Complementary Treatments for AGA
Nizoral Shampoo（Ninazol Shampoo） is a shampoo that contains 2% ketoconazole, an active ingredient with antifungal properties. Ketoconazole has been reported to have anti-androgenic effects, which can help prevent hair loss [11].
For those who are concerned about the texture and scent of the shampoo, we recommend using Ketoconazole lotion instead.
How to use
- Nizoral Shampoo
-
After wetting the hair, put an amount of about 100 to 500 yen coin size in your palm. Gently lather it up in your palm and apply it to the scalp, massaging lightly with your fingertips. Leave it on for 5 minutes, then rinse thoroughly with water.
Using it three times a week is sufficient, but if you have concerns about dirt, you can use it daily without any issues. In that case, rinse it off immediately without leaving it on for 5 minutes, just like regular shampoo.
- Ketoconazole Lotion
-
Apply approximately 0.5mL (about half the size of a 10-yen coin) to the scalp twice a day and massage it lightly.
If you are using minoxidil lotion, it is recommended to use ketoconazole lotion first. The effectiveness is the same regardless of the order, but using minoxidil first may cause the hair to become powdery or dry.
- Precautions
-
- Do not use while pregnant or while breastfeeding.
- If you notice any abnormality such as redness, irritation, or rash on the scalp, please consult a doctor.
List of references/websites
- B S Hugo Perez. “Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men” Med Hypotheses. 2004;62(1):112-5. doi: 10.1016/s0306-9877(03)00264-0. PMID: 14729013
- C Piérard-Franchimont et al., “Ketoconazole shampoo: effect of long-term use in androgenic alopecia” Dermatology. 1998;196(4):474-7. doi: 10.1159/000017954. PMID: 966913
- 前島 英樹ら, “壮年性脱毛患者に対するケトコナゾールローション外用の効果に関する検討” 西日本皮膚科 2007; 69: 182―185.
- Jaime R Fields, “Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review” Dermatol Ther. 2020 Jan;33(1):e13202. doi: 10.1111/dth.13202. Epub 2020 Jan 2. PMID: 31858672
- Tater KC, Gwaltney-Brant S, Wismer T. Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001-2019). J Am Anim Hosp Assoc. 2021 Sep 1;57(5):225-231. doi: 10.5326/JAAHA-MS-7154. PMID: 34370845.
- プロペシア錠0.2mg／プロペシア錠1mg https://www.info.pmda.go.jp/go/pack/249900XF1021_3 最終アクセス 2023.02.10
- グラクソ・スミスクライン株式会社 医薬品インタビューフォーム ザガーロカプセル0.1mg ザガーロカプセル0.5mg 2021年11月改定
- Modha JD, Pathania YS. A comprehensive review of oral minoxidil in alopecia. J Cosmet Dermatol. 2022 Sep 6. doi: 10.1111/jocd.15324. Epub ahead of print. PMID: 36065675.
- Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2021 Mar;84(3):737-746. doi: 10.1016/j.jaad.2020.06.1009. Epub 2020 Jul 2. PMID: 32622136.
- Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, Hermosa-Gelbard A, Moreno-Arrones OM, Fernandez-Nieto D, Vaño-Galvan S. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. J Am Acad Dermatol. 2019 Aug;81(2):648-649. doi: 10.1016/j.jaad.2019.04.054. Epub 2019 May 2. PMID: 31054970.
- Hugo Perez BS. Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men. Med Hypotheses. 2004;62(1):112-5. doi: 10.1016/s0306-9877(03)00264-0. PMID: 14729013.
- Pereira AFJR, Coelho TOA. Post-finasteride syndrome. An Bras Dermatol. 2020 May-Jun;95(3):271-277. doi: 10.1016/j.abd.2020.02.001. Epub 2020 Mar 25. PMID: 32317131; PMCID: PMC7253896.
- Wessells H, Roy J, Bannow J, Grayhack J, Matsumoto AM, Tenover L, Herlihy R, Fitch W, Labasky R, Auerbach S, Parra R, Rajfer J, Culbertson J, Lee M, Bach MA, Waldstreicher J; PLESS Study Group. Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia. Urology. 2003 Mar;61(3):579-84. doi: 10.1016/s0090-4295(02)02401-9. PMID: 12639651.
