Treatment of Male Balding: Lessons from 18,918 Japanese Males

Lessons from 18,918 Japanese Males


One of the biggest weakness in so many hair loss studies is the small sample sizes and limited number of patients studied.

A new study from Japan examined the treatment outcomes and side effects in 18,918 male patients who underwent a specific “AGA combination therapy” between 2011 and 2017.

The “AGA combination therapy” consisted of 1 mg oral finasteride once daily, 2.5 mg oral minoxidil and 5% topical minoxidil twice daily, and an injection once monthly for more than six months with a mesotherapy mixture containing minoxidil, arginine, aspartic acid, caffeine, copper tripeptide, lysine, niacin, panthenol, propanediol, propylen glycol, retinyl palmitate, pyridoxine, sodium hyaluronate, and ubiquinone.

Overall, 80 percent of patients reported satisfaction with the results of the treatment after 12 months post-treatment.

What is particularly important to note in this study was the rate and type of complications. Minor complications were observed in a total of 802 (4.2%) patients out of 18,918. Slight pain due to injection was found in 651 patients (3.4%), and slight bleeding was found in 56 patients (0.3%). Swelling due to oral minoxidil was found in 42 patients (0.22%), and dizziness in 28 patients (0.15%). Itching of the scalp from topical minoxidil was present in 7 patients (0.04%), and redness in 4 patients (0.02%). Sexual dysfunction (erectile dysfunction and low libido) were observed in 14 patients (0.07%). These minor complications resolved spontaneously.

In contrast to other studies which indicated an incidence of sexual dysfunction as high as 2 % of finasteride users, this large study from Japan suggested a much lower rate of sexual side effects. These low rates are noted even in the presence of 5 mg daily of oral minoxidil which too has the potential to cause erectile dysfunction. This study also pointed to the possibility of combining topical and oral minoxidil with low rates of dizziness and edema.

Overall, this study pointed to a benefit and relatively low incidence of side effects with an “AGA combination therapy” with topical and oral minoxidil, oral finasteride and mesotherapy.


Tanaka Y et al. J Clin Aesthet Dermatol 2018

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

Share This