・AGA male alopecia At our clinic, we are working to treat male pattern baldness so that male patients who are suffering from thinning hair can live as comfortably as possible every day. What is Androgenetic Alopecia (AGA)? AGA is an abbreviation for "Androgenetic Alopecia". "Androgenetic = due to male hormones" In Japanese, it is called androgenic alopecia (androgenetic alopecia). As many men age, the hair around the forehead hairline and whorl on the top of the head becomes thinner, shorter and softer, and eventually the hair recedes and disappears. This is because there are many hair follicles at the hairline and on the top of the head that are sensitive to male hormones, and the growth of hair matrix cells is inhibited by bad male hormones. Hair constantly undergoes repeated growth and hair loss. This cycle is called the hair cycle. A normal hair cycle lasts several years. On the other hand, in the case of AGA, the hair cycle is shortened to several months, and the hair falls out before it grows thick and long. As a result, the number of thin and short hair increases, making thinning hair more noticeable.

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AGA treatment targets cases where the hairline recedes, the whorls are enlarged, and thin, short hair appears thick, rather than physiological hair loss. This is the disease we treat called ``chronic progressive alopecia.'' Male pattern baldness always causes hair thinning and shortening, which occurs on the front and top of the head. Confirming vellus hair is the key to diagnosis. Check with a magnifying glass or scope. In addition, alopecia areata caused by stress or immune abnormalities, telogen effluvium, traction alopecia where hair is involuntarily pulled out, and cicatricial alopecia caused by keloids after trauma must be excluded. After examining these and confirming them, we make a diagnosis and prescribe medication.

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Treatment begins with an outpatient diagnosis of AGA. Additionally, it is preferable for men to be treated if they have no plans to become pregnant or have already completed their pregnancy. How to treat AGA AGA guidelines have been created that define treatment guidelines. At our hospital, we administer drugs that are highly recommended, so-called recommendation level A, in accordance with treatment guidelines. The first choice drug is finasteride (Propecia). Administer dutasteride (Zagaro) if it is ineffective. (Excerpt from AGA guidelines) Treatment method Recommendation level Finasteride (oral medication) A (D for female type) Dutasteride (oral medication) A (D for female type) Minoxidil (topical drug, 5%, female type: 1%) A

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Male hormones are strongly involved in the onset of AGA. When DHT, a bad male hormone called dihydrotestosterone, binds to the male hormone receptors in the dermal papilla cells of the scalp, it damages the hair roots and inhibits hair cell growth. Bad male hormones are produced by converting the normal male hormone testosterone by the action of 5-alpha reductase. There are two types of 5α-reductase: type I and type II. Type I enzymes are present in all cells and organs, and type II enzymes are targeted in alopecia. Finasteride blocks type II enzymes, and dutasteride inhibits both type I and type II enzymes. The major difference between finasteride and dutasteride is not only which type of enzyme they block, but also the difference in half-life (the time it takes for the component to reduce by half from the blood).

If taken consistently for around six months, finasteride has a half-life of 2.8-4.2 hours, while dutasteride has a half-life of 3-5 weeks, so they remain in the body longer.
The reports that dutalide is more effective seem to be related to the concentration that remains in the body.
However, in terms of side effects, finasteride is immediately removed from the bloodstream once the drug is stopped, and the side effects disappear, but dutasteride has the risk that it takes time to be removed.
In actual treatment, oral administration of finasteride (Propecia) is started.
The initial dosage is 1 mg. The effectiveness is evaluated after six months.
If there is no effect after 6-12 months, the finasteride dosage is increased to 2 mg.
For those who do not see any effect even after the increased dosage, dutasteride (Xagaro) will be administered.
Most patients see results with finasteride.
In elderly patients, dutasteride may be used because of high levels of 5α-reductase.
Both oral and topical medications take time to take effect, so treatment continues for at least six months.

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★Treatment costs

AGA treatment is not covered by health insurance and is not eligible for medical expense deductions on income tax.

AGA treatment falls under the category of "expenses for beautifying or changing appearance" as defined by the National Tax Agency, and is not considered a medical expense.

On the other hand, hair loss-related conditions other than AGA may be partially covered by insurance.

Alopecia areata is a condition that can be treated using health insurance.

Finasteride tablets (Propecia) 4,000-6,000 yen/month

Dutasteride tablets (Zagaro) 8,000-13,000 yen/month

Side effects

Finasteride and dutasteride, which are AGA treatment drugs, have a mechanism of action that inhibits male hormones, so in very rare cases, sexual changes such as decreased male sexual function, erectile dysfunction, decreased libido, mild depressive symptoms, mood swings, and breast disorders (gynecomastia, nipple pain, breast pain, breast discomfort) may occur.

Dutasteride has also been reported.
The probability is less than 1% for finasteride and around 4% for dutasteride.

Although the probability of liver dysfunction is very low, it must be administered with caution to patients with liver diseases.
If you experience symptoms such as fever, jaundice, or nausea after taking the drug, stop taking it immediately and consult a doctor.
It has also been reported that the value of the tumor marker PSA for prostate cancer decreases by about 50%.
Patients who are being followed up with PSA for benign prostatic hyperplasia should be careful because their PSA values ​​will be lower than those of the chisai.

★Points to note

-Sudden hair loss may occur 1-2 months after taking finasteride or dutasteride.

This is more common in relatively young people under 40 years old.

However, it is these patients who tend to see a steady increase in hair growth after that.

It is thought that new healthy hair pushes out the old, thin AGA hair. As the reaction slows down in middle age, it takes 6-12 months to confirm the effect.

-The oral medication must be taken once a day, every day. It can be taken at any time. If you forget, you can take it before going to sleep.

-The goal of the treatment is, first of all, to suppress the progression of hair loss.

Second, to restore the vitality of hair matrix cells and increase hair growth.

An objective evaluation is required to determine the effect.
I also recommend taking photos of your head and hair every month.

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Cooperation between medical care and nursing care

We have staff and nurses with experience working in elderly care facilities, ensuring close coordination at the on-site level between medical care and nursing care.

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Providing comprehensive medical services

We ensure ample consultation time and provide the kind of thorough medical services that are only possible as a small clinic, with a patient-centered approach.

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