Hair Loss Treatment Guideline Update

Some countries release detailed official recommendations on hair loss treatments every few years. Usually, these are based upon guidelines from their national dermatological associations.

In virtually every country in the world, oral Finasteride and topical Minoxidil are typically the top two hair loss treatment recommendations. Those two are the only ever FDA approved medications to treat hair loss, so no surprise. However, thereafter you can find some unexpected treatment suggestions.

Hair Loss Treatments in Japan

In Japan, the 2018 Dermatological Association recommendations start with the following:

“Finasteride 1 mg daily, dutasteride 0.5 mg daily and topical 5% minoxidil twice daily for MPHL, and topical 1% minoxidil twice daily for FPHL, are recommended as the first-line treatments.”

The appearance of “Dutasteride” in the above is not as surprising as it would seem in most other countries. This is because Dutasteride has only been approved as a treatment for androgenetic alopecia (AGA) in South Korea and Japan. It seems like topical Finasteride is not popular in Japan (or for that matter, anywhere in the world). The oral version heavily dominates.

More surprisingly, topical Adenosine is listed as a second line of treatment to combat hair loss in Japan. Laser hair growth devices are also recommended as an option.

Finasteride is not recommended for female pattern hair loss (FPHL) sufferers in Japan. In many western countries, women are offered Finasteride for their hair loss as long as they are not planning to get pregnant in the future.

Strangely, oral Minoxidil is not recommended as a hair loss treatment in Japan. In contrast, oral Minoxidil for hair growth seems to be increasingly popular in nearby Asia/Pacific countries such as Thailand and Australia. And also increasingly popular in Spain (see next section). See this new study in support of the drug’s hair growth effects.

Prescribing Habits for Androgenic Alopecia in Spain

In September 2020, an updated survey of Spanish dermatologists showed interesting findings in regards to the prescribing habits for AGA.

Out of 243 dermatologists who responded, the most common treatments prescribed for male androgenetic alopecia were:

  1. Topical Minoxidil (100%).
  2. Oral Finasteride (92.6%).
  3. Oral Dutasteride (75.7%).
  4. Oral Minoxidil (50.6%).
Hair Loss Treatment Recommendations by % of Dermatologists in Spain, 2019-2020
Hair Loss Treatments
Hair Loss Treatment Recommendations.

Dutasteride and Oral Minoxidil Popular

It is extraordinary that Dutasteride and oral Minoxidil are so widely prescribed in Spain to treat male pattern baldness. In fact, the survey found oral Minoxidil to be prescribed even more widely for females (both premenopausal at 67.9% and postmenopasal 63%).

Oral Minoxidil is a blood pressure medication that can cause side effects such as faster heart rates, dizziness and increased body hair. I am amazed at how readily Spanish dermatologists are prescribing it to both men and women as a hair loss treatment.

In regards to Dutasteride for hair loss, Spain is a real trendsetter. This is surprising, since the drug has not been officially approved to treat hair loss in that country or in the EU. See my past posts with before and after photos of Dutasteride using hair loss patients in Spain:

Case Study

One of this blog’s avid readers is a person from Spain named “cuellar”. On our hair loss chat, he recently posted the below before and after photos of his hair. The “after” is 9 months into daily treatment with oral Minoxidil and oral Dutasteride. He said that the former has become extremely popular in Spain, confirming the findings of the above survey.

“Cuellar” thinks that he has lost ground recently per another newer photo, but hopefully it is just a temporary shed. He will keep us updated on his progress. He has seen no side effects other than a modest increase in body hair quantity. Maybe he can also try to get Dutasteride injections from Dr. Vañó since they live in the same country?!

Dutasteride and Oral Minoxidil Before After
Dutasteride and Oral Minoxidil: Before and After Hair Growth Photos (9 Months).


46 thoughts on “Hair Loss Treatment Guideline Update”

  1. As someone who is allergic to topical minoxidil, oral minox is something that intrigues me. However the potential sides scare me.

    I have read that 2% of topical minoxidil goes systemic. So if you were applying two 1ml doses of 5% minoxidil a day, 2mg of minoxidil would be circulating your system anyway. Therefore taking a low dose of 1.25mg orally, the side effect profile would be similar?

    Does anyone know of these calculations are accurate?

  2. I wish I didn’t have side effects with Dut. I took it for 3 months and experienced very sore nipples. It eventually went away when I stopped. Ugh!

  3. Oral Minoxidil was intense for me. It gave me INSANE regrowth for about four months to where I loved my hair, but then my sunken eyes, puffy cheeks and fluid retention were just not worth it.. i did try using lasix with this as a diuretic to mitigate the fluid and eye issues with no change..

    Everyone is different, but minoxidil is a commitment for the long term and I’m shedding very badly now being off =/

  4. Based on results alone, why don’t dermatologists recommend a hair system, given the instant dramatic guaranteed results? Why do they just recommend the futile chemicals they are working on? Vested interests. Admittedly a hair system is the work of the devil, but a dermatologist with good conscience should just state not to take any of their chemicals; they are just not there yet.

      1. Yes Tom. I need a re-fit/re-glue every 3 weeks due to my level of physical activity but someone else could go 4/5 weeks. The system itself lasts 12 weeks before any noticeable difference in it. Its a full poly one, meaning it will not fall off but it makes sweating a bit itchy. You would instead have to have a lace one if in hot climate.

          1. Very happy. I stopped for over a year due to frequent trips to really hot places in the far East and Africa. But with recent events it’s not like I can do that right now.

    1. I also think about it. I’m tired of using all these medications getting insane side effects. It’s terrible. I want to have hair system

      1. I got a hair system , 3 hrs in I ripped it off. Crap feels like a super tight cap on. You can’t take hot showers anymore. Constantly have to maintain it. I rather be bald then go thru the hell of a hair system.

    1. Results will be published in December – afaik.

      The trial is almost over, patient assessment and data readout is being done in November.

      It‘s only 36 patients, therefore I am confident to get official results before 2021.

      1. Cool thank you Ben, I really hope that histogen pulls through, after the disappointing news about Dr tsuji I had high hopes for Dr tsuji and hair cloning but it looks like most likely in 2035 it’ll be available

        1. Marc you cheat, you wrote that you have contact with riken and that cloning is 20 years away, and now you are disappointed because it didn’t happen this year or next? Dr. Tsuji is still working at Riken, recently published on skin

  5. Hi Admin, I just re read your 2017 interview with Dr. Terskikh and it was amazing, very informative. Maybe it’s time for another one? There is a YT video from last October where he said that it will take “at least 3-4 years to deploy the treatment to the clinic”. I wonder if he meant by that clinical trials or commercialisation? Would be great to have some clarification on that and other points!

  6. Hey Admin,
    Since we are talking about Spain: Any news on that topical finasteride from Almirall? I think thats supposed to come out this year or early 2021.

  7. When Winlevi is available in a few months, is there a chance a compound pharmacy would be willing to or able to increase the 1% to 7%? Or just enough to help get results for hairloss?

  8. Is it possible that among us bald guys there isn’t one who’s also a super chemist or scientist able to develop something for this damn baldness????

  9. In this TV-show Takashi Tsuji told about hair cloning. Is anybody able to view this video and translate it?

    ヒューマニエンス 40億年のたくらみ – NHK

  10. Does anybody know the length of a piece of string?
    (Wish I could answer your question Marc).
    In the meantime, I’m going surfing. :-)

    1. Thanks! They already announced that investment in the past, but interesting to hear that they could conduct their trials in the UK rather than in the US.

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