Long-term (10-year) efficacy of finasteride in 523 Japanese men with androgenetic alopecia

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Research Article
Clinical Research and Trials
Clin Res Trials, 2019 doi: 10.15761/CRT.1000273
ISSN: 2059-0377
Volume 5: 1-5
Long-term (10-year) ecacy of nasteride in 523 Japanese
men with androgenetic alopecia
Masayuki Yanagisawa1-3, Hiroshi Fujimaki2,4, Akira Takeda1,2, Mitsuru Nemoto1, Takayuki Sugimoto1 and Akio Sato1-3*
1Department of Plastic and Aesthetic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
2Tokyo Memorial Clinic, 2F Yamaha Building, 2-16-7 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan
3Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
4Department of Plastic and Reconstructive Surgery, Tokyo Women’s Medical University, 8-1 Kawada-cyo, Shinjuku-ku, Tokyo 162-8666, Japan
Abstract
Finasteride is a standard medical treatment for androgenetic alopecia; however, no long-term study of up to 10 years has been performed in Japan. erefore, we
evaluated the ecacy and safety of 1 mg/day nasteride in 532 Japanese men who were treated for androgenetic alopecia for 10 years. We performed subjective
evaluations, using questionnaires administered to patients, in addition to the objective evaluation by doctors. e ecacy was assessed using the Norwood-Hamilton
scale and modied global photographic assessment score, the standardized 7-point rating score using scalp photographs. For the Norwood-Hamilton classications,
stages IIa and IIv were combined as II, IIIa and IIIv were combined as III, IVa was combined as IV, and Va was combined as V. e proportions of patients with
improvement (score ≥ 5) and prevention of disease progression (score ≥ 4) were 91.5% and 99.1%, respectively. e Norwood-Hamilton classication grading
improved by approximately 1 grade from 3.35 ± 1.11 to 2.55 ± 1.30 after the 10-year treatment. e groups that showed Norwood-Hamilton: I/II/III and IV/V/VI/
VII at the rst visit showed statistically signicant dierences in the modied global photographic assessment score at the 10-year treatment subjective evaluation
(6.27 ± 0.62 vs 5.52 ± 0.78, P<0.001). Furthermore, the quantitative analysis of the objective evaluation using the questionnaire was also signicantly dierent
(P<0.001). During the study period, no serious adverse reaction was recognized. Long-term (10-year) treatment with 1 mg/day nasteride in Japanese men with
androgenetic alopecia showed high ecacy in subjective and objective evaluations.
*Correspondence to: Akio Sato, MD, PhD. Tokyo Memorial Clinic, 2F Yamaha
Building, 2-16-7 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan, E-mail: drsato@
crux.ocn.ne.jp
Key words: androgenetic alopecia, nasteride, Japanese, long-term, modied
global photographic assessment, Norwood-Hamilton scale
Received: September 09, 2019; Accepted: September 16, 2019; Published:
September 19, 2019
Introduction
Finasteride was authorized in Japan for the treatment of
androgenetic alopecia (AGA) in 2005; subsequently, prescription of
this medication commenced. Presently, nasteride is authorized in over
60 countries and is administered to over 3 million patients for AGA.
Dihydro-testosterone (DHT) has a key role in mediating progressive
scalp hair loss in men with AGA, and nasteride blocks the conversion
of testosterone to DHT as a selective type II 5α-reductase inhibitor,
which justies its use in AGA treatment [1-3]. Although the ecacy
of AGA treatment with nasteride has been demonstrated by several
large-scale and long-term studies, [4-7] no long-term investigation
for up to 10 years has yet been conducted in Japanese subjects [8-10].
erefore, the objective of this study was to evaluate the ecacy and
safety of large-scale and long-term AGA treatment with nasteride,
which, to our knowledge, is the rst of such studies in Japan. In this
study, a subjective evaluation was conducted using a questionnaire on
AGA administered to each patient; moreover, an objective evaluation
was performed by doctors.
Methods
Study population
We examined 532 Japanese men who had been diagnosed
with AGA at the rst visit to the Tokyo Memorial Clinic Hirayama
(hereaer, “the clinic”) during the period between December 2005
and January 2009 and had been treated with 1 mg/day nasteride
for 10 years until January 2019. Furthermore, all patients answered a
questionnaire about the long-term treatment of AGA aer 10 years
treatment. Written informed consent for participation in the present
study was obtained from all patients.
Ecacy Evaluation
Objective ecacy - Scalp photographs
e ecacy was objectively assessed using the Norwood-
Hamilton scale (N-H) [11,12] and the modied global photographic
assessment score (MGPA) [13,14], (Figure 1) with the following
standardized 7-point rating score using scalp photographs: 1,
signicant disease progression; 2, moderate disease progression; 3,
slight disease progression; 4, no change; 5, slight improvement; 6,
moderate improvement; and 7, signicant improvement. In the N-H
classications, stages IIa and IIv were combined as stage II, IIIa and IIIv
were combined as III, IVa was combined as IV, and Va was combined
as V. In the MGPA assessment, we evaluated scalp photographs at
the rst visit and yearly and categorized the MGPA in every N-H
classication at the rst visit (Figure 2).
Subjective ecacy - Questionnaire
e subjective ecacy was assessed using a long-term AGA
treatment questionnaire, which was digitalized to the following
numerical rating scale (NRS: 0-3: slightly, 4-6: moderate, 7-10:

Yanagisawa M (2019) Long-term (10-year) ecacy of nasteride in 523 Japanese men with androgenetic alopecia
Volume 5: 2-5
Clin Res Trials, 2019 doi: 10.15761/CRT.1000273
A
. B.
C
. D.
E
. F.
G
. H.
I. J.
K
.
Figure 2. Scalp photographs at the rst visit and yearly, were evaluated about MGPA and N-H
A: At rst visit
B: At 1 year of treatment
C: At 2 years of treatment
D: At 3 years of treatment
E: At 4 years of treatment
F: At 5 years of treatment
G: At 6 years of treatment
H: At 7 years of treatment
I: At 9 years of treatment
K: At 10 years of treatment
Figure 1. The modied global photographic assessment score (MGPA): the standardized
7-point rating score using scalp photographs: 1, signicant disease progression; 2, moderate
disease progression; 3, slight disease progression; 4, no change; 5, slight improvement; 6,
moderate improvement; and 7, signicant improvement.
Scalp photographs of representative patient's for evaluation of MGPA.
Vertex photographs and (or) forehead photographs were taken for every patient at each
examination and used for evaluation.
A: Base line (MGPA=4) (Vertex photograph at rst visit)
B: Base line (MGPA=4) (Forehead photograph at rst visit)
C: MGPA=5 (Vertex photograph at 6 months of treatment)
D: MGPA=5 (Forehead photograph at 6 months of treatment)
E: MGPA=6 (Vertex photograph at 24 months of treatment)
F: MGPA=6 (Forehead photograph at 24 months of treatment)
G: MGPA=7 (Vertex photograph at 60 months of treatment)
H: MGPA=7 (Forehead photograph at 60 months of treatment)
(There is no display about cases of MGPA: 1/2/3)
A. B.
C. D.
E
. F.
G
. H.
signicant) [15,16] (Figure 3). Questionnaire items were as follows.
Q1: To what degree are you satised with your treatment? Q2: To what
degree do you feel your hair has improved? Q3: To what degree do
you wish to continue treatment? Q4: How would you compare your
hair loss to the hair of people of the same age pre-treatment? Q5: How
would you compare your hair loss to the hair of people of the same
age 10 years post-treatment? Numerical variables of the results are
presented as summary statistics (mean ± standard deviation); the data
were analyzed using Welch’s t-test for the ecacy evaluation. Statistical
analyses were performed using Microso Excel Statistics program
version 2.14; a P<0.05 was considered statistically signicant.
Safety Evaluation
Adverse reactions were recorded to evaluate safety by questionnaire.
Results
Patient Characteristics
e characteristics of all patients evaluated for AGA treatment
efficacy were as follows: age at rst visit, 37.8 ± 10.0 years; age range,
20–69 years; and values of each N-H at the rst visit: I/II/III/IV/V/VI/
VII, 6/116/204/124/61/18/3, respectively.

Yanagisawa M (2019) Long-term (10-year) ecacy of nasteride in 523 Japanese men with androgenetic alopecia
Volume 5: 3-5
Clin Res Trials, 2019 doi: 10.15761/CRT.1000273
Ecacy Evaluation in 10 years treatment
Objective ecacy - Scalp photographs
e proportions of patients with improvement (MGPA ≥ 5) or
prevention of disease progression (MGPA ≥ 4) at treatment year 10
were 91.5% (487/532) and 99.1% (527/532), respectively. e ecacy
evaluation showed that the MGPA improved significantly from year
1 through to year 10 of treatment compared with the baseline (MGPA
= 4). e MGPA of each N-H group was linear according to the N-H
number; the total was between N-H:III and N-H:IV (Figure 4 and
Table 1). Receiver operating characteristic curve (ROC) analysis was
performed to classify patients with improvement (MGPA ≥ 5) and
deteriorating (MGPA<5) condition at year 10 of treatment; the cut-o
point was N-H: III. (the area under the curve [AUC], which indicates
the predictive value, was 0.746.). Furthermore, the MGPA of the total
study population and the N-H:I/II/III group at the rst visit improved
from year 5 through to year 10, with statistically signicant dierences
(P<0.001). e early stage AGA group (N-H: I/II/III at rst visit)
showed more improvement with long-term AGA treatment (10-year)
with nasteride than the other groups did in the objective evaluation.
e N-H classication of AGA patients improved by approximately 1
grade over the 10-year treatment with nasteride; significant dierences
were observed from pre-treatment (3.35 ± 1.11) to post-treatment (2.55
± 1.30, P<0.001) in comparison of digitized classication.
Subjective evaluation - Questionnaire
e high subjective ecacy of AGA treatment was revealed
by the answers to Q1, “To what degree are you satised with your
treatment?” (7.09 ± 1.78); Q2, “To what degree do you feel your hair
has improved?” (6.95 ± 1.82), and Q3, “To what degree do you wish to
continue treatment?” (8.26 ± 1.84).
A signicant dierence was observed between Q4 and Q5 (pre- and
10-year post-treatment, 3.41 ± 2.12 and 4.93 ± 2.21, respectively, P <
0.001) (Table 2). Furthermore, a comparison between the N-H: I/II/
III and N-H:IV/V/VI/VII groups at rst visit revealed a statistically
signicant dierence in the answer to Q 1, 2, 4, and 5 (P<0.001) and
Q3 (P<0.05). e early stage AGA group (N-H: I/II/III at rst visit) also
showed a greater improvement following long-term (10-year) treatment
with nasteride than the other groups did in the subjective evaluation.
Safety Evaluation
During the study period for 10 years, no serious adverse reaction
was recognized. Mild and temporary adverse reactions were recorded
in 6.8% (36⁄532) of the entire study population by questionnaire. e
adverse reactions were decreased libido (5.6%, n=30) and erectile
dysfunction (3.0%, n=16). All adverse reactions were mild and all
patients continued treatment for 10 years.
Discussion
Ecacy Evaluation
Objective evaluation - Scalp photographs
We evaluated the long-term (10-year) ecacy and safety of AGA
treatment with 1 mg/day nasteride in a large study population (532
patients), as the rst study of this kind in Japan, to our knowledge. A
high objective ecacy was demonstrated by the MGPA, which revealed
improvement and prevention of disease progression in 99.1% of the 532
Japanese men with AGA treated with 1 mg/day nasteride for 10 years.
Furthermore, the outcome was similar to or better than that reported
N-H Number 0Y 1Y 2Y 3Y 4Y
I6 4.00 5.33 ± 0.51 5.56 ± 0.50 5.72 ± 0.62 6.00 ± 0.64
II (a,v) 116 4.00 5.17 ± 0.61 5.59 ± 0.70 5.82 ± 0.72 5.99 ± 0.75
III (a,v) 204 4.00 5.21 ± 0.47 5.59 ±0.53 5.79 ± 0.55 5.95± 0.56
IV (a) 124 4.00 5.09 ± 0.42 5.38 ± 0.50 5.53 ± 0.57 5.62 ± 0.60
V (a) 16 4.00 5.02 ± 0.29 5.35 ± 0.41 5.38 ± 0.40 5.37 ± 0.46
VI 18 4.00 5.02 ± 0.36 4.98 ±0.38 5.00 ± 0.29 5.00 ± 0.27
VII 3 4.00 4.78 ± 0.31 5.00 ± 0.27 4.89± 0.29 4.89 ± 0.42
Total 532 4.00 5.14 ± 0.51 5.49 ± 0.59 5.66 ± 0.62 5.78 ± 0.66
5Y 6Y 7Y 8Y 9Y 10Y
6.22 ± 0.53 6.39 ± 0.53 6.39 ± 0.64 6.50 ± 0.63 6.61 ± 0.49 6.50 ± 0.57
6.13 ± 0.67 6.20 ± 0.67 6.20 ± 0.65 6.29 ± 0.67 6.27 ± 0.70 6.33 ± 0.66
6.09 ± 0.58 6.13 ± 0.58 6.13 ± 0.59 6.20 ± 0.61 6.21 ± 0.60 6.22 ± 0.59
5.74 ± 0.62 5.75 ± 0.62 5.75 ± 0.73 5.74 ± 0.73 5.74 ± 0.74 5.72 ± 0.79
5.38 ± 0.53 5.34 ± 0.53 5.34 ± 0.58 5.33± 0.64 5.28 ± 0.68 5.34 ± 0.61
4.96 ± 0.47 4.87± 0.47 4.87 ± 0.49 4.89 ± 0.58 4.89 ± 0.66 4.87 ± 0.64
4.78 ± 0.31 4.78 ± 0.31 4.78 ± 0.42 4.67 ± 0.27 4.67 ± 0.27 4.67 ± 0.27
5.89 ± 0.68 5.92 ± 0.72 5.92 ± 0.72 5.96 ± 0.77 5.96 ± 0.78 5.96 ± 0.78
Mean ± Standard Deviation (Mean ± SD) *, there were signicant dierences in MGPA at
year 10 between N-H:I/II/III and N-H:IV/V/VI/VII groups (P<0.001)
Table 1. Changes in modied global photographic assessment scores (MGPA) from before
treatment through to year 10 in each Norwood-Hamilton scale (N-H) group at rst visit
Q1 7.09 ± 1.78
Q2 6.95 ± 1.82
Q3 8.26 ± 1.84
Q4 3.41 ± 2.12
Q5 4.93 ± 2.21
Table 2. Numerical analysis of answers to questionnaire using numerical rating scale (NRS)
Mean ± SD *
Q1: To what degree are you satised with your treatment?
Q2: To what degree do you feel your hair has improved?
Q3: To what degree do you wish to continue treatment?
Q4: How would you compare your hair loss to the hair of people of the same age pre-treatment?
Q5: How would you compare your hair loss to the hair of people of the same age 10 years
post-treatment?
Figure 3. Numerical Rating Scale (NRS): entry example. NRS: the standardized 11-point
rating was scored by patients themselves, 0-3: slightly, 4-6: moderate, 7-10: signicant
Figure 4. Changes in modied global photographic assessment scores (MGPA) from
before treatment through year 10 of treatment on each Norwood-Hamilton scale (N-H)
group at rst visit.

Yanagisawa M (2019) Long-term (10-year) ecacy of nasteride in 523 Japanese men with androgenetic alopecia
Volume 5: 4-5
Clin Res Trials, 2019 doi: 10.15761/CRT.1000273
by other studies in Japan [8-10,13,17]. Dierences have been known
to occur in the progression of AGA symptoms between Japanese and
Caucasian men [8,18]. is ecacy of the investigated treatment in
Japanese men exceeded that reported in other studies in Caucasians.
e superior response of Japanese men with AGA was reported to
likely be attributable to their hair characteristics (greater diameter,
black color, and lower density), which facilitated the detection of slight
changes [10,19-23]. A novel nding observed in this study was the
signicant dierence in the improvement of AGA following nasteride
treatment between the N-H: I/II/III and N-H: IV/V/VI/VII groups
at the rst visit. e ROC analysis revealed a similar dierence, that
was performed to classify patients with improvement (MGPA≥5) and
deteriorating (MGPA<5) condition at year 10 of treatment; the cut-o
point was N-H: III (AUC: 0.746). Furthermore, the MGPA of the total
study population and the N-H: I/II/III group at the rst visit signicantly
improved from treatment year 5 to 10 (P<0.001). is ecacy was
dierent from that of a 5-year study in Japanese men, which reported
that the ecacy began to plateau aer 4 years of treatment [10]. Several
studies have reported that AGA progresses in N-H classication with
age, [7,11,12,18] and that younger patients show more improvement
than that of older patients with AGA treatment [24,25]. In this study,
AGA patients at the early stage of N-H classication showed more
improvement than patients at the later stage did.
Subjective evaluation - Questionnaire
Several studies using questionnaires on AGA administered to
patients and doctors have been reported [26-28]. We evaluated the
questionnaires administered to patients with AGA who were treated
with nasteride for 10 years. A highly subjective ecacy was revealed
by all answers to the questionnaires. Especially, the analysis showed
that the score of the response to Q3; “To what degree do you wish to
continue treatment?” was high (8.26 ± 1.84), which could be attributed
to the fact that the patients had undergone the treatment for 10 years
already. However, the subjective ecacy of long-term treatment of
AGA with nasteride was evident based on the dierences in the results
between Q4 and Q5 (pre- and post-treatment, 3.41 ± 2.12 and 4.93 ±
2.21, respectively, P<0.001). A high ecacy and signicant dierence
in improvement of AGA with nasteride treatment was also observed
between the N-H: I/II/III and N-H: IV/V/VI/VII groups at rst visit in
the objective evaluation using the questionnaire.
Safety evaluation
Adverse reactions were recorded in 6.8% (36/532) in the safety
evaluation in this study, which was slightly higher than that observed in
other studies in Japanese men [8,9,17]. is observation was thought to
have been caused by the fact that the investigation period of this study
was longer than that of others and, therefore, the patients had aged
more. Incidences of decreased libido and erectile dysfunction have
been known to increase in proportion with age. In the investigation
in 40 years or older of Asians, the incidences of decreased libido and
erectile dysfunction were 6.0–38.7% and 40.6–70.0%, respectively
[29,23]. Overall, the adverse reactions were all mild, and the incidence
was lower than the generic incidence of decreased libido and erectile
dysfunction in Asians. As adverse reactions were recorded by patients
in a subjective questionnaire, the result was thought to be slightly
dierent from the correct number of adverse reactions in this study.
Strict safety evaluation was not investigated in this study. Several
studies on AGA treatment with nasteride have reported that there
are no signicant dierences from the placebo in adverse reactions,
[13,30,31] and that the risk of discontinuing the treatment because of
adverse reaction is similar to that of the placebo [32].
In summary, long–term (10-year) AGA treatment with nasteride
1 mg/day demonstrated a high ecacy and safety based on subjective
and objective evaluations in Japanese men. Specically, the N-H
classication of AGA patients improved by approximately 1 grade aer
10 years of treatment with nasteride. Furthermore, a novel discovery
of this study was that the group with N-H:I/II/III at the rst visit
showed greater improvement than the group with N-H: IV/V/ VI/VII
at rst visit, following 10 years of AGA treatment with nasteride. We
recommend that AGA patients should start treatment with 1 mg/day
nasteride at the early stage of classication of AGA (within N-H: I, II,
or III) for adequate ecacy.
Acknowledgments
We would like to thank the stas and residents of our departments.
Conict of interest statement
e authors state no conict of interests
References
1. Kaufman KD, Dawber RP (1999) Finasteride, a Type 2 5alpha-reductase inhibitor,
in the treatment of men with androgenetic alopecia. Expert Opin Investig Drugs 8:
403-415.
2. Drake L, Hordinsky M, Fiedler V (1999) The eects of nasteride on scalp skin and serum
androgen levels in men with androgenetic alopecia. J Am Acad Dermatol 550-554.
3. Kaufman KD (2002) Androgens and alopecia. Mol Cell Endocrinol 198: 89-95. [Crossref]
4. Finasteride Male Pattern Hair Loss Study Group (2002) Long-term (5-year)
multinational experience with nasteride 1 mg in the treatment of men with
androgenetic alopecia. Eur J Dermatol 12: 38-49. [Crossref]
5. Kaufman KD, Girman CJ, Round EM, Johnson-Levonas AO, Shah AK, et al (2008)
Progression of hair loss in men with androgenetic alopecia (male pattern hair loss):
long-term (5-year) controlled observational data in placebo-treated patients. Eur J
Dermatol 18: 407-411.
6. Kaufman KD, Rotonda J, Shah AK, Meehan AG (2008) Long-term treatment with
nasteride 1 mg decreases the likelihood of developing further visible hair loss in men
with androgenetic alopecia (male pattern hair loss). Eur J Dermatol 18: 400-406.
7. Rossi A, Cantisani C, Scarno M, Trucchia A, Fortuna M, et al. (2011) Finasteride, 1
mg daily administration on male androgenetic alopecia in dierent age groups: 10-year
follow-up. Dermatol Ther 24: 455-461.
8. Sato A, Takeda A (2012) Evaluation of ecacy and safety of nasteride 1 mg in 3177
Japanese men with androgenetic alopecia. J Dermatol 39: 27-32. [Crossref]
9. Kawashima M, Mizoguchi M, Igarashi A (2006) Long term (3 years) ecacy and
safety proles of nasteride in Japanese men with AGA (androgenetic alopecia). Jpn J
Clin Dermatol 60: 521-530.
10. Yoshitake T, Takeda A (2015) Five-year ecacy of nasteride in 801 Japanese men
with androgenetic alopecia. J Dermatol 42: 735-738. [Crossref]
11. HAMILTON JB (1951) Patterned loss of hair in man; types and incidence. Ann N Y
Acad Sci 53: 708-728. [Crossref]
12. Norwood O (1975) Male pattern baldness: classication and incidence. South Med J
68: 1359-1365.
13. Kawashima M, Hayashi N, Igarashi A, Kitahara H, Maeguchi M, et al. (2004)
Finasteride in the treatment of Japanese men with male pattern hair loss. Eur J
Dermatol 14: 247-254. [Crossref]
14. Kaufman KD, Olsen EA, Whiting D (1998) Finasteride in the treatment of men with
androgenetic alopecia. Finasteride Male Pattern Hair Loss study group. J Am Acad
Dermatol 39: 578-589.
15. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance
of changes in chronic pain intensity measured on an 11-point numerical pain rating
scale. Pain 94: 149-58.
16. Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating
scales. J Clin Nurs 14: 798-804. [Crossref]
17. Sato A, Sanada Y, Hirayama T (2007) Clinical ecacy of Finasteride 1 mg Among 708
Patients with AGA (Androgenetic alopecia). Skin Surgery 16: 126-131.

Yanagisawa M (2019) Long-term (10-year) ecacy of nasteride in 523 Japanese men with androgenetic alopecia
Volume 5: 5-5
Clin Res Trials, 2019 doi: 10.15761/CRT.1000273
Copyright: ©2019 Yanagisawa M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
18. Takashima I, Iju M, Sudo M (1981) Alopecia Androgenetica – Its incidence in Japanese
and associated conditions. In: Orfanos CE, Montagna W, Stuettgen G (Eds) Hair
Research: Status and Future Aspects. Berlin: Springer Verlag pp. 287-293.
19. Otsuka H, Nemoto T (1988) Study on Japanese hair. J Jpn Cosmet Sci Soc 12: 192-197.
20. Franbourg A, Hallegot P, Baltenneck F, Toutain C, Leroy F (2003) Current research on
ethnic hair. J Am Acad Dermatol 48: S115-119. [Crossref]
21. Hayashi S, Okumura T, Ishida A (1976) Preliminary study on racial dierence in scalp
hair. In: Kobori T, Montagna W (Eds). Biology and Disease of the Hair 555-561.
22. Hori Y, Nakagawa H (1987) Hair Color and Melanin Pigments Racial dierences. In:
Kobori T, Montagna W (Eds) Chapter 7. The Medical Science of Hair pp. 148-172.
23. Pinkus F (1927) Die Gruppenstellung der Haare. In: Jadassohn J (Ed) Handbuck der
Haut-und Geschlechtskrankheiten. B, Teil 1, Berlin, German pp. 239-244.
24. Whiting DA, Olsen EA, Savin R, Halper L, Rodgers A, et al. (2003) Ecacy and
tolerability of nasteride 1 mg in men aged 41 to 60 years with male pattern hair loss.
Eur J Dermatol 13: 150-160. [Crossref]
25. Olsen EA, Whiting DA, Savin R (2012) Global photographic assessment of men aged
18 to 60 years with male pattern hair loss receiving nasteride 1 mg or placebo. J Am
Acad Dermatol 67: 379-386.
26. Miyakura T, Tsuboi R, Okoshi K (2008) An analysis of the classication and
background of AGA patients treated with nasteride and remarks on the ecacy of this
drug based on patient feedback. Jpn J Dermatol 118: 213-219.
27. Lulic Z, Inui S, Sim WY (2017) Understanding patient and physician perceptions of
male androgenetic alopecia treatments in Asia-Pacic and Latin America. J Dermatol
44: 892-902.
28. Sorbellini E, Pinto D, Marzani B, Rinaldi F (2018) Drug Treatment for Androgenetic
Alopecia: First Italian Questionnaire Survey on What Dermatologists Think about
Finasteride. Dermatol Ther (Heidelb) 8: 259-267.
29. Low WY (2008) Erectile dysfunction, premature ejaculation and hypogonadism and
men’s quality of life. an Asian perspective. JMH 5: 282-288.
30. Cheng JYW (2007) Prevalence of erectile dysfunction inAsian populations: a meta-
analysis. Int J Impot 19: 229-244.
31. Gupta A, Charrette A (2014) The ecacy and safety of 5a-reductase inhibitors
in androgenetic alopecia: a network meta-analysis and benet-risk assessment of
nasteride and dutasteride. J Dermatolog Treat 25: 156-161.
32. Mella J, Perret MC, Manzotti M, Catalano HN, Guyatt G (2010) Ecacy and safety of
nasteride therapy for androgenetic alopecia. Arch Dermatol 146: 1141-1150.