The AGA Treatment Revolution 57　Minoxidil has a

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　Minoxidil has a different mechanism of action compared to finasteride and dutasteride, making it possible to use them together. Many patients with male pattern baldness at our clinic are using them in combination. Additionally, minoxidil can be used not only for male pattern baldness but also for female pattern hair loss, which is a significant advantage that finasteride does not offer.

　Minoxidil requires at least four months of daily use before its effects become noticeable. In the first 1-2 months, it's common to feel like hair loss has increased temporarily as hair follicles in the resting phase enter the growth phase, causing old hairs to fall out. Subsequently, new hairs grow from these follicles and mature into terminal hairs.

Minoxidil was released in Japan in 1999, 13 years after its introduction in the United States. The launch was by Taisho Pharmaceutical under the product name RiUP with 1% minoxidil concentration. In 2009, a 5% minoxidil product was released under the name RiUP X5. Nowadays, besides RiUP, generic versions of the medication are also available.

　The reason for the delayed release of RiUP in Japan, compared to the United States, was the aim to market it as an over-the-counter (OTC) medication. OTC medications can be purchased without a prescription at pharmacies and drugstores. RiUP and its generics are classified as Category 1 OTC medications, which, due to their high effectiveness, also carry a higher risk of side effects (though serious side effects are not frequently associated with minoxidil), necessitating pharmacists to provide thorough information to buyers.

　This is a "principle," and under the supervision and guidance of pharmacists, registered sellers and general staff at pharmacies and drugstores can also sell Category 1 medications. For example, the anti-inflammatory pain reliever Loxonin, which became popular during the COVID-19 response, is also a Category 1 medication. In contrast, finasteride and dutasteride are prescription medications that can only be used with a prescription from a doctor or other licensed prescriber.

Recommendation level: A. Strongly recommend the use of topical minoxidil for male pattern baldness (5% minoxidil) and female pattern hair loss (1% minoxidil).

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