I've always been deeply interested in hair loss treatment. The most common belief of Singaporeans who send in treatment enquiries on DxD is that all hair loss is permanent - it’s not.
(If you want to read a doctor's guide to hair transplant and hair transplant costs in Singapore, you can check out this previous post).
However, it bothers me when patients visit a doctor only AFTER they have wasted their hard-earned money on ineffective treatments. About 99% of hair loss treatments in Singapore that you see advertised on local media do NOT work at all. You probably know exactly which adverts I'm talking about - they often feature a Mediacorp artiste.
Just how much money is wasted? A lot. Hair loss treatment is a whooping $3.5 billion industry.
Hence, I've decided to write this article to help Singaporeans suffering from hair loss. As hair loss treatment is a really big topic to discuss in detail, my article is broken into 2 parts:
- Part 1 (this post) covers the causes of hair loss, Male Pattern Hair Loss (MPHL), and effective hair loss treatment options in Singapore. It also exposes current unethical practices in Singapore's hair loss industry.
- Part 2 focuses on Female Pattern Hair Loss (FPHL), causes and treatment options.
How much hair loss is normal?
Losing 100 to 150 hairs per day (Cleveland Clinic Journal of Medicine, 2009) is considered by doctors to be normal.
Any increase in amount of hair loss is much more worrying. Eg. if you used to drop about 10 strands of hair every time you washed your hair, but recently started dropping 30 strands instead.
Hence, you shouldn’t stress too much about the actual amount of hair that you are losing. Pay closer attention instead to any increase in hair loss over time.
Hair loss has negative psychological and social effects
Humans are visual creatures who utilise physical appearances and visual cues to communicate with each other. For example, someone may be telling a lie when he breaks eye contact.
I digress, but the point I want to make is that our hair is a part of our physical appearance, which others will consciously or unconsciously judge us for.
IMHO, hair loss is one of the worst medical/aesthetic conditions to deal with, because it has significant negative effects on mental health and social confidence.
The statements below all have clinical studies to back them up:
- Hair loss causes low self-esteem and anxiety due to a perception of diminished attractiveness.
- 40% of hair loss sufferers are women. This is particularly devastating as women are more likely to restrict social contact as a result of hair loss.
- Men who suffer from hair loss are 75% less confident, especially when interacting with women.
Thus, hair loss and balding is a matter that shouldn't be trivialised.
Why do you see so many hair loss treatment adverts in Singapore?
Have you ever wondered why there are so many multi-million dollar hair treatment centres and businesses in Singapore?
These non-medical hair centres capitalise on our deep subconscious fear of going bald by promoting (and often hard-selling) expensive and non-scientific hair loss treatments.
These therapies have no long-lasting results whatsoever, and often cost thousands of dollars.
What happens when their treatment shows no sign of working? Pick from any of the following reasons (as told by the sales staff):
- "You haven't bought enough hair products"
- "You haven't gone for enough sessions"
- "You need to purchase the pricier treatment options to start seeing good results."
How can you spot these misleading advertisements?
It’s easy - just check out the hair loss centre's website. They will have NO doctors on their site, even though they may use terms in their adverts such as:
- Designed by doctors
- Latest hair loss treatment technology
- Medically proven
- Backed by medical science
- Medical-grade hair treatment
- Hair loss/scalp treatment specialists
- Medical-grade growth factors
- Stem cell treatment
(Yes, I did a quick search online to see the sort of phrases used to trick patients into thinking that it will be a real doctor seeing and treating them).
If there are no doctors present for a proper medical consultation when you actually visit the hair loss centre, you can just about dismiss every single claim that contains the word "medical".
Typically, these hair loss centres also prominently feature a celebrity/DJ/Mediacorp actor. Such endorsement deals usually cost up to 5 - 6 figures in Singapore, and frequently display unrealistic before and after pictures taken from different angles. (FYI, doctors are NOT allowed to advertise with before/after pictures, or celebrity endorsements in Singapore).
Finally, there will be really tiny print stating that “there is no scientific evidence to show that any of our methods work”.
I cannot emphasize this enough – you do not go to your Bomoh to treat your illness; so why would you go to a centre with no medically trained staff to treat your hair loss condition?
To get the best hair loss treatment, you should ALWAYS seek professional medical advice from doctors to determine the exact cause of your hair loss.
What are the next steps to take in Singapore if you have hair loss?
If you suspect that you have hair loss, you should find a doctor/dermatologist to diagnose the root cause of your hair loss.
The diagnosis may involve:
- Consultation to find out medical, lifestyle and family information.
- Scalp examination (looking at patterns of hair loss)
- Blood tests for nutrient deficiencies
Once you know the cause of hair loss, you can choose targeted treatments. When the cause is due to nutrient deficiency for example, hair loss is usually temporary.
In such cases, hair growth can be encouraged by addressing the underlying problems — although it may take several months to see progress.
What happens when you delay medical treatment for hair loss?
The longer you wait before seeking treatment, the less likely you are to recover hair that has already been lost.
This is because hair follicles under go a process called miniaturization.
Miniaturization is when the hair follicle's diameter shrinks, and causes the hair to appear finer. These hair strands will also not be able to grow to its normal length.
Eventually, the hair follicle’s diameter reduces to the point where new hairs no longer grow.
What are some common causes of hair loss?
The most effective treatment for hair loss depends on what is causing your hair to fall out in the first place. These causes include:
- Poor diet/missing nutrients (eg. zinc and iron)
- Excessive pulling
- Hair styling services
- Medication side effects
Sometimes, the cause is also due to a combination of factors. I've seen patients with hair loss due to a mix of stress and recent surgery.
The good news is, all of these causes can be tackled effectively, but only if you see a doctor who prescribes the right treatment.
Male pattern hair loss, on the other hand, occurs in men who have a genetic sensitivity to the hormone dihydrotestosterone (DHT). This can be slightly tricker to tackle!
What causes Male Pattern Hair Loss?
Androgenetic Alopecia aka Male Pattern Hair Loss (MPHL) is the most common type of hair loss amongst Singapore men.
Here are some quick facts:
- It affects up to 70% of men.
- It can start as early as the teenage years (starting at both temples and the front hairline).
- It usually worsens with a receding hairline, followed by hair loss over the vertex and mid-frontal areas (the top of the head).
- Thankfully, the occipital scalp (back of the head) is spared.
Male Pattern Hair Loss is due to hormonal causes:
- Testosterone is converted by 5-Alpha Reductase (5-AR) into Dihydrotestosterone (DHT).
- DHT binds with scalp receptors, which causes: hair thinning, weakening hair grafts (miniaturization), and eventual hair loss.
How do I know if I have Male Pattern Hair Loss?
Male Pattern Hair Loss (MPHL) is diagnosed clinically through a doctor’s consultation and examination.
No laboratory tests are necessary, unless there is also other abnormal hair loss throughout the rest of your scalp. The Norwood-Hamilton classification (shown above) is used to determine the stage of hair loss.
What medications are effective for Male Pattern Hair Loss?
First-line FDA approved treatments for Male Pattern Hair Loss (MPHL) include:
1. Oral Finasteride (Propecia)
Things to know/what to expect:
- Finasteride is highly effective in treating the areas of the scalp NOT INVOLVING THE TEMPLES.
- It is more effective over the vertex and superior-frontal region of the scalp.
- It is ineffective over the temporal and anterior hairline region.
- The temples and anterior hairline regions are best treated with a hair transplant.
- The recommended dosage is 1mg once daily, taken with or without food.
- It has been shown to improve both total and anagen (new) hair counts.
- It prevents or slows the progression of MPHL, and about 2/3 of those taking it experience some improvement.
- Effects become noticeable after 3-6 months, and the improvement peaks around after 12 months.
- A common mistake amongst patients is to stop the medication when it “does not seem to be effective” after only 1-2 months.
Possible side effects:
- Loss of libido (sex drive)
- Ejaculatory dysfunction
- Gynaecomastia (growth of breast tissue in men, and nipple swelling)
These are all temporary side effects, and patients usually recover once the medication is stopped.
Rare side effects:
Adverse sexual effects due to Finasteride intake has been reported to last up to 40 months upon cessation. However, results are still inconclusive as to whether Finasteride causes persistent sexual side effects.
Dutasteride is a non-selective 5-AR inhibitor with superior hair growth effects, as compared to Finasteride.
However, side effects are reported to occur more frequently than Finasteride. Thus, it is still mainly used "off-label" in Singapore by doctors who prefer this medication over Finasteride.
3. Topical (spray) Minoxidil
Things to know/what to expect:
- Minoxidil was originally a medication for high blood pressure, but was discontinued because it caused significant hypertrichosis (excessive hair growth) at a high dose.
- The topical (spray) form is FDA-approved for treatment of Male Pattern Hair Loss.
- The recommended dose is 1 mL applied twice daily on the dry scalp, and left in place for at least 4 hours.
- For maximum effectiveness, it's highly recommended to rub Minoxidil into the scalp after application.
- Minoxidil only slows down hair loss. It is unlikely to result in the growth of new hair.
- However, it is worth noting that you can combine Minoxidil with other treatments to have more prominent hair thickening results!
Possible side effects:
- Skin irritation
- Hypertrichosis (excessive hair growth) on the face and hands
- Tachycardia (fast heartbeat)
You can buy Minoxidil over-the-counter in Singapore (sold as Rogaine) to save money. It's commonplace for some practices to add Minoxidil to expensive shampoos and charge exorbitant prices.
What treatments exist for Male Pattern Hair Loss that do not involve taking medications?
1. Low-Level Laser Therapy (LLLT)
Things to know/what to expect:
- You can expect stronger and thicker hair shafts!
- Recommended treatment regimes are 20 minutes of treatment, 3 times a week.
- Medical Grade LLLT devices are available in Singapore only at medical clinics.
It was discovered by chance in the 1960s when mice irradiated with a low fluence red laser grew hair. Since then, more than 10 clinical studies have been published that demonstrate its effectiveness.
LLLT works by:
- Increasing blood flow in the scalp (similar to the effects of Minoxidil)
- Reducing scalp inflammation
Possible side effects:
2. Surgical Hair Transplant
Things to know/what to expect:
Hair transplant in Singapore is suitable for:
- Male Pattern Hair Loss (especially involving front hairline and temples)
- Female Pattern Hair Loss (involving front hairlines in the advanced stages, or if the response to non-surgical therapies are not satisfactory enough)
- Alopecia areata (if stable for more than 1 year)
- Scarring alopecia (hair loss due to causes such as burns, trauma, surgery)
Hair transplant is a permanent solution to increasing hair density on a bald scalp. It restores aesthetic proportions of the face so that the forehead does not look disproportionately larger than the rest of the face.
Why is surgical hair transplant effective (how come transplanted hair doesn't just fall out again)?
Ever wondered why old men still have the U-shaped band of hair at the sides and back of head even in the advanced stages of Male Pattern Hair Loss?
It's because hair follicles at the side and back are NOT sensitive to DHT.
Thus, hair transplants involve extracting hair follicles from the back and sides of your head. These are then implanted on the front and top of your head. Hair follicles harvested from the back of the head retain their DHT-independent behaviour when implanted in the frontal scalp.
This means that transplanted hair will not shed again if done correctly.
How are surgical hair transplants carried out?
Hair transplantation is performed under local anaesthesia, and has a very low complication rate.
Hair grafts extracted from the donor area must be implanted to mimic the direction and density of hair originally present in order to look natural.
Advances in hair transplant techniques now allow hair grafts to be extracted from non-scalp areas such as the:
Hair can also be transplanted to non-scalp areas such as the:
- Pubic Areas
Expected side effects:
- Transplanted hairs will drop in the first 3 months.
- The transplanted hairs re-grow after 3 months, and the best results will occur at 18 months.
- You should undergo hair transplant at least 9 months before any important social events! (ie marriage, graduation ceremony etc)!
How much does hair loss treatment by a medical doctor cost in Singapore?
Here's a price breakdown you can expect to pay for various hair loss treatment options in Singapore:
Doctor consultation: $60-120
Finasteride cost in Singapore (box for 1 month): $60-80 (generic), $95-$110 (original)
Low-Level Laser Therapy cost in Singapore: $1000-$1200
Hair Transplant cost in Singapore: $4-8/graft (manual FUE), $8-$12/graft (ARTAS Robotic FUE). The number of grafts required is determined during consultation. Average hair transplant surgery requires about 2,000 grafts.
To get a better sense of the total cost involved for your particular condition, you can send an enquiry to a few doctors here.
Why is it important to find a good hair transplant doctor in Singapore?
The success of your hair transplant depends entirely on the quality and training of the practitioner performing it. You only have a limited number of grafts at the sides and back of your head, and any grafts that don’t survive are permanently gone. Skilful teams with good technicians know how to handle grafts quickly and delicately, so that they don't dry out or get crushed.
So if you are interested in getting a hair transplant, the most important thing to do is to talk to a few doctors to get a sense of how experienced they are.
In summary, the truth is that there is no magic pill or lotion that can immediately cure baldness, but there are effective methods to stablise and manage hair loss.
The vast majority of seemingly "miracle cures" for hair loss that you see in Singapore — such as hair treatment, thickening shampoos or special scalp massages to stimulate hair growth— are nothing more than snake oil. Even medical therapies can be ineffective if the treatment doesn't address the root cause.
The key really is to seek professional medical advice, and determine the cause of hair loss before embarking on treatment.
Dr Israr Wong is an aesthetic doctor. Known to patients for his friendly, jovial, and humorous personality, some past and present interests include supporting Man United FC, playing regular 11-a-side competitive football and singing for a hip-hop/R&B acapella boy band called the “H-Soul Brothers” during his JC days.
- Gupta AK, Danika CA et al. “Progression of surgical hair restoration techniques.” J Cutan Med Surg. 2015 Jan-Feb;28(1):17-21.
- Rogers NE, “Hair transplant update.” Semin Cutan Med Surg. 2015 Jun;34:89-94.