The ultimate guide to hair loss? We've done it. Read on for the types and causes of hair loss, how to recognise male pattern baldness, hair loss treatment in Singapore and finally the truth behind the myth of creatine and hair loss.
Are you finding hair everywhere but on the top of your head? Do you feel extra self-conscious worrying about people noticing your bald spot? Hair loss is not just an old man’s problem, but also affects many young men today. When you’re suffering from hair loss, time is of the essence. The earlier you nip it in the bud, the more likely it is that you’ll be able to preserve more hair. At Noah, our doctors can provide you with hair loss treatment options that won’t leave the contents of your wallet as sparse as your scalp.
There are actually many different types of hair loss, but the most common type in men is androgenetic alopecia - the infamous male pattern baldness. Another type of hair loss that men suffer from is alopecia areata, which occurs because the body is attacking its own hair follicles - a ‘friendly fire’ of sorts. Alopecia areata usually presents in patchy hair loss, complete loss of hair on the head, or even total loss of body hair (American Academy of Dermatology, n.d.).
In this guide, we'll be focusing on androgenetic alopecia (male pattern baldness) and some of the causes and signs of balding, diving into what sort of treatment is available in Singapore, and debunking a common myth about hair loss amongst bodybuilding circles.
According to the National Skin Centre (NSC) of Singapore (2013), the 3 main causes of Androgenetic Alopecia are age (20 and above), testosterone, and genetic inheritance. Some other reasons for hair loss include chronic illness, scalp diseases, side effects from medication and excessive pulling of hair from tightly bound hair styles (man buns - we’re looking at you).
The three most common signs of balding are:
Nobody wants to see their hairline recede like the sea during low-tide, but that’s usually the first and clearest evidence of balding. If your hairline goes from flat to more of an M-shape with hair thinning at the temples, this is a likely indication that you’re suffering from alopecia. If you suspect your hairline may be receding, it’s a good idea to document photos over the course of a year or so to help you determine the progression of your hair loss.
Balding doesn’t always start from your hairline. Some men experience balding beginning at the top of their head instead, with thinning of the hair on the crown of their head. This may be difficult to observe, because nobody usually takes selfies of the back of their head, but the simplest way to get these photos to track your hair loss is to stand with your back facing a mirror and snap your reflection. You can do this every couple of months to compare if your hair thickness is decreasing.
It’s normal to lose up to 50 hairs every day (NSC, 2013), but once you start noticing an excessive amount (>100 hairs) of daily hair fall, it may indicate male pattern baldness. However, it’s important to note that unusual increased hair fall can also be temporary (lasting a couple of weeks) due to stress, fevers or medication. You should only sound the alarm if you realise you have been losing excessive hair daily over a long time.
While it’s easy to be frightened at the drop of some hairs, don’t be too quick to assume that you’re going bald. These are some signs that are often misconceived as hair loss identifiers, but aren’t the most definitive proof to rely on:
The safest bet if you’re ever uncertain about hair loss symptoms you may be experiencing, is to consult a health professional. At Noah, we provide free evaluations from licensed doctors who will be able to tell you if you’re truly suffering from a hair loss condition and prescribe the right treatment for you.
Finasteride, the generic form of a medication also known as PropeciaⓇ, is a drug developed to halt further hair loss, licensed in Singapore since 1998. If you’re wondering what the difference is between finasteride and PropeciaⓇ, the answer is: they perform the same function and work the same way, the only difference is that - one is branded.
Finasteride is the treatment of choice that the doctors at Noah prescribe for androgenic alopecia (male pattern baldness) treatment. Finasteride is a 5ɑ-reductase inhibitor and works by preventing testosterone from converting into dihydrotestosterone (DHT). DHT is an androgen (sex hormone) that plays a part in the development of “male” sex attributes, e.g. body hair (Jewell, 2019). However, DHT can also speed up the rate of hair loss (Jewell, 2019). DHT also causes hair follicle shrinkage which results in hair loss. Finasteride is great because it doesn’t put your testosterone levels at detriment, but helps to prevent it converting to the hair-loss-inducing DHT.
Finasteride starts working immediately and can cut DHT production by up to 70%, but it will take a few months to see hair regrowth. Patience is a virtue, and this can’t be more relevant when it comes to hair growth. The time it takes for your hair to grow to its full length can take up to a year with a consistent dose of finasteride.
As with any medication, it is possible to experience side effects therefore it is important to consult with a doctor to make sure the treatment is appropriate for you. The more common side effects of finasteride include a decreased sex drive, difficulty getting and maintaining an erection, and a lowered amount of semen. In rare cases, male breast cancer has been warned as a risk associated with finasteride after a review by the UK Medicines and Healthcare products Regulatory Agency (MHRA) in 2009. However, in Singapore, there have not been any cases of male breast cancer linked to finasteride (HSA, 2010). If you are a patient taking finasteride, it is advised that you contact your doctor immediately should you experience any changes in your breast tissue (e.g. lumps, pain, or nipple discharge).
Minoxidil is another widely used hair regrowth treatment for male pattern hair loss. It has an immediate effect but can take a few months to show noticeable changes, like other hair loss treatments. Minoxidil reduces elevated systolic and diastolic BP by decreasing peripheral vascular resistance via vasodilation. Applied topically, it stimulates hair growth secondary to vasodilation, increases cutaneous blood flow and stimulates resting hair follicles. Unlike finasteride, a DHT conversion blocker, minoxidil works by improving the environment for your existing hair follicles to facilitate hair growth (Goren et al., 2017). Minoxidil is thought to trigger and prolong the initial phase of hair growth called anagen, thereby causing your hair follicles to restart the hair growth process prematurely (Messenger and Rundegren, 2004). This may cause some hair shedding for some when first using minoxidil. However, although this process may make it seem like you’re dropping more hair, minoxidil is actually working to produce a rise in hair diameter and length.
Essentially, minoxidil begins taking effect immediately, but you won’t see noticeable results for the initial 3 to 6 months of use. After which, the improvement should become more obvious and the full effects of minoxidil will usually be visible after a year of continued use.
So why is finasteride Noah’s treatment of choice and not minoxidil? To be frank, we not only want to help you stop your hair loss, but also help you grow hair. So while minoxidil helps to grow hair follicle size, finasteride and its DHT conversion blocking properties can go one step further in helping you retain testosterone levels, in turn making it possible to actually grow more hair.
Ketoconazole is an antifungal medication that’s used as a treatment for nail and skin conditions such as ringworm, candidiasis and seborrhoeic dermatitis. Ketoconazole shampoo is also promoted for the treatment of male pattern baldness as well, used once a week. and also helps with dandruff since it’s used for seborrhoeic dermatitis.
However, its effectiveness is limited in comparison to finasteride and minoxidil - it's for dandruff, so it won't do much for male pattern baldness. Existing literature is limited in showing that ketoconazole is as effective as medication like minoxidil in stimulating hair follicles and finasteride is in preventing the testosterone to DHT conversion causing male pattern baldness. If you’ve already been experiencing hair loss, it would be beneficial to speak to one of our doctors to see if your treatment should include medication to prevent further hair loss.
Hair transplants involve taking healthy hair from your head and transplanting it to the areas which are thinning. Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) are the two accepted methods to hair transplant surgeries to date. FUE is a more recently developed procedure which can involve less scarring than FUT due to the nature of the surgery, and is more commonly done in Singapore and Asia.
FUE hair transplants in Singapore can cost upwards of $6,000 to $15,000. This can vary depending on the quantity of hair grafts you require, the cost of each graft and the surgeon’s fee. Apart from cost, there are other factors to consider when deciding whether to do this procedure. For example, recovery and post-surgical care are equally important stages in hair transplantation. You will need to properly keep your wound dressing clean and manage any medication that your doctor will prescribe.
FUT procedures require a slightly longer recovery time of 2-3 weeks while FUE can take about 1-2 weeks to heal. There may also be potential complications to hair transplant surgery including swelling, pain, scarring, infection and anaesthesia complications, to name a few.
While hair transplants may be one route to take for hair loss, less invasive alternatives such as medication and shampoo treatment are also available and more affordable too.
If you’re into bodybuilding, you’ll probably be familiar with creatine, a popular supplement that’s supposed to help muscle growth, improve athletic performance and strength. Over the years, online blogs and forums somehow came to the conclusion that a side effect of creatine is hair loss. However, the evidence linking creatine and hair loss is lacking and often only anecdotal, with some men claiming they know of someone who experienced hair loss while on creatine. At the same time, an equal number of men claim to have no such issue.
The only academic research that studied the potential link between creatine and hair loss was a 2009 study by Merwe et al. (2009), of a group of 20 university-aged rugby players. The researchers reported that creatine may increase the transformation of testosterone to DHT, which is the hormone that causes male pattern baldness. However, the study did not definitively prove that creatine causes hair loss. It is also significant to note that the players were supplemented with 5 times the recommended dose of creatine, and only for 3 weeks.
As such, because the research was done with such a small sample of men over a short duration taking heightened doses of creatine, it is impossible for these results to be generalised to all men supplementing with creatine to say that hair loss is a definite side effect. There is still insufficient credible research to prove a causal relationship between the two, and creatine is still a safe supplement for muscle building.
American Academy of Dermatology (n.d.). Hair loss types: Alopecia areata overview. (Link)
Goren, A., Naccarato, T., Situm, M., Kovacevic, M., Lotti, T., & McCoy, J. (2017). Mechanism of action of minoxidil in the treatment of androgenetic alopecia is likely mediated by mitochondrial adenosine triphosphate synthase-induced stem cell differentiation. Journal of Biological Regulators and Homeostatic Agents, 31(4), 1049–1053. (Link)
Health Sciences Authority (2010, Apr 19). Finasteride and potential risk of male breast cancer. (Link)
Jewell, T. (2019, Jan 10). What you need to know about DHT and hair loss. Healthline. (Link)
Merwe, J., Brooks, N., & Myburgh, K. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical Journal of Sports Medicine, 19(5), 399-404. doi: 10.1097/JSM.0b013e3181b8b52f
Messenger, A. G., Rundegren, J. (2004). Minoxidil: mechanisms of action on hair growth. The British Journal of Dermatology, 150(2), 186–194. (Link)
National Skin Centre (Singapore) (2013, Oct 28). Hair Loss. (Link)