What Is Male Pattern Hair Loss Or Baldness?
If you notice your hairline starting to recede and your once thick hair starting to thin, you likely have hair loss. In Singapore, hair loss in men is primarily caused by Androgenetic Alopecia, or Male Pattern Hair Loss.
Male pattern hair loss can start as early as your late teens and gradually gets worse with age. It is characterised by a receding hairline and loss of hair at the top and front of the head. While male pattern hair loss affects almost all men at some point in their lives, some men experience this condition more severely due to hormones (androgens) and genetics.
What Is The Cause Of Male Pattern Hair Loss?
DHT, or dihydrotestosterone, is a hormone derived from testosterone. In excess amounts especially on the scalp, DHT can cause hair follicles to weaken, shrink and eventually die, resulting in hair loss.
Interestingly, while DHT destroys hair on our scalp, it also causes hair growth in some other parts of our bodies such as the chest, back and other areas. This is the reason why many hairy men are also bald.
What Hair Loss Medications Are Available In Singapore?
Thankfully, there are effective medications available that can reduce and even reverse the progression of Male Pattern Hair Loss. With these medications, we can not only reduce hair loss but achieve hair regrowth too in certain cases.
There are two types of hair loss medication in Singapore: Minoxil (topical and oral) and Finasteride. Refer to our FAQ below for more information.
Other than these hair loss medications, those with more advanced hair loss can also opt for a hair transplant or Regenera Activa to improve the appearance of their hair loss.
FAQ
Minoxidil solution is a vasodilator that works by dilating small blood vessels and promotes the flow of oxygen and nutrients to the scalp, encouraging hair regrowth. Minoxidil is available in two forms: topical (applied on the scalp, twice daily) and orally (taken once daily).
Topical Minoxidil
- Applied to the scalp twice a day for a minimum of 6 months
- Increased hair growth is usually seen after 4 months of continued use
- If it is effective, it should be continued long term
- Available in strengths of 2% and 5%
- Patients usually start off with 5% but if the solution causes scalp irritation, 2% can be tried
Side effects include scalp irritation, manifesting as itching or stinging. Unwanted hair growth may occur, such as on the forehead if application is not precise. As there is very little absorption into our system beyond the scalp, internal side effects are not likely although rarely, hair growth in other sites have been reported.
If treatment is stopped, loss of the newly grown hair will occur in 3-4 months.
Oral Minoxidil
- Taken orally once a day as per physician’s instructions (oral minoxidil is a prescription-only medicine)
- First signs of hair regrowth is usually seen from 4 months of continued use; full effects stabilise after 12-18 months
- Recommended dosage – 0.25-2.5mg
- Usually prescribed if patients cannot tolerate topical minoxidil or if topical treatment does not work for them
- Similar to topical minoxidil, effects of oral minoxidil will wane once treatment is stopped
Side effects include hair growth at other parts of the body and very rarely, blood pressure changes.
Note: Minoxidil causes hairs in a resting state (telogen phase) to shed and replace with new hairs in the growing phase (anagen phase).
Because of this, rapid hair loss can occur initially but this is a temporary effect that happens as the resting hairs shed. Once they are replaced with hairs in the growing phase, you will notice thicker, fuller hair.
Interesting fact: Minoxidil was originally used as a high blood pressure tablet, but caused unwanted hair growth as a side effect. This prompted scientists to develop it as a topical medication to treat hair loss!
Oral Finasteride works by blocking 5-alpha reductase, the enzyme that converts testosterone into dihydrotestosterone (DHT). DHT, a potent version of testosterone, contributes to hair loss by selectively damaging hair follicles. Finasteride reduces the levels of DHT in the scalp, hence reducing the harmful effect of DHT on hair follicles. I recommend taking Finasteride 1 mg once a day, with or without food, any time of the day.
Studies have shown that daily Finasteride halts hair loss or regrows hair in 9 out of 10 men taking it long term. Daily use for a minimum of 3 months may be necessary before a patient will notice prevention of further hair loss or increased hair growth. Finasteride should be continued long term.
Finasteride is generally well tolerated in the clinical trials, with most patients reporting no serious side effects. Very rarely, Finasteride can cause decreased sex drive (1.8% in those taking Finasteride vs 1.3% in placebo group), decreased volume of ejaculate (0.8% vs 0.4%) and male breast enlargement. All side effects resolved with discontinuation of medication, also in many men who continued with therapy.
Yes!
Clinical trials have shown that Finasteride and Minoxidil are safe to take together. In fact, many studies have been conducted using Finasteride and Minoxidil together to prevent hair loss and to regrow new hair. A 2015 study shows that use of both Finasteride and Minoxidil together helps maintain a good hair density level, although interestingly, topical Finasteride was used in the study.
Data from another big study in 2017 shows that Finasteride, in combination with Minoxidil, is the most effective treatment available for slowing and stopping Male Pattern Hair Loss.
They are completely different medications that work via different pathways. While both reduces hair loss and promotes hair growth, one does it at the surface level while the other is a hormonal medication that works from within. Because Finasteride markedly reduces DHT production, most medical professionals will recommend it as a first line treatment before using Minoxidil. However, both drugs are also commonly used together to get a better result.
With Minoxidil, it is not uncommon to experience side effects like hair growth on other parts of the body. This can be resolved with laser hair removal or shaving/waxing. However, stop using Minoxidil and tell your doctor immediately if you have any serious side effects, including:
- Dizziness.
- Fast/irregular heartbeat.
- Fainting.
- Chest pain.
- Swelling of hands/feet.
- Unusual weight gain.
- Tiredness.
- Difficulty breathing especially when lying down.
Tell your doctor if you notice these temporary side effects with Minoxidil:
- Itching
- Redness
- Burning of scalp
A very serious allergic reaction to Finasteride is unlikely, but seek immediate medical attention if any of the following occurs: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Some of the side effects of Finasteride are harmless and temporary, while others may persist even after stopping. Tell your doctor if you notice any of the following:
- Decreased sexual ability/desire/libido.
- Decrease amount of semen released during sex.
- Breast enlargement/tenderness/pain.
- Pain in the testicles.
- Inability to urinate.
Pre-treatment instructions: Always inform your doctor of all medications, including supplements you may be taking as well as your medical history.
Post-treatment instructions: Monitor if any of the side effects described to you by the doctor occurs then let your doctor know about them. You may be asked to lower the dosage or to completely stop treatment.
Finasteride is suitable for any healthy male looking to prevent further hair loss and increase hair growth. Minoxidil is suitable for any healthy adult looking to control further hair loss and promote hair growth.
Minoxidil is unsuitable for those with a heart condition or with unrealistic expectations such as complete reversal of hair loss and/or prevention of hair loss.
Finasteride may unsuitable for the following circumstances:
- Women and children.
- Unrealistic expectations or seeking complete reversal of hair loss and/or prevention of hair loss.
- Hypersensitivity to any component of the medication.
- Abnormal liver function or damaged liver.
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