April 8, 2020

What are alternative options to hair transplant?

The most common cause of hair loss in males is androgenic alopecia, which has a characteristic pattern of hair loss. As many as 50% of the male population suffer from some form of hair loss by the age 50, worsening as they get older.

​Why ​The ​Fuss ​Over ​Hair?

As one of my patients once told me in the consultation room (coming to see me for his hair loss problem, no less). He said “doc, hair is the most important, unimportant thing in our life.” How spot on! That got me thinking about what I always ponder: that since time immemorial, hair has been a fascination and obsession even in the olden times, where luscious, thick full hair is associated with power, vitality and youth. Our hair gives us our personality and confidence. We spend quite a lot of time, money and effort on grooming our hair.  The hair care industry is worth billions of dollars annually and constantly growing.

​Hair loss is not a medical disease in most cases, so why are we so obsessed with having a full head of hair? Why is it that our confidence levels are associated with the amount of hair on our heads?

​We are wired biologically to assess others around us, to size them up, evaluate if they are a potential adversary, how strong is our opponent, can we defend ourselves against them should they try to over-power us, or in a potential partnership, we want to know that our team mate or business partner will be healthy and reliable enough for us to form a long-term relationship. In seeking out a life partner, again we are subconsciously assessing if the person is worthy or capable of having offspring with us. This is something innate and happens within split seconds, and often we do it unknowingly or even involuntarily. Hence, how others see us affects how we see ourselves too, and having good hair is an important part of that assessment.

​There Are Many Alternatives To A Hair Transplant

​In patients who are thinning, and getting affected by it but are not ready or suitable for a hair transplant, there are many alternatives to prevent worsening and in many cases, to improve the existing condition. Some of the established and proven treatments would include oral medication like Finasteride (trade name Propecia), minoxidil hair growth spray or low level laser therapy (LLLT). We will briefly discuss hair supplements too. Even in patients who have had a hair transplant, maintaining the results of the hair transplant for years to come is a very important topic.


​Finasteride is the most established and effective treatment option for male pattern hair loss. It is a prescription drug that was US FDA approved since 1997 for treatment of male pattern hair loss. It is manufactured by the pharmaceutical giant MSD. It is not suitable for women and studies done on female pattern hair loss have only yielded mixed results. For men, the dose is a 1mg pill taken orally and daily.  It works by blocking the enzyme alpha-reductase, which converts testosterone to dihydrotestosterone (DHT). When DHT is lowered by about 70% in the blood stream, it helps to stop further miniaturization of hairs seen in male pattern hair loss. In many cases, the hair also thickens up. As long as there are still fine hairs left on the scalp, there is a good chance those hairs can respond to finasteride. If the scalp is shiny smooth and all the fine hairs have gone, then it is unlikely to benefit from finasteride.

​After 23 years in the market, there has not been anything more effective, proven or with the same safety margin as finasteride for the treatment of male pattern hair loss. This medication is a wonderful option for many, but there is an 8% chance of experiencing sexual side effects. Most commonly reported are a decrease in sexual libido, erectile dysfunction or ejaculation disorders. These side effects are reversible upon stopping the medication or lowering the dose and the side effects usually go away within a week or so. Thankfully, the other 92% of men do not have any of such side effects, only enjoying thicker, fuller hair.

There is a more powerful version of DHT blocker known as dutasteride or Avodart. Avodart is made by the pharmaceutical giant GSK. It has been approved for use in male pattern hair loss in Korea, Taiwan and Singapore, to name a few countries. Avodart lowers DHT by up to 90% and is reserved for patients with very aggressive, early onset male pattern hair loss or in whom finasteride did not work as well as expected.


​Minoxidil is widely available in most clinics and pharmacies and this is another very popular option if the patient is looking for subtle improvements or simply to slow down hair loss. Expect up to 10 or 20% improvement in the hair growth. It is suitable for both men and women. Since 2014, minoxidil is the only US FDA approved topical treatment for hair loss.

Minoxidil was originally designed as a blood pressure lowering medication. However, it was noted that it also stimulated hair growth. It has since become more popular as a hair loss medication than a blood pressure medication.

Minoxidil is commonly available in pharmacies and clinics as a 5% liquid or foam formulation, used twice a day. It is simply sprayed on the thinning scalp, or it comes with a dropper to drip onto the scalp, then gently massaged into scalp for the best absorption.  As a topical treatment, minoxidil is safe and can be purchased over the counter. Very rarely, some patients experience irritation of the scalp, like itching, redness and flaky scalp skin. Even more occasionally, some experience increased hair growth at unwanted areas like the face, forehead and even other parts of the body. Some report mild headaches, giddiness, likely due to a slight drop in blood pressure. In such cases, we may lower the dose to the 3% or 2% formulation.

There are higher formulations above 5% available, but this has been shown to increase chances of scalp irritation and side effects without much more benefit to strengthening hair growth.

Minoxidil also comes in a pill form and some find this to be more convenient than using a spray as it may leave hair oily.


CG210 is a hair spray using purely botanical extracts, with the active ingredient cellium gc. Manufactured by Abbott pharmaceutical, CG210 has been shown to reduce inflammation in scalp, often related to hair thinning. Their tag line that “hair shedding back to normal in 44 days” is based on a published scientific paper. We find this spray not only helps to reduce unwanted hair fall, but it also helps to thicken hair in early to mild hair loss patients. This is because it shortens the shedding phase of hair, and lengthens the growth phase so critical for thick and healthy hair. It was shown to have anti-inflammatory properties, very often a cause of chronic hair loss.

  • ​C​omprised of natural botanical products and is considered safe even for pregnant and nursing mothers
  • ​Odourless, colourless and not oily - so this makes it very tolerable for daily use
  • ​Most suitable for those with early to mild hair loss, or simply want to maintain and prevent age-related hair thinning/shedding
  • ​Suitable for those who have temporary hair loss or increased shedding due to a stressful period or post-pregnancy, post menopausal, etc.
  • ​Can be combined with other modalities like finasteride or minoxidil for those with moderate to severe hair loss.

​Low Level Laser Therapy (LLLT)

​Low light laser therapy (LLLT) is a light-based treatment with devices using a 670nm wavelength of light energy to stimulate improved blood circulation and to stimulate more hairs into the hair growth cycle. Unlike the skin lasers that one tends to think of, LLLT is painless and have very little associated risks. Of note, there are a few established brands in the market. The most powerful version is the Revage 720 device that is used in clinic. Patients undergo a 25-minute session once or twice a week for a period of 4 to 6 months. For those who prefer the convenience of home use, the iGrow hands free helmet laser (25 minutes per session on alternate days). The Hairmax laser hairband takes just 1.5 to 3 minutes per session on alternate days.

​Hair Supplements And Shampoos

​There are a few hair supplements on the market that are touted to reverse early hair loss or to maintain healthy hair. There is not a lot of scientific evidence to support such claims, unfortunately. While some of these remedies may beneficial in some cases, it may not work for advanced hair loss. And often, the supplements only work if one has a deficiency. Some of the more commonly encountered supplements are Biotin, Pantogar, Viviscal, Saw palmetto, etc. There are some studies that claim melatonin may also help with hair loss. Certain shampoos, which contain active ingredients like caffeine, copper peptide, ketoconazole, etc may also help to reduce hair fall. Do take the marketing claims with a pinch of salt, lower your expectations to avoid disappointment.

​You can get our Freia Professional Scalp Care Shampoo For Men / Women on our online store: www.freia247.sg

If you are experiencing hair loss, seek help early to get your condition diagnosed properly. Start treatment early to prevent it from getting worse. Consistency if key, so make your hair care routine a daily ritual to ensure success. Be patient, you often need to wait about 6 to 9 months to start seeing results. Your doctor will monitor and guide you on your progress. Hair loss is a chronic issue and be prepared that you will have to invest a bit of time and effort into maintaining your crowning glory.

​Think Hair, Think Dr. Harold
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