Why medicine comes first
Androgenetic alopecia is ongoing. Medicine addresses its hormonal driver or the hair cycle, which laser and exosome products do not replace.
Which medicine you receive is a prescribing decision. It follows Dr Sin Yong's assessment, your blood tests and your own view of the side effects.
How anti hair loss medication options in Singapore differ
| Medicine | How it acts | Key limit |
|---|---|---|
| Oral finasteride | Blocks the conversion of testosterone to DHT | Does not restore lost follicles, and must be taken continuously |
| Topical finasteride | Acts on the same enzyme at the scalp, with lower systemic exposure | Some is still absorbed, and it does not treat shedding or patchy loss from another cause |
| Topical minoxidil | A vasodilator that prolongs the growth phase and enlarges shrunken follicles where applied | Does not block DHT, and the effect is not expected to hold after stopping |
| Oral minoxidil | Works on the same hair-cycle mechanism through the bloodstream | Off-label use, with heart and fluid effects to consider |
| Anti-androgen hormonal therapy | Hormonal medicine | Selected women only |
The seven-step framework
Not everyone needs every step
The seven steps are a framework, not a fixed recipe. Steps are brought in according to your diagnosis, how you respond and what you tolerate. Many patients will use only some. Some may decide against oral medicine after discussing it, and that is a reasonable choice. Medicine can be stopped or changed if side effects occur. Whether it is advised at all is decided after assessment. Your own priorities count here, because this is treatment you are likely to continue for a long time. The two FDA-approved routes for androgenetic alopecia are a topical vasodilator and an oral DHT-pathway therapy, and most plans start from these. Nothing on this page is a reason to start, stop or change a medicine without speaking to your doctor. Bring a list of anything you already take.
Choosing a route with your doctor
Oral finasteride acts through the whole body. The topical form acts on the same enzyme at the scalp. Exposure is not zero, though.
Topical minoxidil works where it is applied. Its effect is not expected to hold after stopping, so it is a long-term commitment.
This is an off-label use. Heart conditions and low blood pressure are reviewed first, and fluid retention or a fast heartbeat must be reported.
Another DHT-pathway medicine is used in some countries, but it is not FDA-approved for this purpose. Please ask about it at consultation if you have heard of it.
Who it may suit
The diagnosis comes first. Other forms of loss are treated differently.
You will attend follow-up and have blood tests.
You have talked them through and accept them.
You want this in place before adding energy or topical treatments.
Who should avoid it or wait
Finasteride-type medicines are not for pregnancy, breastfeeding or planning pregnancy. Women who are or may become pregnant should not handle finasteride.
A known allergy to a component of the medicine.
Oral therapy is reviewed individually.
Heart conditions or low blood pressure are reviewed individually before oral vasodilator-type medicines.
A history of mood disorder or sexual side effects is discussed before you start.
Thinning from thyroid disease or low iron is addressed first. Scarring or patchy loss goes to dermatology.
What medicine cannot do
Finasteride does not restore follicles already lost. Minoxidil does not block DHT. Topical finasteride does not treat shedding or patchy loss that has another cause. Laser and exosome products do not replace the medical base. Medicine is not suitable for every type of hair loss, and it cannot give back the density of earlier years. Stopping oral therapy typically leads to hair loss resuming. No duration of benefit can be promised, and benefit varies between people. Medicine also cannot be judged in a few weeks, so please keep to your review plan.
Side effects to know about
Scalp irritation.
Changes in libido, erection or ejaculation in a minority of men. Reported mood changes. Lower PSA readings, which matter for prostate screening.
Early shedding, and unwanted hair on the face or body.
Fluid retention, a faster heartbeat, light-headedness and dizziness.
New or worsening low mood, anxiety or thoughts of self-harm. Persistent sexual changes. Rash, facial or lip swelling, or trouble breathing. Breast tenderness or lumps, testicular pain, chest pain, or ankle swelling.
Blood tests and monitoring
| Stage | What is checked |
|---|---|
| Baseline | Ferritin, iron, TIBC, TSH, free T4, zinc, full blood count and liver function |
| Hormone panel | Testosterone, DHT and SHBG, as appropriate |
| Follow-up at 3 to 6 months | Treatment response and safety, including liver function with oral therapy |
| If results are abnormal | Referral on, particularly for suspected endocrine disease |
How the fee is set
No figures are published. The fee depends on which medicines are prescribed, whether the route is oral, topical or a supplement, the monitoring blood tests needed, and whether laser or exosome products are combined. A written quote follows assessment at consultation. If you are also considering procedures, read about H2LT laser or the wider hair loss treatment overview. For women, see female hair loss treatment. For men, see male hair loss treatment. Review timing and how long you continue are set at consultation.