Hair loss, known medically as alopecia, is a leading concern in Singapore, affecting over 44% of research participants in a 2022 local survey. Hair loss affects millions of people, regardless of age, gender, or ethnicity. Let us take an in-depth look into the causes, diagnostic methods, and strategies for hair loss management.

What is hair loss?

Hair loss happens when the natural cycle of hair growth and shedding is disrupted, or when the hair follicle is damaged and replaced with scar tissue instead (also called scarring alopecia). 

What causes hair loss?

Hair loss can be caused by medical issues such as nutritional deficiencies and hormones. If you suffer from hair loss, it is recommended to undergo a hair loss screening test at Assure Family Clinic.

Assure Family Clinic’s hair loss screening includes the following components:

1. Full Blood Count [FBC]

2. Iron Panel

• Ferritin
• Serum Iron
• Total Iron Binding Capacity [TIBC]
• % Iron Saturation [TSAT]

3. Vitamin B12

4. Folate

5. Vitamin D

6. Thyroid Profile:

• Free T3
• Free T4
• TSH

7. Zinc

8. Hormone Test​

Males	Females
TestosteroneSex hormone binding globulin	Follicle Stimulating Hormone (FSH)Luteinising Hormone (LH)ProlactinEstradiol (E2)ProgesteroneTestosterone

Besides nutritional deficiencies and hormones, there are also many factors that can lead to hair loss, largely depending on the specific type. Common kinds of hair loss include: 

1. Androgenetic Alopecia (AGA) / Female Androgenetic Alopecia (FAGA) 

AGA is one of the most common forms of hair loss. In AGA, hair loss can begin at any point after reaching puberty and becomes more progressive with age. It can affect people of both genders.

• In men –  AGA is responsible for 95% of hair loss in men, and in Singapore, 50% of men face AGA by age 50. Male-pattern hair loss is observed in 7 stages:

1. Hair loss is typically first seen in the hairline and/or thinning at the crown of the scalp. 
2. Hairline recession often progresses near the temples. 
3. Deep hairline recession around the temples, with the hairline forming the shape of a ‘U’ or ‘M’.
4. A noticeable bald spot at the crown of the scalp.
5. Hairline recession merges with a growing bald spot.
6. Thinning of the hair between the temples and crown. 
7. Complete baldness at the top of the head, with only a band of hair around the side of the head.

• In women –  FAGA is experienced by 40% of women by age 50. Hair loss is first noticeable as a wider centre part due to diffuse hair thinning at the top and crown of the scalp. Advanced stages of FAGA would be observed as a bald patch at the centre top of the head. 

AGA in both men and women can be attributed to a multitude of factors:

• Hormones – In some cases of AGA, male sex hormones, and more specifically dihydrotestosterone (DHT), are in excess. It was observed that a high level of DHT can shrink hair follicles, which makes it harder to develop a healthy head of hair. DHT, in excess, is also believed to shorten the hair growth cycle. 

• Genetics – A common factor in AGA is genetic predisposition. Many individuals have a family history of AGA because the AR gene, which is responsible for the body’s production of androgens, is inherited from the parents. 

• Age – Typically, early stages of AGA are noticed by age 30, but AGA can start from early adulthood and progressively worsen over time. Approximately one in four men notice the initial symptoms of hair loss before the age of 21.

• Diet & Lifestyle – For individuals who are genetically predisposed, certain choices in lifestyle and diet can exacerbate AGA. Diets lacking in vitamin B12, vitamin D, biotin, riboflavin, iron etc., smoking, and alcohol consumption, as well as chronic stress, are all known to worsen AGA.

2. Traction Alopecia

By its name, traction alopecia is a form of hair loss caused by continuous and excessive tension, or traction, on the hair and scalp. This tension is often due to:

• tight hairstyles like slicked-back ponytails and buns, tight braids
• hair extensions or weaves
• hair rollers worn for excessive periods (e.g. worn to sleep)

Traction alopecia is more noticeable in individuals of Asian origin due to their typically, straight, dark hair, and it causes hair to come off in patches along the hairline.

3. Alopecia Areata

Alopecia Areata is an autoimmune disorder that attacks the hair follicles. This disease leads to hair loss in small, round patches on the scalp, eyebrows, eyelashes, and other facial hair areas.

The age of onset of alopecia areata and the rate of progression can vary amongst individuals. However, it often develops first in children and teens. The exact cause of alopecia areata is not yet fully understood. Still, some observed factors for this disorder include:

• Genetics – While in many cases, affected individuals have no family history of alopecia areata, researchers have discovered connections between several genes and the condition, which suggests that one could be genetically predisposed to alopecia areata. 

• Autoimmune Disorders – It was observed that alopecia areata is more common in individuals who have other autoimmune disorders such as vitiligo, morphea, thyroid disorders, and even type 1 diabetes, etc.

4. Frontal Fibrosing Alopecia (FFA)

Frontal Fibrosing Alopecia (FFA) has similar features to alopecia areata. It is an autoimmune disorder that causes hair loss at the front and sides of the hairline. Advanced stages of FFA also affect the eyebrows, and other areas, including the arms, legs, underarms, and pubic area. 

However, unlike alopecia areata, FFA is a form of scarring alopecia and is characterized by progressive frontotemporal hair loss. While FFA can affect individuals of any age and gender, it is most commonly seen in post-menopausal women. The exact cause of FFA is still not fully known, and so far only a few possible factors have been considered. These include: 

• Inflammatory Response – Apart from hair loss in the frontotemporal areas, FFA is also characterised by inflammation in the same affected areas. It is possible that this inflammation contributes to the destruction of hair follicles, which makes FFA a form of scarring alopecia.

• Hormones – Medical researchers believe that hormones may be a contributing factor because FFA typically affects post-menopausal women, and it is possible that the hormonal imbalance experienced after menopause triggers the inflammatory response.

Can hair loss be reversed?

Hair loss, depending on its cause and stage of severity, can be reversed or slowed down. Scarring alopecia, unfortunately, is irreversible. 

Scarring alopecia usually involves inflammation at the proximal region of the hair follicle. When stem cells found in that region are destroyed, it is impossible to regenerate the hair follicle, leading to permanent hair loss. 

Some forms of scarring alopecia and their symptoms include: 

• Frontal Fibrosing Alopecia (FFA)  
  • Frontotemporal hair loss and hair loss at the eyebrows/other areas of hair growth
  • Itchiness/pain at the scalp
  • Small bumps (resembling pimples) near the hairline and on the face
  • Rosacea (reddened/flushed skin mainly at the cheeks)
• Central Centrifugal Cicatricial Alopecia (CCCA)
  • Hair Loss in the centre of the scalp, either as one central patch, or scattered patches
  • Tenderness/burning at the scalp
• Pseudopelade of Brocq (PPB)
  • Hair Loss in small, asymmetrical patches
  • Affected areas are slightly depressed (said to resemble ‘footsteps in the snow’)

When detected and treated early, the rate of hair loss can be slowed/stopped and symptoms can be alleviated. In some cases, hair loss can even be reversed if treated before hair follicles can develop scars, so be sure to consult a doctor when you notice these signs and symptoms. 

Treatments for hair loss

There are numerous treatments available for forms of hair loss that are reversible. The choice of treatment would depend on underlying causes and the specific type of hair loss— you can consult our General Practitioner (GP) & aesthetic doctor for a diagnosis and tailored advice on how to better manage your condition.

1. Alopecia Areata

Treatment options for alopecia areata are recommended based on its severity and the affected individual’s age. Treatment for this form of hair loss aims to stimulate hair growth and manage the autoimmune response that causes the hair loss.  

• Corticosteroid 
  • Topical Corticosteroids in the form of prescription-strength ointments/creams are applied directly to the affected areas, 1-2 times daily. This medication helps to reduce inflammation and promote hair regrowth. 
  • Injections of corticosteroids are directly administered into areas with hair loss, every 4-6 weeks. This is often recommended for larger or more persistent areas of hair loss. 

• Minoxidil 

• Minoxidil is another topical medication typically used alongside corticosteroids to promote hair regrowth.

2. Androgenetic Alopecia (AGA/FAGA)

• Medication 
  • Minoxidil – Minoxidil helps to promote hair regrowth, increase hair thickness, and slow the progression of hair loss. 
  • Finasteride – Finasteride is typically prescribed to men experiencing male-pattern baldness to reduce excess dihydrotestosterone, thereby promoting hair regrowth.
  • Spironolactone – Spironolactone is typically prescribed to women with suspected hormonal imbalances, to reduce hair loss and increase hair thickness.

• Low-Level Laser Therapy (LLLT) – LLLT devices use low-level laser light to stimulate hair follicles and promote hair growth. It is a safe and painless treatment, however, it does require multiple sessions over a period of months.

• Lifestyle Changes – Since poor nutrition is known to exacerbate AGA, your GP may recommend vitamins and supplements such as vitamin B12, vitamin D, biotin, iron, and more. Assure Family Clinic offers personalised practitioner-grade dietary supplements that are tailored to your unique health goals, which can boost your nutrition and potentially mitigate hair loss.

Who should I consult for hair loss?

When experiencing concerns about hair loss and scalp health, it is important to consult a GP.

To prepare for your consultation, do take note of:

• Medical History
  
  • Consider past medical conditions you have or have had in the past
  • Family history of any hair loss-related conditions

• Documenting your hair loss and/or symptoms 

The rate of your hair loss and the pattern of hair loss helps your GP better diagnose the type of alopecia you may be experiencing. Taking note of other associated symptoms such as itchiness/burning at the scalp can help as well. 

During the consultation, expect that your GP may perform physical examinations on your scalp or even recommend further tests, such as blood tests, to diagnose the cause of your hair loss and put together a personalised treatment plan. 

Summary 

Understanding the underlying causes and learning about the available treatments for hair loss is key for those experiencing this condition. Noticing symptoms early and consulting a GP in Singapore for an accurate diagnosis, followed by appropriate treatment, can help individuals regain their confidence and maintain healthy hair.

Visit Assure Family Clinic

If you are suffering from hair loss, you can book a consultation with our GP who is skilled in aesthetic medicine. Dr Au is a trained Aesthetic Doctor with a Diploma from the American Academy of Aesthetic Medicine (AAAM).  She can help you to accurately diagnose your type of hair loss and suggest a treatment plan. In particular, she is experienced in a variety of treatments and personalised practitioner-grade dietary supplements. Book an appointment today to start alleviating your hair loss through a holistic approach. 

References

1. Statista: Leading hair concerns among people Singapore 2022. [Online] 
2. WellaHolic: Hair Loss Alert: Don't Ignore the Signs of Traction Alopecia. [Online] 
3. SingHealth: KK Women's and Children's Hospital. Hair Loss: Causes and Treatment. [Online] 
4. The Sire: Androgenetic Alopecia: Causes of Androgenetic Alopecia in Singapore. [Online]
5. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Alopecia Areata. [Online] 
6. PubMed Central (PMC): Hair Disorders: A Comprehensive Review. [Online]
7. PubMed Central (PMC): Alopecia: A Review of Laser and Light Therapies. [Online] 
8. Oxford University Hospitals (OUH): Alopecia. [Online
9. Healthline: Frontal Fibrosing Alopecia: Causes, Symptoms, and Treatment. [Online] 
10. National Center for Biotechnology Information (NCBI) Bookshelf: Central Centrifugal Cicatricial Alopecia. [Online] 

Did you know that pneumonia, also known as lung inflammation, is the third major cause of death in Singapore? Thankfully, pneumococcal vaccines can lower an individual’s risk of contracting this preventable disease. This blog article explains the importance of pneumococcal vaccination, shedding light on the different types of pneumococcal vaccines - PCV13, PPSV23 and PCV20. 

The Importance of Pneumococcal Vaccination

Before we dive into the specifics, let us understand why pneumococcal vaccination is crucial. Streptococcus pneumoniae, the bacterium targeted by these vaccines, is one of the leading causes of respiratory infections, including pneumonia, meningitis, sinus and middle-ear infection. This poses a serious health risk, particularly to vulnerable populations, and can lead to severe illnesses and, in some cases, even death. While most healthy individuals recover from pneumonia within weeks, prevention is key as it can be life-threatening especially for the elderly.

Benefits of pneumococcal vaccination:

• Helps prevent respiratory infections
• Typically leads to milder symptoms and lower rates of complications if infected (compared to unvaccinated counterparts)
• Safeguards public health by contributing to herd immunity and limiting the societal spread of respiratory infections
• Reduces healthcare costs associated with treating preventable diseases

Rest assured, the common side effects of pneumococcal vaccination, like soreness, redness, or swelling at the injection site, mild headache, body aches or fatigue, and fever, typically disappear within 2 to 3 days.

Who Needs Pneumococcal Vaccination

Contrary to popular belief, the pneumococcal vaccine is not the same as the flu shot — these are distinct vaccines. People who have received the flu shot may still need pneumococcal vaccination, particularly the following groups of individuals:

• All infants: two doses of PCV13 (at 4 and 6 months of age), with a booster at 12 months, are usually recommended.
• Elderly: those 65 years and above will typically benefit from one dose each of PCV13 and PPSV23 to enjoy lifetime protection.

However, the aforementioned information is just a general guideline thus a consultation with a General Practitioner (GP) is necessary to determine your suitability for pneumococcal vaccination.

Types of Pneumococcal Vaccination

PCV13: Targeted Protection for 13 Strains

Pneumococcal Conjugate Vaccine 13, or PCV13, is a key player in the fight against pneumococcal diseases. With targeted protection against 13 strains of the bacteria, PCV13 is recommended for all age groups, emphasising the importance of comprehensive prevention.

PPSV23: Extensive Coverage for Adults

Pneumococcal Polysaccharide Vaccine 23, or PPSV23, takes the baton for adults aged 65 and older, offering coverage against 23 strains. This vaccine is particularly important for older individuals, as well as individuals with certain medical conditions.

PCV20: Simplifying Protection with a Single Dose

The latest breakthrough in pneumococcal vaccination is the Pneumococcal Conjugate Vaccine 20, or PCV20. What sets it apart? A single-dose regimen designed to cover 20 pneumococcal strains — this vaccine covers seven more bacterial strains than the PCV 13. Moreover, unlike certain existing vaccines like PCV13, only one PCV20 dose is required for optimal protection. According to the National Centre for Infectious Diseases,  PCV20’s broader protection enables it to replace the two existing vaccines (PCV13, and PPSV23) available in Singapore. 

Subsidies for Pneumococcal Vaccine

With government subsidies in place, pneumococcal vaccines are an accessible and cost-effective solution for Singaporeans seeking comprehensive pneumococcal protection. Assure Family Clinic is a CHAS clinic, therefore Singaporeans can enjoy highly subsidised pneumococcal vaccinations. For eligible Singaporeans, MediSave can also be utilised to pay for the remaining cost of pneumococcal vaccinations.

Empowering Health Through Informed Choices

In the dynamic landscape of preventive healthcare, being informed is the first step to empowerment. PCV13 and PPSV23, backed by subsidies, have been important in the fight against pneumococcal diseases. With the arrival of PCV20, we witness a leap toward simplicity and efficiency in vaccination.

Assure Family Clinic offers the pneumococcal vaccinations PCV 20, PCV13, and PPSV 23. Explore the options and make informed choices for the health of you and your loved ones.

For personalised advice regarding pneumococcal vaccination, consult our GP. Schedule your pneumococcal vaccination with Assure Family Clinic today!

[Make an Appointment]

References

1. Singapore first country in Asia to get new pneumococcal vaccine - National Centre for Infectious Diseases. www.ncid.sg. Accessed February 2, 2024.
https://www.ncid.sg/News-Events/News/Pages/Singapore-first-country-in-Asia-to-get-new-pneumococcal-vaccine.aspx

2. Pneumococcal_disease. www.healthhub.sg. Accessed February 2, 2024.
https://www.healthhub.sg/a-z/diseases-and-conditions/topic_pneumococcal_disease#7

3. Pneumococcal-Vaccine. www.healthhub.sg.
https://www.healthhub.sg/a-z/medications/pneumococcal-vaccine

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What is the Human Papilloma Virus (HPV)?

HPV, or Human Papillomavirus, is the most prevalent viral infection among sexually active adults. It spreads through various sexual activities, including vaginal, anal, and oral sex, as well as close skin-to-skin contact during intercourse. Almost all individuals who are not vaccinated, regardless of gender, will experience an HPV infection at some point in their adult lives. HPV is responsible for over 99% of cervical cancer cases in females, contributing to making cervical cancer the tenth most common cancer among Singaporean women.

What are the effects of HPV on men?

While the majority of HPV infections in men show no symptoms, in some cases, the virus persists without being cleared by the body, leading to the development of genital warts. These warts manifest as small, flesh-coloured, cauliflower-like growths on the skin. Additionally, HPV can contribute to the onset of penile, anal, and oral cancers in some men, emerging months or years after the initial infection. Importantly, 85-91% of anal cancer cases are attributed to HPV, and over 90% of genital warts stem from HPV. Although all men can be affected by HPV, individuals with poor immune systems due to other illnesses or treatments face a disproportionately higher risk.

What are the benefits of men getting the HPV vaccination?

Since there is no existing widely available screening for HPV infections in men, vaccination is the most crucial preventive measure. Given the virus's high contagiousness, vaccination is the most effective strategy for avoiding HPV transmission. Administering the Gardasil 9 HPV vaccine at an early age significantly reduces the risk of contracting the virus during sexual activity.

The Gardasil 9 HPV vaccine is recommended for both men and women aged 9 to 45 years old. While older men may still benefit from vaccination, it is more likely that they have already been exposed to the virus, making the vaccine less effective.

What is the process for HPV vaccination?

The Gardasil 9 HPV vaccine is administered in three doses at 0, 2, and 6 months. The second dose is given two months after the first, and the third dose is administered six months after the initial dose. 

Individuals may experience common side effects, such as pain and swelling at the injection site, a mild headache (observed in 13% of patients), and fever (seen in 6.1% of patients). 

Visit Assure Family Clinic

All in all, contrary to popular belief, the Gardasil 9 HPV vaccine is recommended not only for females from 9 to 45 years of age but also for males of the same age range.

Get the full course (3 doses) of the Gardasil 9 HPV vaccine at $750 nett.

Book an appointment with Assure Family Clinic.

References

1. Health hub. Preventing HPV infection: HPV Vaccination https://www.healthhub.sg/a-z/diseases-and-conditions/faqs-on-hpv-and-hpv-immunisation

2. Mayo Clinic. HPV vaccine: Who needs it, how it works https://www.mayoclinic.org/diseases-conditions/hpv-infection/in-depth/hpv-vaccine/art-20047292

In today's fast-paced world, health and wellness have become paramount concerns for people of all ages. The quest for optimal well-being often leads individuals to explore a variety of healthcare options beyond conventional medicine. One such approach gaining popularity is integrative medicine.

Let’s delve into what integrative medicine is, provide examples of its application, distinguish it from holistic medicine, identify who can benefit from it, and help you determine if it's the right choice.

What is Integrative Medicine?

Integrative medicine is an approach to healthcare that combines the best of both conventional and complementary therapies. It recognises that each patient is unique and that health and healing involve the physical body, mind, emotions, and spirit. Integrative medicine emphasises the importance of a patient's active role in their healthcare journey, often employing a partnership between the patient and the healthcare provider.

This approach blends evidence-based conventional medicine with complementary therapies like exercise prescriptions, nutraceuticals or herbal supplements, nutritional counselling and mind-body techniques. It aims to address the root causes of health issues rather than merely treating symptoms, promoting overall wellness and prevention as key pillars of its philosophy.

Examples of Integrative Medicine Therapies

Integrative medicine encompasses a wide range of therapies and treatments tailored to an individual's unique needs. Here are some common examples:

• Mindfulness and Meditation — Techniques that focus on calming the mind, reducing stress, and improving mental wellbeing.
• Nutritional Counselling — Guidance on adopting a balanced diet and making informed choices about nutrition to support overall health.
• Nutraceuticals and Herbal Medicine — The use of plant-based remedies to address various health concerns, often tailored to the individual.
• Exercise Prescription - A detailed exercise plan customised to the individual’s physical condition and needs.
• Yoga and Tai Chi — Mind-body practices that combine physical postures, breathing exercises, and meditation to promote flexibility, balance, and relaxation.
  

Integrative Medicine vs. Holistic Medicine

While integrative medicine and holistic medicine share a common goal of treating the whole person rather than just specific symptoms, there are differences between the two approaches.

Holistic medicine is a broader concept that considers all aspects of a person's life, including social, environmental, and lifestyle factors. It often incorporates complementary therapies but does not necessarily integrate them with conventional medical treatments. Integrative medicine, on the other hand, specifically combines evidence-based conventional medicine with complementary therapies, creating a more structured and collaborative approach to patient care.

Who is Integrative Medicine For?

Integrative medicine is suitable for a wide range of individuals, including those:

• Seeking alternatives or complements to conventional treatments
• Interested in a more personalised and holistic approach to their health
• Struggling with chronic conditions that have not responded well to conventional treatments alone
• Committed to taking an active role in their healthcare and wellness journey

Conditions that May Benefit from Integrative Medicine Approach

• Chronic conditions such as hypertension, diabetes, and heart disease
• Obesity and weight concerns
• Hormonal imbalances
• Menstrual problems such as irregular menses, heavy periods, and PCOS
• Allergies, eczema, and acne
• Fatigue, low energy, burnout

Should I Consider Integrative Medicine?

Deciding whether integrative medicine is right for you is a personal choice. Here are some factors to consider:

• Your Health Goals — Integrative medicine may be a good fit if you're looking for a more comprehensive approach to improving your health and addressing underlying issues.
  
• Openness to Complementary Therapies — Are you open to exploring therapies like nutritional counselling, herbal medicine, or mindfulness practices alongside conventional treatments?
  
• Desire for a Collaborative Approach — Integrative medicine often involves collaboration between healthcare providers from different disciplines. This may be appealing if you value a team-based approach to your health.
  
• Chronic Conditions — If you have chronic conditions that conventional medicine alone cannot adequately manage, integrative medicine may offer additional or alternative options.
  
• Patient Responsibility — Integrative medicine often requires active involvement in lifestyle changes, dietary modifications, and complementary therapies. Consider your willingness to commit to these changes.

Visit Assure Family Clinic

Integrative medicine is an evolving approach to healthcare that embraces the integration of conventional medicine and complementary therapies to promote overall wellness and address the root causes of health issues. It's suitable for those seeking a holistic approach to health, open to complementary therapies, and interested in active participation in their healthcare journey.

Ultimately, exploring integrative medicine should align with your health goals and preferences. Consult with our experienced holistic doctor at Assure Family Clinic to discuss your needs, explore treatment options, and make informed decisions about your well-being.

Assure Family Clinic provides the full range of conventional GP services and other types of integrated wellness services that can help you thrive from the inside out. Based on the principles of integrative medicine, Assure Family Clinic takes the ‘whole person’ approach. The GP clinic combines modern healthcare and holistic practices that take the whole person into account, including their diet, genetics, hormonal changes, lifestyle, and not just their symptoms. 

Assure Family Clinic provides health screening packages, as well as add-on packages that will help you gain deeper insights into your well-being. Other services include comprehensive weight management programme, nutritional assessment screening, gut microbiome testing, comprehensive allergy testing, and personalised practitioner-grade supplements.