Expat Hair-loss and Treatments

6 Things You Need to Know about Hair Loss and Effective Treatments

Look on any expat forum and you’ll find a common plea: “Help, I’m losing hair!” There are a number of reasons for this, and also some effective treatments. But there are also an alarming number of myths about the causes, and bogus “miracle cures” and supplements that are utterly worthless. Today let’s set the records straight so you can get the help you need to address the underlying causes of hair loss, and hopefully even regrow hair.

If your hair is falling out, it can be a really scary thing, especially if you’re a woman. You’re not alone. Nearly 50% of women and men experience hair loss by the age of 50. Before you pursue any treatment, you’re going to need to know the exact cause to determine the right treatment. Many expats experience hair shedding upon moving to a new country, which people often incorrectly attribute to the water, food or other environmental factors. It can, however, be caused in part by the move itself – more on that in a minute.

I’d look like a mallard if I went bald. So when I started noticing a lot more hair in the shower, I researched the heck out of causes and treatments, interviewed and got diagnosed by the top hair loss experts in the world, and got a thorough, comprehensive handle on the issue. (Being an investigative journalist is about as lucrative as selling coconuts on the beach, but it pays off in situations like these). Since many fellow expats – and non-expat friends – face this same scary situation, and because it’s quite hard to find a complete and unbiased guide on the subject, I figured I’d share what I learned with you. Hopefully this will help you, too.

Note: I’m not selling anything or making any money off this story – this info is totally impartial. I just want to share what I learned with the hope that it’ll help others in a similar situation. Please do leave a comment to let me know if this helps you. 

Here’s what I learned:

1. See a Doctor

Sudden hair loss is a medical condition. It can be caused by a hidden health problem, so it’s important to see a specialized doctor to diagnose the cause and determine the correct treatment to address the underlying issue.

So which doctors specialize in hair loss? Dermatologists. If you can find a trichologist, that’s even better. Trichologists are dermatologists who deal specifically with the scientific study of hair and scalp issues.

During your appointment, your dermatologist will ask for your health history, so bring along the results of your most recent wellness check, blood test results, and other pertinent details of your medical history. She/he will also do a visual inspection of your scalp to see the pattern of hair loss, do a pull-test to see how many hairs come loose, determine hair density and identify any follicle issues. Your dermatologist may even pluck a few hairs to study under a microscope.


To learn more about how dermatologists diagnose hair loss issues in their various forms, see this informative piece from the National Institutes of Health .

If you suspect a hormonal imbalance may be the root cause of your issues, you may want to see an endocrinologist first.

2. Common Causes

There’s a wide array of hair loss causes, which is why it’s crucial to see a doctor to get a diagnosis. It can be due to anything from stress to medications, heredity to hormone changes. Some of the most typical reasons for hair loss include:

Physical and emotional stress can trigger sudden hair loss. This can include moving to a new country (hello expats!), grief, anxiety, illness or surgery, sudden weight loss, and even high fevers. While you may notice thinning for many months after you experience stress, the good news is that once the stress abates, hair will usually regrow. To learn more about stress-related hair loss, here’s a great article from the prestigious Mayo Clinic.

Hereditary hair loss is the most common cause of thinning and balding among men and women. It can begin happening as early as puberty for some people, or much later in life for others. It usually occurs in visually identifiable patterns, such as a receding hairline and bald spots, which is easily diagnosed by a dermatologist. Miniaturized hairs (thin, short “baby hairs” that won’t grow more than a few inches) are often another identifier. Heredity being what it is, hair loss is common in certain ethnic backgrounds. For example, around Penang, you’ll see lots of women and men of Chinese descent with thinning hair and baldness, which is because androgenic alopecia is a common disorder among Asians – there’s up to a 73% prevalence rate. You can learn more about from the National Institutes of Health here. Some ethnicities, such as Native Americans, don’t carry these genes, so they never lose their hair due to heredity.

Hormonal changes. Thyroid problems, pregnancy, menopause, perimenopause and other hormone imbalances or changes can cause hair loss. If the hormones can be rebalanced, hair loss is often reversible. A blood test is usually required to determine hormone imbalances. When people retire and move to another country (hello again, expats!), sometimes hair loss occurs at the same time of the move because of coincidental age-related hormonal changes.

Certain medications can cause hair loss, including beta blockers, steroids, blood thinners, large doses of Vitamin A (like retinoids, for treating acne), birth control pills, immunosuppressants, anticonvulsants, weight loss supplements, mood stabilizers, and (obviously) chemotherapy drugs.

Medical conditions. There are also a number of medical conditions that can make you lose hair, including ringworm, lupus, psoriasis, diabetes, and a disorder that makes your immune system attack your hair follicles (which sounds thoroughly unpleasant).

To learn more about common causes, here’s a fantastic resource from the Mayo Clinic.

There are many other less common causes for hair loss, including severe iron deficiency, protein malnutrition, and chronic hair-pulling, among others. You’ll need to see a dermatologist to figure out what could be causing your hair loss.

3. Effective Treatments


There are only three FDA approved treatments that have been clinically proven to stop and/or reverse hair loss.

Talk with your dermatologist to develop a treatment plan, learn whether or not these treatments would work for you and discuss possible side effects:

HairMax LaserComb – Clinical trials have showed a 90% success rate for this hand-held at-home laser wand (and its new head-band), which is FDA cleared. The lasers can stimulate metabolism and protein synthesis in the cells of hair follicles. It works for both women and men, particularly for androgenic alopecia. Using it three times per week, trial participants saw marked improvement in hair density and quality, and a reversal in hair thinning.

Rogaine (Minoxidil) – Rogaine, a topical treatment, has been proven effective for both women and men. And it’s the only FDA-approved medication to treat androgenic alopecia and alopecia areata in women. According to Dr. Jennifer Fu, a top researcher and hair loss expert based in the San Francisco Bay Area, results vary for each patient. In test groups, 40% of women report some hair regrowth, and 19% report moderate regrowth. But for some women, it only stops hair shedding, and for others, it has no impact at all. It needs to be applied daily for 4-8 months to see if it’ll have an impact. For men, it’s effective for 30-50% of those who use it daily. (Those in Malaysia – good news. Minoxidil is finally being sold here). It comes in liquid form, which is applied twice per day, and also in aerosol foam, which is applied only once per day.

Propetia (Finasteride) – For men only, this FDA-approved hair loss medication works well for men with androgenic alopecia. Working differently than Rogaine, Propetia – an oral medication – is a DHT inhibitor. Up to 60% of men taking Propetia have experienced the cessation of hair loss, and new hair growth. But it can take 6-8 months of use to see a difference.

4. Ignore “Miracle Cures” and Friends/Shops Who Swear They Know the Cause of Your Hair Loss

According to Spencer Kobren of the American Hair Loss Association, “Most of the products and services that are being sold in [the hair loss] industry don’t work.”

Well-meaning friends and products may promise an immediate, easy fix, but please, don’t listen to them – just see a doctor. If you have a toothache and friends say that putting a dead mouse in your mouth will ease the pain, would you do it? Or would you go to a dentist? (Seriously, people used to recommend the mouse “treatment.”) The more time you waste on useless remedies, the more hair you may lose – possibly permanently.

Resist the urge to listen to people who swear “it’s the water” (it’s not) or “must be the MSG” (no, it isn’t) or “it’s the spicy food and the heat” (nope and nope) or “you need a new showerhead” (face-palm.) Don’t even listen to me – just listen to doctors who are trained in this field, scientific research studies and findings from reliable institutions. (Note that “Hair Fall” clinics, hair-loss shampoos, and websites with names like “LuxHair” and “Refinery39” are not reliable sources of information – their sole motivation is to make money off you. Rely on science, not marketing.)

You may hear people say things like, “But when I started washing my hair with the tears of bats/cut MSG from my diet/began using a new toothbrush, my hair started growing back – it really helped me!” The appropriate response is: “What an interesting coincidence,” because it’s likely just something random that coincided with hair regrowth. For example, if their hair was falling out due to stress and the stress abated right around the time they started washing their hair only with Evian, it doesn’t mean that Evian cured them, or that tap water was to blame for the problem in the first place.

“Miracle cures” and supplements are no better. Sadly, the market for hair growth products and services is largely unregulated, especially in lesser-developed countries where anything goes. You just can’t trust the claims of companies that say their cure will work.

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For example, many “anti hair fall” shampoos don’t contain any ingredients that are effective at treating hair loss. As for supplements, according to the American Hair Loss Association, there’s no clinical data showing that any of the popular natural supplements promoted to treat hair loss (such as saw palmetto, pygeum africanum, and stinging nettle) have any effect at all. To learn more about supplements for hair loss, here’s a thorough research study on the subject.


These kinds of “miracle” hair clinics sure look convincing, don’t they? Don’t believe the marketing – the only experts in this field are qualified dermatologists.

It’s safest to rely only on the advice and products recommended by the FDA and your dermatologist.

5. What’s NOT Causing It – Hair Loss Myths, Debunked

There are so many misconceptions, which drives me crazy since a lot of people believe them as fact and place their hopes on the false promises of bogus solutions and cures. So let’s clear up the most common whoppers:

It’s the tap water. If you suspect that tap water is to blame, you’re not the only one to think so. But it’s not the cause of hair loss. According to Dr. Mike Ryan, a renowned trichologist in Dubai, lots of expats come to him claiming that the water must be causing the problem since they felt the problem started upon arrival. He says that hair thinning and loss is not linked to water quality. In fact, there’s not one shred of evidence or any scientific finding that links tap water to hair shedding – anywhere in the world.

It’s the MSG. This is a widely circulated myth with no basis in fact whatsoever. According to the Hair Loss Learning Center, “MSG and other seasonings do not cause or contribute to hair loss.” There isn’t one piece of scientific evidence to suggest that MSG has any impact on your hair.

Wearing hats causes hair loss. No, not unless your hat is on so tight that it entirely cuts off circulation to your scalp (in which case, you’ve got bigger problems since you’re probably passed out at the moment).

Washing your hair too much. Unless you’re shampooing with Clorox, or some other substance that’s charring or irritating your scalp, washing your hair doesn’t cause hair loss. You may just notice more fallen hair in the shower than you do when it drops off during the day.

Clogged pores on your scalp. Clogged pores are not associated with hair loss – anyone who suggests otherwise is probably trying to sell you a useless “scalp detox cleansing” treatment. If it were true, frequent shampooing would cure the problem and result in a full head of hair, but that’s just not the case. There is no scientific evidence that sebum (the oil produced by the scalp) impacts hair loss.

6. Treatments Undergoing Trials and Off-Label Hair Regrowth Meds

There are many treatments being tested in clinical trials. Without multiple scientific studies to indicate their effectiveness, there’s no way to know if they’ll work or not. While none of these may be worth trying yet, it’s not a bad idea to keep an eye out for news about research study results on these treatments:

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Platelet Rich Plasma (PRP). This is the hottest new hair rejuvenation treatment that’s getting lots of buzz, but at the moment, there’s no scientific evidence proving its effectiveness. This vampire-like treatment involves getting your blood drawn, then it’s run through a centrifuge to separate out the plasma and platelets. Then the platelet rich plasma is injected into your scalp in areas where you’re losing hair. The normal function of platelets and plasma is to aid in healing when we’re injured, so the idea behind this treatment is that, hopefully, by injecting platelets and plasma into your scalp, perhaps it can trigger hair rejuvenation. According to Dr. Neil Sadick, a prominent New York City dermatologist and hair specialist, the hope is for PRP to “stimulate the growth of follicles, thus reversing the hair miniaturization seen in male and female hair loss.” Studies are underway, but at the time of writing this, there’s no clinical data or scientific proof that it does. In Penang, there’s one clinic that offers PRP: Eternal Clinic in Bayan Lepas.

Biotin, oral supplements. This is another buzzy one. Unfortunately, according to the Linus Pauling Institute at Oregon State University, “There is just not enough scientific evidence to prove that biotin supplementation can improve hair loss.” The National Institutes of Health further adds: “Research demonstrating the efficacy of biotin is limited. In cases of acquired and inherited causes of biotin deficiency as well as pathologies, such as brittle nail syndrome or uncombable hair, biotin supplementation may be of benefit. However, we propose these cases are uncommon and that there is lack of sufficient evidence for supplementation in healthy individuals.” To learn more, here’s NIH’s conclusions about biotin supplements for hair loss.  I could only find one study that suggested effectiveness, which you can read here.

Peppermint essential oil. There’s only one scientific study I could find on this, which you can view here. The experiments, which were done on mice, showed remarkable hair regrowth with daily application of peppermint essential oil. Who knows if it’ll work on humans, but if you try it, at least your head will feel minty-fresh and tingly. 🙂


Off-label medications used for hair loss. There are some medications that are used primarily for one purposes (say, for example, oral contraceptives), that have been found to have an impact on hair rejuvenation. Here’s a list of them.

Please remember: this article is not to be used in place of a visit to your doctor; it’s just to give you some helpful info.

For those suffering from hair loss, I feel for you and hope that you’ll be able to get the help you need to diagnose the underlying cause and find an effective treatment plan. If this story helped you, please leave a comment and let me know.

6 thoughts on “Expat Hair-loss and Treatments

    • Seriously – people used to think that sticking a dead mouse in your mouth would cure a toothache! Sorta makes you want to mess with gullible people, huh? 🙂


  1. Thanks for the article. I moved to Penang 3 months ago and the current rate of hair loss is uncomfortable. I went to an Endocrinologist last week and they checked hormones, thyroid, etc…it all checked out okay. He recommended my next visit be to a dermatologist. My hair is all over the floor. Do you have anyone in Penang you would recommend seeing? Thanks Stacy


    • Hi Stacy! Sorry for the delayed response – I was on vacation. I don’t know of any dermatologists here in Penang who specialize in hair loss. But I can recommend a great dermatologist at Adventist Hospital: Dr. Khoo. I don’t know how much training or experience she has in hair loss, but I’ve found her to be extremely knowledgable in other areas of dermatology, so if I were to go to anyone on island about hair loss, it would be her. Here’s her info: http://pah.com.my/doctor/dr-khoo-siew-swan/ I hope that helps!


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