Hair Loss Medications: What You Need to Know Alongside Your Hair Transplant

Finasteride is often the first medication that comes up when discussing hair loss treatments. Originally approved by the FDA for treating benign prostatic hyperplasia in 1992, it was soon discovered to be highly effective in addressing hair loss. Finasteride works by inhibiting the enzyme 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT). (Word salad I know). In layman's terms, DHT is a hormone that plays a major role in shrinking hair follicles, which leads to thinning hair and eventually hair loss. By reducing DHT levels, Finasteride helps maintain existing hair and can even lead to some regrowth in thinning areas.

Even if you’ve just begun your hair loss journey, you’ve probably heard of Finasteride. This is because the potency of the drug lies in its ability to effectively halt hair loss for most users (ever wondered why male celebrities don’t go bald anymore). Clinical studies show that Finasteride can stop hair thinning in about 83% of men, with around 65% experiencing some degree of regrowth over a five-year period. However, it's important to understand that while Finasteride is highly effective at stopping further hair loss, it is not typically known for growing back lost hair completely. Its strength is in stabilizing existing hair, making it crucial for anyone looking to maintain their hair after a transplant. Finasteride is most commonly taken in 1mg per day pill form but can also be applied topically (for reduced results). It is important to note that for the majority of people do not need the entire 1mg, and for decreased side effects - and price - you can take 1mg every other day, or use a pill cutter to take your desired dose daily. There is no way to test the best dosage for you so there is some trial and error involved. You should ask your doctor first to see if there are any particular complications for doing so in your case.

Of course, Finasteride isn’t without its downsides. Sexual side effects are the most commonly reported—such as decreased libido, erectile dysfunction, and reduced semen volume. Studies suggest that Finasteride users face a 1.66-fold increased risk of experiencing these sexual side effects. I know that sounds scary, but for most people, these side effects are rare and reversible, but before pulling the trigger you should know that there have been reports of persistent symptoms even after discontinuing the medication. Additionally, some users may experience neurological effects like depression or anxiety. The decision to start Finasteride should be made carefully, ideally with a healthcare professional who can help weigh the pros and cons based on your situation.

If you're older and your hair loss has been stable for a decade or more, you may not need Finasteride at all. In cases where hair loss has fully stabilized over a long period, the benefits of Finasteride may be limited, and your doctor might recommend proceeding without it.

To get started with Finasteride, you'll need a prescription from a doctor (if you are in the US). This typically involves a consultation with a dermatologist or healthcare provider who can assess your condition and determine if Finasteride is suitable for you. Many online telehealth platforms like Hims also offer consultations for hair loss, allowing you to get a prescription without needing an in-person appointment.

So now that you’re keeping your existing hair, let’s get into how you can regrow what you’ve lost - enter Minoxidil.

Minoxidil, initially developed in the 1960s as a treatment for high blood pressure, was found to have an interesting side effect—it stimulated hair growth. By the 1980s, it was approved for treating hair loss and has since become a household name for anyone dealing with thinning hair (most people call it Rogaine). Unlike Finasteride, which works by reducing DHT, Minoxidil is a topical vasodilator that increases blood flow to the scalp. This enhanced circulation helps to enlarge hair follicles, extend the growth phase of hair, and prevent further miniaturization of hair shafts.

Minoxidil is particularly potent when it comes to regrowing hair, especially in areas of thinning, such as the crown. Approximately 40% of men and women experience moderate to dense hair growth after using Minoxidil consistently for 3-6 months. However, it is important to note that Minoxidil does not prevent hair loss—it stimulates hair follicles to grow, but it does not address the underlying hormonal causes of hair loss. This means that while Minoxidil can lead to noticeable regrowth, especially when used consistently over several months, it is not a solution for stopping the progression of hair loss. To maximize its effectiveness, Minoxidil is best used in combination with treatments like Finasteride that can tackle the root causes of hair thinning.

One important consideration for those undergoing a hair transplant: topical Minoxidil or Finasteride immediately after surgery isn't the best idea. The topical solution can irritate the scalp during the healing process, potentially hindering the recovery of the grafts. Instead, doctors often recommend switching to oral versions of these medications until the scalp has fully healed.

Minoxidil is generally well-tolerated, though some people may experience mild skin irritation or unwanted facial hair growth if it spreads beyond the intended application area. There may also be initial shedding as hair follicles transition to a new growth phase. It’s a simple, consistent addition to your routine—often applied twice a day—and offers a boost to hair growth, making it a popular choice for those undergoing a transplant. The best part? Minoxidil is available over-the-counter, so you won't need a prescription to get started.

Both Finasteride and Minoxidil have a symbiotic relationship with hair transplants, significantly enhancing the overall outcome. Hair transplants relocate healthy hair follicles from the back of the head to balding areas. These transplanted hairs are more resistant to DHT, as they come from areas that are genetically less susceptible to hair loss. However, the existing, non-transplanted hair is still vulnerable to DHT. Without Finasteride, this hair will continue to recede and fall out, which can lead to a situation where only the transplanted hair remains—resulting in a "bangs transplant," where the transplanted hair is left isolated among thinning areas.

By incorporating Finasteride, patients can protect their existing hair from DHT damage, ensuring a more natural and uniform look over time. Minoxidil complements this by increasing blood flow and supporting the growth of both transplanted and native hair, making it stronger and thicker. The combination of preventing further loss with Finasteride and promoting regrowth with Minoxidil helps maximize the success of the transplant and maintain a fuller look.

You may also be wondering why doctors often ask patients to stop taking Finasteride and Minoxidil in the week or two leading up to a hair transplant. This is usually done to reduce the risk of excessive bleeding during surgery. Both medications can affect blood flow, and discontinuing them temporarily can help minimize complications during the procedure.

It is also crucial for patients to stabilize their hair loss before undergoing a transplant. Doctors often recommend taking Finasteride and/or Minoxidil for at least 6 months before surgery. This period allows patients to see how they react to the medications, assess any side effects, and ensure that their hair loss is under control. Stabilizing hair loss before the transplant helps achieve a better long-term result and prevents the need for additional transplants in the future. It’s important to note that if you aren’t receptive to the medications before a transplant, you more than likely are not a great candidate to get one.

It’s crucial to understand that both Finasteride and Minoxidil require a long-term commitment. Most patients are advised to continue using them indefinitely, as discontinuation can lead to the gradual reversal of gains and a return to hair loss. In other words, all the hair you have kept/gained will quickly fall out. Additionally, these medications are typically recommended for adults, often for men above 25, as younger patients may not be the best candidates due to the unpredictable progression of hair loss at an early age. The combination of these medications and a hair transplant offers a proactive approach, but it does require dedication and consistency to achieve and maintain the desired results.

If you find yourself shedding hair and experiencing side effects from Finasteride that are too much to handle, a hair transplant may not be the right option for you. It's not worth spending thousands of dollars if your existing hair can't be stabilized first. We advise being on Finasteride for at least 6-12 months before considering a transplant, as this timeframe will help you understand how your body reacts to the medication and whether it's a sustainable option before investing heavily in surgery.

If you’re considering these medications, be prepared for a lifelong commitment. The reality is that without them, the benefits gained can fade. But for many, the opportunity to maintain or even regrow some hair makes it worth it. At the end of the day, it’s all about finding what works for you and understanding that hair loss is a journey—a marathon, not a sprint.