Hair Transplant Medication: Minoxidil and Finasteride

Why a transplant does not stop pattern hair loss#

A hair transplant moves follicles from the back and sides of the scalp, where hair tends to resist pattern hair loss, to areas that have thinned. Those transplanted follicles generally keep their resistance. The hair that was already in the treated area, and around it, does not change. If you have pattern hair loss, that native hair can go on thinning after the procedure, in the same way it would have without it.

Over the years, this can leave a transplanted hairline standing in front of a thinning area, or reduce the overall density around the grafts. It is the main reason doctors sometimes suggest medication alongside a transplant: not to help the transplanted hair grow, but to protect the hair you still have.

Whether you need medication at all is an individual medical decision. Some people do well without it; for others it is a central part of the plan. This article explains the options so you can have a better-informed conversation with a prescriber. It is not a substitute for that conversation, and it does not give doses.

Short-term medication vs long-term treatment#

It helps to separate two different things.

Short-term medication around the procedure. After a hair transplant, the medical team usually gives you medication and products for the healing period, which may include pain relief and, depending on the team, other medicines to reduce swelling or the risk of infection. These are taken for days, not years, exactly as the team prescribes.

Long-term treatment for pattern hair loss. Minoxidil and finasteride fall into this category. According to the NHS, they are the main treatments for male pattern baldness, and minoxidil can also be used for female pattern hair loss. The NHS also notes that these treatments do not work for everyone and only work for as long as they are used.

Minoxidil: how it is used#

Minoxidil is most commonly used as a lotion or foam applied to the scalp. It is thought to work by prolonging the growth phase of hair follicles and increasing their size, although the exact mechanism is not fully understood. It does not block the hormonal process behind pattern hair loss.

Points worth knowing:

• It is available without a prescription in many countries, which makes it easy to start without advice. It is still a medicine, and it is worth discussing with a doctor, particularly around surgery.
• Temporary extra shedding is common at first. The American Academy of Dermatology notes that some people see increased hair loss in the first weeks of use, which stops as regrowth begins.
• Effects take time and stop when you stop. Any benefit usually takes months to show, and hair gained or kept tends to be lost again after stopping.
• Oral minoxidil is sometimes prescribed by specialists at low doses for hair loss. This is a different use of the medicine, with different side effects, and is only for a doctor to decide on.

Common side effects of minoxidil#

• scalp irritation, dryness, itching, flaking or redness;
• unwanted hair growth on the face or other areas, which the AAD highlights particularly for women;
• temporary increase in shedding when starting.

Less commonly, people report dizziness, a fast heartbeat or swelling; seek medical advice if this happens. Minoxidil is generally not recommended during pregnancy or breastfeeding. Tell the prescriber about any heart condition or blood pressure problem.

Finasteride: how it works#

Finasteride is a tablet that reduces the body's conversion of testosterone into dihydrotestosterone (DHT), the hormone most closely linked with male pattern hair loss. By lowering DHT, it can slow hair loss and, in some men, lead to some regrowth. It is a prescription medicine for hair loss in many countries.

Who it is for, and who should not take it#

According to the NHS, most men aged 18 and over can take finasteride, but it is generally not recommended for women or children, and the NHS hair-loss page states that women should not use it. Tell the prescriber if you have ever had depression or thoughts of harming yourself, liver problems, severe bladder problems, or an allergic reaction to any medicine.

Finasteride can affect the development of a male baby's genitals. Product information advises that women who are or may become pregnant should not handle crushed or broken tablets. The NHS notes that only very small amounts are present in semen, and that the risk to a pregnant partner is unlikely to be significant.

Because finasteride lowers PSA, a blood test used in checking for prostate cancer, tell any doctor who arranges a PSA test that you take it.

Side effects of finasteride#

The NHS lists as common side effects problems getting an erection, reduced interest in sex and problems with ejaculation, such as less semen. It notes that these usually improve after a while but can sometimes continue even after stopping.

Serious side effects are rare but important:

• Low mood or depression. The NHS advises that if you take finasteride for hair loss and develop low mood, you should stop taking it straight away and contact a doctor. It also recommends telling family or friends you are taking it, so they can help notice changes in mood or behaviour. Thoughts of self-harm need urgent medical help.
• Breast changes, such as lumps, pain, swelling or nipple discharge, should be reported to a doctor promptly.
• Allergic reactions, which in rare cases can be serious.

Some men have also reported reduced sperm quality, which usually returns to normal after stopping, according to the NHS. If you are planning to have children, raise this with the prescriber.

Topical finasteride products also exist in some countries. They are not simply a safer version of the tablet, and they should only be used on medical advice.

Other options your doctor may discuss#

Depending on your situation, a doctor may also talk about:

• other prescription medicines used by specialists, particularly for women, where finasteride is not suitable;
• procedures such as platelet-rich plasma (PRP) injections, where evidence is still developing and results vary;
• low-level laser or light devices, with mixed evidence;
• camouflage options such as hair fibres or scalp micropigmentation.

For women, the causes and treatment of hair loss can differ significantly from men's; our article on female hair loss causes explains why, and when a female hair transplant may help.

Starting, stopping and timing around surgery#

This is where decisions must be made with a prescriber and the medical team performing the transplant, together:

• Before surgery. Some teams ask patients to pause topical minoxidil for a short period before the procedure; others do not. Tell the team exactly what you use.
• After surgery. Topical products are usually not applied to fresh grafts. Teams commonly advise waiting until the scalp has healed, which may be several weeks. Some may suggest restarting sooner or later depending on your case.
• Finasteride. Some prescribers suggest continuing through the procedure; others prefer different timing. Do not start, stop or change it on your own.
• Shock loss. Temporary shedding of native hair after a transplant is common. Some doctors believe medication may help limit it; this is a decision for the prescriber. Our hair transplant recovery timeline explains what shedding typically looks like.

If you are having an FUE hair transplant or any other technique, bring a full list of your medicines and supplements to the assessment, including anything bought without a prescription.

Questions for your doctor#

1. Do you recommend medication in my case, and why?
2. What are the side effects I should watch for, and what should I do if I notice them?
3. Should I pause anything before the procedure, and when can I restart afterwards?
4. How long would I need to use it, and what happens if I stop?
5. Is it safe with my other medicines and health conditions?
6. If I am planning a pregnancy, or my partner is, does that change the advice?

For the wider picture of candidacy, techniques and recovery, see our guide to hair transplants in Turkey. Your doctor will advise whether any medication is appropriate for you.

This article is general information and does not replace advice from a doctor or pharmacist. If you have side effects from a medicine, contact a healthcare professional. You can report suspected side effects to your national medicines regulator; in the UK this is the Yellow Card scheme.