While hair transplant surgery is a highly effective solution to previous hair loss, it isn’t necessarily the first or final step of hair restoration. Many patients suffer from hereditary or pattern balding, therefore to reduce future hair loss, a hair transplant surgeon may recommend ongoing preventative treatments such as finasteride.
Finasteride is the most commonly prescribed hair loss drug worldwide and one of the most successful non-surgical treatments for male hair loss [1]. In this article, we’ll discuss finasteride, whether you should use it after a transplant, the advantages of finasteride, and what alternatives there are.
Finasteride is one of two FDA-approved hair loss treatment medications out there. It is available both as a topical treatment or oral tablet. It works by reducing the production of a hormone called dihydrotestosterone (DHT) which causes hair follicles to shrink and eventually stop growing hair.
It is commonly available in both 1mg and 5mg strengths. For hair loss, finasteride is sold as Propecia at 1mg strength while the 5mg treatment is available to treat benign prostate enlargement under the name Proscar.
Multiple studies have found finasteride highly effective at stopping and even reversing hair loss. It is important to note, however, that finasteride effectively increases scalp hair growth only. Body hair is not affected as it is not sensitive to DHT levels. For patients looking to improve their facial hair, minoxidil can effectively improve beard growth.
Unlike minoxidil, a hair loss treatment which works as a vasodilator, generally finasteride is not suitable for women.
You do not need to take finasteride after a hair transplant. It does not affect the success of the procedure itself.
However, many doctors recommend using finasteride as an additional tool during the transplant process, particularly for patients with androgenetic alopecia (also known as female pattern hair loss or male pattern baldness). Although research on the effectiveness of finasteride-assisted hair transplant recovery is limited, initial results indicate there are three main advantages:
While a hair transplant can have significantly transformative effects, men with male pattern baldness will continue to experience hair loss after their hair transplant surgery. It is unlikely that transplanted hair will shed however, areas such as the crown, hairline, and temples remain vulnerable to further balding. Therefore, hair loss will continue if left untreated. This progressive balding can leave the transplanted hair surrounded by areas of balding, which in turn will give an unnatural and patchy appearance.
Finasteride prevents this further hair loss by blocking the production of DHT, helping to maintain hair and even reverse past hair loss. The medication is appropriate following both an FUE (follicular unit extraction) and FUT (follicular unit transplantation) procedure.
Initial studies into finasteride-aided hair transplant recovery are promising. One 2005 study examined 79 men with androgenetic alopecia who were treated with either a placebo or 1mg finasteride following a hair transplant. The results were evaluated by a dermatologist, and while the patients with the transplant and placebo saw a 67% increase in visible hair, those treated with finasteride saw on average a 94% increase [2].
Based on these results, finasteride is commonly recommended following a hair transplant, especially for patients suffering from androgenic alopecia. Not treating future hair loss is one of the biggest reasons people may require a second hair transplant.
A study in 2000 was conducted to investigate the effect of a 1 mg dose of finasteride on the hair growth cycle over a 48-week period [3]. The results showed that finasteride had a dual impact: it not only increased the total number of hairs but also enhanced the number of hairs in the anagen phase, which is commonly referred to as the growth phase. Having more hairs in the growing phase than the resting phase (telogen phase) would result in the patient experiencing greater, and faster, hair growth.
While finasteride does not affect the transplanted hair, this increased growth phase can help patients visually recover from a transplant procedure. Most traditional FUT and FUE hair transplant procedures require the donor area to be shaved, something that can be a clear indicator of a hair transplant operation. However, the increased, faster regrowth of donor areas can help patients quickly return to their normal appearance.
After a hair transplant procedure, the majority of patients encounter a period of hair shedding that typically occurs within 2-4 weeks. This type of hair loss is referred to as telogen effluvium or “shock loss,” and is temporary.
This condition occurs when the shock of the hair transplantation causes both the newly transplanted hairs and neighbouring existing hairs to fall out, leaving the hair follicle roots securely embedded in the scalp. In the weeks and months that follow, these hairs will regrow. Read more about shock hair loss following a hair transplant.
However, using finasteride after hair transplant surgery is believed to reduce the risk of shock loss as well as encourage a faster recovery when effluvium does occur [4]. Studies are yet to examine this definitively, but multiple medical reviews indicate that this understanding is heavily widespread across the hair transplant community [5].
You can take finasteride before your transplant, and many clinics would suggest starting as soon as possible to prevent further balding. If the hair loss has progressed significantly, patients may be advised to delay surgery for several months to slow down the rate of hair loss.
Patients with considerable or ongoing hair loss may need to take finasteride for extended periods of time, potentially indefinitely. If a patient stops using finasteride, their production of DHT will resume and hair loss will quickly begin again. Check out our gallery of finasteride results for more information on the finasteride hair growth timeline.
Long-term use also provides the best results for maintaining hair density. A review of finasteride studies noted that 48% of patients had clear hair growth after one year, compared to 66% of patients after two years [6]. Another study examined the finasteride use of 2,561 men over five years and recorded that 87.1% of patients noted hair regrowth within that time [7]. Please note that these results are purely non-surgical and the patients did not have a hair transplant.
Finasteride also works best with daily application, so long-term, regular application is best to see the greatest results.
There are several alternative hair-loss treatments to finasteride.
The most effective of these is minoxidil, the only other FDA-approved hair loss treatment. Unlike finasteride, minoxidil does not affect patients’ hormones making it a more suitable treatment, especially for female patients.
Finasteride can also cause side effects including low libido, sexual dysfunction, and, more rarely, depression and swelling around the chest [8]. Patients should immediately inform their doctor if experienced and in these cases, minoxidil may be a more appropriate treatment. Read more about finasteride vs minoxidil.
Dutasteride is an alternative DHT blocker, although it can have similar side effects. There are also a range of natural DHT blockers including caffeine shampoos, rosemary oil, pumpkin seed oil and black seed oil.
For patients who do not wish to continuously treat their hair loss, a second hair transplant may be the most viable option to maintain a full head of hair. However, progressive balding can reduce the viable donor areas and so patients should be aware that a second transplant is not always an option.
At the Wimpole Clinic, we’re proud to say that our hair transplant success rate is 97-100%. We want to make sure you’re satisfied with the results for years to come, and so part of our service includes encouraging patients to treat their ongoing hair loss using finasteride or minoxidil.
This preventative treatment is not essential but recommended, and we at the Wimpole Clinic will work with you to develop an individual, specialised plan.
To learn more about Wimpole Clinic, take a look at our hair transplant clinic reviews, and our hair transplant before and after gallery. If you like what you see and want to know what we can do for you, book a consultation with a hair loss specialist today.
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