Post hair-transplants care for women

A lot of information about hair transplants and post-transplant care is available on the internet. However, these articles are usually targeted at men and do not account for the growing number of women who undergo such procedures. This article therefore is specifically written for women.

Here, we give you our expert overview of post-transplant care for women. What medicines are available, how well they work, potential side effects, and alternative treatments to help you make an informed decision.

Consider the cause of hair loss or thinning

For men, the cause of balding is male pattern baldness 90% of the time. In women, the cause of hair loss isn’t as predictable and can be triggered by many conditions and circumstances. Consequently, a medical professional must thoroughly examine the cause before any procedures and medication administration (1).

If a hair transplant is to be considered, the cause of hair thinning or balding must be triggered by a condition in which hair is not expected to return. Short-term causes of hair loss may include stress, pregnancy, infection, malnutrition, and taking certain medications such as oral contraceptives(2).

What medications or treatments may be recommended?

The most common cause of permanent female hair loss is androgenetic alopecia, and the remainder of this article will presume this to be the cause of hair loss or thinning. Androgens refer to the group of hormones that includes testosterone.

Both men and women have androgens that can affect hair growth, although the pattern of loss for each sex differs for a variety of reasons we won’t cover in this article.

Pain medication

Following a hair transplant, pain medication may be needed to manage any discomfort. Patients should always adhere to their surgeon’s advice and avoid overusing pain medication.

Generally, paracetamol will be the preferred treatment, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Both these medicines can be purchased at a pharmacy over the counter. Aspirin may want to be avoided because it is unknown whether oral aspirin inhibits or affects Minoxidil response (see next section)(3). There are plenty of other NSAID medicines, so this shouldn’t be an issue.

For those experiencing more significant discomfort, the next step up would be opioids like codeine. These should be used with caution due to the potential for dependency and side effects, such as drowsiness or nausea, and we recommend you discuss this with your surgeon if needed.

5-alpha reductase inhibitors

While popularly known as the male or masculine hormone, testosterone is also produced in smaller amounts in women. Likewise, men also produce female hormones, but again, in smaller amounts.

5-Alpha reductase (5AR) is an enzyme that converts testosterone into dihydrotestosterone (DHT), a hormone that interacts with hair follicles and contributes to hair loss. Consequently, post-hair transplant treatments usually include 5AR inhibitors (Finasteride, Dutasteride and Minoxidil) that block the 5AR enzyme and reduce the amount of DHT in the scalp.

For women however, the literature states that they are for men only and must not be used by women(4). Particularly so for pregnant women or women who might become pregnant, as it may cause abnormalities of the external genitalia of a male fetus(4).

What is the recommended post hair-transplant treatment for women?

In clinical practice, finasteride and dutasteride are both used off‐label for the treatment of women with alopecia or hirsutism, although these treatments are only partially effective.

The effectiveness of finasteride treatment in women varies and only some studies concluded that finasteride may be considered for the treatment of female pattern hair loss in patients who fail other treatments and adhere to reliable contraception during use(4,5).

Topical treatments

Topical treatments are not taken by mouth but applied to the skin, like creams, foams, solutions and lotions. While considered less convenient than oral medicines, they have one major advantage: reduced whole-body (systemic) absorption. This means that topically applied treatments typically have a localised effect on the area they are applied to, without significantly impacting hormone levels throughout the rest of the body. This localised action minimises the risk of systemic side effects, making topical treatments a better option for those concerned about the broader effects of treatment.

Specifically, this means that women can use topical treatments such as Minoxidil. Topical Finasteride is available however studies on efficacy of topical finasteride in females have been limited(5) and is currently not recommended.

The most common topical formulation of Minoxidil is known as Regaine, and is available as a foam or solution.

Regaine

Regaine, the brand name for topical Minoxidil, is one of the most widely used treatments for hair loss in women. Available as both a foam and a solution, Regaine has been clinically proven to be effective in promoting hair regrowth in women experiencing androgenetic alopecia. It works by prolonging the growth phase of the hair cycle and increasing blood flow to the scalp.

It is typically applied directly to the scalp once or twice daily, and users may begin to see results within a few months of consistent use. As with any treatment, it is important to follow the recommended guidelines and consult with a healthcare professional to ensure it is the right option for your specific situation.

How long should I use Minoxidil after my transplant?

Most surgeons recommend to wait a few weeks following the transplant procedure before beginning, or restarting, topical minoxidil. Once started however, it is recommended to continue taking Minoxidil indefinitely to maintain the benefits. Stopping the medication can lead to a resurgence of hair loss, as the underlying hormonal causes are not permanently altered.

Continuous use helps to preserve both the transplanted and existing hair. Always consult with your healthcare provider to tailor the duration of minoxidil use to your specific situation and to monitor for any potential side effects.

Should I use Minoxidil before my hair transplant?

Applying Minoxidil before your hair transplant can be beneficial, but it is recommended to stop a week prior to the procedure(6). Starting Minoxidil treatment in advance can help stabilise hair loss, which may improve your existing hair's overall health and density. This can create a better environment for the transplant and potentially enhance the results.

Additionally, minoxidil can minimise the risk of shock loss, where existing hair temporarily sheds after the procedure. Consult with your hair transplant surgeon or healthcare provider to determine the best timing and strategy for incorporating minoxidil into your hair restoration plan.

Treatments available from Oxford Pharmacy

With a prescription or following a consultation with us, Oxford Online Pharmacy offers most prescription hair loss treatments. Minoxidil foam and solution is available to buy without a prescription as are several supporting vitamins and shampoos.

References

1. Hair Transplant Surgery | The British Association of Aesthetic Plastic Surgeons. Accessed August 23, 2024.
2. Hair Restoration. Accessed August 23, 2024.
3. Goren A, Sharma A, Dhurat R, et al. Low-dose daily aspirin reduces topical minoxidil efficacy in androgenetic alopecia patients. Dermatol Ther. 2018;31(6):e12741.
4. Teichert M, van Puijenbroek E, Stricker BH. Contraindicated use of 5‐alpha‐reductase inhibitors in women. Br J Clin Pharmacol. 2017;83(2):429-431.
5. Iamsumang W, Leerunyakul K, Suchonwanit P. Finasteride and Its Potential for the Treatment of Female Pattern Hair Loss: Evidence to Date. Drug Des Devel Ther. 2020;14:951-959.
6. Zito PM, Raggio BS. Hair Transplantation. In: StatPearls. StatPearls Publishing; 2024. Accessed August 23, 2024.