Should I use Finasteride after a hair transplant?

Finasteride is a daily treatment that is often recommended following a hair transplant. It effectively slows hair loss caused by testosterone, which is a leading factor in male pattern baldness, making Finasteride for hair loss a popular choice.

While hair transplant surgery addresses previous hair loss, ongoing treatment with Finasteride can help preserve the results and prevent, or reduce, more future hair loss.

Do you have to take Finasteride after a hair transplant? Here, we give you our expert overview of Finasteride, what it does, how well it works, how long it lasts, its potential side effects, and alternative treatments to help you make an informed decision.

Do I need to take Finasteride after a hair transplant procedure?

In short, no. But it’s usually well-tolerated, and recommended by most surgeons to improve and maintain the results post-surgery.  While a hair transplant replaces areas of already lost hair, it doesn’t stop future loss or thinning of the non-transplanted hair.

Taking Finasteride can significantly enhance the longevity of your transplant by preserving your existing hair, preventing further thinning and sometimes even increasing hair density.

One study with a group of 79 people found that following a hair transplant, therapy with Finasteride 1 mg daily improved hair growth and hair counts compared with placebo(1).  By week 48 post-transplant, 94% of those who received Finasteride showed visible improvement from baseline in hair growth compared with only 67% of those who received placebo(1).

How Finasteride helps promote hair growth

Finasteride does not bind to testosterone receptors and neither does it bind with male hormones, female hormones, or progesterone. It works to help grow hair by blocking the action of an enzyme called 5-alpha reductase (5AR)(2). 5AR turns testosterone into dihydrotestosterone (DHT), a hormone that interacts with hair follicles on the scalp and contributes to hair loss.

Finasteride reduces the amount of DHT in the scalp, slows down hair loss and promotes the regrowth of thinning hair. Over time, Finasteride may result in thicker, fuller hair and can help maintain the results of a hair transplant. It's important to note that Finasteride is most effective in the early stages of hair loss and requires consistent ongoing use to sustain its benefits.

What is “shock loss?”

"Shock loss" refers to the temporary loss of hair that can occur after a hair transplant. Specialists think it is caused by the trauma and inflammation following the transplant procedure that can compromise blood supply to the hair follicles.

Although it can be alarming, shock loss is common and typically temporary. The hair usually begins to regrow within a few months as the follicles recover and enter their normal growth cycle(3). Full recovery is almost always seen in the following 3–4 months(4).

Topical hair loss treatment Minoxidil has been shown to reduce the chance, severity and recovery time of shock loss, and the likelihood of having to have further transplants(4).

What is “inverse pattern baldness?”

Typically, male pattern baldness begins with a receding hairline or thinning at the crown of the head, while the hair on the sides of the head remains intact.

“Inverse pattern baldness" refers to the hair loss pattern that can result when transplanted hair is growing healthily but the surrounding non-transplanted hair continues to recede or thin over time.

Treatments for this inverse pattern include further hair transplants, medications like Finasteride, or topical solutions like Minoxidil. The aim is to prevent balding of the non-transplanted hair that surrounds the new transplanted section, protecting the visual impact over time.

The end result is a full head of hair with no obvious difference between the transplanted section and the remaining hair.

Is Finasteride my only option?

Following a hair transplant, the post-procedure treatment options are limited. While Finasteride is not your only option, the only other prescription strength options currently available are Minoxidil and Dutasteride. All three options are available in a tablet or capsule and require daily dosing.

Minoxidil and Finasteride are also available in a topical formulation which is applied directly onto the scalp. These may be more suited for those who dislike, or are unable to take oral medications. Additionally, lifestyle changes, such as a healthy diet and stress management, can support hair health.

Minoxidil, Finasteride and Dutasteride all promote hair regrowth

All the treatments in this list work by inhibiting the enzyme 5-alpha reductase (5AR), which in turn reduces the levels of dihydrotestosterone (DHT). Lowering DHT levels helps prevent the shrinkage of hair follicles and slows hair loss.

Finasteride

Finasteride came on the market in the 1990s, although the underlying research began two decades earlier(5). It may be the most commonly used 5AR inhibitor for hair loss, and you may see it referred to as Propecia tablets, which is the brand name for Finasteride 1mg tablets.

It’s now available as a generic medicine, which means it can be found for a better price when compared to the branded drug.

Minoxidil

Discovered in the late 1950s and initially used to treat high blood pressure. It was noted that the drug also stimulated hair growth(6).

Minoxidil is available as a tablet but is more commonly known as the topical solution Regaine (Rogaine in the US) that is applied directly to the scalp.

Whether taking the tablet or applying the solution or foam, they are to be used every day. The oral dose is 2.5mg once daily, while the topical solution is advised to be used once or twice daily depending on the strength and whether the patient is male or female(7). Topical solutions should be started approximately 4 weeks after the transplant to allow time for the transplanted hair follicles to become anchored(8).

Dutasteride

The most recent discovery on this list, Dutasteride was patented in 1996 and sold under the brand name Avodart. It’s also available as a low-cost generic.

During the discovery phase, Dutasteride was developed to block both type 1 and 2 forms of human 5 alpha-reductase(9). Finasteride only blocks type 2(10).

This makes Dutasteride three times more potent than Finasteride at blocking the type 2 5AR enzyme(11). We only consider prescribing Dutasteride for people who have already tried Finasteride for at least 6 months without success.

FAQs

How long should I take Finasteride after my transplant?

It is recommended to continue taking Finasteride, and other 5AR inhibitors, indefinitely to maintain the benefits. Stopping Finasteride after a hair transplant can lead to a resurgence of hair loss, as the underlying causes of hair loss are not fixed by a transplant. Continuous use helps to preserve both the transplanted and existing hair by reducing the effects of DHT. Always consult with your healthcare provider to tailor the duration of Finasteride use to your specific situation and to monitor for any potential side effects.

Should I use Finasteride before my hair transplant?

Using Finasteride before your hair transplant can be beneficial. Starting Finasteride treatment in advance can help stabilise hair loss by reducing DHT levels, which may improve the overall health and density of your existing hair. This can create a better environment for the transplant and potentially enhance the results. Additionally, Finasteride 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 finasteride into your hair restoration plan.

Safety review of Finasteride

In April 2024, the UK medicines regulator (MHRA) released a report about the risks associated with Finasteride, including persistent sexual dysfunction and suicidal thoughts(12). While these are known potential, and uncommon side effects documented in the literature, the review was initiated in response to enquiries made to draw more attention to them(12).

The recommendations following this review include a patient card to be included in the box detailing some of these side effects and that in some cases, these effects may continue after stopping(12).

For patients wanting to avoid Finasteride, we suggest you consider daily Minoxidil tablets. Tablets are generally more convenient than applying a foam or liquid every day, but topical solutions tend to have fewer potential side effects as the effect is restricted to the application site.

References

1. Leavitt M, David PM, Rao NA, Barusco M, Kaufman KD, Ziering C. Effects of Finasteride (1 mg) on Hair Transplant. Dermatol Surg. 2006;31(10):1268-1276.
2. Propecia 1 mg Film-Coated Tablets - Summary of Product Characteristics (SmPC) - (emc). Accessed August 4, 2024.
3. Kerure AS, Agrawal SM, Dhurat R, Ginzburg A. Donor Area Acute Effluvium following Follicular Unit Extraction—Trichoscopic Simulator of Alopecia Areata: Series of Four Cases. J Cutan Aesthetic Surg. 2020;13(1):31-34. doi:10.4103/JCAS.JCAS_77_19
4. Kerure AS, Patwardhan N. Complications in Hair Transplantation. J Cutan Aesthetic Surg. 2018;11(4):182-189.
5. How was finasteride invented? Finasteride Watch. Accessed August 8, 2024.
6. Bryan J. How minoxidil was transformed from an antihypertensive to hair-loss drug. The Pharmaceutical Journal. July 20, 2011. Accessed August 8, 2024.
7. ROGAINE® Minoxidil Hair Regrowth Treatment for Thinning Hair. ROGAINE®?. Accessed August 8, 2024.
8. Do You Need to Use Minoxidil After A Hair Transplant - Benefits & Results - Wimpole Clinic. Accessed August 11, 2024.
9. Frye SV. Discovery and clinical development of dutasteride, a potent dual 5alpha-reductase inhibitor. Curr Top Med Chem. 2006;6(5):405-421.
10. Goldenberg L, So A, Fleshner N, Rendon R, Drachenberg D, Elhilali M. The role of 5-alpha reductase inhibitors in prostate pathophysiology: Is there an additional advantage to inhibition of type 1 isoenzyme? Can Urol Assoc J. 2009;3(3 Suppl 2):S109-S114.
11. Hirshburg JM, Kelsey PA, Therrien CA, Gavino AC, Reichenberg JS. Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review. J Clin Aesthetic Dermatol. 2016;9(7):56-62.
12. Finasteride PAR Accessed August 8, 2024.