Medical Treatment
Medical treatment is the part of hair restoration nobody gets excited about, and it is the part that decides everything. Two drugs have solid evidence behind them. Finasteride blocks the hormone that drives male pattern loss, and minoxidil prolongs the growth phase of the follicles you still have. Everything else sold for hair loss sits somewhere between promising and decorative.
Neither of them does what a transplant does. They do not move hair into a bald area, and no drug regrows a follicle that has been gone for years. What they do is hold the ground you still occupy, and sometimes recover a little of what was recently lost.
That sounds modest. I think it is the whole game. A transplant is a one-off redistribution of a finite supply, and the loss it was treating keeps going underneath it. Hold the surrounding hair and a transplant can look right for decades. Do not, and you get an island of transplanted hair with a widening gap behind it, which is the commonest way a technically good operation ends up looking wrong.
Who medical treatment is for
Anyone with androgenetic hair loss who wants to keep what they have, which is almost everyone reading this. The best time to start is early, because both drugs are far better at holding hair than at bringing it back.
Anyone planning a transplant should be on something first, ideally with a year or two of stability behind them. Most careful surgeons ask for it, and the ones who do not are the ones to worry about.
The exceptions are real. Finasteride is not appropriate in pregnancy or for anyone who may become pregnant, and it needs a proper conversation about side effects that some men find unacceptable. Minoxidil suits almost everyone but has to be continued indefinitely. Loss that is not androgenetic, such as alopecia areata, scarring alopecias or thyroid-driven shedding, needs a dermatologist rather than a hair loss clinic.
Trans women on oestrogen and an androgen blocker are often already receiving most of what finasteride would do, and should ask their prescriber rather than adding to it independently.
Before you start anything
Take a proper set of baseline photographs, four angles in flat daylight, before your first dose. Both drugs work slowly and mostly invisibly, and without a before you will spend a year unable to tell whether anything is happening.
Choosing between them
Finasteride is the one that changes the trajectory, because it addresses the cause. If you are going to take one thing, take that, assuming you have weighed the side effect conversation properly.
Minoxidil is the one that adds visible thickness, works anywhere on the scalp, and carries far less baggage. It is the obvious starting point for anyone who does not want a systemic drug, and the obvious addition for anyone already on finasteride.
Taking both is standard and they work on different mechanisms, so the combination does more than either alone. Most dermatologists would start there for someone with active loss who wants to keep their hair.
Everything else is a longer conversation. PRP and the rest covers platelet-rich plasma, microneedling, ketoconazole shampoo, dutasteride, oral minoxidil and the supplement aisle, which range from reasonable adjuncts to marketing.
Where practitioners genuinely disagree is on oral minoxidil and on dutasteride, both of which are used off-label, both of which are more potent than the standard option, and both of which need a prescriber who will monitor you rather than a website that will post it.
At your first appointment
Ask the prescriber to talk you through the side effect profile in numbers rather than reassurance. It is your decision to make, and making it on actual figures is the only way to be comfortable with it years later.
Guides
The pages below cover each treatment in turn: what it does, what the evidence actually shows, what it costs and what it asks of you. Read finasteride and minoxidil first. They are the only two with results that would matter to a surgeon.
The last page is about what happens after a transplant, which is where most people quietly stop taking things and where the trouble starts.
Finasteride
The only widely available drug that addresses the cause rather than the symptom. It holds hair, it has a side effect conversation, and it works for as long as you take it.
Minoxidil
The one you can buy over the counter. It thickens what you have rather than stopping loss, and it has to be continued indefinitely.
PRP and the Rest
Everything offered alongside the two drugs that work. Some of it is a reasonable adjunct, some of it is expensive, and the difference is worth knowing.
Keeping a Transplant
The transplant is the easy part. This is the thirty-year part, and it is where most results are quietly lost.
Medical treatment recovery
Nothing here has a recovery in the surgical sense, but everything has a timetable, and it is slower than people expect.
Both drugs go through a shedding phase in the first two to three months, where hairs in a resting phase are pushed out as new growth starts underneath. It looks like the treatment is making things worse. It is not, and stopping at that point is the most common way people abandon something that was about to work.
Visible change takes six to twelve months, and the honest first result is often not regrowth but the absence of further loss, which is hard to appreciate without photographs. Full effect is judged at a year.
Stopping reverses it. Everything a drug held is lost over the following six to twelve months, and usually you end up where you would have been had you never started. This is a lifelong commitment or it is nothing.
Medical treatment cost
Cheap, relative to everything else on this site, and permanent. Generic finasteride costs a few pounds or dollars a month; minoxidil is similar. Over thirty years that adds up to a meaningful figure, and it is still a fraction of one transplant.
Subscription services charge several times the generic price for the same molecules with better packaging. I have never seen a good clinical argument for paying it. There is nothing wrong with the convenience if you value it, and there is no clinical difference.
The costs to actually watch for are the ones around the edges. PRP courses run to four figures a year in some clinics, laser caps are sold at a few hundred, and the supplement market is essentially unregulated. None of that is where your money does most work.
Where it fits
Medication comes first, before any surgical plan, and continues afterwards indefinitely. If you take one thing from this site, take that.
Start with finasteride if you are going to use it, give it twelve months, and photograph the result. Add or start minoxidil at any point. Only then should a transplant be planned, on a head where the loss is documented as stable.
After surgery, everything continues. Some surgeons pause minoxidil for a couple of weeks around the operation and most continue finasteride throughout. Follow their protocol, then go back to the long-term routine and stay on it.
Eligibility
Anyone can buy minoxidil over the counter almost everywhere. Finasteride requires a prescription in most countries, which is appropriate, and it is widely available through general practice and online prescribers.
The thing worth saying is that a proper diagnosis comes first. Androgenetic loss looks different from telogen effluvium, from alopecia areata and from scarring alopecias, and the treatments are entirely different. If your loss is patchy, sudden, itchy, painful or accompanied by scaling, see a dermatologist before you buy anything. The eligibility pages go into who each treatment actually suits.
Frequently asked questions
Do I have to take it forever?
Yes. Stopping returns you to where you would have been within six to twelve months. See recovery.
Which works better, finasteride or minoxidil?
Finasteride addresses the cause and changes the trajectory; minoxidil adds visible thickness. Most people with active loss use both. See choosing between them.
Will my hair fall out when I start?
Often, for two to three months. It is resting hairs being pushed out by new growth, and it is the point at which most people quit too early.
Can I just have a transplant instead?
You can, and the untreated hair around it will keep thinning. That is how a good transplant ends up looking wrong. See the intro.
Does PRP work?
The evidence is mixed and the protocols vary wildly between clinics. It is an adjunct at best. See PRP and the rest.
Thinking about a transplant?
The Start Here guide explains why medical treatment comes first, how much donor hair you actually have, and what a transplant can and cannot move.
start here →