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Any thoughts on Hair Transplant without Propecia/Finasteride? (photos)

First question here on RS :) I'm 25 years old and have been losing my hair since 23. I was on a quarter of Finasteride for a year and did wonders for me, all my hair came back but got really bad sexual side effects from it around 6 months in - had to stop taking it. Minoxidil did nothing for me. Looking at HT now. Some docs are telling me might need two HT's because I'm younger and the hairloss/itching isn't stopping. Any thoughts as to the effectivness of HT's without help from Finasteride?

Doctor Answers 9

June 29th, 2015

Side effects with Propecia

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Some people can get away with a lower dose. a 1/4 tablet of a 5mg dose can be reduced to start off taking one dose every 4th days, then after a few weeks, if you don't have side effects, increase it to one pill every third day, then again in a month of so, try 1 dose every other day and stay on that dose if you can tolerate it without side effects.  This has worked well for many of the patients who had sexual side effects and wanted to be on the drug for the benefits. FYI one pill every other day has 80% of the benefit and one pill every 4th day has 50% of the benefits so the routine I defined here might work for you.

A hair transplant without the drug finasteride in a young man under 35, increases the risk of shock loss. For men who have a hair transplant under 25, the risk for shock loss is close to 90% so create caution should be exercised in the decision to have a hair transplant for men under 25 because the value of the hair transplant could be offset by the loss of hair from shock loss. Those men who are undergoing rapid hair loss and are under 25, the first of shock loss goes up to close to 100%
William Rassman, MD


Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 28 reviews

July 9th, 2015

It depends

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You do not have to take Propecia to have hair transplant surgery.  It is generally recommended but it is not an absolute rule.  Propecia may help by minimizing shock hair loss after surgery, but again, it is not a mandatory rule.

Learn more: http://baldingblog.com/?s=propecia&x=0&y=0

Jae Pak, MD

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 103 reviews

June 29th, 2015

Pills and procedures

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Thanks for the photos.  Yes, some people have a hard time dealing with the side effects.  It's not for everyone.  Most men that we do HT on are actually not on Propecia or Finestaride.  Most just take Rogaine.  I'm not sure you need 2 procedures.  That's tough to predict.
Tim Neavin, MD

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 50 reviews

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June 13th, 2017

Finasteride and hair restoration procedures

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Finasteride does two things for you:

  1. Minimize the risk of shock loss after hair transplant
  2. Maintain the rest of your hair and prevent further hair loss

If you are not using finasteride you may have to experience further hair loss after your procedure. You need to check with your doctor and see what is recommended based on your levels of active hair loss. 

Learn more: http://parsamohebi.com/hair-loss/medical-treatment/propecia-finasteride

Parsa Mohebi, MD

Parsa Mohebi, MD
Beverly Hills Hair Restoration Surgeon
5.0 out of 5 stars 33 reviews

October 21st, 2016

Any thoughts on Hair Transplant without Propecia/Finasteride?

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The “Organic Hair Transplantation” method is a novel development in modern hair transplantation surgery practice which was developed with the efforts of our research and development department. Now; our successful hair transplantation results has evolved to a new era thanks to the “Organic Hair Transplantation” method. We can consider this new method as a revolutionary development.

“Organic Hair Transplantation” is based on injection of a mixture containing adipose derived stem cells obtained from own fat tissue of the patient to the scalp of the patient. The recipient area gets rejuvenated and the viability of transplanted grafts is increased with the effects of adipose derived stem cell injection. The injection of adipose derived stem cells also provides a better work area for the surgeon.

Loss of hair is a natural process when it is between the limits that the body can restore them

Bulent Cihantimur, MD
September 3rd, 2015

At your age, hair transplants are not advised, but we an save your hair and stop further loss without surgery or drugs

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Thank you for your question, and thank you for providing a detailed history of your hair loss problem. You seem to be asking quite a well-thought out question, and with the experience I’ve gained from practicing in Manhattan and Long Island for over 20 years, during which hair transplantation and hair loss treatment was an important part of my practice, I can certainly give you some insight about hair transplantation in men in their 20s.

First and foremost, it is important to keep in mind that in the absence of stabilization, hair transplantation is significantly limited. Without proper stabilization, your hair loss will continue to progress. The donor area, by nature, is also limited, and without stabilization, it will end up that the amount of hair you will need cannot be met by the amount of hair that can be transplanted. Because of this, I generally do not recommend hair transplantation in the absence of stabilization.

There is, however, a treatment that we have developed in our practice that can help with progressive hair loss, and it’s called Hair Regeneration. Hair Regeneration is a hair loss treatment that combines platelet-rich plasma, which is derived from your own blood, and extracellular matrix, which is used for wound healing. This treatment is quite remarkable as close to 100% of our patients with male pattern hair loss were able to stop progression of hair thinning and reverse their hair thinning, making them thicker. We have also been able to demonstrate that the results of this treatment exceeds the results gained from having two hair transplant surgeries.

Although there are a few cases wherein some patients do not respond to the treatment, we also have 3-5 years’ worth of clinical data that shows no signs of regression in patients who’ve received the treatment. For some patients, we may do a second injection, depending on the degree of their hair loss progression. During and after the treatment, we watch our patients very closely and carefully, and during counseling, it is clear that there is a preference for getting an injection every 3-5 years to maintain their hair, rather than getting surgery every few years.

So far we have been so happy and very impressed with the results that we have even began to develop treatment centers, called Trichostem Hair Regeneration centers, for the purpose of bringing this treatment to more people.

Certainly there are many people who are frustrated with the limitations of hair transplantation surgery, and while it is a great procedure, candidates must be selected carefully and appropriately. Again, keep in mind that stabilization is a key factor if you plan to pursue a surgical solution.

I recommend that you also learn about the option of Hair Regeneration and do a bit more research. Try not to be swayed by the allure of different high tech surgical technologies because these will all still be subject to the limitations of the donor area.

I hope that was helpful, I wish you the best of luck, and thank you for your question.

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Learn more: http://nyhairloss.com

Amiya Prasad, MD
July 6th, 2015

Hair Transplant and Minoxidil

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You dont have to take finasteride, however you can have hair transplant to restore your hairline then you can use minoxidil or rogaine. Because you are young you may lose more hair in future; a second hair transplant may or may not be neccessary depending on the rate and quantity of the hair loss.
Ekrem Civas, MD
July 1st, 2015

Hair transplant in younger patient

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not every one needs Propecia. However since  hair loss is progressive, you may continue to lose your native hair in the future. You can regain the lost hair with the hair transplant but to prevent future hair loss you may need to start some sort of medical regiment. For our younger patients who have problems with propecia, they can start or try other medical regiments to see if it works for them. However if they don't want to try or stay on medical regiment and their native hair continues to thin out then they may require second procedure in the future.  So second hair transplant is an option for hair loss of the native hair in the future.  However you can do the first hair transplant and may be very happy for many years to come before requiring any additional treatments. 
Michael Meshkin, MD

Michael Meshkin, MD
Newport Beach Hair Restoration Surgeon
4.9 out of 5 stars 28 reviews

June 29th, 2015

25-year-old with side effects on finasteride

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The earlier suggestion by Dr. Rassman was a good one. But even if a gradually increasing dose of finasteride solves the problem – and especially if it doesn't – you should think seriously about adding another arrow to your quiver: at 25, you have the potential to lose much more hair over the years, so it is very important to try to minimize that future loss. The combination of finasteride + minoxidil + low level laser therapy is more likely to be effective than finasteride alone. Perhaps most important, itching is not associated with male pattern baldness, so I would strongly recommend seeing a dermatologist before making a decision to hava hair transplant. 

Jonathan Ballon, MD (in memoriam)
Atlanta Hair Restoration Surgeon

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