Is it worth it to get a hair transplant without finasteride?

Finasteride is a fantastic drug. For someone your age this would be my top recommendation. Surgery can wait. And doing surgery without finasteride means that your native hair will continue to bald, likely requiring more surgery in the future. The transplant may also look bizarre if all the hair around it has fallen out. This is the key reason I highly recommend finasteride with surgery. The same applies to your father. If he were to have surgery we would want to be sure he maintains the hair he has and does not rapidly bald in the future. He could have full coverage initially but without finasteride that may not last. Finasteride is not a permanent cure but it sure helps out a lot. 

Thank you for your question. You state you are on the edge of getting a hair transplant, and you don't want to take finasteride because you don't want to take a drug for the rest of your life and observed results of people with hair transplant without finasteride which appeared impressive. Further, you submitted photos of your father’s scalp to ask whether or not he would get full coverage without taking finasteride if he underwent hair transplant. The gist of your question is can you get a hair transplant without taking finasteride.
I can share with you the important information I discuss with my patients for management of hair loss, which is a key to understanding. Hair loss is managed, so no matter what, you’re not in any way considering a cure, but what you want is to get the best appearance that works for the look you want to achieve.
A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, based on a system we developed to non-surgically treat men and women with androgenetic alopecia, or genetic pattern hair loss, which makes up 95% of hair loss patients.
To answer the question about your father’s scalp, I think in every hair transplant consultation, the discussion is pretty similar. The goal is for transplant not to cover the entire scalp because there’s intrinsically a mismatch. Whether it’s with an FUT or FUE, you have a limited area of harvesting from the donor area at the back of your scalp. You can get body hair transplant but let’s stick with just that. The top of the scalp has way too much surface area for you to be able to cover everything. Doing transplants for as long as I have, I always discuss with my patients that the goal is to frame the face by creating a frontal hairline, as well as coverage to the mid scalp to get a natural transition. However, a hair transplant does not do anything to the progression of hair loss.
With your concern, even if you didn't submit a photo, if you’re 21-years-old and on the edge of having a hair transplant, it might be fair to conclude you are losing hair at a relatively aggressive pace, and indicates many issues about the feasibility of hair transplant. It is generally a standard among hair transplant surgeons to limit or avoid doing surgery in men under 30. This is because in hair loss, if you have an early onset and a relatively rapid rate of progression, the hair transplant is not likely to keep up with your rate of progression. The typical ideal candidate for hair transplant in my opinion is a middle aged man with a later onset of hair loss, who has more of a frontal balding progression. Basically, they have later onset, a slow rate of progression, they need hair in the front where a transplant can be placed and their relatively slow rate of progression means they may or may not choose to take finasteride, but they will appreciate and get the benefit for many years. Hair loss will still progress, but that is in contrast with a younger person who has an early age of onset, rapid rate of progression, and more advanced loss. A younger person is not an ideal hair transplant candidate. It’s very important to understand there is no cure, but there are strategies to manage hair loss.
When I meet a patient in their 20s, and we have this discussion everyday in our practice, we treat patients from around the world with Hair Regeneration. This is a system we developed out of helping  hair transplant patients. The challenge with hair transplant has always been getting really effective coverage, maximizing the survivability of the grafts, and minimizing scarring. With transplant the challenge was always  maximizing the longevity of the appearance, and that meant encouraging our patients to take finasteride to slow down progression.
It is my perception that although finasteride may be more effective for some people compared to others, a lot of this has to do with the specific genetic pattern, relative aggressiveness of hair loss, and relative sensitivity to DHT. Arguably, someone who has later onset has lower DHT sensitivity than someone who has an early onset. It’s not always black and white like this, but it’s a good framework to decide how to manage a person with hair loss.
I talk to a lot of our younger patients about considering taking finasteride. I provide them the clinical information relevant for them, and not just the information that is more popular on the internet, as well as a strategy for Hair Regeneration treatment. Hair Regeneration is an injection treatment combining platelet-rich plasma (PRP) with Acellular matrix based on algorithms I’ve developed over the past 7-8 years. Those algorithms are based on gender, age, age of onset, rate of progression, degree of progression, and other medical factors in terms of dosing, timing and placement of this injection. However, I would uniformly say that most young people I would discuss finasteride. Patients will choose whether or not to take the drug, but it is part of that discussion.
Hair loss is progressive. Everybody eventually loses hair with rare exception, but it depends on when that hair loss begun and how aggressively it progresses in determining who is a good candidate for transplant and who isn’t. Even people who have a later onset, if they have a more diffuse thinning pattern, they’re not going to be a great candidate for transplant. Like I said, the ideal candidate from my perspective is a middle aged man with frontal balding. T When you talk about your dad’s situation, yes I would still encourage someone with that hair loss pattern to consider finasteride, but it is a different rate of progression compared to a younger person.
It’s important you learn all this. Do some consultations, and figure out what works best for you. I tell a lot of our patients in their 20s that before they think about taking a pill for the rest of your life, understand that being in practice for over 20 years, I can tell you from experience that a lot of men may think that hair is important to them at a certain stage of their life, but as they get older, they may consider it less important. It’s a personal decision. If you are committed to managing your hair loss, it makes the most sense to use every tool you can, and not just ignore something. People who are more middle aged and have a later onset may have a little more breathing room, but there is also typically less urgency in their situation compared to younger people. I hope that was helpful, I wish you the best, of luck and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.