Is AGA treatment necessary after hair transplantation? How to manage medication to protect existing hair

Even after hair transplantation, AGA (androgenetic alopecia) may progress in the original hair that was not transplanted (existing hair). For this reason, treatment using medication may be performed together[1]. The type of medication, when to start, and how long to continue are determined for each individual while monitoring side effects and scalp recovery[2].

What is the difference between transplanted hair and original hair?

Hair transplant surgery involves removing hair follicles (the roots that produce hair) from areas such as the back of the head and transplanting them to areas where hair has thinned. It does not involve replanting the original hair that remains around those areas. If AGA progresses in the original hair, there is a possibility that only the transplanted hair will remain visible. For this reason, a long-term plan includes management to suppress AGA progression.[3].

Why medications are used before surgery

Textbooks indicate that people considering hair transplants should first stabilize hair loss with medications such as finasteride before surgery. When hair loss has stabilized, it becomes easier to determine the hairline position and the required number of grafts (the number of hairs to be transplanted).[3].

What is the role of medications after surgery?

Topical minoxidil (external minoxidil) is sometimes used to help the growth of transplanted hair. According to textbook references, when used together with finasteride, there were more hairs after surgery.[3]On the other hand, the effectiveness, side effects, and who can use it differ depending on the medication.

When should I restart, and how long should I continue?

If you stop AGA medication, hair loss may progress again. For this reason, it is a treatment based on the premise of continuing it.[4]However, Japanese guidelines note that there is variability in the types of conservative treatments (non-surgical, medication-based treatments) used after hair transplantation and the timing of their initiation.[2].

Should I continue taking medication — how is this decided at the consultation?

At the consultation, we confirm the AGA diagnosis, the original progression of hair loss, previous effectiveness and side effects, and precautions related to pregnancy. Do not start or stop medication on your own before or after surgery; coordinate the instructions from the physician performing the transplant and the physician prescribing the medication to decide on a treatment plan suited to you.