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Should You Have A Hair Transplant Without Propecia

The amount of horror stories that exist online about Propecia (finasteride) is astounding. Some claim that Propecia (finasteride) has caused permanent sexual dysfunction, others claim they have cognitive disorders after taking the medication. Today, Propecia (finasteride) remains to be one of the most controversial topics in the hair loss community. However, is Propecia (finasteride) a requirement for those who want to undergo hair transplant surgery? Keep reading this article and find out.

What is Propecia (finasteride)

While some of those reading this article may already know or have heard about Propecia (finasteride), many don't know how the drug actually works. Propecia (finasteride) is a 5-alpha reductase inhibitor. The 5-alpha reductase enzyme is responsible for converting testosterone in to dihydrotestosterone (DHT) through the blood stream. DHT is the hormone responsible for triggering genetic hair loss. Propecia (finasteride) is considered an anti-androgen medication. It can inhibit up to 70% of DHT serum through the blood stream. While DHT has been somewhat villianized in society, it actually has important functions in the body but more on that later. Propecia (finasteride) was approved by the FDA to treat male pattern baldness in 1997 and has since become the most effective treatment for hereditary hair loss on the market.

Why Do We Produce DHT?

DHT is an endogenous androgen sex hormone, as previously mentioned the 5-alpha reductase enzyme converts testosterone in to DHT in certain tissues including the prostate,skin and hair. DHT has many biological functions in the body and is important for the development of male genitalia during puberty. DHT is also responsible for the production of facial hair, pubic hair and body hair, as well as deepening the voice. Moroever, unlike testosterone DHT can not be converted in to estrogen by the enzyme aromotase.

What Can Happen If You Have A Hair Transplant Without Taking Propecia

Unfortunately, androgenic alopecia is a progressive condition that gets worse over time. In the beginning, hair loss is generally exhibited through temporal recession. However, as time goes by the recession expands to the mid-section and ultimately ending at the crown (vertex). In some cases, individuals may even suffer parietal hump (lateral hump) recession. This recession is observed in those suffering from the most severe hair loss pattern on the Norwood scale, which is the Norwood 7 level. If individuals undergo aggressive hairline reconstructions they may be left with unnatural tufts of hair that resembles an island, as the rest of their scalp is eroded by DHT.  Needless to say, this presents a multitude of aesthetic and cosmetic issues and sometimes repairs are impossible depending on the individuals donor supply.

Is Taking Propecia A Requirement For Surgical Hair Restoration?

The short answer is no, but there are some considerations and long-term planning that must be carefully thought out prior to undergoing a procedure. Firstly, individuals should plan for the worst case scenario, which is Norwood 6-7 level of hair loss. They must remain conservative in their approach to hair restoration. In addition, individuals who wish to undergo hair transplantation without finasteride must be realistic. It is likely that they will eventually lose most of the hair on their head. Therefore, it is unrealistic to expect a complete restoration of their scalp. In most cases, the front two thirds of the scalp can be restored with adequate density; leaving the crown (vertex) bald or with light coverage.


Choosing to take Propecia (finasteride) is a difficult decision for many men. The choice between becoming bald or impotent is not appealing to anyone. However, the truth is that millions of men take Propecia (finasteride) with no side effects and hold on to their hair for decades. Moroever, many men never take any medications and never lose any hair besides minor temporal recession. Like everything in life there are pros and cons. Even if individuals cannot tolerate using finasteride they can still have successful procedures with long-lasting results, but that is only if they use their donor supply strategically and conservatively.