Finasteride
An oral 5α-reductase inhibitor that lowers scalp DHT and slows or partially reverses male androgenetic alopecia. Commonly used to stabilise loss before and after transplantation, under physician supervision.
Finasteride is an oral inhibitor of type II 5α-reductase, the enzyme that converts testosterone to dihydrotestosterone. Lowering scalp and serum DHT removes much of the signal driving miniaturisation in susceptible follicles, which slows loss and allows partial re-enlargement of hairs not yet beyond recovery. It is one of the two medical treatments for male androgenetic alopecia with regulatory approval and decades of use behind it.
Its evidence tier is the strongest in the field: the large multicentre randomised trials from the late 1990s that led to its approval showed, in most treated men, arrest of progression, with a meaningful fraction achieving visible regrowth, and long-term extension data support maintained benefit during continued use. The corollary is equally established — the effect requires the drug, and discontinuation returns the scalp to its untreated trajectory over the following year or so.
Counselling is where clinic quality shows. Patients must hear about the small minority who report sexual side effects — and the contested but real discussion around persistent symptoms — alongside possible mood changes, the drug’s effect on PSA readings (prostate screening must account for treatment), why it is unsuitable for women of childbearing potential, and the handling precautions around pregnancy. None of this argues for burying the drug; it is the content of informed consent for a medicine a healthy young man may take for decades.
Around surgery, its role is stabilisation: a transplant redistributes resistant hair but does nothing for the progressing native background, and stabilising that background protects the composite result the patient actually sees. Whether a given patient should take finasteride is a prescribing decision that belongs to the treating physician after individual assessment — not to a coordinator, a package deal or a website. Clinics without prescribing authority still carry duties: accurate information, a referral pathway, and documentation that the medical-management conversation happened before anyone booked theatre time.