During the initial consultation, in addition to reviewing the patient’s medical history and hair loss background (including any previous medical or surgical treatments), the most important step is establishing an accurate diagnosis of the type of alopecia. Not all forms of hair loss are suitable for surgical treatment.
If there is any suspicion of an underlying condition that could affect transplant outcomes, a scalp biopsy may be recommended to ensure a precise diagnosis. Following this, both the donor area and recipient area are carefully evaluated. The donor area is assessed to determine its harvesting capacity, while the recipient area is analysed in terms of extent and degree of hair loss. This allows for the development of a fully personalized surgical strategy tailored to each patient.

In cases of androgenetic alopecia (AGA), the first step is to stabilize hair loss. AGA may begin at a very early age (16–18 years) or develop later in life; however, once established, it does not resolve on its own. While relative stabilization is often observed around the age of 50–55, this cannot be considered fully predictable or guaranteed. For this reason, it is essential to ensure that the existing hair at the time of surgery is as stable as possible, as it is expected to persist over time. If ongoing loss occurs, transplant results may be affected, potentially leading to reduced density and the need for future refinement procedures. A key limitation is that the donor area is finite. Once its extraction capacity has been used, no additional grafts can be harvested in the future. For this reason, the ideal candidate for hair transplantation is a patient with stable hair loss, ensuring the most predictable and long-lasting results.

As its name suggests, androgenetic alopecia is a genetically inherited condition influenced by androgens. Therefore, to slow its progression, it is necessary to act on its underlying cause: androgens. Although multiple factors are involved, the primary driver is DHT (dihydrotestosterone), a metabolite derived from testosterone. DHT is produced through the action of the 5-alpha reductase enzyme, which is present in the prostate, sebaceous glands, and hair follicles.

Finasteride and Dutasteride are anti-androgen medications that work by inhibiting this enzyme, reducing its ability to convert testosterone into DHT and thereby lowering DHT levels in the body. The main difference between the two medications lies in their mechanism of action; Finasteride reduces DHT levels by approximately 70%, as it selectively inhibits type II 5-alpha reductase. Dutasteride achieves a greater reduction—around 94%—as it inhibits both type I and type II isoenzymes. The primary goal of medical treatment in androgenetic alopecia is to preserve the patient’s native hair, which complements the transplanted hair. For optimal and long-lasting results, both transplanted and native hair are equally important in achieving overall density and a natural appearance.