What do you need to know? When a hair transplant and when finasteride?
- Most hair transplant clinics, upon receiving photos, immediately offer surgery without asking about the treatment being used or informing that finasteride or minoxidil can stop baldness in 80% of young men.
- This is unethical from a medical perspective and humanly dishonest, as it exploits patient uncertainty for quick profit, often leading to premature transplants and wasting the limited resources of the donor area.
- As an ISHRS Patient Safety Ambassador, I caution: if a clinic doesn’t ask about medications and immediately offers a transplant to every patient, they are treating you like a customer, not a patient.
A scenario that happens thousands of times a day
You are 28 years old. You have noticed that your hair has been falling out more intensely for some time. The cornrows are receding, clearances have appeared in the frontal line. Concerned, you do what most people do in the 21st century – you look for a solution online.
You send photos to several hair transplant clinics. Turkey, Poland, maybe somewhere else. You wait for a professional opinion. And you get answers. They all sound similar:
“Welcome! Thank you for the photos you sent. You are an ideal candidate for hair transplantation. You need about 2500 grafts. Price: XXX zloty. Appointments available as early as next month. Greetings!”
None of them asked basic questions: Are you using any treatment? How long has the hair loss been going on? How does baldness run in your family? What are your expectations? And above all – have you considered drug treatment at all?
For most of these “clinics” these questions are irrelevant. Because the answers could lead to the conclusion that a transplant is not yet needed. And that would mean losing a customer.
What these pseudo-clinics don’t tell you
As a Patient Safety Ambassador for ISHRS(International Society of Hair Restoration Surgery), I see this pathology every day. Patients come to me after spending tens of thousands of zlotys on premature hair transplants, when their problem could have been stopped for a few tens of zlotys a month.
The truth they don’t want to tell you is simple: in most young men with early androgenetic alopecia, drug treatment can stop or significantly slow the process. Finasteride, dutasteride, minoxidil – these are not some experimental drugs. These are therapies with decades of research, proven efficacy and safety profile.
Finasteride blocks the enzyme that converts testosterone to DHT, the hormone responsible for miniaturization of hair follicles. In about 80% of men it stops baldness, in 50-60% it causes partial regrowth. Minoxidil directly stimulates the follicles to grow. Together they form the most effective combination of conservative treatment for androgenetic alopecia, confirmed by all international guidelines.
If you are in your twenties and have just noticed receding curves, starting drug treatment may save most of your hair for the next ten, fifteen, twenty years. You may not need a hair transplant at all. And if it is ever necessary, it will be to a much lesser extent and with a better long-term effect, because the drug will protect both native hair and transplanted hair.
But this information is not in the interest of a purely profit-driven clinic. A drug-treated patient is a patient who may not return for a transplant for many years, if at all. That’s a lost sale. Much better to convince him that “the only solution” is surgery, preferably right away.
Anatomy of a fraudulent online consultation
Let’s examine the typical “online consultation” offered by profit-driven pseudo-clinics.
Step 1: You send the photos
You often fill out a short form. Name, age, a few headshots. Rarely do they ask about your medical history, medications you are taking, comorbidities. They do not ask if you are undergoing any hair treatment.
Step 2: You get a response within hours
Speed of response is part of the sales strategy. The faster you get an offer, the less time you have to think about it, consult with others, research.
Step 3: Diagnosis: you need a transplant
Whether you have small curves or advanced baldness, the diagnosis is the same. Hair transplant. Only the number of grafts and the price differs. There is no “it’s not time yet” or “let’s try medication first” option.
Step 4: Time and price pressure
“Special price this month only!” “Last free dates!” “Extra 500 grafts free if you sign up today!” Classic sales techniques to get you to make a quick decision before you have time to think.
Step 5: Zero information about alternatives
No one mentions finasteride. No one talks about minoxidil. No one suggests that you might want to try to keep what you have first before you start transplanting hair from the back of your head to the front.
This is not a medical consultation. It’s a process of selling a service.
Why it’s unethical – a doctor’s perspective
As a doctor, I have certain fundamental duties to the patient. These are enshrined not only in the code of medical ethics, but simply in the basic principles of human decency and professionalism.
Primum non nocere – above all, do no harm. If I can help a patient with a less invasive method that is as effective or more effective, I have a duty to offer it. Hair transplantation is surgery. It requires incisions, there is bleeding, risk of infection, scarring. If a tablet can achieve the same or better result, why should I operate right away?
Informed consent. The patient has the right to be fully informed of all available treatment options, their effectiveness, risks and costs. Withholding the fact that drug treatment may be sufficient is a violation of the principle of informed consent. The patient is making a decision based on incomplete, selective information.
Acting for the benefit of the patient. My duty is to maximize the benefit to the patient, not to myself. If a drug treatment for a hundred zlotys a month can give a better long-term effect than a hair transplant, then I have a moral obligation to say so.
Refraining from causing harm. Performing a premature hair transplant in a young man who has not yet tried drugs can be a detriment. We are using up the limited resources of the donor area for something that may not have been necessary. In 10 to 15 years, when baldness progresses for physiological reasons or lack of appropriate treatment, there will be nothing left to take more grafts from.
Each of these rules is broken when a clinic automatically offers a transplant to anyone who applies, without considering alternatives.
Why it’s unethical – the human perspective
Even if we were to ignore the code of medical ethics, human decency itself dictates honesty towards another human being. In many “clinics” the procedures are not performed by doctors but by “technicians” of unknown education and background so their code of medical ethics does not apply. I omit the aspect that such a situation is illegal in Poland, despite the fact that such facilities exist and perform medical procedures. If the person who is to perform your hair transplant does not speak Polish – you can be sure that he or she does not have a Polish Medical License and is breaking the law by endangering your health and life.
When someone comes to me with a problem, he comes with fear, uncertainty, sometimes desperation. He sees his appearance changing, loses confidence, maybe has relationship problems. This is often a person in emotional distress who needs help and honest advice.
Taking advantage of this situation for a quick profit is simply obscene. It’s like selling someone a heart transplant when anti-hypertensive drugs would suffice. Maybe the seller will make more money, but can he look at himself in the mirror afterwards?
A few months ago, a 23-year-old man came to see me who had spent money on a 1,500 graft transplant at a foreign clinic a year earlier. He had medium-sized hair curves. Now, a year later, his hair continues to fall out, because no one told him that he should take medication to inhibit progressive baldness. The transplanted hair remains, but the rest is thinning. He looks worse than before the procedure. And his donor area has been trimmed by the 1,500 grafts we would now need to thicken the thinning areas.
Was this foreign clinic operating legally? Probably yes. Was it ethical? Absolutely not.
What should happen during a proper consultation
Let me show you what an honest, professional trichology consultation in a doctor’s office looks like.
Detailed medical history
The first thing is questions. Many questions. How long does the loss last? How fast does it progress? What was baldness like in your father, grandfather? Do you have any comorbidities? Are you taking any medications? Have you been to a doctor with this problem? Have you tried any treatment? What are your expectations?
These are not bureaucratic annoyances. These are key questions to determine what is actually happening to you and what will be the best solution.
Assessment of baldness stage and prognosis
It is not enough to say “you have androgenetic alopecia.” One must try to predict the progression. A young man with a strong family history of alopecia requires a different strategy than a forty-year-old man with a condition that has been stable for years.
Presentation of all treatment options
And here is the key moment where most pseudo-clinics drop out. A proper consultation includes presenting all available options, not just the most profitable one for the clinic.
For most young men with early androgenetic alopecia, the first line of therapy is DHT blockers combined with minoxidil. This has the best ratio of effectiveness to risk and cost. If this stops the process, a hair transplant may not be necessary at all.
If the medications do not have enough effect, or if the baldness is already advanced, then we talk about transplantation. But a transplant in combination with continued medication, because otherwise the native hair will continue to fall out around the transplanted hair.
Realistic expectations and education
The patient must understand that androgenetic alopecia is a progressive process. We do not have the ability to “cure” it. What we can do is properly manage the ailment. Both medication and hair transplantation require long-term thinking. I have to educate the patient about the mechanism of alopecia, how the different therapies work, what they can and cannot achieve.
Time to rethink
A proper consultation ends not with immediate enrollment in a procedure. It ends with providing information, answering questions and suggesting that the patient think it over in peace, consult with family, possibly another specialist. A good medical decision is a thoughtful one, not a hasty one.
Role of ISHRS and Patient Safety Ambassadors
The International Society for Hair Restoration Surgery (ISHRS) is the world’s largest organization of hair loss treatment specialists. It brings together the best surgeons, researchers and trichologists from around the world. The organization develops clinical standards, treatment guidelines and, of particular importance, promotes ethical practices in the industry.
As an ISHRS Patient Safety Ambassador, I take special responsibility for educating patients about how to choose the right clinic and how to protect themselves from fraudulent practices. It’s a role I take very seriously, because I see every day the consequences of bad decisions made by patients based on misleading information.
ISHRS places great emphasis on ethics and safety. Members are required to abide by a code of ethics that, among other things, requires:
- Presenting all available treatment options
- Actions in the best interest of the patient
- Avoid premature surgical interventions
- Realistic promises and expectations
- Continuous education and qualification
Unfortunately, most clinics offering “quick, cheap transplants” are not members of ISHRS and are not subject to any ethical standards beyond national laws, which are often inadequate.
How to recognize an honest specialist
Here are some simple questions and tests to help you distinguish between a professional and a salesman.
Do they ask questions about your past treatment?
If they don’t ask if you’ve tried finasteride, minoxidil, or been to a dermatologist – they’re not interested in the answers. They are only interested in selling the treatment.
Do they mention drugs as a first-line therapy?
Any real doctor knows that for most young men with early baldness, the first line is pharmacotherapy. If they go straight to the offer of a hair transplant, think twice.
Do they present the advantages and disadvantages of different options?
An honest specialist will tell you that finasteride can have side effects in a small percentage of men. That minoxidil requires twice-daily use and can be troublesome. That transplantation is an operation with risks and limitations. If everything sounds perfect, someone is not telling the whole truth.
Do they allow for the possibility that a transplant is not yet needed?
This is the best test. If a specialist can say “in my opinion it is not yet time for a hair transplant, let’s try medication first”. – you are dealing with a professional. If every patient “needs a transplant” – it’s a salesman, not a doctor.
Do they give you time to think about it?
Pressure for a quick decision, limited offers, “last dates” – these are all red flags. A good doctor understands that the decision to operate takes time and calm.
Are they members of professional organizations?
Memberships in ISHRS, national trichology societies, certifications, scientific publications – these are all signs that you are dealing with a real professional, not a business pretending to be medicine.
Economics of dishonesty – When to get a hair transplant and when to get finasteride
To understand why so many “clinics” operate in this unethical manner, we need to understand the economics of the industry.
Finasteride costs 40-80 zlotys per month. Minoxidil even less. What’s more, a patient on medication may not need a hair transplant for many years, if at all. This means that every patient you tell about the drugs is potentially a lost customer.
From a business perspective, offering a patient medication instead of a hair transplant outright is economic suicide. That’s why clinics that prioritize profit over patient health simply don’t do it.
The business model is simple: maximize the number of treatments. The more patients you convince to undergo transplantation, the earlier, the better for the bill. Long-term patient welfare? That’s not your problem, because most of these clinics don’t have a long-term relationship with the patient. Treatment, payment, goodbye.
For me as a doctor, this is unacceptable. But I understand that for a business pretending to be a clinic, where only profit is on the table, it makes perfect economic sense. So think about whether you want to be a customer or a patient.
What you can do as a patient
As a patient, you are not defenseless against these practices. Here are specific steps you can take to protect your health and your wallet:
Always consult an independent dermatologist
Before you decide to get a hair transplant, go to a dermatologist , who has no financial interest in selling the procedure. A doctor in the public health service, a private dermatologist who does not do transplants – someone who can give you an independent opinion.
Ask directly about drugs
During your consultation with the hair transplant clinic, ask the direct question, “Could finasteride or minoxidil help me?” Observe the answer carefully. If they downplay the drugs, say they “don’t work” (which isn’t true), or simply skip them – that’s a red flag.
Check qualifications and membership
Is the surgeon a member of ISHRS? Is he or she a doctor at all and can practice in Poland? Does he have a Polish license to practice medicine? Does he speak Polish? (If not – not a doctor who could work in Poland). All this can be verified online.
Avoid time pressures and “special offers”
If someone pushes for a quick decision, offers “today only” promotions or scares you that “in a month it will be more expensive” – that’s manipulation.
Report unethical practices
If you have encountered grossly unfair practices, report it to the appropriate institutions. In Poland, this could be the District Medical Chamber, the Ministry of Health, the Office of Competition and Consumer Protection, the District Prosecutor’s Office. For foreign clinics – ISHRS has mechanisms for reporting ethical violations.
My mission as an ISHRS Ambassador – Artur Kierach
I accepted the role of Patient Safety Ambassador on behalf of ISHRS because I see a great need for patient education and protection in our industry. Hair transplantation has become very popular, and unfortunately not all who participate are guided by medical ethics.
My mission is:
Educate patients about what androgenetic alopecia is, what treatment options are available, what they can realistically expect, and how to protect themselves from fraudulent practices.
I promote ethical standards among surgeons and clinics. I talk to fellow surgeons, organize trainings, and publish articles. I try to build a culture where the welfare of the patient comes first.
Working with institutions in Poland and abroad to create better regulation and oversight of the hair transplant industry. It’s a long process, but every step forward matters.
This is not an easy mission. The hair transplant industry has enormous financial resources and strong economic incentives to maintain the status quo. But I believe that truth and ethics will ultimately prevail. Maybe not immediately, but in the long run.
Your hair, your decision, but let it be a wise decision
If there is only one thing to remember from this article, let it be this: hair transplantation should not be the first line of treatment for androgenetic alopecia in most patients with miniaturized hair follicles.
The first line is pharmacotherapy. Finasteride, dutasteride, minoxidil. Drugs that can stop or slow the process, save hair, postpone or even eliminate the need for surgery. They are cheaper, less invasive, and often more effective long-term than transplantation alone without drugs.
Transplantation has its place in treatment. It is an excellent solution for people with advanced, stable baldness who have already tried medications. It is a great addition to pharmacotherapy, helping to restore lost hair in key areas. But it should not be the first, automatic answer to every case of hair loss.
If the clinic you’ve approached immediately proposes a transplant without asking about medications, without fully analyzing your situation, without presenting all your options – ask yourself if they actually have your best interests in mind, or their own profit.
Your hair, your money, your health. But make it a smart, thoughtful, fully informed decision. Because you deserve honesty, professionalism and real medical care, not just a smooth sales process.
You can read more about hair transplantation HERE. If the problem affects you, we invite you to CONTACT us. Visit us on Instagram and TikToku.
