Minoxidil, Finasteride or PRP. Which Should You Start With for Hair Loss

Written By Sofian Youssef

Medication first, PRP on top, not instead. Minoxidil and finasteride are licensed, cheap and backed by decades of trials. PRP has 43 randomised trials showing it increases density, and works best combined with minoxidil. A clinic that sells PRP to someone who has never tried the licensed drugs is skipping the treatment with the most evidence and the lowest price.

Key points

  • A 2025 systematic review and meta-analysis in Dermatology and Therapy of 43 randomised controlled trials and 1,877 participants found activated PRP increased hair density and reduced recurrence compared with placebo, and that PRP combined with minoxidil outperformed either alone.

  • A 2024 systematic review and meta-analysis of the additive value of PRP to topical minoxidil found the combination improved hair density over minoxidil alone, pooling randomised trials on that specific question.

  • A 2023 meta-analysis in Annals of Medicine and Surgery of 9 randomised trials and 230 patients found PRP alone increased density by 25.39 hairs per square centimetre against placebo, and PRP as an adjunct to other treatments by 34.38.

  • Finasteride 1 mg daily and topical minoxidil 5 percent are the licensed first-line treatments for pattern hair loss, and a comparative study of 69 men found PRP with minoxidil outperformed minoxidil alone and PRP alone.

If you are deciding where to start, message us on WhatsApp or email team@thewellnesslondon.com and a doctor will tell you the order that fits your pattern and your age.

What each of the 3 actually does

Finasteride is a tablet taken daily that blocks the enzyme converting testosterone to dihydrotestosterone, the hormone that miniaturises follicles in pattern hair loss. It treats the cause. It is licensed for men, has the largest trial record of any hair loss treatment, and slows or halts loss in most men who take it, with regrowth in a proportion. It is not licensed for women of childbearing age, and a small share of men report sexual side effects, which is a conversation to have with a doctor rather than a reason to skip it.

Minoxidil is a topical solution or foam, or in recent years a low-dose tablet used off licence, that prolongs the growth phase of the follicle and improves its blood supply. It treats the follicle rather than the hormone, works in men and women, and is the licensed first-line treatment for female pattern loss. It has to be continued to keep its effect.

PRP is your own concentrated platelets injected into the scalp to stimulate miniaturising follicles with growth factors. It treats the follicle, not the hormone, which is why it works best with something that does. It is a course of 3 sessions with maintenance, and it is the only one of the 3 that is not a licensed medicine.

What the evidence says about combining them

The finding that matters is consistent across the literature. PRP adds to medication rather than replacing it. The 2025 meta-analysis in Dermatology and Therapy of 43 randomised trials found activated PRP increased hair density against placebo and that PRP combined with minoxidil outperformed either alone. A 2024 systematic review and meta-analysis examined the additive value of PRP to topical minoxidil directly and found the combination improved density over minoxidil on its own. A 2023 meta-analysis in Annals of Medicine and Surgery of 9 randomised trials and 230 patients found PRP alone gained 25.39 hairs per square centimetre over placebo and PRP as an adjunct gained 34.38.

The mechanism explains the arithmetic. Finasteride lowers the hormone that is shrinking the follicle. Minoxidil keeps the follicle in its growth phase longer. PRP delivers growth factors that push a miniaturised follicle towards producing a thicker hair. Each works on a different part of the problem, and a follicle that is protected from DHT, held in growth phase and stimulated to grow does better than one receiving any single input. A comparative study of 69 men found exactly that, with PRP plus minoxidil outperforming both minoxidil alone and PRP alone.

Send us photographs of your parting and crown on WhatsApp and a doctor will tell you which combination fits your pattern.

The order that works, and the one clinics sell

For a man with early to moderate pattern loss the evidence-based sequence is finasteride and minoxidil first, for at least 6 months, then PRP on top if density is still short of what he wants or if he wants to accelerate. For a woman it is minoxidil first, with a blood panel to exclude iron, thyroid and hormonal causes, then PRP on top. In both cases the medication is the foundation and PRP is the amplifier, and the trials that show PRP working well are mostly trials in which the patients were also on minoxidil.

The order clinics sell is often the reverse. PRP first, because it is the product they own, medication mentioned as an afterthought or not at all. That sequence puts the least evidenced and most expensive treatment first and leaves the follicle exposed to the hormone that is shrinking it. A patient who has 3 sessions of PRP without finasteride will see some thickening and then watch it fade, because nothing has been done about the cause. A doctor-led clinic prescribes the drugs, or confirms you are already on them, before it draws blood.

When PRP is the right first step

There are 3 situations where PRP legitimately comes first or stands alone. A man who cannot or will not take finasteride, because of side effects, planning a family, or a medical reason, has lost the treatment for the cause and PRP alongside minoxidil becomes his best combination. A woman of childbearing age, for whom finasteride is not licensed, is in the same position. And a patient who has been on both drugs for a year, is stable, and wants more density than the drugs alone have given, is exactly the patient the combination trials describe.

What PRP does not do in any of these cases is replace the need to address the hormone where that is possible. And what none of the 3 does is help a scalp where follicles have already gone. Bare skin that has been bare for 2 years is a transplant conversation, and neither a tablet nor an injection changes that. A doctor with a dermatoscope can tell which situation you are in within a minute, and the honest sequence follows from that examination rather than from a menu.

A 6 point check before you spend anything on hair loss

Work through this before booking any treatment, including here.

  • Do you know what type of hair loss you have. Pattern loss, shedding, patchy loss and scarring loss are treated differently, and PRP only has evidence for the first.

  • Have you had a blood panel. Ferritin, vitamin D, thyroid function, B12 and, in women, androgens and hormone levels can drive loss that no treatment on this page fixes.

  • Are you on minoxidil, and if a man, have you discussed finasteride with a doctor. If not, that is the first step, and it costs pounds a month.

  • Have you given the drugs 6 months. They take that long to show a result, and stopping early is the commonest reason they appear to fail.

  • Are the thinning areas still carrying fine, short hairs. If yes, PRP has a target. If the skin is bare, it does not.

  • Has anyone offered you PRP without asking any of the above. That tells you what kind of clinic it is.

Our doctors put it this way. The drugs treat the cause. PRP treats the follicle. Doing the second without the first is watering a plant while someone keeps pulling it out of the ground.

Message us on WhatsApp with your age, what you are already taking, and photographs, and a doctor will give you a straight answer.

What PRP does not do without medication

PRP does not lower DHT, so in a man not taking finasteride the process shrinking the follicle continues underneath the treatment. It does not hold the follicle in growth phase the way minoxidil does. Its trial results are largely from patients also on medication, so a clinic quoting those results to someone on nothing is quoting a different treatment. It fades without maintenance, does not regrow bald skin, and is not available on the NHS, whereas finasteride and minoxidil are available privately at low cost and minoxidil over the counter. PRP is the most expensive of the 3 and the least evidenced on its own.

What each costs, and why the order changes the total

Flagship Harley Street and Mayfair clinics commonly charge £600 to £850 or more per session of hair PRP, with a course of 3 taking a plan past £2,000 and maintenance sessions on top. Generic finasteride and over the counter minoxidil cost a few pounds a week between them, and are available through any private GP including The Online GP by The Wellness.

The reframing is what the PRP money buys in each order. On top of medication, a PRP course buys additional density in a scalp that is protected and stable, which is what the combination trials measured. Without medication, the same money buys thickening that fades as the hormone keeps working, followed by another course. The cheap step is the one that makes the expensive step worth paying for.

Care at The London PRP Clinic by The Wellness is doctor-led and priced below flagship rates, with your exact figure confirmed at the free suitability review, which for most new patients starts with prescribing the medication rather than booking the injection.

Ask about the cost for your hair on WhatsApp and we will explain what the review covers.

The free suitability review

Every enquiry here starts with a free, doctor-led suitability review rather than a booking. A GMC-registered doctor examines your scalp, confirms the type of hair loss, arranges blood tests where needed, prescribes or reviews medication, and gives one of two answers. Either you are approved for PRP on top of that foundation, with a clear plan and realistic expectations, or you are not approved yet, with an honest explanation that medication alone is the right start and when to reassess.

We decline a meaningful share of the people who enquire. For hair loss that often means being told to start the drugs and come back in 6 months, which is the advice a clinic selling only PRP cannot afford to give.

Why people choose The London PRP Clinic by The Wellness

  • An 87 percent patient success rate across treatments.

  • A 32 percent average density increase reported in our hair restoration programme.

  • More than 187 five star reviews.

  • Every treatment performed by a GMC-registered doctor.

  • 100 supervised treatments completed by every clinician before they treat a patient here unsupervised.

Frequently asked questions

Is PRP better than minoxidil for hair loss

Not instead of it. A 2025 meta-analysis of 43 trials found PRP combined with minoxidil outperformed either alone, and a 2024 meta-analysis found PRP added density on top of minoxidil. Minoxidil is licensed, cheap and the foundation. PRP amplifies it.

Should I take finasteride before having PRP

If you are a man with pattern hair loss and no reason not to, yes. Finasteride treats the hormonal cause and PRP treats the follicle, and the combination outperforms either. A man who cannot take finasteride should use minoxidil with PRP instead.

Can PRP replace finasteride

No. PRP does not lower DHT, so the process shrinking the follicle continues. For men who cannot take finasteride, PRP with minoxidil is the best available combination, but it is a substitute made necessary by circumstance, not an equivalent.

How long should I try minoxidil and finasteride before PRP

At least 6 months, because both take that long to show a result. If density is still short of what you want after that, or you want to accelerate, PRP on top is the evidence-based next step. Stopping the drugs early is the commonest reason they appear to fail.

Does PRP work for women's hair loss

Yes, for female pattern hair loss with miniaturised follicles, and it fits particularly well for women who cannot take finasteride. Minoxidil comes first, a blood panel excludes iron, thyroid and hormonal causes, and PRP is added on top of that foundation.

How much do minoxidil and finasteride cost compared to PRP

A few pounds a week between them, with minoxidil available over the counter and finasteride on private prescription. Hair PRP at flagship London clinics is £600 to £850 or more per session, with a course of 3 past £2,000. The drugs are the cheap step that makes the expensive step worthwhile.

References

This article is for general information and does not replace a medical assessment. Finasteride and minoxidil have side effects and contraindications. Speak to one of our doctors before starting or combining any hair loss treatment.

Sofian Youssef
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