Hair Loss Treatment When Trying to Conceive, Pregnant or Breastfeeding

If you are trying to conceive, pregnant or breastfeeding, several of the most common hair loss treatments deserve a conversation with your doctor before you continue or start them. For women, antiandrogens such as finasteride, dutasteride and spironolactone are generally avoided in pregnancy because of possible effects on a developing male baby, and minoxidil carries its own cautions. For men, the questions are about fertility, very small amounts of drug in semen, and blood donation rules. Elective hair surgery is usually postponed until after pregnancy. This guide explains the reasoning; the decisions belong with your clinician.

Why hair loss drugs and pregnancy mix badly

Pattern hair loss in both men and women is closely linked to androgens, the group of hormones that includes testosterone and dihydrotestosterone (DHT). Several of the most effective treatments work by blocking those hormones or their effects. That is useful for hair follicles, but androgens also do essential work elsewhere, including during fetal development.

In particular, a male fetus needs DHT for the normal development of the external genitals. A drug that lowers DHT or blocks androgen activity could, in theory and in animal studies, interfere with that process. That is the core reason these medicines carry pregnancy warnings, and why the cautions are strongest for women who are or may become pregnant.

Other treatments raise different questions. Minoxidil is not a hormone blocker, but it is an active drug, and in its oral form it is a blood pressure medicine. When it comes to pregnancy and breastfeeding, the default with most medicines that are not essential is caution.

For women: what to know before and during pregnancy

Finasteride and dutasteride

These drugs are approved for men. When they are used in women for hair loss, it is off-label, and prescribers generally limit them to women who cannot become pregnant or who use reliable contraception. They are not to be used during pregnancy.

The warnings go beyond taking the drug. US labeling for finasteride states that women who are or may become pregnant should not handle crushed or broken tablets, because the drug can be absorbed through the skin. The tablets are coated, which is intended to prevent contact during normal handling as long as they are intact. Dutasteride labeling carries a similar warning about leaking capsules. If you live with someone who takes either drug, this is worth knowing, especially if tablets are split.

Spironolactone

Spironolactone is a blood pressure and fluid medicine with antiandrogen effects, and it is commonly prescribed off-label for female pattern hair loss. Because of its antiandrogen action and animal data suggesting possible effects on a male fetus, it is generally avoided in pregnancy. Women who take it are usually advised to use reliable contraception, and many prescribers ask patients to discuss family plans before starting. Our guide to spironolactone for women's hair loss covers how it is used.

Minoxidil

Topical minoxidil is sold over the counter in many countries, which can make it feel harmless. Product labeling, however, generally advises against use, or advises asking a doctor first, during pregnancy and breastfeeding, and safety data in pregnancy are limited. Low-dose oral minoxidil, an increasingly popular off-label option, is a blood pressure medicine with its own cautions. See our low-dose oral minoxidil guide for background, and raise it specifically with your prescriber if you are planning a pregnancy.

For men: conception, semen and fertility

For men, the concerns are different, and in many respects less direct. A man taking finasteride or dutasteride is not exposing a pregnancy in the way a pregnant woman taking the drug would. But there are three questions worth raising with a doctor.

1. Drug in semen

   Labeling for both drugs notes that small amounts have been detected in the semen of men taking them. Manufacturers and regulators have described the amounts found with finasteride as very low. Whether any precaution is needed during a partner's pregnancy is a question to put directly to your prescriber, because guidance can differ between drugs and countries.

2. Effects on semen and fertility

   Finasteride and dutasteride can reduce ejaculate volume, and labeling includes reports of reduced sperm counts and male infertility. In many reported cases semen measures improved after the drug was stopped, but individual responses vary. If you are having trouble conceiving, tell your fertility doctor that you take one of these drugs.

3. Timing a pause, if any

   Some men choose, with their doctor, to pause treatment while trying to conceive; others continue. Pausing can mean losing some of the hair the medication was protecting. This is a personal trade-off, and the details of when and how belong with a clinician who knows your history.

Our guides to finasteride side effects and dutasteride vs finasteride cover the wider evidence on these drugs.

Blood donation waiting periods

Because finasteride and dutasteride could reach a pregnant woman through a blood transfusion, blood services ask donors who take them to wait before donating. US labeling for dutasteride tells men not to donate blood until at least six months after their last dose, reflecting how long the drug stays in the body. Finasteride is cleared much faster, and blood services have set a shorter deferral for it.

Rules differ by country and change over time, so check the current requirements of your local blood service before you donate, and tell staff about every medication you take, including topical finasteride.

Breastfeeding and postpartum hair loss

Many medicines pass into breast milk to some degree. Antiandrogens are generally not used while breastfeeding, and oral minoxidil is known to pass into breast milk. Even for topical products, the usual advice is to check with a doctor first. If you want to resume or start hair loss treatment after birth, ask whether to wait until you have finished breastfeeding.

It also helps to know that heavy shedding a few months after giving birth is common and is often a temporary shift in the hair growth cycle rather than new pattern loss. It usually settles with time. If shedding continues, or you notice a widening part or thinning crown, a dermatologist can help tell the two apart. Our guide to telogen effluvium vs pattern loss explains the difference.

Why hair surgery usually waits

A hair transplant is elective, meaning it can safely be scheduled for a later date. During pregnancy, clinicians usually avoid elective surgery when it can wait, for several reasons:

• Medications. Surgery involves local anesthetics, often with adrenaline, and usually sedatives, antibiotics and painkillers, none of which are needed for a cosmetic goal during pregnancy.
• Long procedures. Hair transplants often take many hours in fixed positions, which can be uncomfortable and carry their own risks in pregnancy.
• Hair changes. Pregnancy and the months after birth change the hair cycle, which makes it harder to assess your true pattern and plan a hairline.
• Travel. Flying abroad for surgery adds risks in pregnancy, and many travel insurance policies restrict cover late in pregnancy.

For women, most clinicians will want to wait until after pregnancy and breastfeeding, and until postpartum shedding has settled, before assessing for surgery. For men whose partner is pregnant, surgery itself is not restricted by the pregnancy, but if you are pausing or adjusting medication around conception, that may affect timing. Our guide to medications before, during and after a transplant has more detail.

When you are planning a family, hair loss treatment is rarely urgent. A few months of thoughtful planning costs far less than a rushed decision.

How to plan the conversation with your doctor

You will get better advice if you come prepared. Before your appointment, gather the following:

• Every hair loss product you use, including topicals, shampoos, supplements and anything compounded
• The generic name of each medicine, not just the brand
• How long you have used each one and how well it has worked
• Your timeline: trying now, within a year, or later
• For men: whether you have any known fertility concerns and whether you donate blood
• For women: whether you are breastfeeding now or plan to
• Any upcoming plans for PRP, a transplant or travel for treatment

Useful questions to ask include: "Should anything change before we start trying, and if so, when?" "Is there anything I should avoid handling around my partner?" "What are my options if I want to protect my hair during pregnancy and breastfeeding?" A dermatologist working with your obstetrician or fertility specialist is often the best team for these decisions.

Frequently asked questions