Hair Loss Clinical Roadmap — PRP, Mesotherapy, Minoxidil, Transplant

"Hair loss" is not one diagnosis

In the clinic, "my hair is falling out" is the shared label for very different diagnoses. Right treatment follows right diagnosis.

The four most common

Trichoscope (10–200× dermoscopy) resolves 80% of cases in 5 minutes.

Phase 1 — Lab requirement (1–2 weeks)

Minimum panel before treatment: CBC + ferritin (depot iron; should be >70 ng/mL); TSH + free T4; B12 + vitamin D; ANA if relevant; androgen profile in women with concomitant hirsutism / acne.

Ferritin under 70 limits hair regeneration. Doing mesotherapy / PRP on uncorrected iron deficiency costs 30–40% efficacy.

Phase 2 — Androgenetic alopecia protocol

Topical minoxidil. Men: 5% solution or foam, 1 ml twice daily. Women: 5% foam (solution can cause facial vellus). Expect "shedding" in weeks 8–12 — a marker of response, not reason to stop. Effect visible by month 4–6; gains are lost 3–6 months after discontinuation.

PRP. Three sessions, monthly; then maintenance every 6 months. Quality markers: closed kit, two-stage centrifuge, platelet concentration 3–5× baseline. Clinical data: ~75% of patients see meaningful density gain at month 6. Not a replacement for minoxidil, an added layer.

Mesotherapy (hair version). Cocktail: biotin + dexpantenol + B-group vitamins + zinc + caffeine. 4–6 sessions, 10 days apart. Best used as the "tissue-feeding" layer between PRP sessions.

Finasteride (men only; off-label in women). Men: 1 mg/day oral. Contraindicated in women of reproductive age. Sexual side effects 1–2% in literature, requires shared decision-making.

Phase 3 — When transplant?

Transplant complements medical therapy, doesn’t replace it. Three conditions: (1) stabilization first — 12–18 months on minoxidil + PRP before any transplant; (2) adequate donor area (>60–80 FU/cm² occipital, good elasticity); (3) realistic expectation — transplant restores hairline, not full density.

Telogen effluvium — different path

Usually a delayed response to an event 3–6 months earlier. Steps: identify the trigger; correct deficiencies (most often iron + vitamin D); spontaneous recovery in 3–6 months. In this window mesotherapy + PRP can add support. Minoxidil works but is rarely necessary.

Expectation management

• In men, minoxidil + PRP thicken existing hair and stop shedding — they don’t grow new hair where the follicle is already gone.
• In women, the first 3 months can look like "nothing is happening". Evaluate at month 6.
• Any clinic saying "PRP alone is permanent treatment" should be questioned — it’s an adjunct.
• Transplant is not a one-time solution; medical therapy must continue afterward.

Decision table

Bottom line

The correct question is not "which treatment is best" but "which diagnosis, in which order". Treatment without trichoscope + lab loses 30–40% efficacy.