Transitioning is an incredibly complex and personal process that looks different for every person. Some folks change the way they groom, dress, or speak and choose different names and pronouns. Some may choose to take social, legal, medical, or surgical steps to change the way they present to the world. Every person is different, and there’s no right or wrong way to express your trans or nonbinary identity.
If you choose or have chosen hormone therapy as part of your gender-affirming care, you might experience hair loss. Or, if you’re already experiencing hair loss, you might want or need specific medications to control it. Some hormones can cause androgenetic alopecia, also known as “male pattern baldness” or “female pattern baldness.” Others may impact the speed or specific patterns of growth or loss on your head, or the way hair grows on your face and body.
Since trans identities and gender-affirming therapies are so personal, it’s impossible to offer a complete guide on every possible scenario. This article will go into some of the ways that hormone therapy can impact hair growth and loss. Then, it will share some information about different methods for preventing hair loss, and how they interact with hormones. Always remember to discuss all medications and procedures with your gender-affirming care provider.
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Gender-Affirming Hormones and Hair Loss
Gender-affirming hormone therapy can influence hair growth on the head, face, and body. It’s important to speak to your care provider if you’re concerned about any potential impacts on hair and your appearance. In some cases, it may be advisable to use a combination of different medications (eg. hormones and finasteride) to avoid unwanted hair loss. Each person’s situation is different, and your course of treatment will depend on your individual preferences and medical needs.
Gender-affirming testosterone therapy, for instance, can cause male pattern baldness in some people assigned female at birth. For some non-binary and trans masc folks, this can be a desirable effect, as it can increase their “masculine” appearance. Others, though, may consider this type of hair loss undesirable or unattractive, or may feel it ages them. Male pattern baldness caused by testosterone therapy may also cause psychological or emotional discomfort, or exacerbate symptoms of gender dysphoria.
Estrogen therapy, on the other hand, may cause hair growth or cause or worsen hair loss in either sex. The outcome is more variable, and may depend on the quantity of estrogen a given individual is taking. Some trans women who begin taking estrogen may notice that it slows the progression of hair loss or leads to growth. Regrowth, however, is usually not significant enough for estrogen to be considered a stand-alone treatment for hair loss.
Finasteride, DHT, and Hormone Therapy
Finasteride, sometimes sold under the brand Propecia, is a prescription oral medication used to treat androgenetic alopecia in people assigned male at birth (AMAB). It hasn’t been approved by the FDA for use in people assigned female at birth (AFAB). Still, some providers may prescribe if off-label to women and AFAB folks, and some studies show it may be effective. Anecdotally, it may cause some unwanted side effects, like spotting, in people also taking testosterone.
Finasteride works by stopping the body from converting testosterone to dihydrotestosterone (DHT), the main hormone responsible for “male” or Norwood scale pattern baldness. This means it can stop or slow hair loss that could alter your appearance or cause gender dysphoria. It could be a good option if you’re an AMAB trans fem or nonbinary person and don’t want to experience “male” pattern baldness.
Finasteride can safely be taken while also on gender-affirming estrogen therapy, but it can further increase estrogen in the body. Since estrogen can cause side effects like decreased libido and erectile dysfunction, it’s important to consider all the benefits and risks. Finasteride may also trigger “feminization,” or changes in facial and body features (like gynecomastia) to look more traditionally feminine. This may be a desirable outcome for some people and an unwanted side effect for others.
What About Minoxidil?
Minoxidil is safe and effective at slowing or preventing hair loss and encouraging hair regrowth in many trans people. It works for people who experience both types of androgenetic alopecia, “male” and “female” pattern baldness. Also sold under the brand name Rogaine, it’s a topical foam or solution that is applied directly to the scalp. Minoxidil (like finasteride) takes a few months to start working, and it must be used continuously to maintain results.
While not yet approved by the FDA for this purpose, minoxidil can also be used off-label for facial and body hair growth. In some cases, it has been used by trans masc people to grow beards by applying it to the face and neck. Minoxidil can also cause body and facial hair growth if you accidentally drip or rub some anywhere besides your head. Depending on how you want to look, this could be good or bad news, so take care when applying it.
Minoxidil may cause a small, relatively insignificant increase of estrogen levels in the body. It does not seem to directly impact testosterone levels, though there is a chance it could lower them slightly. It may cause some sexual side effects, though these are usually less than for people taking finasteride. In any case, minoxidil is commonly prescribed alongside hormone therapy in gender diverse and transitioning people.
Hair Transplants and Other Options
Minoxidil and finasteride are the only two FDA-approved medication options for controlling hair loss. But there are other options for people who don’t see success with or don’t want to use these medications. For some trans and nonbinary folks, the potential side effects of either medication could be too burdensome. Or, some people might prefer a more permanent solution that doesn’t require daily upkeep to maintain.
Hair transplant procedures can offer lasting hair loss restoration results that don’t require regular maintenance. In these procedures, hair follicles are surgically removed from one part of the head (or body, in some cases) and re-inserted in another. Hair transplants can be used to stop or reverse pattern baldness in trans people. They can also be used to create a more traditionally masculine or feminine hairline. In some cases, transplants can be used to create or fill out a beard or body hair. All are generally considered safe options while on hormone therapy.
Other hair loss prevention options, like natural remedies and experimental therapies, may be safe and effective for people on hormone therapy. Platelet-rich plasma (PRP) injections, while not FDA-approved, may be one of those options. Low-level light therapy, or LLLT, may also be safe and effective for people on hormone therapy. Natural remedies like rosemary oil could also work. Whatever you choose, check with your gender-affirming healthcare provider to make sure it’s safe.
Making the Right Choice for You
Finding the right hair loss prevention method is an extremely personal decision. It all depends on your specific goals and any medications or therapies you choose for your process. The most important thing is affirming your identity, ideally with minimal risk to your health and safety.