Trans Men, HRT & Hair Loss

Trans Man Losing Hair

No man likes to see himself starting to lose hair, but hair loss in trans men poses some specific challenges. Since the most common form of hair loss, which is formally known as androgenetic alopecia, is hormone related, balancing it with hormone replacement therapy (HRT) can be tricky.

Androgenetic alopecia, commonly known as male pattern baldness or female pattern hair loss, tends to be more common and more noticeable in men. Two-thirds of American men will have noticeable signs of androgenetic alopecia by age 35 and about 85% of men will have severe hair thinning by age 50. About 25% of the male population begins to lose their hair by age 21.

Androgenetic alopecia occurs because some people are susceptible to dihydrotestosterone (DHT), which makes hair follicles become shorter in length, narrower in diameter, and lighter in color. Finasteride, commercially known as Propecia, can slow or block the production of DHT, thereby slowing the progression of hair loss.

Trans Men, Hormones & Hair Loss

For trans men, hormone replacement therapy involves increasing the amount of testosterone and DHT, both of which involve secondary male characteristics, and decreasing the amount of estrogen. Decreasing the amount of estrogen affects secondary female characteristics. Taking testosterone and DHT supplements helps trans men develop secondary sex traits like a deeper voice and changes to muscle development and fat distribution. This is where DHT’s role in hair loss is complicated for trans men.

Complications with DHT for Hair Loss in Trans Men

Trans men can take finasteride/Propecia to deter DHT’s tendency to contribute to hair loss on the head, and it works well for some. However, doing so could interfere with what DHT does for trans men in other ways, such as encouraging facial hair growth. Some trans men who took finasteride or Propecia have even reported that their menstrual cycle returned after a few months on the hair loss medications. That’s a side effect trans men generally don’t want. It can even trigger gender dysphoria for trans men, causing great mental distress.

Some trans men try to find a middle ground. They wait to address the hair loss to give their hormone replacement therapy time to develop beards and such. Then, when they’ve reached a satisfactory level of facial hair, they start finasteride, hoping that it will curb the loss of hair on their heads without affecting their beards or other physical traits. It has worked for some, but not for others.

Alternatives to Finasteride/Propecia

If finasteride/Propecia hampers hormone replacement therapy for a trans man, he could try minoxidil, which is commercially known as Rogaine. Originally created as a high blood pressure treatment, minoxidil had the side effect of stimulating hair growth. It’s the only medication other than finasteride that has been FDA approved for treating androgenetic alopecia. It works by increasing blood flow to the hair follicle. However, Rogaine tends only to slow or stop further hair loss. It doesn’t necessarily reverse existing hair loss.

RHRLI Offers Transgender Hair Transplants for Men

For hair rejuvenation without hormones, Robotic Hair Restoration might be a good solution. An evaluation is needed to determine if there is enough good donor hair for the FUE hair transplant procedure. This solution avoids hormone disruption entirely so you won’t have to worry about those side effects.

Get a Free Hair Analysis at RHRLI

Dr. Baiju Gohil is a board-certified surgeon and expert in hair restoration using the ARTAS® system. His commitment to patient care and quality is known as the RHRLI Edge, which also includes a personal hair analysis and consultation for each patient by Dr. Gohil himself. To learn more as to why RHRLI is Long Island’s hair restoration leader, contact us today. Also, be sure to follow us on Facebook and Instagram to see how easy this process is along with before & after photos!

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