When preparing to transition, trans women have to consider many health factors, such as how hormone replacement therapy (HRT) might affect other medications they’re taking or existing health conditions, but androgenetic alopecia, also commonly referred to as “male pattern baldness”, often isn’t at the top of the list. Despite that, hormone-treated transgender women and hair loss can be complicated.
What is Androgenetic Alopecia?
To understand the issue of transgender hormone replacement therapy and hair loss, it helps to start at the beginning. Androgenetic alopecia is a common cause for thinning hair in both men and women. The hair loss follows a pattern. For women, it’s a general, overall thinning that rarely leads to total hair loss, and women’s hairlines are also not usually affected. For men, androgenetic alopecia hair loss starts in an M pattern that gradually fills in, generally leaving a semi-circle of hair on sides and back.
How Does Androgenetic Alopecia Start?
Hair loss happens in androgenetic alopecia because, in genetically susceptible individuals, dihydrotestosterone (DHT) causes hair follicles to become narrower in diameter, shorter in length and lighter in color. It is far more common in men than women and begins earlier in life for men. While there is no cure for androgenetic alopecia, treatments to slow or block the production of DHT can help slow the progression of hair loss, but hair loss will continue if treatment is suspended. One of those treatments, finasteride, can also have side effects such as decreased libido or erectile dysfunction in men.
Effects of Hormone Replacement Therapy on Hair Loss
Hormone replacement therapy and hair loss are still being studied. HRT for trans women involves decreasing the amount of hormones, like testosterone and DHT, associated with secondary male characteristics and increasing the amount of hormones, such as estrogen, associated with secondary female characteristics. While trans women who were suffering from androgenetic alopecia prior to starting HRT may see a reversal of their hair loss, the results have not been universal.
More interestingly, blocking DHT in men tends to only slow hair loss. It doesn’t reverse it so why do many trans women experience a reversal of their prior hair loss once they begin HRT? It’s believed that the addition of estrogen for trans women may make the difference when used in combination with DHT blockers.
Some doctors also believe that the combination of increased estrogen and decreased DHT leads to slight changes in bone and muscle structure around the head. Those changes could ease chronic tension that might cause scalp inflammation, which in turn could trigger increased DHT production, kicking off the cycle of hair loss.
Robotic Hair Restoration for Trans Women
For trans women whose hair does not grow back after using hormone replacement therapy, a robotic hair transplant can be an ideal solution. As with any surgical treatment, the same criteria apply as usual. So long as the trans woman has good donor hair the FUE option can be viable.
The combination of transgender hormone replacement therapy and hair loss still requires study, but the number of trans women whose hair grows back after hormone replacement therapy is encouraging. For those who don’t experience improved hair quality after starting HRT, a robotic hair transplant with ARTAS® is a viable option.
Dr. Baiju Gohil is a board-certified surgeon and expert in hair restoration using the ARTAS® system. His commitment to patient care and quality has become known as the RHRLI Edge, which also includes a personal 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.