Testosterone-Based Hormone Therapy and Hair Loss: Risks and Treatment Options for Transmasculine People

Starting testosterone can be an exciting milestone for many transmasculine individuals, yet the therapy may trigger androgenic alopecia—a form of hair thinning linked to genetic sensitivity to dihydrotestosterone (DHT). A 2021 study in *The Journal of Pediatric Dermatology* found that 33 % of trans people on testosterone-based hormone replacement therapy (HRT) experience some level of hair thinning or loss. The condition mirrors patterns seen in cisgender men, where 80 % are affected by age 70. While many trans men notice little change, hair loss can intensify gender dysphoria for others and is a common concern expressed on online forums such as Reddit’s r/FTM.

The Advocate

Topical minoxidil (the generic form of Rogaine) is FDA-approved for hair loss and can be prescribed for scalp application. It works by increasing blood flow to follicles, extending the growth phase. Oral finasteride, also FDA-approved, blocks DHT to prevent further thinning, though users report side effects that may include reduced facial or body hair growth and, anecdotally, menstrual spotting in some trans individuals. A 2025 case-report study indicated finasteride’s effectiveness for trans patients, while a 2026 *Journal of the American Academy of Dermatology* study reported minoxidil’s specific benefit for those on testosterone. Clinicians sometimes combine both medications to maximize results.

The Advocate

Advances in transplant technology now allow extraction of healthy follicles from denser scalp regions and implantation into thinning areas. Some trans men have used this method to augment facial hair when HRT alone was insufficient. Transplants provide a surgical alternative for those who do not respond to medication.

The Advocate

Hair changes can be affirming for some transmasculine people, aligning physical appearance with gender identity, while for others the loss may be distressing. Because all bodies age, hair thinning is not unique to transgender individuals, yet the ability to address it through medical or surgical means offers greater control over personal transition goals. Consulting knowledgeable healthcare providers remains essential for tailoring treatment to individual needs.

The Advocate