Hair Loss in Transgender Women: What Current Research Shows

Hair can play an important role in identity, confidence and gender expression.

For many transgender women, hair loss may therefore feel particularly distressing. In some cases, androgenetic alopecia (pattern hair loss) may already have developed before transition begins because of years of prior androgen exposure.

A new 2026 review published in Dermatology and Therapy explored what current research shows about androgenetic alopecia in transgender and gender-diverse individuals receiving gender-affirming hormone therapy.

The authors argue that hair loss in transgender individuals should not simply be viewed as a cosmetic issue. Instead, it may significantly affect wellbeing, confidence and quality of life.

Why Hair Loss Can Occur In Transgender Women

The review explains that androgenetic alopecia in transgender women often reflects previous exposure to testosterone and dihydrotestosterone (DHT) before starting feminising hormone therapy.

This means some transgender women may already have:

• temple recession

• frontal hairline changes

• crown thinning

• diffuse scalp thinning

before transition begins.

Importantly, the review notes that feminising hormone therapy may help stabilise further progression of hair loss in some individuals.

However, regrowth may be limited in more advanced cases where follicles have undergone significant miniaturisation over time.

Hair Loss Patterns Are Not Always Simple

One particularly interesting aspect of the review is the observation that transgender patients do not always fit neatly into traditional “male-pattern” or “female-pattern” hair loss categories.

Some individuals may develop mixed patterns involving:

• frontotemporal recession

• crown thinning

• diffuse mid-scalp thinning

  
  

The authors encourage clinicians to increasingly use the term androgenetic alopecia rather than relying entirely on gendered hair-loss terminology.

Oral Minoxidil Is Emerging As An Important Treatment

One of the major themes throughout the paper is the growing role of oral minoxidil.

The authors describe low-dose oral minoxidil as a promising treatment option in transgender and gender-diverse patients because of its effectiveness and generally favourable safety profile.

For transgender women, the review recommends individualised dosing depending on treatment goals and tolerability.

The paper suggests that low doses such as:

• 0.5 mg

• 1 mg

• 1.25 mg

may be used initially, with cautious dose increases in some individuals if appropriate.

This reflects a broader shift occurring in hair-loss medicine, where oral minoxidil is increasingly being used as an alternative to topical formulations in selected patients.

Spironolactone And Antiandrogen Therapy

The review also discusses spironolactone, an antiandrogen medication commonly used as part of feminising hormone therapy in transgender women.

In some individuals, reducing androgen activity may potentially help stabilise ongoing androgenetic alopecia alongside other aspects of gender-affirming hormone therapy.

The paper notes that treatment decisions should ideally be individualised and coordinated appropriately between healthcare professionals involved in a patient’s care.

What About Finasteride And Dutasteride?

The review also discusses medications such as finasteride and dutasteride, which work by reducing conversion of testosterone into dihydrotestosterone (DHT).

The role of these medications in transgender women appears more complex than in cisgender men.

For example:

• hormone therapy status

• testosterone suppression

• prior orchiectomy

• fertility considerations

• treatment goals

may all influence decision-making.

Interestingly, the review suggests that the benefit of finasteride or dutasteride may become less clear in transgender women whose testosterone levels are already strongly suppressed through gender-affirming hormone therapy.

The paper also highlights the importance of considering psychological wellbeing carefully when prescribing these medications, particularly because mood changes and sexual side effects remain areas of ongoing debate and research.

Hair Transplantation And Feminising Hairlines

The review discusses hair transplantation and hairline feminisation as part of gender-affirming care.

In these situations, surgery may involve:

• lowering or reshaping the hairline

• softening frontal contours

• restoring temple density

• improving framing of the face

  
  

The authors note that treatment planning may differ from traditional hair transplantation because aesthetic goals are often closely linked to gender affirmation rather than simply replacing hair density alone.

However, not every patient has sufficient donor hair available on the scalp to achieve a dense cosmetic result through traditional hair transplantation alone.

This can be particularly relevant in individuals with advanced androgenetic alopecia, where scalp donor reserves may already be limited.

The review itself does not specifically discuss the use of non-scalp donor hair sources such as beard or pubic hair transplantation.

Nevertheless, outside the scope of this review, some surgeons are now exploring the use of non-scalp donor hair sources including:

• beard hair

• pubic hair

  
  

These approaches remain more specialised and experimental than standard scalp-to-scalp transplantation and outcomes may vary because non-scalp hairs often differ in:

• texture

• curl

• growth cycle

• diameter

• colour

• growth length

  
  

As facial hair and body hair to scalp hair transplantation techniques continue to evolve, some individuals may potentially wish to consider future donor-hair preservation before permanent facial hair removal. However, this remains a highly specialised and currently experimental area of hair restoration medicine.

You can read more about these developing

areas here:

• No Donor Hair? Not Always: How Surgeons Are Repurposing Hair in Transplants

• Beyond body hair: Can body hair from other areas help a hair transplant?

  
  

PRP, Laser Therapy And Other Approaches

The paper also discusses additional treatments including:

• platelet-rich plasma (PRP)

• low-level laser therapy (LLLT)

• topical therapies

• mesotherapy with dutasteride

  
  

At present, evidence specifically in transgender populations remains limited.

However, the authors suggest these treatments may potentially be used alongside medical therapy in selected individuals.

The review also discusses the role of hair prostheses in advanced hair loss. These may include wigs and other hair systems designed to improve scalp coverage and confidence.

Although not specifically discussed in this review, other cosmetic approaches used in wider hair-loss practice may include:

• scalp micropigmentation (SMP)

• hair fibres

• toppers

  
  

Modern wigs, toppers and hair systems can often look extremely natural and may provide an immediate improvement in confidence for some individuals.

For many people, combining medical treatment, cosmetic camouflage and psychological support may represent a realistic and empowering long-term strategy for managing hair loss.

A More Individualised Approach To Hair Loss

Perhaps the most important message from this review is that treatment goals may differ significantly between individuals.

For example, some people may prioritise:

• preserving existing scalp hair

• increasing hair density

• softening or feminising the hairline

• avoiding systemic medication

• minimising body or facial hair

  
  

As a result, the review encourages an individualised and gender-affirming approach to treatment rather than a one-size-fits-all model.

The authors conclude that androgenetic alopecia should not simply be dismissed as a cosmetic issue in transgender individuals, as it may significantly affect confidence, wellbeing and quality of life.

At the same time, they emphasise that more research is still urgently needed in this area.

Reference

Ramos-Rodriguez D, Sanchez-Baez D, Cabrera-Garcia P et al. Characterization and Management of Androgenetic Alopecia in Transgender and Gender-Diverse Individuals: A Narrative Review. Dermatology and Therapy. 2026.

Author: Dr Gwen Adey

First published 25/06/06

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