Hair loss and transgender people

Scalp hair loss is often a major concern for transgender women and transfeminine people. While some trans men and transmasculine people welcome scalp hair loss, others wish to avoid it. Those who wish to slow their hair loss have many options.

You can skip this overview and see my hair loss recommendations.

Causes of hair loss

Genetics

• The genes you get from your parents are a major influence on the amount and quality of hair you have, the growth cycles, and the chances you will lose it.
• At least 40 points on the X chromosome have an influence on hair loss. That means trans men are more likely to have androgen-induced hair loss after they start taking testosterone.
• Trans women are more likely to experience hair loss in patterns similar to that of maternal relatives. Your mother’s father, brothers, maternal uncles, and maternal grandfather can sometimes give a range of what to expect.
• It’s still difficult at this time to predict who will experience hair loss based on genetics.

Hormones

By far, the most significant preventable factor in scalp hair loss is testosterone.

• Dihydrotestosterone (DHT)
• Things that can cause testosterone levels to change
• Pregnancy and childbirth
• Menopause
• Thyroid problems

Drugs and medical treatments

• These can cause temporary or long-lasting hair loss:
  • Surgery, especially craniofacial surgery
  • Chemotherapy (Anagen Effluvium)
  • Radiation

Medical conditions

• Androgenetic alopecia
• Alopecia areata (patchy hair loss)
• telogen effluvium
• cicatricial alopecia
• traumatic alopecia
• Scalp infections
• Trichotillomania (compulsive hair-plucking)
• Stress
• Diabetes
• Lupus
• Obesity (especially in people assigned male at birth)
• Eating disorders (anorexia and bulimia)

Grooming and fashion

• Traction alopecia can be caused by grooming or styles that pull on hair
  • Hair extensions (hair weave)
  • Tight ponytails
  • Tight pigtails
  • Tight braids or cornrows
  • Incorrect brushes or combs
  • Hats, headbands, or scarves that pull hair or rub scalp
• Incorrect hair cleaning
  • Incorrect shampoos and conditioners
  • Blow-drying, especially with too much heat
  • Hair washing technique

Diet

• Vegetarian and vegan diets
• Significant rapid weight loss
• Antioxidant supplements
• Nutritional deficiencies
  • Iron
  • Zinc
  • Niacin
  • Fatty acids
  • Selenium
  • Vitamin D
  • Biotin
  • Amino acids (especially L-Lysine)
  • Protein
  • Natural antioxidants

Options

Prevention

• You can change 8 things now to help slow hair loss

Drugs

• Taking a prescription androgen blocker is the most effective way to address scalp hair loss.
  • Finasteride (Proscar and Propecia)
  • Dutasteride (Avodart)
  • Cyproterone acetate (Androcur)
  • Spironolactone (Aldactone)
  • Hydroxyprogesterone caproate (Proluton, Proluton Depot)
  • Medroxyprogesterone acetate (Depo-Provera)
• Using topical minoxidil
• Clascoterone (Breezula), a synthetic steroidal antiandrogen being tested
• Anti-fungals and corticosteroids

Diet

• Foods
• Supplements

Topical options

• Topical products
• Shampoos
• Conditioner
• Devices and tools

Radiation

Laser

Surgery

• Surgeries that remove the production source of most androgens (including orchiectomy, vaginoplasty, and vulvoplasty).

References

Guo EL, Katta R (2017). Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept. 2017 Jan; 7(1): 1–10.Published online 2017 Jan 31. https://doi.org/10.5826/dpc.0701a01

Koyama T, Kobayashi K, Hama T, Murakami K, Ogawa R. Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue. Eplasty. 2016 Jan 25;16:e8. eCollection 2016.PMID: 26904154 

English RS Jr, Barazesh JM. Self-Assessments of Standardized Scalp Massages for Androgenic Alopecia: Survey Results. Dermatol Ther (Heidelb). 2019 Mar;9(1):167-178. doi: 10.1007/s13555-019-0281-6. Epub 2019 Jan 22.PMID: 30671883