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Hair loss after gender affirmation treatment

Published: 2025-03-18

Gender-affirming hormone therapy affects the body in many ways, including hair growth and hair loss. Hormones play a crucial role in the life cycle of hair follicles, and changes in hormone balance can lead to both desired and unwanted effects on hair growth. In this article, we will review how testosterone and estrogen affect hair loss, the biological mechanisms behind it, and the treatment options available.

The hair on the body and head goes through a natural life cycle that is influenced by hormonal balance. During the growth phase, the hair follicle actively produces hair, but over time it enters a resting phase where the hair is shed and replaced by a new one. This cycle is influenced by hormones that shorten the growth phase of the hair follicles on the head. This causes the hair to become thinner and grow more slowly, which can lead to gradual hair loss, especially in those with a genetic predisposition to hereditary hair loss.

How does testosterone treatment affect hair loss?

When you start testosterone treatment, the body’s hormonal balance changes. Testosterone is metabolized by the enzyme 5-alpha-reductase and converted to dihydrotestosterone (DHT), which has a stronger androgenic effect than testosterone itself. DHT is the main factor behind androgenic alopecia (AGA), also known as male pattern hair loss. More things that come with testosterone are:

Increased beard and body hair

Testosterone stimulates beard and body hair growth by converting thin vellus hairs into terminal hairs. How quickly and extensively this change occurs depends on genetics and individual sensitivity to androgens.

Miniaturization of the hair follicles on the head

Dihydrotestosterone (DHT) binds to androgen receptors in the hair follicles on the scalp, reducing blood and nutrient supply. This leads to a gradual miniaturization of the hair follicles, making the hair thinner and shorter until it eventually stops growing altogether.

Typical patterns of hair loss

Hair loss in trans men often follows classic patterns, such as a V-shaped hairline at the temples, thinning at the crown, and in untreated cases, a horseshoe-shaped hairline, similar to that seen in cis men.

If hair loss occurs in cis men in the family, the risk of testosterone treatment triggering or accelerating the process increases. Hair loss can begin as early as 6–12 months after starting treatment and continue for several years.

What happens to the hair during estrogen treatment?

For those taking estrogen supplements, both estrogen and testosterone blockers reduce androgen levels, which can affect both hair loss and hair growth on the body.

Reduced body and facial hair

Estrogen inhibits the effect of testosterone, causing beard and body hair to become thinner and grow more slowly. However, beard growth does not disappear completely and often requires laser or electrolysis for permanent removal.

Slowed or prevented hair loss

If hormone therapy is started before significant hair loss occurs, estrogen and testosterone blockers can lower DHT levels and slow further hair loss. However, hair that has already been lost may be difficult to restore with hormone therapy alone.

Improved hair quality

Estrogen can make hair thicker, shinier and grow faster, thanks to increased sebum production that improves the hair’s structure and moisture balance.

Treatment options for hormone-related hair loss

For those who experience a lot of hair loss, there are several treatment options depending on the needs and desired results. At our clinic, we offer PRP treatment, which stimulates hair follicles and improves hair quality, as well as hair transplantation, which is a more permanent solution to restore hair density. For those who want to slow hair loss on their own, there is minoxidil, an over-the-counter medication available at pharmacies, as well as dermarollers, which can improve blood circulation in the scalp and stimulate hair growth. We are happy to help you find the right treatment for your needs.