At Harley Street Hair Transplant Clinics, one of the most frequent questions we’re asked is if transgender people can take finasteride or dutasteride as a hair loss treatment. On this page, you’ll find everything you need to know about how to treat pattern hair loss if you are a transgender patient.
Contents
Key Takeaways
- DHT blocker medications (such as finasteride and dutasteride) can be used as hair loss treatments for cisgender male and transgender patients. Oral finasteride is an effective treatment for light-to-medium pattern hair loss.
- The NHS [1] has stated that DHT Blockers are not recommended for use by cisgender women. This is because finasteride use has been shown to cause growth abnormalities in male fetuses, while women are pregnant [2].
- If you are a trans person, the safest course of action is to consult with a hair loss specialist, hair transplant surgeon, or your local GP. This way, trans patients can receive the best advice as to how to treat their hair loss condition.
Can Trans People Take Finasteride as a Medical Treatment to Combat Hair Loss?
If you’re suffering from hair loss and have an internet connection or social media account, you’ve probably heard of finasteride! Oral finasteride is one of the most popular hair loss medications available today. Thousands of cisgender men across the UK and Northern Ireland take it!
While finasteride remains a popular hair loss treatment in men, it is not recommended for cisgender women. This is due to some scientific research showing finasteride to cause complications in embryonic development. This, however, leaves one question unanswered: is finasteride suitable for transgender people?
In short, it’s complicated! Yes, transgender people can take finasteride to tackle hair loss. However, it’s important to do so under the guidance of a GP or hair transplant surgeon. These healthcare professionals understand the specific needs of transgender people and the potential health risks DHT-blocking medications can pose to trans women and men.
The reason finasteride can be unsuitable for trans people is due to hormone levels. Both, oral finasteride and transgender medication are forms of hormone therapy that target the body’s sex hormones. Let’s uncover why taking finasteride and transgender hormone therapy can be problematic/
What Happens During a Transgender Person’s Transition?
When a trans person goes through their transition, they will usually undergo hormone therapy. This is where a person takes a high concentration of hormones (orally or intramuscularly) to alter their existing sex characteristics.
Trans women (male to female) are given feminising hormone therapy, or “anti-androgen medical treatment”, to feminise the body. Hormones such as oestrogen and progesterone are taken, which in turn causes the development of female sex characteristics. These include the development of breast tissue, a decrease in testicle size, increased fat distribution around the body, and a decrease in muscle mass.
Trans men (female to male) are given masculinising hormone therapy, or “androgens” to make the body look more manly. Hormones such as testosterone are taken. As testosterone levels increase, this has some effects on the body. A person’s menstrual cycle will stop, muscle mass will increase, voice will lower, and there will be an increase in body hair and facial hair growth. Many trans men also opt for chest reconstruction surgery.
This outlines that hormones play a key role in the transition process. A person’s sex steroid levels are altered to make a person more “masculine” or “feminine”. Both androgen and anti-androgen therapy are powerful treatments that help treat feelings of gender dysphoria.
What is Finasteride and How Does it Work?
Finasteride is a DHT-blocking medication used to treat male pattern hair loss (androgenic alopecia) and diffuse hair thinning. This medication is a type of 5-alpha-reductase inhibitor medication (5-ARI). 5-ARI medications, such as finasteride and dutasteride, have an anti-androgenic effect on the body, preventing the body’s uptake of dihydrotestosterone (DHT).
Scientific research shows high DHT concentrations play a vital role in hair loss from pattern baldness. Once DHT has been produced by the body, these powerful male-sex hormones bind to hair follicles on the scalp, causing hair loss.
5-AR is critical in the production of testosterone to DHT. Taking finasteride, a 5-ARI, prevents the body from producing DHT, stopping hair loss at the source! With lower levels of DHT in the body, less hair loss is likely to occur, keeping our scalps looking thick and full!
How are Both Treatments Related and Will Finasteride Affect My Hormone Therapy?
Both treatments are related as they change the body’s hormone levels to alter bodily functions and a person’s appearance. The major difference is that people use finasteride to prevent hair loss while trans patients take hormone medication to treat gender dysphoria.
Believe it or not, 5-ARIs are often prescribed to male-to-female trans patients as they are powerful anti-androgens! Aside from preventing hair loss, DHT blockers block the biosynthesis of androgens which, in turn, limits the levels and effects testosterone and DHT have on the body.
So, the balance of DHT and testosterone levels plays a vital role during a person’s gender transition, meaning any additional hormone-altering medications should be cleared by a doctor or surgeon before use. That is not to say finasteride cannot be taken by trans people! Your healthcare practitioner is best placed to guide you through the process!
Why Do Transgender People Want to Take Finasteride?
Many trans patients, both female-to-male (FTM) and male-to-female (MTF), consider finasteride as a hair loss treatment. Trans women may have suffered from male pattern baldness before their transition. Trans men may be experiencing pattern hair loss due to the increase in male sex androgens circulating in the body.
Trans Women (MTF) and Hair Loss
Before a transgender woman takes hormonal treatment as part of their transition, they may have suffered from a condition called androgenetic alopecia (male pattern hair loss). Patients with this condition experience hair loss in the temple region and (in some cases) the crown.
Male pattern baldness is a hereditary condition, meaning people suffering from it are born with a genetic predisposition to pattern hair loss. Pre-transition, DHT molecules can bind to the receptors in your hair follicles causing hair loss in the temples, hairline, and crown.
As trans women do not have a womb, finasteride does not pose the same fertility risks as it would with cisgender women. Post-transition, transgender women who take oestrogen and anti-androgens (like spironolactone) as part of their hormone therapy, may find that taking finasteride further aids in reducing androgen levels and associated hair loss.
Trans Men (FTM) and Hair Loss
Once a female begins transitioning into a male and testosterone levels increase, this can cause hair loss. While the benefits of testosterone can make a person more masculine, one of the downsides of this is a higher likelihood of hair loss.
Female to male trans patients may consider finasteride to prevent hair loss from occurring. This, however, can be problematic for some patients. While finasteride can be used, it may have a detrimental effect on hormone therapy and the womb.
Scientific research on this topic is increasing but is still in its infancy. On this topic Michael S. Irwig believes: “in the absence of efficacy and safety data on 5α-reductase inhibitors in gender-diverse populations, clinicians should discuss this issue with patients who request or are contemplating their use” [3].
The best course of action is to speak to your GP or doctor before taking finasteride.
Finasteride Efficacy: Does it Work For Trans People?
The efficacy of finasteride has been studied since the early 1990s. It is a safe and effective medication for treating hair loss with relatively few side effects. But what does the research say?
In a study of nearly 2,000 men suffering from pattern hair loss, results showed that 83% of finasteride users experienced no further hair loss during the two-year trial. Comparatively, 72% of participants in the placebo-controlled trial experienced hair loss. Thus, finasteride is an effective treatment for hair loss when used over a long period [4].
The effectiveness of finasteride for transgender patients can vary depending on several factors, including the individual’s hormonal profile, the specific goals of treatment, and how well the medication is tolerated.
Another key consideration is the severity of the hair loss before a person starts taking finasteride. DHT blockers are most effective when treating early to mid-stage pattern hair loss. The sooner you start taking finasteride as a treatment, the more effective it will be.
For patients who have suffered extensive hair loss before their transition, a hair transplant may be the only available option. Once a patient has had a hair transplant, finasteride is usually recommended to prolong the result of surgery and prevent further hair loss.
Conclusion
Finasteride can be an effective option for managing hair loss in transgender patients, particularly when integrated into a comprehensive hormone therapy plan. Its effectiveness can vary, and it should be used under the guidance of a knowledgeable healthcare provider to ensure the best outcomes and to manage any potential side effects. Regular follow-up and individualised treatment adjustments are key to optimizing results.
