Androgenetic alopecia refers to hair loss due to the effects of androgens, such as testosterone and its derivatives, on the hair follicles. Typically, testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase. In some people, DHT acts on hair follicles on the scalp, resulting in hair loss.
Incidence
Androgenetic alopecia is a common problem for trans men and transmasculine people who are taking testosterone for their masculinising hormone treatment. A recent study has suggested that the rate of androgenetic alopecia in trans men is roughly 1.3 times greater than the rate in cis men and roughly 2.5 times greater than the rate in cis women (Gao et al., 2023a). The development of androgenetic alopecia tends to peak in the fourth year of masculinising hormone treatment (Thoreson et al., 2021).
Trans women can also suffer from androgenetic alopecia. The rate of androgenetic alopecia in trans women is roughly similar to the rate in cis men, but is roughly 1.9 times greater than the rate in cis women (Gao et al., 2023a).
Treatments
There are a number of treatments that are available for androgenetic alopecia (Gao et al., 2023b).
First-line treatments
- Topical minoxidil 5% is a cream that is applied to the scalp once or twice daily.
- Finasteride 1mg daily is taken as a tablet.
- For trans women and transfeminine people, spironolactone 200mg daily can be used to treat androgenetic alopecia.
- If available, low level laser light therapy can be helpful to treat hair loss.
Second-line treatments
- Oral minoxidil dosed at 1.25mg daily for trans women and 2.5mg daily for trans men can be used as a second-line treatment if first-line treatments have been unsuccessful.
- Dutasteride 0.5mg daily taken as a tablet can be used as a second-line treatment.
- If available, hair restoration procedures could be considered.
Can Minoxidil and Finasteride be taken together for hair loss prevention?
Yes, some treatment regimes do prescribe minoxidil and finasteride together, particularly for treating male pattern baldness (androgenetic alopecia). This combination is commonly used because the two medications work in complementary ways.
How They Work
Minoxidil: Primarily a vasodilator that helps stimulate hair growth by increasing blood flow to hair follicles. It is typically applied directly to the scalp.
Finasteride: A 5-alpha reductase inhibitor that reduces the production of dihydrotestosterone (DHT), a hormone that causes hair follicles to shrink in individuals with male pattern baldness.
Benefits of Using Both Together
Different Mechanisms: Minoxidil promotes hair growth directly, while finasteride targets the underlying hormonal cause (DHT). Together, they can address both the immediate symptoms and the root cause of hair loss.
Improved Efficacy: Studies have shown that using minoxidil and finasteride together can be more effective than using either medication alone in promoting hair regrowth and slowing hair loss.
Dual Action: Minoxidil works on the scalp to support existing follicles, while finasteride prevents further follicle shrinkage.
Common Regimens
Minoxidil: Applied topically to the scalp (usually 1–2 times per day).
Finasteride: Taken orally, typically at a dose of 1 mg per day.
This combination is widely recognised and prescribed for those looking to slow hair loss and encourage regrowth.
If you would like to include these medications in your current regimen, we please ask that you submit your Treatment recommendation request.
You can request Finasteride within the form itself by selecting to be recommended this and this will then be included in your recommendation and Minoxidil can then be purchased as an extra at the end of the form.
Testosterone levels in trans men
Although androgenetic alopecia is related to testosterone treatment, it is important to maintain your testosterone levels within the recommended target ranges. This is because sufficient levels of testosterone are required for the desired masculinising changes to occur. Furthermore, having insufficient levels of testosterone may lead to menopause-like symptoms, such as hot flashes, mood instability, and loss of bone density.
There is currently no evidence that the severity of androgenetic alopecia is related to the dose of testosterone. Therefore, decreasing your testosterone dose may be unlikely to alleviate androgenetic alopecia.
References
Gao, J. L., Sanz, J., Tan, N., King, D. S., Modest, A. M., and Dommasch, E. D. (2023a). “Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study”. JAMA Dermatology, 89 (3): 504-510.
Gao, J. L., Streed, C. G. Jr, Thompson, J., Dommasch, E. D., and Peebles, J. K. (2023b). “Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics”. JAMA Dermatology, 89 (4): 774-783.
Thoreson, N., Grasso, C., Potter, J., King, D. S., Peebles, J. K., and Dommasch, E. D. (2021). “Incidence and Factors Associated With Androgenetic Alopecia Among Transgender and Gender-Diverse Patients Treated With Masculinizing Hormone Therapy”. JAMA Dermatology, 157 (3): 348–349.