Hair | The MtF Handbook

Most women want a full head of long, luxurious hair. But, if you are an older trans woman, you probably have had to deal with Male Pattern Baldness, or androgenetic alopecia. A spectacularly unfortunate side-effect of Testosterone, MPB is a particularly common challenge to overcoming dysphoria and achieving the look you want.

It is estimated that 85% percent of men experience some level of hair loss as they age. Unfortunately, most hair loss is not easily reversible, and the best treatment is prevention. Treatment effectiveness also depends on where the hair loss is occurring: clinical evidence suggests that hair loss on the crown of your head is easier to treat than frontal recession, but this may just be an effect of study design.

Regardless of where your hair loss is occurring, there are a number of good options for dealing with various degrees of baldness and triggering hair regrowth, depending on your needs and budget.

Option 1: Use a Wig

Wigs are the easiest, fastest and most effective way to deal with hair loss. A wig will give you a brand new head of hair, and best of all, you’re not limited to your natural hair color or type.

I’ve written about choosing your wig before; short version is that for the best look, you’ll want to go with a natural human hair lace wig. Amazon has a few good starter lace wigs you can buy to try out. Here is my favorite.

The downsides of wigs are time and hassle. They take a bit to put on in the morning (though the full lace ones can be worn for multiple days at a time) and can be a little bit more temperamental to style and keep in place than your natural hair.

But for most trans women with MPB (especially more advanced stages), a wig will be the best and fastest way to get a full head of feminine hair.

Option 2: Hair Loss Treatments

There are a number of prescription and over-the-counter (OTC) hair loss treatments available. Unfortunately, your results may vary depending on the type of hair loss you have and how far it has progressed; generally the longer you’ve been dealing with MPB, the harder it is to get hair to regrow.

Lasers

There are a number of different types of laser treatments that claim to stimulate hair regrowth. If you have most or all of your hair and are worried about keeping it, hair laser treatments may be something to try. They claim to work by using light to stimulate blood flow to dormant hair follicles, triggering regrowth.

Most of what I’ve read indicates these are pretty ineffective for places where the hair follicles have already died (can’t stimulate what isn’t there), but may be worth adding to your daily routine in order to keep and increase the volume of hair you already have.

The HairMax Laser Hair Growth Comb Ultima 9 Classic is a great option with a relatively low cost and some clinical evidence suggesting it works.

Minoxidil (AKA Rogaine)

Minoxidil is one of the oldest and best known chemical treatments for hair loss. For a long time this was only available with a prescription, but now topical treatments are available over-the-counter.

Minoxidil, also known most commonly as Rogain, works by increasing blood flow to hair follicles, as well as potential acting as a mild anti-androgen (Testosterone blocker). This triggers the growth phase of the hair follicle and makes it last longer, leading to more and longer hairs than occur naturally.

The OTC options usually contain 5% Minoxidil as a topical cream or shampoo you apply once a day. It typically takes 2-3 months to begin seeing any hair regrowth. Minoxidil has only really been studied for treating ‘vertex’ hair loss, that is thinning at the top of your head, but there is some newer evidence showing it works for all areas of the scalp.

Finasteride

There are a couple prescription medications available for hair loss treatment. The first option is a higher oral dose of Minoxidil, which you’ll need to get via your Primary Care doc or by visiting a doctor who specializes in hair loss.

The other option is Finasteride, a potent anti-androgen. Finasteride stops hair loss by inhibiting the production of DHT, a form of Testosterone that has been shown to be the primary cause of Male Pattern hair loss. Whereas Minoxidil works to stimulate the growth of hair follicles directly, Finasteride works to protect the follicle you have and potentially trigger follicles that have gone dormant to regrow.

If you are already on HRT, Finasteride may already be a part of your treatment because it is such a good all around anti-androgen with fewer side effects than Spirolactone. Otherwise, you can usually add it to your HRT regimen if you consult with your endocrinologist.

Option 3: Surgical or Medical Procedures

If nothing else is working to restore hair loss, surgery is always an option. Unfortunately, if you’ve already lost more than 50% of your hair, even surgery may not be able to restore your previous hairline.

Generally, hair transplant surgeries rely on different methods to move hair from one part of your head or body to another. This used to mean taking complete strips of skin and hair follicles and suturing them in place in a new location, but this is rarely done any more because of the unnatural looking results.

The most common method now is the Follicular Unit Transplants (or FUT), which place individual hair follicles in new locations on your scalp. The most advanced versions of this method use robots to automate much of the procedure, but it can also be done by hand by a skilled surgeon or dermatologist.

Let me know in the comments if there are other hair loss options that have worked for you!

If you are transitioning from male to female, you have probably considered getting a wig. Whether you have short hair or have male pattern baldness, a wig can be an important part of creating an authentic feminine look and make you immediately feel better about your appearance.

Unfortunately, it’s really hard to find good information on wigs for trans folks, and it can feel overwhelming, especially if you’ve never had any exposure or experience with them before.

I wore a wig for the first year of my transition, and I still occasionally wear one to this day. They’re great if you know what to look for, and can be a fun way to try a new color or hairstyle without any regrets!

There are lots of good options for wigs that won’t break the bank; but like most things, you get what you pay for, and I think its worth spending a bit more on a good quality wig since your hair is such an important part of your appearance.

Tip 1: Get a Lace Wig

First things first, you need to decide what kind of wig to buy. Their all different kinds, but I recommend a lace wig, either front or full lace. These will give you the most realistic look, and can be left on for days at a time with only minimal touch up – you can even shower and swim in them if you like!

A lace wig is one where the hair is tied onto a very thin mesh or tulle fabric (called a lace). The hairs at the edge of the lace are usually hand tied and plucked to give you a realistic looking hairline. A front-lace wig only has lace at the front and is meant to be worn down, while a full lace wig will have lace all around the circumference and can be styled and worn anyway you choose.

The downside of lace wigs is that they’re more expensive than other types, and they take a bit longer to apply. In order for the lace to adhere to your skin, you need to use a wig glue and apply it all around the edge of the wig. This can take some time, but the upside is you can then wear the wig for an extended period, and even sleep in it if you like!

There are two front-lace wigs on Amazon that I’ve tried and recommend, a 12” and a 22”. Both are relatively low-cot and worth giving a try if you want to see how it looks.

After you get your lace wig, you’ll need to trim the lace to match your desired hairline.

Last note: if you can, get a lace that matches your skin tone. It can be hard to blend a darker lace into your makeup if you have lighter skin.

Tip 2: Pay More for a Human Hair Wig

Cheaper wigs are usually made of synthetic fibers, and are hard to make look realistic. If you’re interested in looking your best, nothing is better than a real human hair wig:

They last longer than synthetics.
They’re easier to wash and style since you can use any normal hair product and heat.
They feel better.

The downside is cost; human hair wigs can be more expensive than synthetics (but still quite reasonable). Some people prefer virgin hair wigs (meaning they’ve never been dyed or treated) but those are really expensive and don’t provide much benefit. A Remy hair wig still has the cuticle attached and is collected in bunches, so the hair all runs in one direction and looks shiny and natural.

If you’re looking for a good source of full or front-lace human hair wigs, I recommend LaceWigsBuy – they have a pretty wide selection in stock (and a hug selection custom made to order) with fast shipping.

Tip 3: Get a Shorter Wig

As appealing as long flowing locks might seem, long hair can be frustrating. If you’ve never had long hair before, I recommend going with a 12” or 14” wig first. You’ll need to learn how to handle, wash and style your hair (its a lot!) and it can be overwhelming if you’re trying to figure it out with almost 2 feet of hair.

A 12” wig will go down to your shoulders and you can still put up in a pony-tail or behind your ears.

Some Final Tips

A few other things I learned wearing a wig.

When you first get your wig (or put it on after storing it) you’ll want to make sure it lays down on the top of your head. Use a hot comb for a few minutes to help the hair lay down, avoiding that ‘poofy’ unkempt look.
Be liberal with hair and anti-friz spray. Wigs can collect static and be hard to get ‘down’ than your natural hair, and again, you want to avoid the poofy look.
If you want an extra realistic hairline, don’t be afraid to pluck some of the hairs in the lace so the pattern is more realistic. Especially with cheaper wigs that have been made by machine, the hair is in exact rows which doesn’t look natural (but you can only tell if you look really closely).
Don’t be afraid to trim around the ears, especially if you have a smaller forehead. Most wigs are made to standard sizes, and can hang over your ears if you don’t trim them up (or make your ears stick out).

I hope this helps! Let me know if you have any other wig questions in the comments and I’ll do my best to answer!