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.
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.
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!