Using Finasteride While Transitioning

When transgender people embark on their transitioning path, they uncover a new world of philosophy, medicine, and treatments that have the potential to change their lives for the better.

There are countless methods used to facilitate a safe and effective transition, including some medicines that may not be expected. While hormones are the primary point of interest for transition therapy, more trans patients seek supplementary medicines, like Finasteride, to achieve their aesthetic goals.

Still, there are many questions surrounding Finasteride for trans individuals, and for those in need of a complete overview, we’re here to help. Let’s walk through the basic facts about Finasteride, how patients, both FTM and MTF, should implement the medication, and how to navigate some common risks that come with the territory. Let’s begin.

Finasteride Basics and Background

Finasteride has been in the public eye for more than 50 years and achieved FDA approval in 1997. Here are the facts about Finasteride that everyone should know before adding it to their regimen.

How Does It Work?

The active mechanism of Finasteride is a 5-alpha reductase inhibitor, which makes it different from other types of hair loss remedies and medications on the market. While the other FDA-approved hair loss medicine Minoxidil is a topical blood flow booster, Finasteride directly interacts with an important testosterone byproduct called dihydrotestosterone (DHT).

Since DHT has long been identified as a primary cause of male-pattern balding, Finasteride works to stop the conversion of testosterone to DHT and thereby save healthy hair from miniaturizing and falling out. 

While the medication may not reduce existing levels of DHT in the scalp, it can stop testosterone from turning into this harmful compound that results in hair loss. Therefore, Finasteride is seen as more of a preventive measure rather than one that can reverse the trend of hair loss after years of thinning and receding.

A big advantage of Finasteride is its ease of use and simplicity. Just one small tablet per day is required, and no topical gels or solutions are needed to achieve results.

Efficacy and Results

Speaking of results, what do studies say about the effectiveness of Finasteride, and how should trans patients interpret these findings?

There’s no doubt the DHT does decrease with the use of Finasteride, as demonstrated in studies from the time of FDA approval for the drug. In fact, serum DHT levels fell on average of 70% in men taking Finasteride after just 42 days of treatment.

The more important question is whether these reduced DHT levels actually resulted in the improvement of existing hair quality and whether hair loss trends slowed or stopped during clinical trials. 

In another study, researchers found that men with moderate androgenetic alopecia saw significant slowing of hair loss progression, while self-administered assessments of hair growth were generally positive. From an objective point of view, noticeable hair growth was observed for nearly 50% of men in the study.

Finasteride for Trans Men

With these impressive results in clinical settings — plus plenty of anecdotal evidence to follow — it’s clear why many trans men (FTM) are eager to try Finasteride in their efforts to maintain healthy hair throughout the transitioning process.

Let’s find out why FTM individuals may consider using Finasteride and what expert opinions you should take into account before adding it to your protocol.

Why Do FTM Patients Use Finasteride?

As trans men undergo the first stages of transition, they are typically guided toward a balanced regimen of masculinizing hormones to reduce estrogen levels while raising testosterone and other androgens that promote male traits.

These attributes include everything from muscle mass to voice deepening, as well as hair on the face and body. However, with higher testosterone concentrations in the body comes the risk of hair loss as those compounds are transformed to DHT. It’s the same mechanism of male pattern balding that we have observed before, only applied to the FTM transition process.

Therefore, it’s not unordinary for FTM patients to seek out Finasteride as a way to preemptively combat alopecia as they set forth on their transition path. Because the medicine works to reduce the rate of conversion from testosterone to DHT, it’s commonly prescribed among FTM patients who want to keep their hair during the masculinization process.

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What Are the Risks for FTM Patients?

While studies are still in the works to determine the exact outcomes of Finasteride for FTM patients, it’s worth observing trends in the trans male community to see what types of risks and side effects may occur.

Since Finasteride only works to lower DHT concentrations, we might presume that other aspects of the transition plan would go unaffected by its use. However, this isn’t always the case, as Finasteride may in fact limit the degree of masculinization in certain trans male patients.

This is because the body’s hormonal system is extremely complex and interconnected, and DHT does more than just cause hair loss. DHT is instrumental in male physiology for many other reasons, including prostate health, sexual health, fat distribution, hair distribution, and mood.

This explains why you may see FTM patients experiencing more acute side effects from Finasteride that aren’t always common among those with genetically male physiologies.

For example, an FTM individual may take Finasteride for several weeks, only to notice that their masculinization progress has slowed in other areas. This isn’t always a welcome trend considering their efforts to look and feel more masculine, and it sometimes results in them leaving the Finasteride behind.

Perhaps scalp hair looks better after some time on Finasteride, but the medicine also limits facial hair growth or causes one’s voice to change. As with all things in hormone replacement, using Finasteride as an FTM person is a matter of tradeoffs, and some trial and error is expected.

The good news is that Finasteride stops working almost immediately after discontinued use, and FTM patients can try it out for themselves to see what happens with minimal risk long term.

Finasteride for Trans Women

It’s not just trans men who sometimes use Finasteride to maintain their hair. The medicine is increasingly used in the lineup of medicines used for trans women and their goals to look and feel more feminine. Here’s what MTF patients should know about Finasteride. 

Why Do MTF Patients Use Finasteride?

People transitioning from male to female have different priorities and therefore rely on a unique set of medicines and hormones to achieve their goals. Estrogenic compounds are the most commonly prescribed, but other synthetic hormones can also work to counteract testosterone and promote feminization. 

Among these lesser-used medicines is Finasteride, since blocking DHT can indeed limit the masculinizing effects of this testosterone byproduct and help MTF individuals get on the right track with lower risk.

In fact, Finasteride is being prescribed more often for MTF patients as a more subtle way to limit masculine traits and work in tandem with estrogenic compounds during the transition phase. Even if patients don’t express concerns about hair loss, Finasteride might be a smart supplementary medicine to include in the lineup.

Of course, a small reduction in DHT is not going to yield dramatic results in the feminization process, but every little bit helps an MTF person on their transition journey.

As a bonus, MTF patients who may be at risk for balding are doing themselves a favor by using Finasteride early on since this may save them time and effort down the road. Since many MTF individuals also desire healthy, long hair to affirm their identities, Finasteride is something that can fit well into most regimens.

Are There Risks for MTF Patients?

With so many variables at play for MTF patients, there are no guarantees that Finasteride will promote hair growth or help them look and feel more feminine as they transition. The addition of estrogen and reduction of testosterone via hormone therapy is quite strong and may overshadow any gains made by Finasteride long term.

While some endocrinologists and therapists will automatically prescribe Finasteride to MTF patients, it’s important to consider all the possible outcomes and see if that’s something you really want moving forward.

What Are the Guidelines for Finasteride While Transitioning?

Whether you’re FTM, MTF, or pursuing a unique gender identity of your own, we urge that everyone follow these guidelines when using Finasteride for a safe, risk-averse experience.

Work Closely with Your Support Team

It may be easier to obtain Finasteride than ever before. 

Still, as a trans person taking many different hormones and medications at once, you should always consult with your doctors and supporting experts before you add anything new to your routine.

Finasteride might not be the most powerful medicine in the world, but the effects are definitely noticeable and can make a difference in the overall course of your transition process.

Whether your doctors prescribe Finasteride to you or you seek it out yourself, be sure to get the facts from the professionals you trust and track any changes — however small — along the way.

Try Natural Methods Too

Achieving more hair growth as a transgender person isn’t just about taking medicines and hoping for the best. Lifestyle improvements and natural remedies should also be part of your game plan if you want the optimal outcomes for your hair and body in general.

Medicines and supplements work best when your body and mind are healthy from proper nutrition, exercise, and other positive habits. Make sure you have these essentials in order before you seek out medications like Finasteride and others.

Consider the Surgical Route

Lifestyle, hormone therapy, and Finasteride can only take you so far if you’ve experienced significant hair loss before or during your transition. For many trans patients, hair restoration surgery offers a way to transform your look with permanent, real results.

Traditional hair transplantation via FUE or FUT is a popular option for FTM and MTF individuals, while hairline lowering methods may be more applicable for trans women who want a more feminine appearance. 

Explore your options with a hair restoration professional, like Dr. Jae Pak, and see what procedure may be best aligned with your goals. 

Use Finasteride Safely and Limit Risk

For millions of people every year, Finasteride is a game-changing medicine that brings hair back and keeps it going strong. Trans patients can also succeed with Finasteride, but the situation is a bit more complex. 

With this guide, you can make the right decision for your needs and work with hair restoration experts, like our staff at Jae Pak MD Medical, who have your back. 

Sources: 

Hormone therapy for transgender patients | PMC

Practical Guidelines for Transgender Hormone Treatment | Endocrinology, Diabetes, Nutrition & Weight Management 

Finasteride – StatPearls | NCBI

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