Trans Male Pattern Baldness: Everything You Need to Know

Beard Transplant Patient (F2M Gender Affirming Surgery)

Changes in appearance can be dramatic during the process of transitioning to match one’s gender identity. Unfortunately, not all those changes will be intentional.

While major leaps have been made in hormone therapy and other methods in the sphere of transgender treatment, there are still some limitations. Trans male pattern balding is among the more prominent concerns for FTM and MTF patients

Since male pattern baldness occurs to various degrees in cisgender men at a rate of over 70%, it’s not surprising to see that trans patients experience rates of balding when introducing male hormones to their regiment or even going from male to female.

The good news is that trans male pattern baldness can indeed be addressed with many of the same techniques used by men for decades. Circumstances are unique with trans patients, of course, but we can apply some familiar principles to attain results, whether through medicine, ongoing therapeutics, surgical procedures, and more.

Here’s everything you need to know about trans male pattern baldness so that you can feel confident in your head of hair, no matter where you’re at in the transition process.

Trans Male Pattern Baldness Basics

Anyone who has embarked on the transitioning journey knows that balding can occur at some point down the road – the question is how likely this will happen and to what extent.

Here is the background info you should know about transgender MPB before looking into treatments, therapies, and other measures.

Stats and Patterns

Although the amount of available information on transgender hair loss is limited, we can gather from case reports that male pattern balding is rather prevalent for patients transitioning from male to female or vice versa.

One study showed that out of nearly 1000 participants, 65% percent of trans women reported hair loss or thinning on the scalp during their transition process, while 43% of trans men had the same experience.

The caveat of this study is that 91% of participants reported taking gender-affirming hormones at the time of responding, meaning that these results are likely directly influenced by exogenous chemicals in conjunction with existing hormone levels in the body.

In terms of how pattern balding actually looks in the context of transgender patients, we typically see progressions that match the usual stages seen in the Norwood scale.

This means that balding tends to begin with thinning and receding on the frontal portion of the scalp and the hairline, followed by thinning on the vertex known as the “bald spot”.

There is a range of outcomes shown in the Norwood illustrations, but even in most cases of transgender hair loss, the patterns appear recognizable and predictable as documented in the literature over time.

Causes of Trans MPB

As is the case with pattern balding in men for decades, science has struggled to determine the precise cause for why previously healthy hair appears to miniaturize and fall out over the course of one’s life.

However, some key discoveries have been made that shine a light on the process of male pattern balding in both FTM and MTF patients. Rather than focusing on heredity and environmental factors, the scientific focus is now keyed into hair life cycles and the presence of compounds related to the male sex hormone testosterone.

Dihydrotestosterone (DHT) appears to play a prime role in how the life cycles of individual follicle units start, stop, and begin again. This compound is a byproduct of testosterone and is therefore found in high concentrations in patients at various stages of the transition process.

For example, MTF patients may have naturally high levels of testosterone prior to transitioning, and the presence of DHT in the scalp may be considerable, even after a period of time taking hormones for feminization purposes.

Conversely, an FTM patient will likely introduce exogenous testosterone to the body at some point in the transition process, inviting the creation of DHT in the scalp at some point down the road. Because testosterone takes time to saturate the system and break down into DHT, trans men are likely to experience pattern balding further in the future of their treatment.

There are other factors that come into play and influence the speed and severity of pattern balding, whether the patient is FTM, MTF, or non-binary. As we’ll soon address, lifestyle and health factors are also crucial and how one chooses to style their hair.

Everyone is Different

First and foremost, the body’s hormonal profile and natural functions of the body are the main culprits for male pattern balding across the board. In transgender people, this can be a highly complex situation, requiring a high degree of knowledge, experience, foresight, and direct care.

While we have a basic understanding of pattern balding for transgender patients, much of this information is still being unveiled alongside the existing lines of research being conducted for standard MPB and thinning hair in female patients.

Also keep in mind that some FTM patients are not opposed to the masculinization of the hairline, even if this means seeing a mature hairline (about 1.5 inches higher than a youthful hairline) or perhaps some mild pattern of balding as they age.

Addressing Trans Balding – Can It Be Fixed?

Hair loss is already a complex issue for which there is no complete cure, and introducing hormone therapy to the equation can further complicate things from a hair restoration perspective.

However, numerous efforts have been made in the field of transgender hair restoration for patients across the spectrum, with a high degree of satisfaction and lasting results.

Here are the four main ways that a transgender person can address pattern balding, whether they have already experienced loss or they are simply working in a preventive manner.

Hairstyle and Lifestyle

There is much that a transgender person can do to alter the look and feel of their hair in a way that matches their identity and empowers their confidence, even when faced with balding.

FTM patients may want to experiment with close-cropped hair or crew cuts, which can emphasize the “square” masculinization of the face during the transition process.

MTF patients tend to want to grow their hair long at first, which can present more opportunities to cover or mask thinning hair at the front of the scalp or at the vertex.

At a certain point, however, individuals must also move to proactively improve the quality of their hair to any degree they can manage. This starts with positive lifestyle adjustments that can include clean eating, exercise to boost blood flow, stress reduction, and general metabolic function that is important for all people.

These factors may not have a noticeable effect on reversing hair loss, but they have been shown to help limit the early onset of hair loss in patients of all backgrounds.

Popular and Approved Medicines

When first moving to combat hair loss, transgender patients may seek products such as organic supplements, essential oils, hair loss shampoos, and other items marketed towards this niche demographic.

While it’s hard to say whether these products are effective due to a lack of scientific support, the two FDA-approved hair loss medications – Minoxidil and Finasteride – have strong track records for results in trans patients, with minimal side effects and high availability.

With Minoxidil, a topical solution also known as Rogaine, direct application to the target area twice a day is the method of administration. The active ingredients work as vasodilators, boosting blood flow in the scalp and promoting the healthy function of hair follicles in the region.

Minoxidil is approved for both men and women and transgender patients at any stage.

Finasteride, an oral tablet that targets DHT in the scalp, also works quite well with numerous studies in support. However, since Finasteride does work in relation to male hormones, transgender patients should proceed with caution with this medicine or avoid it altogether.

Only under the direct supervision of a hormone specialist and hair restoration professional should these medicines be taken by trans patients.  

Advanced Therapeutics

A broad array of hair loss therapies have made their way to the public in recent years, most of which are green-lit for transgender patients of all kinds.

Low-level laser light therapy is not only an effective way to preserve and promote healthy hair on the scalp, but it also has a range of other benefits for the skin and systems of the body.

Microchanneling is another method rising in popularity in the trans community, utilizing microscopic needles to initiate natural collagen production and growth hormones on the scalp.

Finally, treatments like platelet-rich plasma therapy and stem-cell therapies are being rolled out slowly, and are expensive, preliminary results are proving satisfactory for the short term for hair loss patients.

Hair Restoration Surgery

More transgender people are seeking out hair restoration surgery to achieve highly specialized and permanent results. These involve extracting healthy follicle units from the back of the scalp (donor area) and transplanting them to the target region on the front or top of the head.

Transgender hair transplants are serious procedures that require close collaboration between surgeon, clinic, and patient, especially for clients with complex medical backgrounds.

However, with the highly advanced state of technology and input from skilled surgeons and technicians, these hair transplant techniques can be incredibly effective and give trans patients the results they’ve been looking for all along.

If you are seeking out hair transplantation services as a transgender person, be sure to find a clinic that specializes in this area of expertise so that you get the custom care you deserve.

While many clinics focus on hair transplants, you’ll want to team up with a hair restoration specialist that offers support on all fronts – including medicine, therapies, and additional guidance to fully address transgender pattern balding in a safe and effective way.

Transition While Keeping Your Hair

The process of transitioning can be somewhat stressful, and pattern balding can compound these emotions. Work with an expert specialist like Dr. Jae Pak to create a custom strategy for transgender hair restoration and set all concerns aside.

Sources:

Hair Loss and Transgender People | Transgender Map

Trans Life: Male Hormones | The Guardian

Hair Loss Among Trans Patients | Practice Update

Find out if Hair Restoration is right for you.

Speak with Jae Pak, M.D. today!