Androgenetic Alopecia in Transgender and Gender Diverse Populations: A Review of Therapeutics

October 2021 in “ Journal of The American Academy of Dermatology ”

Julia Gao, Carl G. Streed, Julie D. Thompson, Erica D. Dommasch, Jon K. Peebles

androgenetic alopecia topical minoxidil finasteride low-level laser light therapy spironolactone oral minoxidil topical finasteride oral dutasteride platelet-rich plasma hair restoration procedures AGA Rogaine Propecia LLLT Aldactone PRP

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Platelet-Rich Plasma →

growth factors taken from your blood and injected into your scalp to stimulate hair

Studysummary This review discusses treatment options for androgenetic alopecia in transgender and gender-diverse patients, highlighting first-line treatments like topical minoxidil and finasteride, but reports no new clinical results. Our plain-language summary of this paper — not a Tressless recommendation.

The document reviews treatments for Androgenetic Alopecia (AGA) in transgender and gender-diverse patients. First-line treatments include topical minoxidil 5%, finasteride 1 mg, low-level laser light therapy, and for transfeminine patients, spironolactone 200 mg. Second-line options include oral minoxidil (1.25 mg for transfeminine and 2.5 mg for transmasculine patients), topical finasteride 0.25% alone or with minoxidil 2%, oral dutasteride 0.5 mg, platelet-rich plasma, or hair restoration procedures. Treatment progress should be assessed after 6-12 months using non-sex-based scales like the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate with the patient's primary gender-affirming clinician(s) to ensure shared knowledge of all medications.

View this study on jaad.org →

Discuss this study in the Community →

Research cited in this study

48 / 48 results

research Safety of Low-Dose Oral Minoxidil for Hair Loss: A Multicenter Study of 1404 Patients

39 citations , February 2021 in “Journal of The American Academy of Dermatology”

In this study, low-dose oral minoxidil for hair loss was associated with infrequent systemic adverse effects, and only 1.7% of patients discontinued treatment due to these effects.

research Incidence and Factors Associated With Androgenetic Alopecia Among Transgender and Gender-Diverse Patients Treated With Masculinizing Hormone Therapy

3 citations , February 2021 in “JAMA Dermatology”

Masculinizing hormone therapy increases the risk of hair loss in transgender and gender-diverse patients.

research Intradermal Injections With 0.5% Minoxidil for the Treatment of Female Androgenetic Alopecia: A Randomized, Placebo-Controlled Trial

7 citations , December 2020 in “Dermatologic Therapy”

In this study, intradermal injections of 0.5% minoxidil significantly improved hair growth and volume in women with female androgenetic alopecia compared to a placebo, with a good safety profile reported.

research Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride

40 citations , November 2020 in “JAMA Dermatology”

This pharmacovigilance study found an increased association of suicidality and psychological adverse events with finasteride use, especially among younger patients using it for alopecia.

research Ongoing Concerns Regarding Finasteride for the Treatment of Male-Pattern Androgenetic Alopecia

5 citations , November 2020 in “JAMA Dermatology”

Finasteride may cause side effects; more research needed.

Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic Assessment

research Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic Assessment

24 citations , September 2020 in “Dermatology and therapy”

This study found that low-dose oral minoxidil 5 mg daily significantly increased hair growth in men with androgenetic alopecia over 24 weeks, with increased hair count and vertex area improvement, though most experienced hypertrichosis and some had pedal edema.

research Characterization and Management of Hypertrichosis Induced by Low-Dose Oral Minoxidil in the Treatment of Hair Loss

7 citations , September 2020 in “Journal of The American Academy of Dermatology”

This article describes the characteristics and management of hypertrichosis induced by low-dose oral minoxidil used for hair disorders, but reports no new clinical findings.

research Oral Minoxidil Treatment for Hair Loss: A Review of Efficacy and Safety

59 citations , July 2020 in “Journal of The American Academy of Dermatology”

This study concluded that oral minoxidil is an effective and well-tolerated alternative to topical minoxidil for healthy patients struggling with application-related compliance issues.

research A Systematic Review of the Effect of Platelet-Rich Plasma on Androgenetic Alopecia in Women

11 citations , June 2020 in “Dermatologic Therapy”

This systematic review study found that platelet-rich plasma treatment may improve hair density and diameter in women with androgenetic alopecia, although the findings are limited by the small sample sizes and pilot nature of the included studies.

research Treatment of Male and Female Pattern Hair Loss with Sublingual Minoxidil: A Retrospective Case-Series of 64 Patients

16 citations , May 2020 in “Journal of The European Academy of Dermatology and Venereology”

This publication involves a case-series report on the treatment of male and female pattern hair loss using sublingual minoxidil in 64 patients, but it does not include an abstract or results.

research Spironolactone for Treatment of Female Pattern Hair Loss

15 citations , April 2020 in “Journal of The American Academy of Dermatology”

This article notes the lack of physician-reported outcome studies supporting the efficacy of off-label spironolactone in treating female pattern hair loss, despite its common prescription alongside FDA-approved topical minoxidil.

research Androgenetic Alopecia: Effects of Oral Finasteride on Hormone Profile, Reproduction, and Sexual Function

10 citations , February 2020 in “Endocrine”

This study found that finasteride treatment in males with androgenetic alopecia was linked to significant changes in sperm parameters and increased testosterone levels, but no sexual dysfunction was observed, and sperm parameters returned to baseline after treatment stopped.

research Examining the Safety and Efficacy of Low-Level Laser Therapy for Male and Female Pattern Hair Loss: A Review of the Literature

11 citations , January 2020 in “Skin appendage disorders”

This study reviewed clinical trials and found that low-level laser therapy significantly increased hair diameter or density in both men and women with pattern hair loss compared to a sham device, though the involvement of industry relationships in some studies suggests cautious interpretation.

research Androgenetic Alopecia in Gender Minority Patients

8 citations , November 2019 in “Dermatologic Clinics”

This study highlights the importance of clinicians understanding the effects of gender-affirming hormones like testosterone, estrogen, and antiandrogens on hair growth, to effectively diagnose and treat androgenetic alopecia in gender minority patients.

research Very-Low-Dose Oral Minoxidil in Male Androgenetic Alopecia: A Study with Quantitative Trichoscopic Documentation

24 citations , September 2019 in “Journal of The American Academy of Dermatology”

This study found that using very-low-dose oral minoxidil (0.25 mg/d) led to improvement or stabilization of hair parameters in 40% to 60% of men with androgenetic alopecia, although results were not statistically significant for the overall group.

research Minoxidil 1 mg Oral Versus Minoxidil 5% Topical Solution for the Treatment of Female-Pattern Hair Loss: A Randomized Clinical Trial

53 citations , August 2019 in “Journal of The American Academy of Dermatology”

This study observed that low-dose oral minoxidil and topical minoxidil 5% solution both improved hair density in women with female-pattern hair loss, but oral minoxidil may offer advantages in reducing hair shedding.

research Efficacy of Platelet-Rich Plasma for Treating Androgenic Alopecia of Varying Grades

19 citations , June 2019 in “Clinical Drug Investigation”

This study concluded that platelet-rich plasma injections significantly improved hair density, thickness, and scalp inflammation in both male and female pattern hair loss, with better outcomes in lower-grade cases.

research Hair Loss Among Transgender and Gender-Nonbinary Patients: A Cross-Sectional Study

7 citations , May 2019 in “British Journal of Dermatology”

In this study, testosterone use in gender-minority patients was associated with significantly worse androgenetic alopecia severity scores, while feminizing hormone therapy did not significantly change hair loss severity.

research Effectiveness and Safety of Low-Dose Oral Minoxidil in Male Androgenetic Alopecia

52 citations , May 2019 in “Journal of The American Academy of Dermatology”

This study evaluated the effectiveness and safety of low-dose oral minoxidil (2.5-5 mg daily) in men with male androgenetic alopecia, aiming to contribute data to an area with limited previous reports. Results are not provided in the abstract.

The Efficacy and Safety of Dutasteride Compared with Finasteride in Treating Men with Androgenetic Alopecia: A Systematic Review and Meta-Analysis

research The Efficacy and Safety of Dutasteride Compared with Finasteride in Treating Men with Androgenetic Alopecia: A Systematic Review and Meta-Analysis

38 citations , February 2019 in “Clinical Interventions in Aging”

This meta-analysis found that dutasteride was more effective than finasteride in increasing hair count and improving photographic assessments for men with androgenetic alopecia, while both drugs had similar rates of sexual dysfunction-related adverse effects.

research Shedding Light on the FDA’s 510(k) Approvals Process: Low-Level Laser Therapy Devices Used in the Treatment of Androgenetic Alopecia

6 citations , September 2018 in “Journal of Dermatological Treatment”

This review examines the FDA's 510(k) approval process for low-level laser therapy devices used in treating androgenetic alopecia and reports no new clinical findings.

research Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature and Proposed Treatment Protocol

45 citations , September 2018 in “International Journal of Women's Dermatology”

This review discusses the use of platelet-rich plasma as a treatment for androgenetic alopecia and highlights the need for standardized protocols, reporting no new clinical results.

Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study

research Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study

36 citations , September 2018 in “American Journal of Clinical Dermatology”

This study found that a topical combination of 0.25% finasteride and 3% minoxidil may increase hair diameter more effectively than 3% minoxidil alone in postmenopausal women with female pattern hair loss.

research Understanding and Addressing Hair Disorders in Transgender Individuals

32 citations , January 2018 in “American Journal of Clinical Dermatology”

This article provides a framework for understanding hair disorders and treatment options in transgender individuals undergoing hormonal therapy and reports no new clinical results.

research Female Pattern Hair Loss: A Pilot Study Investigating Combination Therapy with Low-Dose Oral Minoxidil and Spironolactone

80 citations , December 2017 in “International Journal of Dermatology”

This study reported that once-daily treatment with oral minoxidil and spironolactone for 12 months reduced hair loss severity and hair shedding in women with pattern hair loss, with generally mild side effects, though results came from an uncontrolled, observational pilot study.

research Evidence-Based Guideline for the Treatment of Androgenetic Alopecia in Women and Men – Short Version

145 citations , November 2017 in “Journal of The European Academy of Dermatology and Venereology”

This guideline review by the European Dermatology Forum evaluates current treatments for androgenetic alopecia but reports no new research findings, aiming to assist dermatologists in selecting safe and effective therapies.

research Therapeutic Experience with Oral Finasteride for Androgenetic Alopecia in Female-to-Male Transgender Patients

32 citations , July 2017 in “Clinical and Experimental Dermatology”

This study assessed the use of oral finasteride in transgender men with androgenetic alopecia and found that all patients improved by one grade on the Norwood–Hamilton scale within about 5.5 months, with no significant adverse effects reported during the 16.2 months of follow-up.

Low-Level Light and Minoxidil 5% Combination Versus Either Modality Alone in Management of Female Patterned Hair Loss: A Randomized Controlled Study

research Low-Level Light and Minoxidil 5% Combination Versus Either Modality Alone in Management of Female Patterned Hair Loss: A Randomized Controlled Study

34 citations , May 2017 in “Lasers in Surgery and Medicine”

This study found that combining low-level light therapy with topical minoxidil 5% may lead to better hair regrowth and patient satisfaction in treating female pattern hair loss compared to using each treatment alone.

research The Effectiveness of Treatments for Androgenetic Alopecia: A Systematic Review and Meta-Analysis

178 citations , April 2017 in “Journal of The American Academy of Dermatology”

This systematic review and meta-analysis found that minoxidil, finasteride, and low-level laser light therapy significantly improve hair growth in men with androgenetic alopecia, while minoxidil is also effective for women, compared to placebo.

research Quality of Life Assessment in Patients with Alopecia Areata and Androgenetic Alopecia in the People's Republic of China

32 citations , January 2017 in “Patient Preference and Adherence”

This study found that both alopecia areata and androgenetic alopecia moderately reduced the quality of life for Chinese patients, especially in younger individuals and those experiencing hair loss for over a year.

A Comparative Study of Microneedling with Platelet-Rich Plasma Plus Topical Minoxidil (5%) and Topical Minoxidil (5%) Alone in Androgenetic Alopecia

research A Comparative Study of Microneedling with Platelet-Rich Plasma Plus Topical Minoxidil (5%) and Topical Minoxidil (5%) Alone in Androgenetic Alopecia

48 citations , January 2017 in “International Journal of Trichology”

This study found that combining microneedling with PRP and topical minoxidil (5%) significantly improved hair growth in men with androgenetic alopecia compared to using minoxidil alone.

research Dermatologic Care of the Transgender Patient

41 citations , December 2016 in “International Journal of Women's Dermatology”

This review discusses the unique dermatologic needs of transgender individuals during transitioning and emphasizes the importance of accommodating care in medical settings; it reports no new clinical results.

research Hormonal and Surgical Treatment Options for Transgender Men (Female-to-Male)

26 citations , December 2016 in “Psychiatric Clinics of North America”

This review describes current medical and surgical treatments for transgender men, highlighting the effectiveness and general tolerability of hormone treatment, and suggesting that surgical benefits often surpass associated risks, although it reports no new clinical findings.

research Meta-Analysis of Efficacy of Platelet-Rich Plasma Therapy for Androgenetic Alopecia

57 citations , May 2016 in “Journal of Dermatological Treatment”

This analysis suggests that platelet-rich plasma therapy may be promising for treating androgenetic alopecia, but further controlled trials with standardized measures are needed to confirm its efficacy.

Cross-Sex Hormone Therapy in Trans Persons Is Safe and Effective at Short-Term Follow-Up: Results from the European Network for the Investigation of Gender Incongruence

research Cross-Sex Hormone Therapy in Trans Persons Is Safe and Effective at Short-Term Follow-Up: Results from the European Network for the Investigation of Gender Incongruence

204 citations , May 2014 in “The Journal of Sexual Medicine”

This study concluded that current cross-sex hormone treatments for trans men and trans women are effective with a low risk of side effects in the short term, though they did observe specific clinical changes.

Efficacy and Safety of a Low-Level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-Controlled, Double-Blind Study

research Efficacy and Safety of a Low-Level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-Controlled, Double-Blind Study

147 citations , January 2014 in “American Journal of Clinical Dermatology”

This study found that low-level laser treatment with the HairMax Lasercomb significantly increased terminal hair density in both men and women with pattern hair loss, with no serious adverse events reported.

research Short- and Long-Term Clinical Skin Effects of Testosterone Treatment in Trans Men

110 citations , October 2013 in “The Journal of Sexual Medicine”

This study found that testosterone therapy in trans men increased facial and body hair growth while the prevalence and severity of acne peaked at 6 months but were primarily mild after long-term treatment.

research Hairline Lowering: A Cosmetic Procedure for Women with High Hairlines

22 citations , August 2013 in “Facial Plastic Surgery Clinics of North America”

A cosmetic procedure can lower the hairline by up to 10 cm, with high satisfaction but potential for temporary sensation loss and rare risks.

research Patient Selection, Candidacy, and Treatment Planning for Hair Restoration Surgery

12 citations , August 2013 in “Facial Plastic Surgery Clinics of North America”

This article reviews the essential aspects of patient consultation and examination in hair restoration surgery and outlines factors affecting candidate selection and contraindications, but reports no new clinical results.

research Androgens and Hair Growth

209 citations , September 2008 in “Dermatologic Therapy”

This review discusses the role of androgens in hair follicle regulation and suggests that a better understanding could enhance treatments for conditions like hirsutism and alopecia, but does not present new findings.

research A New Classification of Pattern Hair Loss That Is Universal for Men and Women: Basic and Specific (BASP) Classification

125 citations , May 2007 in “Journal of The American Academy of Dermatology”

This study describes the development of the BASP classification system, providing a universal and systematic approach for classifying pattern hair loss in both men and women.

The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

research The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

215 citations , November 2006 in “Journal of The American Academy of Dermatology”

This study found that dutasteride increased scalp hair growth in men with male pattern hair loss, particularly at a 2.5 mg dose, and was more effective than finasteride over 24 weeks.

research Effects of Finasteride (1 mg) on Hair Transplant

23 citations , October 2005 in “Dermatologic Surgery”

This study found that finasteride 1 mg daily, taken before and after hair transplant surgery, significantly improved scalp hair coverage and density in men with androgenetic alopecia compared to placebo.

research Treatment of Female Pattern Hair Loss With Oral Antiandrogens

179 citations , March 2005 in “British Journal of Dermatology”

This study found that 88% of women with female pattern hair loss who received oral antiandrogens saw no progression or improvement in their condition.

research Hypertrichosis in Females Applying Minoxidil Topical Solution and in Normal Controls

63 citations , April 2003 in “Journal of The European Academy of Dermatology and Venereology”

This study found that minoxidil topical solution was associated with a dose-related occurrence of hypertrichosis, especially facial hair, in women treated for androgenetic alopecia.

research Multifactorial Classification of Male and Female Androgenetic Alopecia

32 citations , June 2000 in “Dermatologic Surgery”

Different factors help diagnose and treat hair loss accurately.

research Psychological Effects of Androgenetic Alopecia on Women: Comparisons with Balding Men and Female Control Subjects

222 citations , October 1993 in “Journal of The American Academy of Dermatology”

This study found that androgenetic alopecia causes significant psychological distress, particularly in women, who exhibit a more negative body image and less adaptive functioning compared to controls.

research The Psychological Effects of Androgenetic Alopecia in Men

192 citations , June 1992 in “Journal of The American Academy of Dermatology”

Hair loss can cause low self-esteem, anxiety, and depression in men.