This story was originally published on Them.
Getting ready to start testosterone can be an exciting time in any transmasculine person’s life. That said, like literally any medication, HRT can sometimes come with unintended side effects. Feeling pre-T anxiety, including around hair loss, is common for transmasculine people and trans men starting testosterone-based hormone replacement therapy (HRT).
Many who are considering starting testosterone-based HRT will post online about their concerns, often attributing their main hesitation for scheduling an endocrinology appointment at their local LGBTQ+ health clinic to their fear of losing hair. This inevitably sparks discourse about working through internalized beauty standards about hair, age, and transness, but that is a topic for another day. If you’re considering starting T and worried about your hair, this is the guide for you.
Androgenic alopecia, the medical term for baldness triggered by a genetic predisposition to androgen sensitivity in the hair follicles that shrinks them over time, impacts 80% of cisgender men by the age of 70. When transmasculine people start testosterone-based HRT, it can trigger this kind of hair thinning and loss over time for some people.
According to a 2021 study in The Journal of Pediatric Dermatology, 33% of trans people on testosterone-based HRT experience some level of androgenic hair thinning or loss, though it is important to note that research on HRT-related baldness is limited. Though the exact cause of balding can vary from person to person, this largely occurs due to genetic predisposition to high levels of dihydrotestosterone (DHT), which can cause hair follicles to become lighter and smaller over time.
It’s important to note that many trans men experience little to no change in their hairline when they start HRT. Also, let’s be clear: balding and hair loss are not inherently negative effects of HRT. For many transmasc people, a changing hairline can help us feel more confident, hot, and secure. That said, it’s impossible to deny that hair loss is a common deterrent for others who otherwise want to start T, frequently dotting the pages of Reddit’s r/FTM, YouTube, TikTok, and other online forums where trans people seek answers and advice from each other. And for some people, losing hair doesn’t just impact their confidence; it can activate gender dysphoria.
But before you panic, know that this doesn’t mean HRT needs to be off the table if you want to preserve your hairline. Scientific experts and everyday transmasc people and trans men alike have found solutions to address and prevent androgenic alopecia triggered by starting HRT. Below are some options for people experiencing testosterone-related hair loss, from topical medication to transplants.
Minoxidil
This FDA-approved hair loss treatment, known to many as the generic form of Rogaine, can be prescribed as a topical treatment, like a liquid or foam, applied directly to the affected hair follicles. Originally developed to treat high blood pressure, it is now a common way many people treat their hair loss. A 2026 study published in the Journal of the American Academy of Dermatology found that it was specifically effective at treating hair loss for trans people on testosterone.
When you apply it to your scalp, it stimulates additional blood flow to the area, which can help extend the growth phase of your hair follicles. (It’s also been anecdotally used by some trans men and masc people to help facial hair growth, though this is not clinically proven and not approved by the FDA for this purpose.)
To apply, your scalp and hair should be completely dry so that it can adhere and sink into your skin. Once you have your prescribed dose ready to go, massage the product into your scalp, starting from the center and extending outward, and let it sit on your head for four hours before you consider shampooing. As with other topical medications, make sure to wash your hands thoroughly afterwards to avoid spreading it around. The most common side effects to look out for are itchiness and skin irritation.
Finasteride
Unlike Minoxidil, which promotes hair growth by directly stimulating the follicles when applied, Finasteride is usually prescribed as an oral medication used to prevent baldness before it occurs by blocking dihydrotestosterone (DHT). It is FDA-approved to increase head hair growth, but because it blocks DHT, there are other reported side effects that can come with it, such as slowing or stopping bottom growth, limiting facial hair and body hair growth, and anecdotally causing period spotting for some trans people.
A 2025 study published in the Journal of Medical Case Reports found that finasteride is an effective way to treat androgenic alopecia in trans people taking testosterone;however, there were some reported impacts on the effectiveness of HRT. Sometimes, doctors may prescribe Minoxidil and Finasteride in tandem to treat hair loss or balding.
Hair Transplant
Modern medicine is an amazing thing! There have been developments in recent years that make hair transplants more effective and accessible. They work by taking thick and healthy hair follicles from a fuller part of your head and transplanting some to the area you have experienced thinning in that you would like to treat. That means they can be a great way to address concerns about your hairline that you haven’t been able to treat with medication. Some trans men have even used transplant technology to grow facial hair when HRT wasn’t enough.
Embrace it!
This isn’t exactly a treatment, but hair loss doesn’t have to be a bad thing. For some transmasc people, it can be an affirming and desired part of the process of transition. Others might feel ambivalent. And ultimately, it’s important to remember that all bodies change as they age. For many cis men, this means balding or hair thinning. Ultimately, there are ways to treat hair loss if it isn’t something you want, which is why it’s always good to consult a healthcare professional about your transition goals.
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