Jul 17, 2023·edited Jul 17, 2023Liked by Doc Impossible
Hair has been the bane of my existence since I started transition. Too much hair in the wrong places and not enough in the right places. If you were to ask me (and even if you don't) I would say that hair has the biggest impact on my dysphoria. While I have grown out what I have left, and have had some success with recovery, I will never be able to regain what I once had.
Thank you for the very informative article, I learned a lot from it.
One really important thing to remember is that modern wig technology was invented by and for cis women who experience literally and exactly the same hair loss we struggle with.
Needing and using a wig makes you not one iota different from a massive portion of other women.
This is what gets me through the day... and when I encounter another hair challenged transfemme I tell them exactly the same thing. In a way, I feel more connected to CIS females just because of that. As a matter of fact, my wife's best friend and I share wig and topper tips all of the time. I am even embracing the fact that wigs can be a fun way to have some variety with my style, I have a nice hot pink wig in my Amazon cart right now.
I am still regretting the decisions I made years ago concerning my transition and the effect it has had on my re-transitioning 20 year later. This is something I am resigned to accept.
Amazing. Love the transition tips that apply to all kinds of gender funky people. The reverse insight about using fina to prevent alopecia in trans men seems so obvious when you say it. I never would have thought to add oral or topical Rogaine if a person wanted to advance their facial hair growth as a trans man.
I know a trans guy who spent the first couple of years of their medical transition veeeeeeery carefully applying liquid or foam minoxidil to his beard area, since the men in his family tended to get their facial hair pretty late (often not enough for much of a beard until their mid-to-late-20's, and a beard was what he wanted most out of transition. He loved his soooo much, so it's pretty hard to forget, you know?
I came back to reread this, cause I'm desperate to regrow the hair recession at the corners of my head.
Since I started hrt (~7mo), I've seen the recesssion area fill up with vellus hairs. Amusingly enough, I have vellus hairs ahead of any terminal hair I can remember.
While I wait and hope for them to progress do I risk damaging progress by dying my hair? I'm paranoid but also sick of the heavy grey.
When it comes to minoxidil, I was under the assumption (with no real evidence so it’s valid I’m wrong in saying this lol) that the reason you loose all of the hair was because the DHT/T starts effecting it again once you stop. From what I understand minoxidil’s primary effect is causing blood vessel dilation/growth in the scalp when applied topically which helps follicle growth, so it makes sense that it would go away once as much blood stops reaching the follicles. I guess I’m mostly just wondering what the mechanism for minoxidil really is and why it can’t be permanent if you start estrogen while on it.
Minoxidil works by dilating blood Vessels (it's heart medicine, remember!) When it does so, more T and DHT get supplied to hair follicles that hadn't had strong blood flow before, allowing them to virilize for the first time. Stopping minoxidil causes those blood vessels to constrict again, and since growing hair takes up a lot of resources that the follicles can't get without strong bloodflow, the hair follicles are no longer able to continue growing terminal hairs, so they go dormant.
So yeah, it's just a completely different method of action, that has nothing to do with estrogen.
Also, I know you said you tried a lot of things and wasted a lot of money. I know HRT helped you. Did you have any other science-back treatments from this list? Transplants, for example? Your hair looks great, BTW.
I mean, hair transplants were the very first thing I mentioned in all of the options for hair restoration. I've had a couple of transplants, in addition to the other stuff I've tried. Hair transplants are *the definitive* treatment for hair loss.
Honestly, the hair regrowth and how much younger trans girls look in their "after" photos are two big reasons I might consider HRT. Plus, you know, other reasons.
Just as a head's up, finasteride can cause transmasculine people's periods to come back. I tried it pre-hysto and immediately bailed once that happened. I'm back on it post-hysto and think it's the right decision for me now, but the periods aspect is a huge and significant one for a lot of transmasc people
Thanks for the note! Unfortunately, there isn't a lot out there about fin/dut and transmascs in the scholarly literature, so I can't really report that in the article itself--with a large enough population, you can get virtually any effect on virtually any drug, and it's not responsible technical writing to report on outliers until a relationship is established.
I'm keeping an eye out on the research literature though!
Wow! Tips that I can start using immediately! My hair is fine--I don't know about type 2a, but it's not the full, heavy mane I'd love to have--so I've added sulfate-free shampoo, dry shampoo, and biotin to my shopping list.
By the way, when I got to "Whatever, Nerd..." I thought "No! I was just getting into all this hair science!"
Thanks for linking to the Ustuner paper! That's a more compelling theory of the mechanism of action than hand-waving DHT. I would think the theory could be tested by checking for accelerated alopecia in patients who have gotten cosmetic surgeries that increase scalp tension (e.g. facelifts?), but maybe cosmetic surgeons who do those don't want to help that get published.
You linked to the paper about topical estradiol for chemo-driven alopecia in mice, and to estradiol + spiro HRT treating androgenic alopecia, but have you seen any case studies published about humans applying topical estradiol to their scalp to treat androgenic alopecia?
Another excellent article. My hair jumped ship a long time ago from my head to my back! Also, I have extremely thin finger nails. I had read about biotin being great to help make them stronger and thicker. I took it for a while increasing the level up and it helped a lot. One major downside that showed up though was it elevated one of my thyroid readings. My doctor was concerned about it so I stopped taking the biotin and the thyroid reading went back down. Thought it might be worth sharing. Keep up the great articles!
Biotin is used as a reagent in many tests--thyroid and estrogen are two common ones--so all you usually need to do is stop taking it for about four days before taking a test, so the results don't' come back all screwy. Still, if the doc says to discontinue, it's best to listen!
Unfortunately, there's A LOT less research data on trans masculine folks (seriously, that one study I cited is almost the entire body of research on hair and transmascs), so there's not much to cover there.
Hmm... I don't know that there'd be enough content there to sustain a full article. "Be patient, because E will do most of your work for you. If not, laser, because IPL is for chumps. If you're Black, a redhead, or blonde, I'm so, so sorry."
I mean, that'd kind of be the whole entire article.
Or if you're prematurely gray. Fifteen years ago, before I had any inkling of the tumultuous times ahead, I went for three sessions of laser treatment to try and get rid of my beard, which I've always hated. They told me going in that it would only be partially effective because I had so much gray--no melanin to absorb the energy of the laser.
So my beard became much grayer immediately after, but over the following year, about half of the dark hair grew back.
But if E can do most of the work, I'll jump for joy!
Hair has been the bane of my existence since I started transition. Too much hair in the wrong places and not enough in the right places. If you were to ask me (and even if you don't) I would say that hair has the biggest impact on my dysphoria. While I have grown out what I have left, and have had some success with recovery, I will never be able to regain what I once had.
Thank you for the very informative article, I learned a lot from it.
One really important thing to remember is that modern wig technology was invented by and for cis women who experience literally and exactly the same hair loss we struggle with.
Needing and using a wig makes you not one iota different from a massive portion of other women.
Different from maybe not, but having five standard deviations worse hairline is still significant dysphoria...
It can be incredibly hard for sure. 🫂
This is what gets me through the day... and when I encounter another hair challenged transfemme I tell them exactly the same thing. In a way, I feel more connected to CIS females just because of that. As a matter of fact, my wife's best friend and I share wig and topper tips all of the time. I am even embracing the fact that wigs can be a fun way to have some variety with my style, I have a nice hot pink wig in my Amazon cart right now.
I am still regretting the decisions I made years ago concerning my transition and the effect it has had on my re-transitioning 20 year later. This is something I am resigned to accept.
Amazing. Love the transition tips that apply to all kinds of gender funky people. The reverse insight about using fina to prevent alopecia in trans men seems so obvious when you say it. I never would have thought to add oral or topical Rogaine if a person wanted to advance their facial hair growth as a trans man.
Subscribing 👍
I know a trans guy who spent the first couple of years of their medical transition veeeeeeery carefully applying liquid or foam minoxidil to his beard area, since the men in his family tended to get their facial hair pretty late (often not enough for much of a beard until their mid-to-late-20's, and a beard was what he wanted most out of transition. He loved his soooo much, so it's pretty hard to forget, you know?
Hi!
I came back to reread this, cause I'm desperate to regrow the hair recession at the corners of my head.
Since I started hrt (~7mo), I've seen the recesssion area fill up with vellus hairs. Amusingly enough, I have vellus hairs ahead of any terminal hair I can remember.
While I wait and hope for them to progress do I risk damaging progress by dying my hair? I'm paranoid but also sick of the heavy grey.
Thanks,
Ivy
It's definitely best to not dye hair in tender stages like that. Give yourself some time.
When it comes to minoxidil, I was under the assumption (with no real evidence so it’s valid I’m wrong in saying this lol) that the reason you loose all of the hair was because the DHT/T starts effecting it again once you stop. From what I understand minoxidil’s primary effect is causing blood vessel dilation/growth in the scalp when applied topically which helps follicle growth, so it makes sense that it would go away once as much blood stops reaching the follicles. I guess I’m mostly just wondering what the mechanism for minoxidil really is and why it can’t be permanent if you start estrogen while on it.
Good question!
Minoxidil works by dilating blood Vessels (it's heart medicine, remember!) When it does so, more T and DHT get supplied to hair follicles that hadn't had strong blood flow before, allowing them to virilize for the first time. Stopping minoxidil causes those blood vessels to constrict again, and since growing hair takes up a lot of resources that the follicles can't get without strong bloodflow, the hair follicles are no longer able to continue growing terminal hairs, so they go dormant.
So yeah, it's just a completely different method of action, that has nothing to do with estrogen.
This article is very informative. Thank you so much.
Getting my hair back was a... Long... Process, but damn if it wasn't worth it.
Also, I know you said you tried a lot of things and wasted a lot of money. I know HRT helped you. Did you have any other science-back treatments from this list? Transplants, for example? Your hair looks great, BTW.
I mean, hair transplants were the very first thing I mentioned in all of the options for hair restoration. I've had a couple of transplants, in addition to the other stuff I've tried. Hair transplants are *the definitive* treatment for hair loss.
Honestly, the hair regrowth and how much younger trans girls look in their "after" photos are two big reasons I might consider HRT. Plus, you know, other reasons.
Just as a head's up, finasteride can cause transmasculine people's periods to come back. I tried it pre-hysto and immediately bailed once that happened. I'm back on it post-hysto and think it's the right decision for me now, but the periods aspect is a huge and significant one for a lot of transmasc people
Thanks for the note! Unfortunately, there isn't a lot out there about fin/dut and transmascs in the scholarly literature, so I can't really report that in the article itself--with a large enough population, you can get virtually any effect on virtually any drug, and it's not responsible technical writing to report on outliers until a relationship is established.
I'm keeping an eye out on the research literature though!
Wow! Tips that I can start using immediately! My hair is fine--I don't know about type 2a, but it's not the full, heavy mane I'd love to have--so I've added sulfate-free shampoo, dry shampoo, and biotin to my shopping list.
By the way, when I got to "Whatever, Nerd..." I thought "No! I was just getting into all this hair science!"
Thanks for linking to the Ustuner paper! That's a more compelling theory of the mechanism of action than hand-waving DHT. I would think the theory could be tested by checking for accelerated alopecia in patients who have gotten cosmetic surgeries that increase scalp tension (e.g. facelifts?), but maybe cosmetic surgeons who do those don't want to help that get published.
You linked to the paper about topical estradiol for chemo-driven alopecia in mice, and to estradiol + spiro HRT treating androgenic alopecia, but have you seen any case studies published about humans applying topical estradiol to their scalp to treat androgenic alopecia?
Nothing systemic, and it'd be very dose dependent. Too much estrogen would result in hair *loss*.
I'd actually consider hearing that hair recovery was possible, and seeing some amazing results is what actually properly cracked my egg
Another excellent article. My hair jumped ship a long time ago from my head to my back! Also, I have extremely thin finger nails. I had read about biotin being great to help make them stronger and thicker. I took it for a while increasing the level up and it helped a lot. One major downside that showed up though was it elevated one of my thyroid readings. My doctor was concerned about it so I stopped taking the biotin and the thyroid reading went back down. Thought it might be worth sharing. Keep up the great articles!
Biotin is used as a reagent in many tests--thyroid and estrogen are two common ones--so all you usually need to do is stop taking it for about four days before taking a test, so the results don't' come back all screwy. Still, if the doc says to discontinue, it's best to listen!
Unfortunately, there's A LOT less research data on trans masculine folks (seriously, that one study I cited is almost the entire body of research on hair and transmascs), so there's not much to cover there.
Hmm... I don't know that there'd be enough content there to sustain a full article. "Be patient, because E will do most of your work for you. If not, laser, because IPL is for chumps. If you're Black, a redhead, or blonde, I'm so, so sorry."
I mean, that'd kind of be the whole entire article.
Or if you're prematurely gray. Fifteen years ago, before I had any inkling of the tumultuous times ahead, I went for three sessions of laser treatment to try and get rid of my beard, which I've always hated. They told me going in that it would only be partially effective because I had so much gray--no melanin to absorb the energy of the laser.
So my beard became much grayer immediately after, but over the following year, about half of the dark hair grew back.
But if E can do most of the work, I'll jump for joy!
Souls like you might be getting to know an electrologist well in the future then. 🫂