Hair Loss on T: I Tried Finasteride So You Don't Have To

This is one person's experience, not health advice. Hair loss treatments affect everyone differently, and how finasteride interacts with testosterone hasn't been well studied in trans masc people. Talk to your prescriber before you start, stop, or change any medication.

It wasn't until I was about 8 years into hormone therapy that I started noticing my hairline was shifting. The changes were slow enough at first that they were almost imperceptible.

But by year 10, the thinning near my forehead had become too apparent to deny, and I finally had to admit it. I had the dreaded MPB (male pattern baldness).

I had always known it was a possibility. I knew other trans guys who had begun their transition around the same time I had and were now completely bald. But my hair had always been so thick and curly that the possibility had felt remote.

Once I started looking into it, I realized MPB is far more common than I'd assumed. Health sources suggest more than two-thirds of cis men will have some hair loss in their lifetime. There are no trans-specific studies yet, but from what people say, once we start T, we're about as likely to go bald as cis guys.

Hair loss on testosterone

So, do trans men go bald? Yes, you can get male pattern baldness on T. Your body turns some testosterone into DHT (dihydrotestosterone), and DHT is strongly linked to hair follicles shrinking. How much hair you lose, if any, mostly comes down to your genes. If baldness runs in your family, T makes it more likely. If it doesn't, you may never notice much loss at all.

It usually looks the same as it does in cis men: a receding hairline, thinning at the crown, or both. If you started T as an adult, it can feel sudden even when it's been slow. For a lot of us, hair was something we held onto through early transition, so watching it thin can hit hard.

Starting with Rogaine (minoxidil)

When I started truly noticing my hair thinning, I did what many people facing baldness do first: I started using Rogaine.

Rogaine comes as a foam and as a liquid, and you use both the same way. Twice a day, rub it into your scalp where you're thinning, then wash your hands well. I prefer the liquid, since the foam can leave hair feeling stiff.

The active ingredient, minoxidil, works right on your hair follicles to help regrowth and slow more loss. Follicles exposed to it grow thicker and longer hair. It was the first hair growth treatment the FDA approved, and it works for a lot of people. It doesn't touch testosterone or DHT, so it's generally considered safe to use on T.

One note: liquid Rogaine has propylene glycol, which can irritate sensitive skin and make it itchy. The foam doesn't. If the liquid bugs you, try the foam.

For a while, my Rogaine routine was a relatively successful stopgap. My hair loss slowed back down to a crawl you could barely notice. At least from the front.

Then one afternoon I ended up in a fitting room with mirrors that reflected from every angle, and I saw the back of my head echoing toward infinity. An endless wave of balding crowns crashing against my stubborn denial.

I wasn't just thinning at the front anymore. I was thinning at the back too. Faced with this, I decided it was time to try something more drastic.

What is finasteride?

First I looked into hair transplants and decided surgery wasn't for me. My hair loss wasn't bad enough to need it, and transplants can run up to $30,000 depending on the surgeon and procedure. So I started looking at non-surgical options.

One of the most popular and proven options is a prescription pill called Propecia, or finasteride in its generic form. It blocks your body from turning testosterone into DHT. DHT is an androgen like testosterone, but a lot stronger, and it's believed to be the main cause of male pattern baldness. Less DHT can slow or stop the loss, and some people get a little regrowth.

Finasteride and testosterone

Here's where it gets complicated on T. As an androgen, DHT is about 5 times stronger than testosterone. When you inject T, your body turns some of it into DHT, and DHT does real work in your transition. It helps with facial hair, body composition, and some of the deeper physical changes a lot of us want.

So the question I had (and lots of trans men have) was: if I block DHT, will I lose some of the effects I've been working for?

I talked with my primary care provider, the one who prescribes my T, and asked her opinion. She was skeptical about prescribing both injectable testosterone and a DHT blocker at the same time, but said we could try it.

"However," she warned, "it could result in a few other unwanted side effects."

"Like what?"

"Lower sex drive, some fat redistribution…"

I decided the potential confidence boost from keeping my hair might outweigh a possible dip in sex drive, and gave it a shot.

Some people also worry finasteride could slow voice changes or beard growth. What's out there is mostly anecdotal. If your voice has settled and you've got the beard you want, the risk is probably lower. If you're earlier in transition, bring this up with your prescriber.

What happened when I tried it

The first month was smooth sailing. I noticed no difference in my sex drive, no obvious change in my hair, but felt cautiously optimistic.

By month two, I started to notice very subtle thickening in the areas that had been thinning. Things were looking up.

And then I hit month three, and something unexpected happened.

I found blood in my boxers.

My blood.

Menstrual blood.

It was only a little spotting, but it was enough to send me into a cold-sweating panic.

I want to be clear: I know there are trans masc people who would not be upset by this. I know someone who recently stopped T and celebrated the return of their cycle by posting photos of their bloody underwear on social media and calling himself a "#periodprince." If that's you, all the power in the world. I celebrate anyone celebrating their own body, especially when it means giving the world a middle finger to do it.

I am not one of those people.

I stopped the pills immediately and made an emergency appointment to see my doctor. She suggested cutting my dose in half. I took her suggestion one step further and cut the pills into quarters.

Less than a week later, I had my first full-blown period in ten years.

I will spare you the details. What I will say is that whatever was happening on my head became completely secondary to what was happening in my head. I would be happily hairless for the rest of my life if only to never have that experience again.

Since then, I've searched a lot for trans masc people who take both T and finasteride without problems. Most of what's online is other people asking the same questions I was. A handful say they use both with no issues. More say their beard growth slowed or their voice changes stalled. And a few, like me, got their period back.

I quit finasteride once and for all and went back to my twice-daily Rogaine routine, resigned to the possibility that I would one day look like Humpty Dumpty. Or maybe Michael Stipe. Hopefully the latter.

One afternoon, while lamenting my situation to a cis gay male friend, he told me: "Think of it this way: balding is the most masculine thing that can happen to your hair."

Small comfort for those who care little for masculinity. But for others, maybe those words land.

Finasteride on T: quick answers

More on T: injection pain and swelling, subQ shots, syringes and needles, and oral testosterone.