FTMs and Hair Loss: I Tried Finasteride So You Don't Have To


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 it was almost imperceptible. However, by year 10 the thinning near my forehead became too apparent to deny and I finally had to face the fact that I had succumbed to the dreaded MPB (Male Pattern Baldness).
Of course, I had always known that losing my hair was a possibility. I knew other trans folks - guys who had begun their transition around the same time I had - who were now completely bald. But my hair had always been so thick and curly in my youth that the possibility had seemed like a remote one.  

Once I started to look into it, however, I realized MPB is actually way more common than you might think. Medical sources say more than two-thirds of cis men will experience some form of hair loss in their lifetime.

What does this mean for trans masculine folks on testosterone? As far as I know, there are no trans-specific studies to date, but anecdotally, people say that once we begin hormone therapy, we are about as likely to go bald as our cis counterparts.


So when I started truly noticing my hair thinning, I did what many other people facing balding do: I started using Rogaine

For the uninitiated, Rogaine comes in 2 basic formats - gel and oil - which are both applied in the same general way. Two times a day, rub some into your scalp where your hair is thinning and be sure to wash your hands after, lest you end up with hairy palms. Personally, I prefer the oil, as the gel hardens your hair a bit like an actual gel. 

Rogaine's active ingredient Minoxidil works by regenerating small hair follicles and repairing damaged cells to facilitate hair regrowth. Follicles exposed to Minoxidil grow thicker and longer than before, hence the increased hair coverage. It was the first hair growth treatment approved by the FDA, and yes, it works. 

A note here that Rogaine in oil form contains propylene glycol - a chemical that can cause irritation and itchiness in folks with sensitive skin. The gel does not, and so if you experience any discomfort with the oil, you might want to consider switching to the gel.

For a while, my Rogaine routine was a relatively successful stopgap. At the very least, my hair loss procession slowed back down to an unnoticeable crawl.   

However, one afternoon while shopping, I found myself in one of those changing rooms with mirrors that reflect your image from every conceivable angle. From this new perspective, I could see the back of my head echoing to infinity. It was an endless wave of balding crowns crashing against my stubborn denial. I finally had to admit I wasn't just thinning at the front now. I was thinning at the back as well. 

Faced with this desperate situation, I decided it was time to try more drastic measures. 
After tumbling down Google’s rabbit hole researching hair transplant procedures, I eventually determined that the surgical path was not for meFor starters, my hair loss wasn't really extreme enough to warrant a transplant. What's more hair transplants can be incredibly expensive - up to $30,000 depending on the surgeon and the procedure. 

With surgery off the table, I began to look into the world of non-surgical medical interventions for hair loss. 
One of the most popular and proven effective solutions is a prescription pill called Propecia - or Finasteride in its generic form. Finasteride works by blocking your body from converting testosterone to Dihydrotestosterone (DHT). DHT, like testosterone, is an androgen and is in part responsible for those much-coveted characteristics: facial hair, muscle mass, and a deeper voice. It’s also believed to be responsible for hair loss.

Another fun fact about DHT: it's *much* more powerful than testosterone. If you are injecting testosterone, your body will convert a small percentage of what you inject into DHT. Presented with this knowledge, I wondered how much heavy lifting DHT was doing in my hormone therapy.

I very much wanted to keep the facial hair and body composition effects from my T shots. That is, quite frankly, a significant part of why I have subjected myself to twice monthly injections since 2004. 

But if DHT is so much more powerful than testosterone, would my body change drastically with less of it in my system? Curious, I talked with my primary care provider - the one who prescribes me T - to ask her opinion.

She was a bit skeptical of the idea of giving someone both injectable testosterone and a DHT blocker but said we could give it a try.
"However," she warned, "taking it could result in a few other unwanted side effects."
"Like what?" I asked.
"Lower sex drive, some fat redistribution…"
I hoped the increase in confidence from not losing my hair would counterbalance whatever loss in sex drive I experienced on the drug and bit the bullet.

The first month was smooth sailing. I actually saw no noticeable difference in my sex drive or the amount of hair on my head but felt hopeful nonetheless.

By month two, I started to notice very subtle thickening in the areas that had begun to thin. All was looking up!

And then I hit month three and something unexpected happened. 
I found blood in my boxers. 
My blood. 
Menstrual blood.
I am sure there are trans masculine folks who would not be upset by this turn of events. In fact, I know someone who recently stopped T and gloried in the return of his menstrual cycle. He took photos of his bloody underwear and posted them on social media, calling himself a “#periodprince.”
If you happen to be one these folks, all the power in the world to you. I celebrate anyone who is celebrating their body - and especially those who have to give the world a middle finger to do so.
Unfortunately for me, I am not one of those people. 

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

I stopped the pills immediately and made an emergency appointment to see my doctor again. In her office, she told me I could try cutting my dose in half. It seemed a sensible suggestion, but haunted by the specter of red-stained boxer briefs, I bought a pill cutter and took her suggestion one step further. I cut my dose into quarters and took 1/4 of what I had been prescribed instead.
Less than one week later, I had my first full blown period in 10 years.
I will spare you the details, but I will say that whatever was happening ON my head became completely secondary to what was happening IN my head. I’d be happily hairless for the rest of my life if only to never have that experience again.

Since then, I've scoured the internet for examples of trans masc folx who are successfully taking both T and Finasteride. Most of what's out there are other pleas for information, but there are a handful of people who report using both successfully. There are even more who complain of low beard growth and slow voice changes. A few like me, saw the return of their menstrual cycle. 
And so, I quit Finasteride once and for all and resumed my regime of twice daily Rogaine, resigning myself to the inevitability that I would one day look like Humpty Dumpty. Or maybe Michael Stipe. Yeah... hopefully, the latter. 
One afternoon, while lamenting my hair loss to one of my cis gay male friends, he told me, “Think of 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, words of consolation, I am sure.


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