FTMs and Hair Loss: I Tried Finasteride So You Don't Have To
Finasteride for Trans Men: Hair Loss, Side Effects & What Happened When I Tried It
A first-person account from someone who's been on T for over a decade — what finasteride does, how it interacts with testosterone, and why I ultimately quit.
This article is based on one person's personal experience and is not medical advice. Hair loss treatments affect everyone differently, and the interaction between finasteride and testosterone-based HRT is not well studied in trans masculine people. Always consult your prescriber before starting, stopping, or changing 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 face the fact that I had succumbed to 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. Medical sources suggest more than two-thirds of cis men will experience some form of hair loss in their lifetime. As for trans masculine people on testosterone — there are no trans-specific studies to date, but anecdotally, people say that once we begin hormone therapy, we're about as likely to go bald as our cis counterparts.
Hair Loss on Testosterone — What's Happening
Yes — trans men and trans masculine people on testosterone can experience male pattern baldness (MPB). Testosterone therapy increases androgen levels, and some of that testosterone is converted to DHT (dihydrotestosterone), which is strongly associated with hair follicle miniaturization and hair loss. Whether and how much hair you lose depends largely on your genetics — if baldness runs in your family, T increases your likelihood of experiencing it. If it doesn't, you may never notice significant hair loss at all.
Male pattern baldness on testosterone typically follows the same patterns it does in cis men — a receding hairline, thinning at the crown, or both. For trans masculine people who started T as adults, the onset can feel sudden even when it's been gradual. For many of us, hair was one of the features we held onto through early transition. Watching it thin can carry its own particular weight.
Starting with Rogaine (Minoxidil)
Yes. Minoxidil (Rogaine) is safe to use alongside testosterone therapy and is one of the most accessible first-line treatments for hair loss in trans masculine people. It doesn't interact with testosterone or DHT — it works directly on hair follicles to stimulate regrowth and slow further loss. Results vary, but many people see improvement with consistent use.
When I started truly noticing my hair thinning, I did what many people facing baldness do first: I started using Rogaine.
For the uninitiated, Rogaine comes in two basic formats — a foam/gel and a liquid/oil — both applied the same general way. Twice a day, rub it into your scalp where your hair is thinning, and wash your hands thoroughly afterward. Personally, I prefer the liquid, as the foam can leave hair feeling stiff.
Rogaine's active ingredient, minoxidil, works by regenerating small hair follicles and repairing damaged cells to facilitate regrowth. Follicles exposed to minoxidil grow thicker and longer than before, producing greater hair coverage. It was the first hair growth treatment approved by the FDA, and yes — it works for a lot of people.
One note: the liquid form of Rogaine contains propylene glycol, a chemical that can cause irritation and itchiness in people with sensitive skin. The foam does not. If you experience discomfort with the liquid, the foam is worth trying.
For a while, my Rogaine routine was a relatively successful stopgap. My hair loss slowed back down to an unnoticeable crawl — 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 and How Does It Work?
After researching hair transplant procedures — and determining the surgical path was not for me (for starters, my hair loss wasn't extreme enough to warrant it; for another, hair transplants can run up to $30,000 depending on the surgeon and procedure) — I began looking into non-surgical medical interventions.
One of the most popular and proven-effective options is a prescription pill called Propecia, or finasteride in its generic form.
Finasteride works by blocking your body's ability to convert testosterone into dihydrotestosterone (DHT). DHT is an androgen — like testosterone, but significantly more potent. It's believed to be the primary driver of male pattern baldness by causing hair follicles to miniaturize over time. By reducing DHT levels, finasteride slows or stops this process and, in many people, allows some regrowth of miniaturized follicles.
Finasteride + Testosterone — The DHT Question
Here's where it gets complicated for trans masculine people on HRT.
DHT is much more powerful than testosterone — approximately 5 times more potent as an androgen. When you inject testosterone, your body converts a percentage of it into DHT. And DHT is doing meaningful work in your hormone therapy: it contributes to facial hair growth, body composition, and some of the deeper physical masculinization many of us are working toward.
So the question I had — and that many 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 simultaneously, 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 trans masculine people report concerns about finasteride slowing voice changes or beard growth. The evidence here is anecdotal — finasteride targets the DHT conversion pathway, and DHT does play a role in androgenic effects. Whether taking finasteride on T noticeably affects voice deepening or facial hair depends on the individual, their dose, and how far along their transition is. If your voice has already stabilized and you have the beard growth you want, the risk is lower. If you're earlier in transition, discuss this specifically with your prescriber.
What Actually 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 masculine people who would not be upset by this. I know someone who recently stopped T and celebrated the return of their cycle — posted photos of their bloody underwear on social media and called 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 extensively for examples of trans masculine people successfully taking both T and finasteride. Most of what exists online are other people asking the same questions I was asking. There are a handful who report using both without issue. There are more who report slower beard growth or stalled voice changes. And a few, like me, experienced the return of their menstrual cycle.
I quit finasteride once and for all and returned 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.
FAQ: Finasteride for Trans Men
Can trans men take finasteride for hair loss?
Technically yes — finasteride is not contraindicated with testosterone therapy, and some trans masculine people do use both. However, the interaction between finasteride and testosterone-based HRT is not well studied, and individual responses vary significantly. Some people use both without issues; others experience unwanted side effects including return of menstruation, lower libido, or slowed androgenic effects. Always discuss with your prescriber before starting finasteride on T.
What are the side effects of finasteride for trans men?
Reported side effects in trans masculine people on testosterone include: return of menstruation or spotting (even years into T), reduced sex drive, fat redistribution, and some reports of slower beard growth or voice changes. Not everyone experiences these — some trans men use finasteride on T without issues — but the menstruation risk in particular is significant enough that it warrants a careful, low-dose trial with close monitoring if you choose to try it.
Does finasteride affect voice changes or beard growth on T?
Possibly. DHT plays a role in androgenic effects including beard growth, body hair, and some aspects of voice deepening. Blocking DHT conversion with finasteride could theoretically slow these effects — and some trans men do report this anecdotally. If your voice has already stabilized and you're satisfied with your beard growth, the risk is lower. If you're earlier in transition, this is a significant conversation to have with your prescriber before starting finasteride.
Does finasteride cause bottom growth loss in trans men?
There is community concern about this, as DHT plays a role in clitoral/bottom growth during testosterone therapy. While there is no definitive clinical study specifically on finasteride's effect on bottom growth in trans men, the mechanism is plausible — reducing DHT could slow or affect DHT-dependent changes. If bottom growth is important to you, this is worth discussing explicitly with your prescriber before starting finasteride.
Can I use minoxidil (Rogaine) on testosterone instead?
Yes — minoxidil is a safer first-line option for trans men dealing with hair loss because it works directly on hair follicles without affecting your hormonal system at all. It doesn't block DHT, interact with testosterone, or carry the risks finasteride does for people on HRT. It works for many people as a long-term maintenance treatment. Start there before considering finasteride.
Will hair grow back if I stop testosterone?
Possibly, depending on how long you've been on T and how much miniaturization has occurred. Hair follicles that have been fully miniaturized may not recover even after T is stopped. Follicles that are in early stages of miniaturization may partially recover. There's no guarantee either way — and the decision to stop T carries far more weight than hair alone. If hair loss is a significant concern, starting minoxidil early (before significant loss occurs) is generally more effective than trying to reverse established loss later.
What's the difference between finasteride and minoxidil?
Minoxidil (Rogaine) is a topical treatment applied directly to the scalp — it stimulates hair follicles and has no hormonal effects. Finasteride is a prescription oral medication that works by blocking testosterone-to-DHT conversion. Minoxidil is available over the counter and is generally considered safe alongside T. Finasteride requires a prescription, has hormonal mechanism, and carries significantly more risk for trans masculine people on HRT — including possible return of menstruation and effects on androgenic changes.