Dermatologic Care of Hair in Transgender Patients: A Systematic Review of Literature

Abstract

Transgender patients on masculinizing and feminizing hormonal therapy undergo myriad physical and psychologic changes. Dermatologists are uniquely qualified to guide patients in the gender-affirming process, especially as it relates to hair. Given the paucity of literature guiding dermatologists in this process, a systematic review was performed to better understand the physiologic changes of hair in patients on masculinizing and feminizing hormonal therapy as well as the variety of treatment options that exist to help transgender patients to attain their desired hair growth pattern. This review reports findings and treatment options supported by the performed literature review as well as treatment recommendations based on the authors' own experiences treating this unique patient population.

Androgenetic Alopecia in Transgender Men: A Literature Review and Therapeutic Insights

“…Following the adjustment for pertinent confounding variables, the length of testosterone therapy persisted as a foretelling risk factor for the onset of alopecia (OR: 1.05, 95% CI: 1.01-1.09, p = 0.016). However, a survey conducted by Motosko and Tosti [15] suggests that the risk of developing androgenetic alopecia likely depends on factors such as the patient's age, being less likely related to the duration or type of testosterone therapy. The same idea had previously been suggested by Wierckx et al [13][14], who, although finding no association between androgenetic alopecia (AGA) and the duration or subtype of testosterone therapy, a noteworthy correlation with age (r = 0.31, P = 0.03) was observed.…”

Dermatological considerations for transgender and gender diverse patients: An Australian perspective

“…52 For low-dose oral minoxidil, dosages ranging from 1.25 to 5 mg have been proposed in transmasculine patients and a lower dose of 0.25 mg in transfeminine patients to mitigate the risk of off-site hypertrichosis. 53 Oral finasteride 1 mg daily is the most common treatment prescribed by Australian dermatologists for male AGA, 51 however, poses a theoretical risk of interference with testosterone therapy. 40 Changes in muscle mass and fat redistribution may take up to 5 years to develop and as such, the commencement of oral finasteride after 5 years of commencing masculinising GAH has been proposed as a conservative approach.…”

“…Topical minoxidil 5% foam or solution has been recommended as a first‐line therapy for both transmasculine and transfeminine patients with AGA 52 . For low‐dose oral minoxidil, dosages ranging from 1.25 to 5 mg have been proposed in transmasculine patients and a lower dose of 0.25 mg in transfeminine patients to mitigate the risk of off‐site hypertrichosis 53 . Oral finasteride 1 mg daily is the most common treatment prescribed by Australian dermatologists for male AGA, 51 however, poses a theoretical risk of interference with testosterone therapy 40 .…”

Managing Dermatologic Effects of Gender-Affirming Therapy in Transgender Adolescents

“…121,122 Androgenic alopecia from testosterone therapy, seen in some young adults, may be treated by 5-alpha-reductase inhibitors like finasteride. 29 However, 5-alpha-reductase inhibitors may reduce systemic testosterone effects. 20,123 84% of transgender women receiving estrogen still report persistent excess facial and body hair.…”