Effect of gender-affirming hormone therapy on hair growth: a systematic review of the literature

Abstract

Gender affirming hormone therapy (GAHT) leads to changes in body composition, secondary sex characteristics and in the distribution and pattern of hair growth. Transgender individuals undergoing GAHT may experience altered hair growth patterns that may be affirming and desirable, or undesirable with subsequent impacts on quality of life. Given increasing numbers of transgender individuals commencing GAHT worldwide and clinical relevance of the impact of GAHT on hair growth, we systematically reviewed the existing literature on the impact of GAHT on hair changes and androgenic alopecia (AGA). The majority of studies used grading schemes or subjective measures of hair changes based on patient or investigators’ examination. Very few studies used objective quantitative measures of hair parameters but demonstrated statistically significant changes in hair growth length, diameter and density. Feminizing GAHT with estradiol and/or antiandrogens in trans women may reduce facial and body hair growth, and can improve AGA. Masculinizing GAHT with testosterone in trans men may increase facial and body hair growth as well as induce or accelerate AGA. The impact of GAHT on hair growth may not align with a transgender person’s hair growth goals and specific treatment for AGA and/or hirsutism may be sought. Further research on how GAHT affects hair growth is required.

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

“…48 Masculinising GAH therapy may increase facial and body hair growth but may induce AGA in genetically predisposed individuals. 49 Notably, this typically masculine feature may be reaffirming in some transmasculine patients but for others, it may be undesirable. A recent retrospective cohort study of 37,826 patients demonstrated that TGD patients receiving masculinising GAH therapy were 2.5 times more likely to develop AGA as compared to cisgender women.…”

“…Feminising GAH exerts a degree of hair reduction through decreased growth rate and thickness, favouring reduction in body hair as compared to facial hair. 49 Subsequently, gender-affirming procedures are required for further feminisation. Gender-affirming hair removal represents the most commonly performed facial procedure among transfeminine individuals.…”

“…AGA is a common disorder of hair loss that affects up to 80% of cisgender males by the age of 80 48 . Masculinising GAH therapy may increase facial and body hair growth but may induce AGA in genetically predisposed individuals 49 . Notably, this typically masculine feature may be reaffirming in some transmasculine patients but for others, it may be undesirable.…”

“…Feminising GAH exerts a degree of hair reduction through decreased growth rate and thickness, favouring reduction in body hair as compared to facial hair 49 . Subsequently, gender‐affirming procedures are required for further feminisation.…”