Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics

Authors

Julia L. Gao, Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; George Washington University School of Medicine & Health Sciences, Washington, District of Columbia. Electronic address: jgao@gwu.edu.
Carl G. Streed, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts.
Julie Thompson, Fenway Institute, Fenway Health, Boston, Massachusetts.
Erica D. Dommasch, Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Jon Klinton Peebles, Department of Dermatology, Kaiser-Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland.

Document Type

Journal Article

Publication Date

10-1-2023

Journal

Journal of the American Academy of Dermatology

Volume

89

Issue

4

DOI

10.1016/j.jaad.2021.08.067

Keywords

FTM; LGBT; LLLLT; LLLT; MTF; PRP; alopecia; androgenetic alopecia; bisexual; dermatology; dutasteride; finasteride; gay; gender diversity; gender identity disorder; gender minority; gender queer; gender-diverse; general dermatology; hair loss; hair restoration procedure; hairline advancement; hairline transplantation; health disparities; lesbian; low-level laser light therapy; medical dermatology; minoxidil; platelet-rich plasma; sexual minority; transfeminine; transmasculine

Abstract

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.

APA Citation

Gao, Julia L.; Streed, Carl G.; Thompson, Julie; Dommasch, Erica D.; and Peebles, Jon Klinton, "Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics" (2023). GW Authored Works. Paper 3710.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3710

Department

School of Medicine and Health Sciences Student Works