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

Document Type

Journal Article

Publication Date



Journal of the American Academy of Dermatology








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


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.


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