Gender transitioning can be a delicate balance of physical, emotional and hormonal changes. Hair can be at the center of many of issues. Are you looking to reverse or minimize hair loss in your transition and/or subtly enhance characteristics of femininity? Looking to grow or boost a beard? Finasteride, dutasteride and spironolactone are common medications that have played a role in hair retention and growth and can also be used to subtly enhance other hormonal therapies. have been in the public eye for decades and can be mainstays of transition regimens.. 

The active mechanism of Finasteride and dutasteride (Avodart)  is a 5-alpha reductase inhibitor, which directly interacts with an important testosterone byproduct called dihydrotestosterone (DHT). Spironolactone slows the production of androgens and minoxidil increases blood flow to hair follicles and increases the caliber of hair follicles making (all) existing hair thick and strong. 

A big advantage of Finasteride /Dutasteride and oral Minoxidil  are their ease of use and simplicity. Just one small tablet per day is required, and no topical gels or solutions are needed to achieve results - although they can be used synergistically. 

There’s no doubt the DHT does decrease with the use of Finasteride, as demonstrated in studies from the time of FDA approval for the drug. In fact, serum DHT levels fell on average of 70% in men taking Finasteride (high dose) after just 42 days of treatment.

In one study, researchers found that men with moderate androgenetic alopecia saw a significant slowing of hair loss progression, while self-administered assessments of hair growth were generally positive. From an objective point of view, noticeable hair growth was observed for nearly 50% of men in the study.

As trans men undergo the first stages of transition, they are typically guided toward a balanced regimen of masculinizing hormones to reduce estrogen levels while raising testosterone and other androgens that promote male traits.

These attributes include everything from muscle mass to voice deepening, as well as hair on the face and body. However, with higher testosterone concentrations in the body comes the risk of hair loss as those compounds are transformed to DHT. It’s the same mechanism of male pattern balding that we have observed before, only applied to the FTM transition process.

Therefore, it’s not unusual for FTM patients to seek out Finasteride as a way to preemptively combat alopecia as they set forth on their transition path. Because the medicine works to reduce the rate of conversion from testosterone to DHT, it’s commonly prescribed among FTM patients who want to keep their hair during the masculinization process.

While studies are still in the works to determine the exact outcomes of Finasteride for FTM patients, it’s worth observing trends in the trans male community to see what types of risks and side effects may occur.

Since Finasteride only works to lower DHT concentrations, we might presume that other aspects of the transition plan would go unaffected by its use. However, this isn’t always the case, as Finasteride may in fact limit the degree of masculinization in certain trans male patients.

This is because the body’s hormonal system is extremely complex and interconnected, and DHT does more than just cause hair loss. DHT is instrumental in male physiology for many other reasons, including prostate health, sexual health, fat distribution, hair distribution, and mood.

This explains why you may see FTM patients experiencing more acute side effects from Finasteride that aren’t always common among those with genetically male physiologies.

For example, an FTM individual may take Finasteride for several weeks, only to notice that their masculinization progress has slowed in other areas. This isn’t always a welcome trend considering their efforts to look and feel more masculine, and it sometimes results in them leaving the Finasteride behind.

Perhaps scalp hair looks better after some time on Finasteride, but the medicine also limits facial hair growth or causes one’s voice to change. As with all things in hormone replacement, using Finasteride as an FTM person is a matter of tradeoffs.

The good news is that Finasteride stops working almost immediately after discontinued use, and FTM patients can try it out for themselves to see what happens with minimal risk long term.

Finasteride for Trans Women
It’s not just trans men who sometimes use Finasteride to maintain their hair. The medicine is increasingly used in the lineup of medicines used for trans women and their goals to look and feel more feminine. Here’s what MTF patients should know about Finasteride.

People transitioning from male to female have different priorities and therefore rely on a unique set of medicines and hormones to achieve their goals. Estrogenic compounds are the most commonly prescribed, but other synthetic hormones can also work to counteract testosterone and promote feminization.

Among these lesser-used medicines is Finasteride, since blocking DHT can indeed limit the masculinizing effects of this testosterone byproduct and help MTF individuals get on the right track with lower risk.

In fact, Finasteride is being prescribed more often for MTF patients as a more subtle way to limit masculine traits and work in tandem with estrogenic compounds during the transition phase. Even if patients don’t express concerns about hair loss, Finasteride might be a smart supplementary medicine to include in the lineup.

Of course, a small reduction in DHT is not going to yield dramatic results in the feminization process, but every little bit helps an MTF person on their transition journey. Spironolactone can also help to feminize by increasing estradiol in addition to reducing circulating androgens that can contribute to hair loss. 

Oral hair preservation and regrowth products can go a long way, but if an individual still needs or wants additional hair on beards, brows or scalp, SmartGraft can be a terrific way to re-arrange and fill in hair lines and customize your look. SmartGraft removes and places hairs one at a time with tiny incisions (so small your hairdresser won’t even know). Procedures are done in the office and up to 3K grafts can be done in one day. Call today for your free consultation to see if medication and/or SmartGraft might be a good addition for you.901.800.6638 or request a consultation through