How To Treat FTM Baldness: A Complete Guide

Hair loss happens to most men at some point in their lives, and it’s not uncommon for women to experience thinning as they age. Therefore, individuals transitioning from female to male (FTM) may confront hair loss as they affirm their gender identities through hormone therapy, masculinization, and other efforts.

FTM baldness should not discourage you or take you off track from your goals, and as we understand the condition on a deeper level, we uncover more effective treatment plans that can make all the difference in keeping the hair you have.

Navigating the transition process is already a challenge, so adding hair loss to the mix can make many FTM individuals second-guess themselves. This guide aims to reassure you that hair loss is not something to fear and that there are plenty of ways to keep it at bay with the proper strategy in place.

Let’s explore the causes of FTM balding, what techniques can be used to help maintain your hair, and which surgical options you may want to consider to achieve your ideal hairstyle in a shorter time frame.

What Causes FTM Hair Loss?

Due to the low availability of research at the clinical level, our understanding of the causes of FTM hair loss is limited in scope. 

However, we can piece together the broad reasons why hair loss may occur more widely among the FTM population and use this knowledge to create effective treatments that don’t interfere with the objectives of transitioning.

Hormonal Changes

While some trans individuals opt out of hormone therapy to pursue gender identity expression, most FTM patients use exogenous male hormones as the basis of these initiatives. Testosterone and other androgenetic hormones are introduced to the body in order to promote masculine physiological developments, including a deeper voice, muscle mass, and hair growth on the face and body.

As male hormones act upon the body’s systems over months and years, hair loss is one of those unwanted side effects that many FTM patients can confront.

The action of androgenetic alopecia is the main driver here. It identifies the DHT (dihydrotestosterone) as the cause of shortened follicle life cycles and miniaturization on the scalp. Hair may begin to show signs of thinning or weakening before shedding at a higher rate in the familiar Norwood scale pattern.

Hair on the frontal region of the scalp tends to go first, receding symmetrically on either side of the head, and forming a rounded widow’s peak, also called the M-shaped balding pattern. 

Hair on the temples may also thin and recede, and some FTM patients may also notice miniaturization or loss on the crown of the head in the typical “bald spot” trend.

As with all things regarding hair loss and gender-affirming hormones, there are no guarantees, and outliers always exist. Most importantly, stay the course with your hormone therapy as instructed by a specialist, and don’t let hair loss lead you to manipulate these variables in a way that may be unsafe.

Environmental Factors

The modern environment in which we live is loaded with unnatural chemicals, from toxins in the water and air to unwanted chemicals in household cleaning products, cosmetics, and more. Even the food we eat is not as nutrient-dense as it once was, and a large portion of the population deals with deficiencies in turn.

Add in sedentary lifestyles, lack of exercise, and stress, and you’ve got the perfect storm for hair loss, no matter who you are. Since FTM individuals are often on other medications and may experience stress at higher levels, it’s clear that environmental factors can play a significant role in hair loss as they transition.

Although it’s impossible to control our environments in a densely populated and complex world, we can make several conscious adjustments that may help preserve hair in FTM patients and help them lead healthier lifestyles overall.

Genetic Factors

We can’t overlook the role of genetics in hair loss since men, women, and transgender people have different inherited traits that impact all aspects of their physiology. 

As a person transitions from female to male with hormone therapy, it’s ultimately up to the individual’s DNA regarding how they respond on a physiological level. Some FTM patients experience absolutely zero hair loss despite being on HRT for years, while others may start to see thinning and balding within just a few months, even with the same protocol.

While we can’t override the natural expression of our genetics, FTM patients can use this information to make strategic decisions about how to preserve their hair and which initiatives are deserving of time, attention, and resources.

Treating FTM Hair Loss: 4 Techniques

Between genetics, lifestyle, environment, and hormone therapy, it seems that some degree of hair loss is simply going to happen at some point in a person’s time transitioning. In this section, we’re laying out the top five ways to fight hair loss for FTM patients and help them keep the hair they love for the long term.

These treatment categories may progress in order of cost and severity, so we suggest starting small and working your way up to the more serious procedures as a rule of thumb.

1. Lifestyle Changes

Regardless of your background, HRT strategy, or long-term FTM goals, healthy lifestyle choices should be made at the beginning of your journey and continued consistently. It’s not just for hair preservation – it’s simply the smart thing to do for your body and mind.

Transitioning can be an exhausting process that takes its toll physically and emotionally, and you want to be in peak condition in your body and mind to stay on course and get where you want to go. 

Lifestyle adjustments don’t need to be drastic but try using this opportunity to establish healthy habits and limit behaviors and consumption patterns that can detract from your efforts. 

Don’t forget that trying different hairstyles and cosmetics can also be very effective. 

2. HRT Protocol Adjustments

While we generally recommend against making changes to your HRT strategy in your effort to fight hair loss, it’s ultimately an individual’s choice how they want to approach this process, provided they work closely with doctors every step of the way.

FTM patients may find that a slightly lower dose of testosterone allows them to experience the physiological changes they want while keeping a greater amount of hair intact. Other patients may find that hair loss reverses after altering their HRT plan, while some FTM individuals realize that the balding patterns are permanent despite those efforts.

Once again, the science of HRT is complex and should not be your primary method of stopping hair loss as an FTM person. It’s a conversation you should have with your physicians and therapists early on so that you have a plan in mind rather than acting on impulse later on.

3. Effective Therapies

An array of non-invasive hair loss therapies have emerged over the past few years, and FTM should consider trying them before moving on to more serious procedures. Microchanneling, for example, involves stimulating collagen production on the scalp with tiny controlled skin punctures. Our Jae Pak MD Medical staff offers microchanneling to help patients achieve their desired look.

More experimental therapies can be found, including blood plasma and stem cell injections that are still expensive and not so common or proven to produce results. 

4. Surgical Options

If you’ve tried everything to keep your hair as an FTM individual and still struggle with thinning or balding, it may be time to look into surgical procedures that potentially offer transformative results. 

Between FUE and FUT transplantation, FTM patients have a broad spectrum of options to harvest and graft existing hair from the back of the scalp to the designated target areas on the front of the head. These procedures vary widely in scope and volume, so work closely with a hair restoration professional to determine the best course of action.

Forehead reduction is a less common choice for FTM individuals since a lower forehead is typically associated with feminine traits. It’s also worth mentioning that hair loss may continue following a procedure like a transplant, and additional medicines and treatments often work best in conjunction with the recovery and rejuvenation process. 

Navigating FTM Hair Loss

FTM patients should feel confident about their hair at every stage of the transition process, and this guide can help achieve that from the start. While thinning hair may be alarming at first, staying aware and taking action early on makes all the difference. 

As always, FTM individuals should stay in close contact with HRT specialists, therapists, and other experts that help them in all areas of the transition. You may also want to consider teaming up with a hair loss doctor, like Dr. Jae Pak, M.D., who has direct experience with FTM patients and can guide you with empathy and expertise. 

Sources:

Sex Hormones and Hair Loss in Men From the General Population of Northeastern Germany | PMC.

Masculinizing hormone therapy | Mayo Clinic