Hi all,

This is my first guide ever so if I get anything wrong or there are any changes I should make please let me know!

Some of us unfortunately start our journeys without all of our hair. While others get to watch their hair grow with the rest of their body, we don’t. This sucks, it really does. The WPATH standards of care say that feminizing hormones won’t cause regrowth. However, we can take fate into our own hands. With that being said, in all my research results here are all highly variable and there aren’t any guarantees. Rate of regrowth seems to depend on how long someone has had their hair loss. Regardless, even if you’ve had hair loss for many years I would still attempt to recover it. You never know what will happen!

I have seen some trans women who didn’t do anything except HRT and were able to regrow their hair, but I personally would explore every option available to me to maximize recovery. The following are the main methods of recovering hair and are considered the gold standard.

Finasteride

Finasteride is a medication prescribed by your doctor taken as a pill orally once a day. It works by blocking the conversion of testosterone into DHT by your body. DHT is a stronger version of testosterone that shrinks the DHT sensitive hair follicles on your scalp. If your testosterone is already blocked you shouldn’t need to take fin as you won’t have any testosterone able to be converted. It is however worth getting your DHT levels checked just in case. Normal DHT levels for women are below 20ng/dL. If your testosterone isn’t blocked or if your DHT is above 20 ng/dL it might be worth considering. If you aren’t on HRT yet, I would highly recommend trying finasteride as it can carry some feminizing effects with it, including less body hair, lower libido and gynecomastia.

As a side note, fin can rarely carry some more serious side effects, such as brain fog, depression and suicidal thoughts. If you start experiencing any of these, stop taking it right away and reach out to your doctor. Please don’t let this stop you from trying it though!

Minoxidil

Minoxidil or Rogaine can be bought over the counter as a liquid or a foam. It works by keeping your hair in the active growth phase for longer. It instructs you to apply it to the scalp twice a day, but the half life is around 22 hours so if you need to it’s okay to take it once a day. If your hair is still grown out I would recommend the foam as it’s easier for it to penetrate to the scalp, but the foam is more expensive than the liquid. There are generic versions of topical minoxidil that are much cheaper than Rogaine.

If you find that the liquid is irritating to your scalp, you can try the foam as it isn’t as harsh. There are some rare side effects such as a rapid heartbeat, faintness or dizziness and you should stop using it as soon as possible if you experience them.

WARNING: Minoxidil is EXTREMELY TOXIC to pets, especially to cats. Any exposure at all can kill your cat and make your dog very sick. Use at your pets' risk if you do.

Microneedling

Microneedling is a new advancement in hair loss recovery with a few studies to back it up. The studies use it to enhance the outcomes of using minoxidil, but I’ve seen people recover hair on it alone, including myself. It stimulates growth by creating micro-punctures in the scalp encouraging the body to produce collagen and repair the follicles. There are two methods of microneedling, manual derma-rolling or motorized microneedling. It is easier and cheaper to get into with manual derma-rollers, but there are a couple of reasons I personally choose motorized. The first is that it is difficult to achieve the intended depth consistently with a derma-roller. Secondly this is something that is creating micro-wounds on your scalp and it is difficult to sanitize. Thirdly, the needles go in at one angle and will leave at a completely different angle, creating more damage than need be.

As far as protocols go I would start with the highest depth up to 1.5mm you can go that is tolerable. For example, I couldn’t go beyond 0.6mm without it being excruciating. This indicated that my scalp had become too thin and I would have to work my way up. I would needle for a few months and then increase the depth by a quarter of a mm. I now can fairly comfortably microneedle at 1.25mm. Mind you this won’t feel good. During the session you are aiming for erythema or pinpoint bleeding on your scalp. As far as how much the studies recommend one week at lower depths and every two weeks at greater depths. The goal here is to cause a minimal amount of damage to the scalp and not to overdo it.

This video by a doctor goes into more detail about microneedling and its efficacy. There are lots of products out there, I personally use the M8 Dr. Pen with 16 needle cartridges and bought it off a random seller on amazon.

Other treatments

Ketoconazole shampoo (Nizoral)
This anti-fungal shampoo has some properties that can reduce the amount of DHT that reaches your hair follicles. Its efficacy is limited, but it can be worth trying, especially if you still have DHT in your system.

Rosemary essential oil + carrier oil such as jojoba or castor
There was a study that showed rosemary oil can be as effective as 2% minoxidil. It functions as an anti-inflammatory/antioxidant on your scalp. Mix three-ish drops into a dollop of carrier oil and massage into your scalp. Leave it on for as long as you like. I put it on in the beginning of my shower and wash it off at the end. More information can be found here.

Topical melatonin
It’s been shown that topical melatonin can improve the effects of hair loss. Just make sure to put it on at night as it can make you drowsy. More information can be found here.

Scalp massage
There is information here stating that scalp massage can be beneficial to hair growth. I do it with a scalp massager I bought off amazon when I shower.

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Your hair grows in phases and thus any growth you see will happen in waves and won’t be steady. As a general rule of thumb, the longer a hair has been gone, the longer it will take to return. Some people respond to treatments fairly quickly, but don’t give up even if you haven’t seen progress for a year. Unlike men, once you have recovered your hair to an extent you find satisfactory as long as you don’t have DHT in your system you no longer have to worry about continuing these treatments! You’re done!

In the meantime I really recommend finding and investing in a good wig. If you’re like me, it’s scary and a huge departure from your current image, but if you can find something that matches your original hair color and texture I promise you’ll feel more like yourself than ever before.

I stole most of this information from the /r/tressless subreddit. They have an off-site wiki with more information and more treatments you can try here.

Also, if you’re a trans veteran, I highly recommend contacting the LGBTQ+ care coordinator in your area. The VA is extremely generous with trans veteran care and will provide for almost everything for transitioning up to pre and after care for surgeries. Sadly not the surgeries themselves currently. This includes things such as hair removal, hormones, prosthetics and wigs.

Good luck everyone!!