I was on T for 2 years, and during this time my temples became sparse (which was to be expected). But not only that, my hair strands also became thinner, my hair texture changed (normally it’s curly but it became wavy), and I experienced slightly wider hair part lines/scalp exposure. My hair color also appeared lighter, from a super dark brown (almost black) to a lighter brownish color.
I brushed all of this off as “Well, my temples are just receded because I have a masculine hairline now. And the hair texture and color change? Probably just hormones… I’ve heard that people’s hair texture can change after big hormonal shifts.”
I have been off T for 3 years now, and none of these hair changes have resolved themself much at all. And my hormone levels are normal! The only thing that has “fixed itself” is that I have a lot more wispy downy fine baby hairs that grew in along my hairline. But other than that, the hair shedding, the extra scalp exposure, super sparse temples, and hair texture and color change was still there.
I thought to myself “why isn’t this going away? I’ve been on my natural estrogen for 3 years. Maybe this is how my scalp/hair will be permanently.”
Then, randomly, in the last 3 months, it randomly started getting WORSE. My temples started receding back even more and I experienced even MORE constant shedding. I decided enough was enough and ordered a scalp biopsy test so that I could get an official diagnosis (if there was one). I was prepared for the results to possibly come back as “inconclusive”, but I figured that getting my follicles examined on a microscopic level was my best bet to figuring out what’s going on.
My diagnosis results? Androgenic alopecia.
I came into the dermatologist office to discuss my diagnosis with her, and plan the treatment. She told me that this is a genetic condition and that my hair follicles are genetically programmed to be sensitive and shrink in exposure to even NORMAL DHT levels. I asked her if I should order a lab to get my DHT levels checked. She told me it’s not really necessary in her opinion because with androgenic alopecia, even if the DHT is normal or even low, the follicles are still sensitive to it and shrink in response to it. She said it’s more about the sensitivity level to the DHT, not necessarily how high the DHT is.
I admitted to her about my past of being on testosterone for 2 years when I thought it was trans and asked her if this could’ve contributed to this. She said “actually yes. You probably would’ve gotten androgenic alopecia/female pattern hair loss down the line anyway, but you taking testosterone probably triggered it to happen much sooner. Like a couple or few decades sooner than it would’ve happened normally. Unfortunately, once it gets triggered/activated, it doesn’t go away, and tends to be a lifelong condition, but you are young and you caught this relatively early, and your hairloss is relatively mild, so I’m optimistic about you experiencing some regrowth with treatment.”
I asked her “Why don’t all detransitioned women get androgenic alopecia? You’re saying that you have to have a genetic susceptibility to it in the first place?”
She said “Yes, you have to have genetics that make your hair follicles sensitive to DHT. The detrans women that experience full regrowth probably aren’t genetically sensitive to DHT.”
And she proceeded to try to console me by telling me not to feel too bad about the testosterone/transitioning thing, she said various things can “trigger” androgenic alopecia in a genetically susceptible person, not just transitioning. She said PCOS can trigger it, random hormonal shifts can trigger it, taking steroids can trigger it, or even certain birth controls can trigger it, or just natural aging.
She prescribed me with oral minoxidil (to stimulate growth) and oral spironolactone (to supress DHT levels). She told me if oral spironolactone doesn’t work for any bizarre reason, she will possibly look into finasteride for me but she said she doesn’t like prescribing that to women. And she said she thinks the spironolactone will work anyway.
She told me (paraphrased, not the exact wording): “Expect to not see any results at all until about 6-12 months. Just keep taking the pills everyday, even if you see no progress, it’s important you keep taking it everyday and don’t skip days or randomly stop. You’ll revert the progress if you stop. You’ll have to take these pills for life. Unless of course, you just don’t want the treatment anymore. In your case, considering your hormones are normal and you don’t have PCOS, this isn’t something you HAVE to treat. It’s not like, a dangerous condition that negative impacts your genuine health functioning, it’s mainly just a cosmetic condition. If you grow up and get older and don’t want to do it anymore and want to rock hair pieces or hair toppers or wigs, or just wear your hair naturally however it is, you have the right to do that. It’s not MANDATORY to take these pills everyday the rest of your life. As long as you’re aware that the hair loss will progress and won’t improve without treatment and you’re informed of that, you can take whatever path you want to”.
Soooo… yeah, long story short (and sorry that this was so long), I see a lot of detransitioned women online say that once they stopped T, their hairloss reverted. Which is great! But if yours DIDN’T revert, OR randomly starts getting worse like mine, look into getting a diagnosis because if you have genetics that prime you to be sensitive to DHT, it’s possible that testosterone could’ve triggered this genetic condition to happen earlier than it would have, if not for the testosterone exposure.
This is not supposed to be any sort of fear-mongering, this is supposed to be helpful and advice that I wish I’d gotten. So many friends and family of mine said “you can barely even see any hair loss, you don’t need a scalp biopsy!! Plenty of women have sparse temples.” So I almost didn’t even go get a biopsy bc so many people kept telling me that I didn’t look like I needed it because my hair loss wasn’t “severe enough”. But I’m glad I got the biopsy because androgenic alopecia is a lifelong, progressive condition (which means it continues to only get worse and worse without treatment), so if I would’ve listened to everyone and not got the biopsy, I’d still have no clue that I have this genetic condition right now.
So if you’ve been off of testosterone for years, and your hair loss and scalp exposure is showing no signs of improvement and in fact, is seemingly getting worse, I suggest going to examine your hair follicles for a diagnosis. It may not be androgenic alopecia, it could be anything, telogen effluvium, alopecia areata, nutrient issues, thyroid issues, low iron, but after ruling out nutrient and thyroid, if it’s STILL going on, then yeah I definitely recommend getting an examination or biopsy.
I just wanted to share my story incase anyone is going through anything similar or is struggling with hair loss or suspects it’s possible that their testosterone usage could’ve triggered androgenic alopecia.
TDLR:
I was on T for 2 years, off for 3 and during the past 3 years my hair loss, increased scalp exposure, and hair strand thinness did not go away, if anything it seemed to slowly be getting worse.
I got a scalp biopsy and was diagnosed with androgenic alopecia, a GENETIC, lifelong condition that my doctor said was likely triggered to start DECADES earlier than it naturally would’ve, due to my testosterone usage. I am 23. She said it probably would’ve happened when I was middle aged/menopausal, but the testosterone usage likely upstarted/triggered it to begin MUCH sooner.
So if you are a detrans woman and have been off T for a long time and your hair loss is not improving at all, or getting worse, I highly suggest first checking your nutrient levels (most importantly vitamin D, biotin, Iron, and Zinc), and your thyroid functioning. If those come back clear and nutrients and thyroid isn’t the issue, then I suggest getting an examination or even a biopsy like I did to examine your hair follicles closely, to get an official diagnosis.
There are many hair loss conditions, there’s also alopecia areata, frontal fibrosing alopecia, lichen planopilaris, CCCA, temporary telogen effluvium, traction alopecia, triangular temporal alopecia, and more. It’s best not to blindly guess what it could be, it’s best to intervene early and get your hair follicles looked at and start treatment asap.
P.S: Sorry if there are any typos! I’ll fix them later. I wrote this real quick before my work shift because this has been weighing on me eversince I recently got diagnosed a week ago, and I felt the need to share my experience.
