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 itās 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 āWell, my temples are just receded because I have a masculine hairline now. And the hair texture and color change? Probably just hormones⦠Iāve heard that peopleās hair texture can change after big hormonal shifts.ā
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 āfixed itselfā 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 āwhy isnāt this going away? Iāve been on my natural estrogen for 3 years. Maybe this is how my scalp/hair will be permanently.ā
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 āinconclusiveā, but I figured that getting my follicles examined on a microscopic level was my best bet to figuring out whatās 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 itās 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 itās 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 couldāve contributed to this. She said āactually yes. You probably wouldāve 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 wouldāve happened normally. Unfortunately, once it gets triggered/activated, it doesnāt 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 Iām optimistic about you experiencing some regrowth with treatment.ā
I asked her āWhy donāt all detransitioned women get androgenic alopecia? Youāre saying that you have to have a genetic susceptibility to it in the first place?ā
She said āYes, you have to have genetics that make your hair follicles sensitive to DHT. The detrans women that experience full regrowth probably arenāt genetically sensitive to DHT.ā
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 ātriggerā 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 doesnāt work for any bizarre reason, she will possibly look into finasteride for me but she said she doesnāt like prescribing that to women. And she said she thinks the spironolactone will work anyway.
She told me (paraphrased, not the exact wording): āExpect to not see any results at all until about 6-12 months. Just keep taking the pills everyday, even if you see no progress, itās important you keep taking it everyday and donāt skip days or randomly stop. Youāll revert the progress if you stop. Youāll have to take these pills for life. Unless of course, you just donāt want the treatment anymore. In your case, considering your hormones are normal and you donāt have PCOS, this isnāt something you HAVE to treat. Itās not like, a dangerous condition that negative impacts your genuine health functioning, itās mainly just a cosmetic condition. If you grow up and get older and donāt 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. Itās not MANDATORY to take these pills everyday the rest of your life. As long as youāre aware that the hair loss will progress and wonāt improve without treatment and youāre informed of that, you can take whatever path you want toā.
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 DIDNāT 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, itās possible that testosterone couldāve 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 Iād gotten. So many friends and family of mine said āyou can barely even see any hair loss, you donāt need a scalp biopsy!! Plenty of women have sparse temples.ā So I almost didnāt even go get a biopsy bc so many people kept telling me that I didnāt look like I needed it because my hair loss wasnāt āsevere enoughā. But Iām 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 wouldāve listened to everyone and not got the biopsy, Iād still have no clue that I have this genetic condition right now.
So if youāve 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 itās 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 itās possible that their testosterone usage couldāve 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 wouldāve, due to my testosterone usage. I am 23. She said it probably wouldāve 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 isnāt 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, thereās also alopecia areata, frontal fibrosing alopecia, lichen planopilaris, CCCA, temporary telogen effluvium, traction alopecia, triangular temporal alopecia, and more. Itās best not to blindly guess what it could be, itās best to intervene early and get your hair follicles looked at and start treatment asap.
P.S: Sorry if there are any typos! Iāll 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.