Finasteride is a popular hair loss treatment for people experiencing male pattern baldness. But Finasteride can also be used by transgender people as part of their gender-affirming hormone therapy (GAHT) to control scalp hair loss and body hair growth.
In this article, you’ll learn all about the benefits and drawbacks of Finasteride for transgender patients, including:
Finasteride is a drug known as a 5-alpha reductase (5AR) inhibitor. 5-alpha reductase is an enzyme that converts testosterone to dihydrotestosterone, the hormone responsible for pattern baldness.
By stopping the activity of the 5AR enzyme, Finasteride stops your body from converting as much testosterone to DHT.
In cisgender men, this can slow or even stop hair loss, but it can also trigger the feminisation of some features. In male-to-female transgender hair loss patients, this may be a desirable side effect.
Finasteride can also treat female pattern baldness in cisgender women and may help reduce unwanted body and facial hair growth. However, if you’re transitioning to become a man, you may aim to grow more hair around the body. So it’s important to discuss whether Finasteride is right for you with your GAHT treatment centre.
Trans men who are transitioning take several hormones that lower oestrogen levels while boosting testosterone levels. This is designed to promote masculinisation of the body: increasing muscle mass, stimulating body hair growth, and deepening the voice.
As testosterone levels rise, the amount of DHT in the body may rise, leading to androgenetic alopecia (pattern baldness). That’s where Finasteride can help.
In female-to-male patients, Finasteride can slow hair loss in those with pattern baldness. One study found that taking 1mg Finasteride a day for 5.5 months improved transgender male hair loss by at least one stage of the Norwood Scale [1].
The Norwood Scale is used to measure the extent and progression of male pattern baldness:
However, researchers have noted that treatment with Finasteride can impair virilisation in female-to-male patients [2]. That means it might inhibit the development of typically masculine characteristics, such as:
You’ll need to decide whether taking Finasteride to reduce hair loss is worth this risk. Some transmasculine patients are unfazed by the development of a receding hairline or crown hair loss, as it can enhance their masculine look [2].
Finasteride may increase oestrogen levels, though not all studies corroborate this [3-5].
The label for Propecia states that 1mg Finasteride can reduce DHT levels by 65%, while increasing circulating testosterone and oestrogen levels by up to 15% [4].
However, one study found that while Finasteride raised testosterone levels, it didn’t impact 17-β oestradiol levels (a type of oestrogen) in female transgender patients [5].
While Finasteride is known to promote scalp hair, it can have the opposite or no effect on body hair. That’s because body hair follicles aren’t sensitive to DHT in the same way as scalp hair [6].
That means taking Finasteride is unlikely to promote chest hair growth. Studies suggest Finasteride has a minimal effect on body hair growth [4, 7].
Yes, trans men can grow facial hair. Finasteride won’t necessarily promote beard growth, but there are other options.
Minoxidil for beard growth has a proven track record of stimulating facial hair growth in trans men [8].
The effect of topical Minoxidil in a 17-year-old trans male patient before treatment, then after 2, 3, and 5 months.
For patients transitioning from male-to-female, GAHT promotes the feminisation of features. This includes breast development, reduction in body hair, changes in fat distribution, and decreased muscle mass.
Finasteride is sometimes offered to trans women to help decrease face and body hair, and to reduce the concentration of the male sex hormone DHT in the body [2, 5].
However, there isn’t much evidence to support the use of Finasteride for body hair reduction, so Finasteride may not always be suitable for trans women [2]. Other anti-androgens may have a similar effect and offer other benefits.
Trans women may have experienced symptoms of pattern baldness prior to starting their transition. In these cases, anti-androgens used in GAHT like spironolactone can reduce hair loss without the need for Finasteride [9].
Finasteride can increase testosterone levels by up to 15%, which may not be desirable for trans women [5]. Each patient must weigh up the potential for testosterone increases with the benefits Finasteride might offer.
The side effects and safety of Finasteride have mainly been studied in relation to cisgender men and women. Known side effects of Finasteride include:
The negative side effects for cis people may not affect or be viewed in the same way by trans people. For example, gynecomastia — the development of breast tissue in men — is often a desirable effect for trans women. Erectile dysfunction and testicular discomfort may not affect trans women, depending on the stage of transition.
More research is needed to establish the side effects of Finasteride treatment for trans patients.
Just two drugs have been approved by the Medicines and Healthcare Products Regulatory Agency for treating pattern hair loss: topical Minoxidil and oral Finasteride.
Transgender patients can use both of these treatments, but it’s important to discuss any hair loss treatments with your doctor. Finasteride is designed to block the production of male sex hormones, so it may not be suitable for everyone.
In addition, these treatments work best in the early stages of hair loss. If your hair loss is already extensive, you may benefit from an FUE or FUT hair transplant. MTF hair transplants are often an important part of gender affirmation.
To find out which treatment is right, book a free consultation at one of the Wimpole Clinic’s nationwide locations. We’ve helped many patients restore their hair with a transgender hair transplant, helping to affirm their gender and boost their self-confidence.
Find out more about Finasteride for trans patients in these FAQs.
Finasteride will affect your hormone levels. It boosts testosterone levels while reducing DHT. It might also increase oestrogen levels.
DHT is a stronger androgen than testosterone, so despite the testosterone boost, you may still see an anti-androgenic effect when using oral Finasteride.
Topical Finasteride is less likely to generate systemic anti-androgenic effects, so this may be an option for some trans hair loss patients.
No studies have investigated whether Finasteride can inhibit penis growth in trans men. In theory, this is possible — DHT is a necessary hormone for the development of male sexual organs. That’s why some patients are advised to apply DHT creams prior to bottom surgery.
In one small study of cisgender men, 36% of patients reported a loss of penis length when taking Finasteride [10]. These instances were self-reported.
If you’ve undergone or are planning to have bottom surgery, speak to your doctor about the potential impact of using Finasteride.
Finasteride has been shown to cause gynecomastia, or male breast enlargement, in a small number of cisgender male patients [11].
While no studies have investigated the impact of Finasteride on breast development in trans patients, this possible side effect may be welcome in trans women.
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