Looking for the estrogen version of this article? Click here to read how estrogen GAHRT impacts hair for trans women and other gender-variant people.
How testosterone HRT impacts hair all over
For many people, hair and gender are closely tied. When you first start to take testosterone, you might be dreaming about certain changes and nervous about others. It’s important to remember and know that testosterone hormone therapy impacts everyone differently. For one, changes vary depending on testosterone levels, which can be lower for those who micro-dose T. Unfortunately, you can’t pick and choose what changes you will see. Hair growth is something that is determined by hormones but also by genetics including race, ethnicity, and hereditary hair patterns.
If you experience hair growth, you can expect to see some hair on your face, arms, chest, back, belly and legs. Likewise, the body hair you already have can grow darker and thicker in most places; it will also likely grow at a much faster rate than it would without taking testosterone. One of the potential changes with testosterone is also hair loss. Some transgender people on HRT (whether they are trans men, trans masculine people, or non-binary people) might see hair thinning or other signs of “male pattern baldness.” There are many different ways that testosterone HRT can affect hair growth and loss, and it’s important to remember that no two bodies are the same. On a positive note, many transgender patients report improved mental health from the effects of testosterone.
Given the devastating reality that the vast majority of medical research excludes the existence of transgender and non-binary people, community knowledge has always been a staple of trans health. Firsthand experiences of people documenting their journeys on testosterone carry a credibility of their own. Much of what we know about the impact of testosterone on hair growth and loss comes from our own community knowledge, what FOLX clinicians have heard from our members, and the extremely limited studies out there done on transgender and gender-variant people.
What to expect
There is no one result for the body or facial hair growth you will or won’t see on testosterone. Some transmasculine people grow thick beards, whereas other trans men will only really be able to grow a mustache or sideburns. Though your body is not completely biologically determined, inherited traits can play a determining factor.
“Everyone's hair growth pattern is very different, and some people can expect to see similar hair growth patterns that they see within their own biological family,” explains E Mora, BSN, Registered Nurse at FOLX. “That may be the best way for some people to predict what hair growth will look like for them.“ While this is one of the potential ways to get an idea of hair growth and patterns, we recognize that not everyone has the same access or ability to compare themselves to their biological family.
However, if you do have the option, try to consider the physical attributes of the cisgender men in your family. Do they tend to have lots of body hair? Are they able to grow full beards? This might give you some indication of what to expect, but also remember that inherited traits are not a one-for-one reliable marker of the facial or body hair growth you can expect to see. Understand that despite genetic markup, your body is still your own and entirely unique, and you won’t know how testosterone affects you until you see for yourself.
Many on testosterone replacement therapy experience gender euphoria when it comes to hair growth. Transgender men, for instance, are often excited to grow their own beard for the first time ever. However, not everyone experiences gender euphoria when it comes to hair growth. It can be complicated and emotionally stressful to navigate. If hair growth is undesirable, there are treatments available to consider, which will be discussed later in this guide.
Beyond just the inherited hair traits of your relatives, race can also impact hair growth. While there are different hair patterns across races and ethnicities, there is no one-size-fits-all description of how testosterone will impact your hair. Keep this in mind when comparing yourself to other people on HRT managing expectations around the hair growth you can expect on testosterone therapy.
Facial hair growth
Facial hair growth is common for those on testosterone replacement therapy, although the amount or how quickly will appear greatly varies. Remember, that patience is key when undergoing any changes that come alongside HRT. It can take years for those on testosterone to reach their desired facial hair goals. Facial hair tends to develop and thicken over a period of years rather than months, similar to changes brought on by puberty. Additionally, facial hair will look different for anyone on testosterone, just like for cis men.
Some transgender individuals on testosterone can grow a beard of their dreams, which can both alleviate gender dysphoria and affirm their gender identity. Although some can develop a thick beard rather quickly, it may take years for others, if at all. Also similarly to cis men, some people on testosterone replacement therapy may never be able to grow a beard or mustache. However, understand that your ability to grow a beard, mustache, or facial hair, in general, doesn't make you any less transgender, non-binary, or gender-variant. Facial hair is not innately gendered and you can be any gender identity with or without facial hair.
Body hair growth
Increased body hair—particularly on the chest, back, arms, legs, and buttocks—is extremely common for those on testosterone replacement therapy. Even if you already have hair on those areas, the texture is expected to become more coarse, thick, and dark. Just remember, it’s impossible to control where hair grows on testosterone replacement therapy. Even on smaller doses of testosterone, you’ll likely see hair growth in new places.
Hair growth is mostly irreversible for those who decide to go off the testosterone hormone treatment. Though the effects of pausing or stopping testosterone replacement therapy can vary from person to person, you’ll likely still grow hair in these places even if you go off testosterone.
“Starting T stimulates new hair follicles and stimulates the hair growth patterns,” Mora adds. “When people stop T, those follicles are still there, but their hair may not grow as thick, fast, and dark as it used to.”
Like cis men, those on testosterone replacement therapy can experience hair thinning and/or balding on their heads, otherwise medically known as androgenetic alopecia. Those on testosterone replacement therapy may experience some degree of frontal scalp hair thinning, especially around the temple areas and the hairline also referred to as “male-pattern baldness” or "pattern hair loss."
“[A 2021 article in the Journal of Pediatric Dermatology] said about 50 percent of men over 40 experience hair thinning or balding, and about 33 percent of trans men on testosterone HRT also experience this,” Mora explains.
Baldness happens because some people are more prone to high levels of dihydrotestosterone (DHT), a metabolite of testosterone that causes hair follicles to become shorter, narrower, and lighter.
Fortunately, there are some non-surgical treatments for hair thinning and balding to pursue if desired. Some prescription therapeutic options include:
- Finasteride: This drug has been approved by the FDA to promote head hair growth. It can be used to prevent baldness as it only blocks dihydrotestosterone (DHT) and not testosterone itself, but this drug can also slow or decrease secondary hair growth.
- Minoxidil: Known commercially as Rogaine, minoxidil was originally developed to treat high blood pressure, but has since received FDA approval for treating hair loss similarly to finasteride. The medication works by increasing blood flow to the hair follicle. However, minoxidil typically only slows or stops further hair loss rather than reverse existing hair loss.
If prescription drugs aren’t helpful, available, or desired, surgical procedures can pose as a solution. The American Society of Plastic Surgeons explains that different types of facial hair transplants typically include hair transplantation, flap surgery, tissue expansion of the scalp, and scalp reduction surgery. It’s important to know that this kind of surgical procedure can also be done for facial hair through beard transplants.
While FOLX is not yet able to prescribe finasteride or minoxidil nor able to mediate surgical procedures, we recommend you contact your health care provider for more information.
When hair growth on testosterone is undesirable
Hair growth on testosterone hormone therapy isn’t always a desirable part of someone’s medical gender transition. In this case, there are ways to manage excessive hair growth, such as by waxing, shaving, or laser/electrolysis hair removal.
While there are options to customize your medical gender transition to a degree, understand that there are real limitations of what HRT can and can’t do, especially for some trans masculine, non-binary, and other gender-variant people. Many hair loss treatments, for instance, might not work for everyone. Additionally, hair removal practices are often temporary and require upkeep.
While gender affirming care can be a tremendous source of joy and gender euphoria, it can also be difficult to grapple with the less desirable traits that come with it. If you have mixed feelings about the effects of HRT, know that you’re not alone; many of us have complicated relationships with hair, despite achieving our desired HRT goals. While hair and gender can be closely linked, they also don’t have to be. It’s important to know that facial and body hair growth isn’t inherently gendered, and the fact that we believe they are is a knock-on effect from cis-centric definitions of binary genders. Consider practicing self-love, body neutrality, and radical acceptance when difficult emotions arise.
While testosterone impacts every individual person differently, hair growth is fairly common. While head hair thinning and/or loss can happen, there are preventative and reactive treatments to pursue if you experience any undesirable side effects. No matter what happens, know that your body is unique and whole, even if your HRT results don’t fully align with your transition goals. While many of us have mixed feelings about hair growth and loss, we’re also ecstatic with the other ways testosterone helps us feel at home in our bodies.
For existing FOLX members with questions about hair growth and loss, reach out to your clinician through your Athena patient portal or reach out to our member advocates at email@example.com. For non-FOLX members who want to learn more, reach out to us at firstname.lastname@example.org if you have any further questions!