Transgender Women Hair Loss Tracking: Monitor HRT Effect on Density
Feminizing HRT can produce significant hairline recession stabilization and in some cases mild regrowth at previous recession sites. For transgender women who experienced androgenetic alopecia before or during early transition, tracking your hair density response to estrogen and anti-androgen therapy provides objective evidence of what HRT is doing for your hairline.
How Feminizing HRT Affects Hair
Androgenetic alopecia is driven by DHT miniaturizing genetically susceptible follicles. Feminizing HRT attacks this process from two directions:
Estrogen: Increases sex hormone-binding globulin (SHBG), which reduces free testosterone available for conversion to DHT. Also directly promotes the anagen (growth) phase of the hair cycle.
Anti-androgens: Spironolactone, cyproterone acetate, or bicalutamide directly block androgen receptors or reduce androgen production, further lowering DHT's impact on hair follicles.
| HRT Component | Mechanism | Hair Effect |
|---|---|---|
| Estradiol | Increases SHBG, reduces free T | Slows DHT-driven miniaturization |
| Spironolactone | Androgen receptor blocker | Blocks DHT at the follicle level |
| Cyproterone acetate | Anti-androgen + progestogen | Reduces testosterone production |
| Bicalutamide | Non-steroidal anti-androgen | Blocks androgen receptors |
| GnRH agonists | Suppresses gonadal hormones | Eliminates testosterone production |
The combined effect of estrogen plus an anti-androgen produces substantially lower DHT levels than either alone. This is why hair changes on HRT can be more dramatic than treatments like minoxidil alone (40-60% moderate regrowth) or finasteride alone (80-90% halt loss, 65% regrowth).
How to Track HRT Hair Response: Step by Step
Step 1: Baseline at HRT Start
The most valuable baseline is taken before or within the first week of starting HRT. If you are already on HRT, your current state becomes your starting point.
Document:
- Full frontal hairline with close-up of temporal points
- Crown density from directly above
- Mid-scalp parting line density
- Current Norwood scale stage (if applicable)
| Baseline Data | Why It Matters |
|---|---|
| Hairline position | Measures any forward movement over time |
| Temple point density | Temples often show earliest regrowth |
| Crown density score | Vertex thinning may recover on HRT |
| Norwood stage | Provides standardized classification |
Step 2: Record Your HRT Protocol
Log every detail of your hormone regimen:
- Estrogen type and route: Estradiol valerate IM, patches, sublingual, or gel
- Estrogen dose: Milligrams and frequency
- Anti-androgen: Spironolactone, CPA, bicalutamide, or other
- Anti-androgen dose: Milligrams daily
- GnRH agonist: If applicable
- Start date: First day of HRT
- Any dose adjustments: With dates and new dosages
Also record your lab values when available:
| Lab Value | Relevance to Hair |
|---|---|
| Total testosterone | Lower T means less DHT substrate |
| Estradiol | Target range supports hair growth phase |
| DHT (if tested) | Direct measure of the miniaturization driver |
| SHBG | Higher SHBG binds more free testosterone |
Step 3: Track Monthly for the First Year
Hair changes on HRT happen gradually. Monthly tracking captures the progression while keeping the commitment manageable.
At each monthly session:
- Photograph the same 4-5 angles
- Rate your subjective impression of density (1-10 scale)
- Note any visible changes (baby hairs at temples, less visible scalp through hair)
- Record current medications and any changes
Step 4: Map the Expected Timeline
Hair is one of the slower-changing aspects of feminizing HRT. Set realistic expectations:
| Timeline | Expected Hair Changes |
|---|---|
| Months 0-3 | Little to no visible change; body hair may begin thinning |
| Months 3-6 | Possible reduction in shedding rate; early stabilization |
| Months 6-12 | Recession stabilization likely; vellus hairs may appear at temples |
| Months 12-18 | Some vellus hairs converting to terminal; hairline may appear softer |
| Months 18-24 | Maximum regrowth typically reached; continued stabilization |
| Years 2-5 | Maintenance phase; density should remain stable on consistent HRT |
Regrowth is most likely at the temples and frontal hairline, where follicles may have been miniaturized relatively recently. Crown restoration is possible but less predictable.
Step 5: Track Scalp and Body Hair Separately
HRT affects scalp hair and body hair in opposite directions. Tracking both creates a complete picture of your androgen suppression response:
Scalp hair (tracking for improvement):
- Hairline position
- Temple density
- Crown density
- Overall volume
Body hair (tracking for reduction):
- Facial hair growth rate
- Chest/back hair density
- Limb hair thickness
These two data streams respond to the same hormonal changes but in opposite directions. If your body hair is thinning but your scalp density is not improving, it may suggest that follicle damage from pre-HRT AGA was too advanced for recovery in those zones.
Adding Treatments to HRT
Some transgender women supplement HRT with additional hair treatments:
| Additional Treatment | Benefit | Considerations |
|---|---|---|
| Minoxidil 5% topical | 40-60% see moderate regrowth | Safe alongside HRT, applied twice daily |
| Finasteride 1mg | Further DHT reduction | May be redundant with strong anti-androgen |
| PRP therapy | 30-40% density increase, $500-2,000/session | Can target specific thin areas |
| Hair transplant | Permanent coverage for scarred areas | FUE recovery 7-10 days, 90-95% graft survival |
If your tracking data at 18-24 months shows areas that did not respond to HRT, these supplemental treatments can fill the gaps. The density data from your tracking helps your surgeon or dermatologist target the right zones.
For additional female-pattern tracking protocols, see our female hair loss tracking guide. For finasteride-specific monitoring, visit our finasteride progress tracking resource.
What Tracking Data Tells Your Medical Team
Your density timeline gives your endocrinologist concrete evidence that HRT is (or is not) producing the expected hair response. This data supports:
- Dose adjustments if response is slower than expected
- Anti-androgen switches if the current medication is not producing adequate DHT suppression
- Referrals to dermatology if scalp hair is not responding despite good hormone levels
- Hair transplant planning if non-surgical options reach their limit
Start Documenting Your HRT Hair Journey
Every month of tracking data adds to the evidence base that informs your treatment decisions. Start building your timeline now.
Upload your baseline photos at myhairline.ai/analyze and begin documenting how HRT is affecting your hair density.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Discuss all treatment decisions with your prescribing endocrinologist or physician.