Tyler’s Journey With Hair Loss and Hormone Therapy—And Effective Solutions for Transgender Men

Tyler James, a 45-year-old transgender man from Oregon, remembers that hair loss was one of the side effects he was told he might experience when he started hormone replacement therapy (HRT). “You're just so excited to start hormones that you think, That's not going to happen to me. I don't care Let me sign wherever I need to,” Tyler shares. “But then it starts, and the reality sets in.”

Hair loss is a fairly common experience among trans men and non-binary people undergoing HRT. Research published in 2021 found that about 33 percent of testosterone-treated transmasculine individuals develop mild alopecia, while 31 percent develop moderate to severe alopecia.

This occurs because exogenous testosterone therapy, an affirming care option for some transgender people, can contribute to male pattern baldness. Testosterone converts to dihydrotestosterone (DHT), a hormone that binds to receptors in hair follicles and can trigger hair loss or thinning in those who are genetically predisposed to DHT sensitivity.

For Tyler, adjusting to hair loss was emotionally challenging. “I had no idea what it would feel like when I actually started losing my hair, how much it would affect my self-confidence,” he says. “I never go anywhere without a hat now.”. 

Knowing that hair loss was a possibility, and given his family history of thinning hair, Tyler decided to start finasteride about three years into his transition as a preventive measure. (It’s easier to keep the hair you have than to regrow hair you’ve lost). However, after a move and some lifestyle changes, he stopped taking the medication. That’s when he really started to experience hair loss. 

When you stop taking hair loss medications like finasteride or minoxidil, your hair loss will likely resume as normal, something Tyler said nobody warned him about. Understanding this earlier would have helped him prepare both emotionally and financially, he says. However, he adds that even if he did know, he would still have decided to take the medication.

After stopping finasteride, Tyler began to notice his hair collecting in the shower drain, and then realized there was noticeable thinning on top. “I wouldn’t say I’m conceited, but I’m definitely concerned with my looks,” he says. “It's was instilled in me growing up,” he says. “At least in my family, looks are highly valued. Hair is a huge part of who I am. When that was gone, I thought, What the hell do I do now?” 

When asked what hair loss treatments he’s tried at some point, Tyler laughs and says, “Basically, I'll sell my soul and get my hair to grow back,” then rattles off a list of things he’s tried: finasteride, topical minoxidil, jojoba oil, castor oil, pumpkin seed oil, oral minoxidil, hair and nail vitamins, a derma-roller, hair loss shampoos, and most recently, Hims minoxidil and finasteride supplement chew. 

He’s seen results from pumpkin seed oil, which he takes orally. He wasn’t sure if it was making a difference at first, so he stopped taking it and noticed his hair felt less thick. His favorite, he says, is Hims chewable supplement with finasteride and minoxidil. “When I started taking the Hims supplement I felt like that was the first time that I noticed a huge difference in my hair.”

Tyler also appreciates the simplicity and ease of a telehealth platform like Hims, as well as the safety and privacy it offers for transgender people.

“It can be hard for a lot of trans people to even leave the house sometimes. Some transgender people live in small towns and don't have access to LGBT healthcare centers. Most of those doctors aren't really educated in trans health issues either,” he says, adding that he’s personally been in healthcare situations where he’s overheard nurses or staff talking about other trans patients in a way that did not make him feel comfortable or safe.

Tyler is careful to say that his feelings about hair loss are personal, and not necessarily representative of the trans community in general. Some transgender men will not lose their hair (though many will). Some may feel neutral about it, and others may even welcome and embrace it as a traditionally masculine characteristic. But for people like Tyler, who are losing hair and want to stop it, he would “a hundred million percent” recommend hair loss treatments. 

“I recommend them to both my male and female friends because so many people don't know how easy it is,” Tyler says, adding that he knows both transgender and cisgender women who experience hair loss. “You don't have to leave your house. It's not invasive. It doesn't take that long. It was super fast, and I think I did [the intake form] at 4:00 a.m.,” he says. 

To stay motivated and track incremental progress, Tyler takes photos of his hair and checks for changes each morning. “It’s like going to the gym. You have to make it a habit, and you'll see benefits, but not right away. It takes time to start seeing the results.” 

Tyler’s ultimate hair goal? He’d love to grow a mullet. "It's been a dream of mine for so long,” he says with a laugh. Eight months into using Hims chewable medications, he’s optimistic about the thickening hair and fewer visible patches on his scalp. With his mullet dreams on the horizon, Tyler offers encouragement: “Stay with it. You’re worth the effort.”

Note: Tyler James is a Hims customer who was compensated for his participation in this article.