Transgender patients on masculinizing hormones face greater androgenetic alopecia risk

Transgender and gender-diverse patients receiving masculinizing hormone therapy have 2.5 times the rate of androgenetic alopecia incidences compared with cisgender women, according to a study.

“As hair is often integral to gender expression and is known to impact psychosocial wellbeing, hair loss may be especially troubling for transgender and gender-diverse patients,” Julia L. Gao, MD, of The Fenway Institute at Fenway Health in Boston, and colleagues wrote.

This retrospective cohort study, comprised of health records from 37,826 patients, examined the incidence of androgenetic alopecia (AGA) among transgender and gender-diverse patients compared with cisgender patients.

Of the patients evaluated, 1,098 were receiving feminizing gender-affirming hormone therapy (GAHT), 1,137 were receiving masculinizing GAHT, 13,305 were cisgender women and 21,279 were cisgender men.

Results showed that transgender and gender-diverse patients receiving masculinizing GAHT had a higher incidence rate of AGA compared with cisgender women (adjusted incidence rate ratio [aIRR] = 2.5; 95% CI, 1.71-3.65) and cisgender men (aIRR = 1.3; 95% CI, 0.91-1.86).

Transgender and gender-diverse patients on masculinizing GAHT also had a higher rate of AGA compared with transgender and gender-diverse patients who were not receiving GAHT and assigned female sex at birth (aIRR = 4.46; 95% CI, 1.45-12.73) or assigned male sex at birth (aIRR = 2.61; 95% CI, 1.16-5.87).

In contrast, transgender and gender-diverse patients receiving feminizing GAHT did not have a significantly increased rate compared with cisgender men. In fact, this population saw improvement in their AGA; however, the researchers said this finding is currently anecdotal.

“AGA can be a distressing condition for many patients and have significant impacts on wellbeing, especially for gender minority individuals,” Gao said. “[Transgender and gender-diverse] patents who are starting masculinizing GAHT should be counseled on the increased risk of AGA.”