Clinical pearls addressing hair growth and loss in transgender patients on hormone replacement therapy

Hair is a defining feature of human appearance and plays an essential role in personality and identity development. Currently, about 1.6% of US adults identify as transgender. Within the transgender community, hair serves not only as a means of self-expression but also as a crucial element in affirming gender identity, helping individuals to align their outward appearance with their inner sense of self. However, there are significant disparities in the care provided to transgender patients, particularly those seeking a more masculine or feminine appearance through hormone replacement therapy. Studies on transgender patient satisfaction with current therapies are limited but indicate overall dissatisfaction with the standard of care. Dermatologists play a pivotal role in advocating and caring for transgender patients regarding their hair and skin needs. A deeper understanding of hormone replacement therapy and hair growth/loss therapy is crucial to prescribing medications aligned with patients' treatment goals. This commentary aims to provide clinical guidance to dermatologists, aiding them in educating transgender patients undergoing hormone replacement therapy about accessible options for hair growth and loss. Treatment algorithms have been proposed based on efficacy, pharmacodynamic interactions with hormone replacement therapy, cost-effectiveness, adverse reactions, and care accessibility tailored specifically for transfeminine and transmasculine patients.