Characterization and Management of Androgenetic Alopecia in Transgender and Gender-Diverse Individuals: A Narrative Review

INTRODUCTION: Androgenetic alopecia (AGA) is a common condition in transgender and gender-diverse (TGD) individuals and may have an important psychosocial impact by exacerbating gender dysphoria and impairing quality of life. Hair loss patterns and treatment considerations in this population are influenced by genetic predisposition, cumulative androgen exposure, and the use of gender-affirming hormone therapy (GAHT). However, evidence-based guidance for the management of AGA in TGD individuals remains limited. METHODS: A narrative review of the literature was conducted using PubMed, Embase, Cochrane, and ClinicalTrials.gov from database inception to 1 January 2026. Publications addressing the epidemiology, pathophysiology, clinical presentation, and management of AGA in TGD individuals were included. Evidence from cisgender populations was considered when TGD-specific data were lacking. Recommendations were formulated on the basis of available evidence and authors' clinical experience (dermatologists and endocrinologists). RESULTS: AGA in transgender men (TM) most frequently develops after initiation of masculinizing GAHT and follows a clinical course similar to cisgender men, whereas in transgender women (TW) it often reflects prior androgen exposure and may stabilize with feminizing GAHT. Oral minoxidil has emerged as a promising therapeutic option across TGD populations owing to its favorable efficacy and safety profile. Dosing should be individualized according to therapeutic goals, including scalp hair regrowth and, when desired, enhancement of beard or body hair. Higher doses may be carefully considered in select TM. The role of 5-alpha-reductase inhibitors appears more relevant in TM, while their benefit in TW with suppressed testosterone levels remains uncertain. Adjunctive therapies such as topical agents, mesotherapy with dutasteride, low-level laser therapy, platelet-rich plasma, and hair transplantation may complement medical treatment. CONCLUSIONS: AGA should be regarded as a clinically significant condition in TGD individuals rather than a purely cosmetic concern. Management requires an individualized, goal-oriented, and gender-affirming approach, with oral minoxidil representing a cornerstone of therapy. Given the limited high-quality evidence, further prospective studies are needed to define optimal treatment algorithms and long-term outcomes in this population.