21, ftm transgender man, got double mastectomy at 19 and telogen effluvium from the surgery triggered ongoing hair problems. ive been on topical minoxidil for about a year and i think it’s helped somewhat (i didnt take progress pictures because i was incredibly embarrassed about my situation). my dermatologist is thinking about oral minoxidil, especially since i’m going through my first finasteride shed rn. but i know that oral min can cause body hair growth and that’s causing a lot of hesitation for me. i really prefer to be androgynous irl (dunno why exactly, i just feel most comfortable that way) and hate being too hairy, i got my beard lasered off when i turned 18. i have dark hair on my legs and arms and a trail on my stomach but that’s really it and i’m happy with that amount. i really don’t want chest or back hair. i value having a mix of masculine and feminine traits and i feel like too much hair would tip the scales too much. but at the same time i obviously want to get the best results possible for my head hair. so i’m just trying to weigh my options. will oral min cause new body hair growth or just thicken hair thats already there? or is it a case-by-case basis? would keeping it on a low dose be worth it? i know for a fact that i’m an outlier on this sub, i’ve never seen any posts approaching hair loss from a similar position of wanting to maintain some femininity, so i don’t expect to hear from very many people in the same boat if at all. but info from people who know more about oral min than me, or just any advice or encouragement, would be really helpful.

This is a real concern that you have.  Small doses of minoxidil might cause an increase in your body hair.  If you try it, these hairs will be dependent upon minoxidil so when you stop it, these hairs should fall out.  It is a real risk, but I doubt a permanent gain in hair will be the result of any experimentation you do.  there are many good alternatives for preventing hair loss on your head, so this should be managed by a good, knowledgable doctor.

 

let’s say you bald at 20 (nw2) and so on needlessly to say you start taking finastride, fast forward 10 years, you become 30 with a wife you are trying to impregnate, you don’t know if fin will cause any problems so you stop taking it.  anyhow what i’m trying to ask is, what would happen to your hair if you stopped taking finasteride – would it continue to bald at the same rate as if you were 20 years old and never started taking finasteride, or would the accumulated hair loss over ten years result in a more advanced stage of balding, possibly Norwood 4?

The answer to that question is that you will play “Catch up hair loss,” which means that in 3-4 months, you will have the amount of hair loss you would have had if you never took finasteride. That means, of course, that your results will reflect your genetics

My grandfather had his juvenile hairline at the age of 102, and it was black, not gray. I am bragging, but my hair is now salt and pepper so at least on the color side, I will be more like the man in the photo than my grandfather.

https://www.healthline.com/health-news/microrna-breakthrough-hair-loss-treatment

I am always skeptical.  This is a new idea, that stiff hair causes balding, and softening the hair can address the balding problem.  The hairs above the surface of the scalp, are already dead. Treatment below the skin, as the new hairs are being formed, would be necessary if this theory made any sense.  We have seen developing hairs that are miniaturized, most of these hairs become soft because they lose bulk.  I have oversimplified the premise, but you should read it to draw your own conclusions.

 

With Dupa and Age related thinning, does every single follicle on the scalp miniaturize? And do the miniaturized follicles in these conditions eventually miniaturize to the point where they fall out and stop growing altogether like in AGA, resulting in a totally bald scalp (including the donor area)? Or do they miniaturize just to an extent but then stabilize and continue to grow at that level?

The best insights I have into this great question are from women who have it.  They are often older, and they usually do not bald from it.  I believe that these DUPA patients tend to be stable; however, since I interfere with the normal course of the disease with drugs like finasteride, I don’t frankly know what would happen if we just did nothing for these patients. I remember one woman who came to me with almost complete balding (donor area as well as the rest of the head), and she had DUPA’ however, since I never saw her when she was younger, I can’t comment on her disease progression.  She did report that the thinning was noticed after menopause. There is, of course, no comparable analogy for men. 

 

Getting 2500 grafts from an FUE doesn’t mean that it will be aesthetically pleasing or successful.  This is an example of a failure on both ends of the FUE process from a Turkey clinic.  To make matters worse, 2500 grafts that were taken from the donor area are lost for future hair transplant work. When needed.  Fortunately, this can be fixed, but there is no bargain when you pay for it twice.

Some men inherit a strong forelock and then bald around it as is the case in this man.  The forelock was not genetically sensitive to his DHT but not the hair around it nor behind it.  He is lucky that these impacted hairs responded to finasteride and minoxidil.