Egg cracked about 6 months ago, Femininzing HRT is close to starting, but I have noticed some typical early signs of AGA/male pattern baldness. Thinning of hairs, more shedding, and a receding hairline are all present. Tough to tell exactly when thinning and receding began, but it was more thana year ago. Itchiness on the top is at the 2 week mark for me, and from what i can tell is an additional symptom of AGA, which does run in my family(on both sides, but not at an age as early as I am).
While the last few months have been the most stressful I’ve ever had, these issues started outside of that period. Dysphoria and an increasing awareness is definitely playing a part now. Minoxidil and a shampoo or two are the minimum I’d like to add for my hair.
I’m thinking of testing my DHT levels alongside my T and E levels to see what the issue could be(higher dht levels, or fine levels but increased sensitivity?)
Should I expect my future HRT regimen to do the preventative work that a typical DHT blocker does?
TLDR: Yes, but there is some nuance.
Very broadly speaking, DHT is mainly created via 5a-reduction of T. Properly administered HRT should reduce T down to negligible (but ideally non-zero) levels. Based on these two facts alone, HRT should be vastly superior to any 5ar-inhibitor regimen any cis man could take.
Now for the nuance part:
- DHT is not only created by 5a-reduction of T. DHT is also created via the androgen backdoor pathway, which converts progesterone to DHT. (Only dutasteride can suppress this effect, not finasteride)
- For most trans women, the androgen backdoor pathway is only important with high amounts of progesterone, and we usually need progesterone medication to bring it up.
- Your T will (likely) never be 0 (nor should it). This means that you’ll likely have some DHT floating around. If your follicles are that sensitive, they can still be affected.
- Your adrenal glands also produce T.
- 5ar-inhibitors can be expensive.
So you can go whole hog and take your HRT AND dutasteride, but it likely isn’t economical. My advice is to rely primarily on HRT first, and observe your hairfall. Even now, count the hairs that have been falling off over the course of a couple of weeks, just to get a baseline. You can do this by using one of those silicone strainers in your shower drain, and counting what gets trapped there. Then, count again once you’ve been 6 months on HRT. Remain observant for the rest of your life. If at any point it looks like the hairfall has been getting worse (especially if you decide to take progesterone), then you can consider using dutasteride.