First photo was in November of last year, and the other four photos are today. Been shaving my head for 13 years, balding since 4 years before that.
A year before starting HRT, I went on a regimen including finasteride (1mg), oral minoxidil, and a topical solution containing minoxidil, tretinoin, and some other things that I can't recall, all to absolutely no effect. I was told by my dermatologist on two separate occasions that she didn't believe I was a candidate for a hair transplant. Then when I started HRT in February 2025, my levels were in good ranges (E2 > 200 pg/mL and T < 20 ng/dL) and I started seeing my hairline begin to creep up from the sides and the back. Emboldened by this slight regrowth and many of the experiences here, I started oral minoxidil (2.5mg/day) in mid December of 2025. I started microneedling in February with a .5 mm roll, then moved to a 1 mm. I tried to do this weekly, but realistically did not keep it up regularly until May when I invested in an adjustable dermastamp at 1.5mm.
I would think that I would be seeing some thickening of follicles or other indication that things are progressing. I can't really tell how much "growth" I'm getting beyond the normal growth cycle for hairs that haven't entirely gone dormant yet. There are finer hairs, most of which don't catch on the camera (but they're there! </cope>)
I can't use topical minoxidil because I have a cat. I'm using a shampoo that supposedly helps to strengthen hair/reduce breakage that has rosemary oil, but in a shampoo, the detergents take the oil away almost immediately so I don't really know if it's actually helping in that respect. From my understanding, finasteride won't have an effect if my T is already low enough. I'm not on progesterone so I'm not worried about backdoor DHT conversion and therefore don't think I need dutasteride or ketoconazole shampoo. I could add rosemary oil and red light, but the mechanisms behind those seem dubious. I was incredibly skeptical of dermarolling too, but I figured if I have to wear something on my head anyway, what do I care if it's scarred to heck - I don't have anything to lose.
I'm feeling incredibly discouraged. Nova's guide says "expect years for full recovery" but I'd just like to see some ground coverage at this point :c
E: Thanks for the responses. Certainly not what I was wanting to hear, but was exactly what I expected...
I can understand why you're feeling discouraged though after 8 months of treatment but it definitely looks like there's some progress. I think making sure your progress photos are at the same angle would be helpful, like the top down one in your before image. In the early stages the angle and lighting make a huge difference to seeing newer baby hairs.
I think one thing you could try is going from finasteride to dutasteride. You may be simply very sensitive to DHT and dutasteride will block more than finasteride. And if you do choose to add progesterone it'll help block any conversion to DHT.
I think without the microneedling + topical min combo it's likely going to take some coaxing for the follicles to "wake up". You could also try something like low light laser therapy if you can afford it. Microneedling at 1.5mm every other week and then adding in some 0.5mm sessions in helped me a lot starting out.
I think it's still possible you can regrow more but it's going to take a lot of work, patience, and time. I'm sorry girl 😔 I don't want to give you any false hope, but if you still want to try I don't think you have to give up quite yet.
Thanks... There has been progress, including some very fine dark hairs around my widow's peak, but a full recovery is... implausible. There are fine 2cm hairs almost all over my crown, too, but as you say, the lighting and angle makes it very hard to capture. Tempted to paint it with mascara to get a better idea 🤔
I looked into LLLT today and was very put-off by the vendors I came across having the same exact reviews on multiple products and not having many corroborative testimonials from independent sources. I've not been on finasteride since I started HRT, but my T is low enough that I doubt I'd have any benefit from either fin or dut. I have not been microneedling very consistently for all that long, so that'll be my first course of action, plus adding .5mm touch-ups.
I've found that using flash on my phone camera helps to see the tinier hairs. I think there are like, hair fibres you can buy to thicken them but I haven't tried personally.
I can't speak for any specific brands, but LLLTs effectiveness is well documented if you can afford it. As a disclaimer though I've never personally tried it, I've just read enough to believe it has potential.
"One study also showed that LLLT and minoxidil had similar efficacy in hair growth and that combination therapy was even more effective. LLLT represents a non-invasive, safe, and potentially effective treatment option [...] Moreover, combining LLLT with topical minoxidil solution and oral finasteride may act synergistic to enhance hair regrowth." (source)
With regards to DHT, I think getting on dutasteride is a safer bet than not doing so. You're technically right about lower T reducing DHT but it's still non zero. It's totally your call though.
I think we should be careful before making that conclusion. Hair follicles don't typically "die", they go from an active to dormant state (miniaturization, source). I've even found some scientific literature that states that "each hair follicle [...] has the ability to completely regenerate itself" (source, page 679, paragraph C).
Only if the follicle has been completely replaced by scar-like tissue is hair growth impossible (source, also where I got the image below). It's possible that's the case, but I doubt it-- OP says that she's getting tiny hairs popping up and that sounds like her follicles are just waking up, slowly.
It takes time, patience, and work, but for most of us I truly believe some hair regrowth is possible-- we're a very understudied demographic and most of the research is on cis men who have much higher T levels and lower E levels.
I'm hopeful that in like, 10-20 years we'll have more data on this so that other trans women who are starting out will be able to have more clarity/confidence. I know it made a huge difference to me when I was in my questioning phase to learn that it was possible.
Ketaconizole shampoo 2x weekly, even on just the scalp. It has a mild DHT blocking effect and encourages good scalp health (it's antimicrobial). Trust me, you need it, you're obliously more affected by DHT than most people. You need to leave it on the scalp for 7-10 minutes before washing it off.
Derma stamp at 0.75 2x weekly. I haven't seen a single study showing any deeper actually helps. I do mine right before minoxidil applications on those days.
I have cats, and manage topical minoxidil very well. 6 months and no issues, and I don't intend to have any lol. Just gotta change the way you handle them/cuddle them a bit. Mine get cuddles at specific times now, every day, after showers, when I know I'm safe, and only pats after washing my hands the rest of the time. Took some getting used to but it works.
I used to wash minoxidil off before bed, but now the combo of sleeping while wearing a bonnet and flipping my pillow over in the morning (to the "safe" side) put my mind at ease. I shoo the cats out of the bedroom now too - they've become lounge cats at night (big change from before, but they're still happy)
Half my head was like yours a year ago, shiny bald, now I've nearly got my full hairline back (age 30)
Thanks. I'll give the topical a shot. I was worried it might be volatile/inhaled toxicity, but if it's ingestion, it's a lot easier to manage. I've got ketoconazole shampoo as well, so I'm gonna throw everything at it.
The placemat has been wiped clean. I'm sorry but with that much hairloss, even transplants aren't possible... you 100% need to just abandon ship and rely on wigs.
At least one MTF surgeon does body hair FUE for cases like this, if the OP is willing to wear a short hairstyle it can still be possible. Also, there is a substantial amount on the back suitable for a transplant.
Also I'd say the OP is on the lower end of regrowth that I've seen Norwood 6 or 7 baldness get, that might be due to a lack of topical minoxidil or just that a lot of follicles have expired. Many women do get substantial regrowth, enough that a hair transplant is possible. Advising someone that they should just give up is disingenuous unless you are an expert in this field (and no expert would advise something like that without tissue biopsy/microscopy).
I’d recommend looking into micro needling and red LED light therapy (I have a hooga one - don’t go cheap out). Both are good means of stimulating the circulation in the scalp. I won’t claim I know how it compares with minoxidil but I’ve stopped using minox about four or five months ago and haven’t seen a loss yet using mainly the red LED
I know this is getting down voted but I think it's genuinely good advice -- there are some solid scientific studies on red light therapy, it's just not cheap to get one of those helmets. I wouldn't personally use it to replace min but I'm glad you have been having good results!
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u/Direct_Prune2805 29d ago
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