Transgender Men Hair Loss Tracking: Monitor Testosterone-Induced AGA
Up to 40% of transgender men experience androgenetic alopecia within 5 years of starting testosterone therapy. If you are on testosterone and noticing changes in your hairline or crown density, tracking these changes from the earliest stages gives you and your medical team the data needed to preserve your hair while continuing your transition.
Why Testosterone Triggers Hair Loss
Testosterone therapy introduces androgen levels that are comparable to cisgender male ranges. The enzyme 5-alpha reductase converts a portion of that testosterone into dihydrotestosterone (DHT), the primary hormone responsible for androgenetic alopecia.
If you carry the genetic predisposition for pattern hair loss (which you may not have known about prior to testosterone therapy), rising DHT levels will begin miniaturizing susceptible follicles, typically at the temples and crown.
| Timeline After Starting T | What May Happen |
|---|---|
| Months 0-6 | Rarely any hair changes; body hair and voice changes begin |
| Months 6-12 | Earliest possible temple recession in genetically susceptible individuals |
| Years 1-2 | Pattern becomes more defined if AGA is present |
| Years 2-5 | Progression to Norwood 2-3 if untreated |
| Years 5+ | Continued progression similar to cisgender male AGA patterns |
The Norwood scale applies the same way it does for cisgender men. At Norwood 2, 800-1,500 grafts would be needed for transplant correction. At Norwood 3, that range increases to 1,500-2,200 grafts.
How to Track Testosterone-Induced AGA: Step by Step
Step 1: Baseline Before or At Testosterone Start
The ideal time to start tracking is before your first testosterone dose. This gives you a pre-hormone baseline that captures your natural hairline position and density.
If you have already started testosterone, begin tracking now. Your current state becomes your baseline.
Photograph:
- Full frontal hairline
- Both temporal points
- Crown/vertex from above
- A parting line photo for mid-scalp density
Step 2: Log Your Testosterone Protocol
Record your hormone therapy details alongside your density data:
| Data Point | What to Record | Example |
|---|---|---|
| Testosterone type | Cypionate, enanthate, gel, patch | Cypionate IM |
| Dose | Milligrams per injection/application | 100mg biweekly |
| Route | Intramuscular, subcutaneous, topical | IM injection |
| Start date | First dose date | January 15, 2026 |
| Dose changes | Date and new dose | Increased to 150mg, March 1 |
| Lab values | Total T, free T, DHT if available | Total T: 650 ng/dL |
This record lets you correlate density changes with specific testosterone levels and dose adjustments.
Step 3: Track Every 4-8 Weeks
During the first 2 years of testosterone therapy, track density at least every 8 weeks. This frequency catches early-stage recession before it becomes advanced.
At each session, focus on the areas most vulnerable to DHT-driven loss:
| Zone | Vulnerability | What to Watch For |
|---|---|---|
| Frontal hairline | High | Recession at temples, M-pattern forming |
| Crown/vertex | High | Circular thinning at the whorl |
| Mid-scalp | Moderate | Reduced density along natural part |
| Sides and back | Low (DHT resistant) | Should remain stable (use as control) |
The sides and back of your head are your control zones. Those follicles are genetically DHT-resistant and should not change density regardless of testosterone levels.
Step 4: Separate Scalp Data from Other Masculinizing Changes
Your hair density is only one piece of your transition tracking. Many desired masculinizing changes also depend on DHT:
- Facial hair growth
- Body hair development
- Voice deepening
- Body composition changes
If you later consider finasteride or dutasteride to protect scalp hair, your tracking data should show the baseline state of these DHT-dependent changes so your doctor can monitor whether DHT-blocking medications affect them.
Step 5: Evaluate Treatment Options With Data
If your tracking data shows progressive recession, bring your density timeline to your prescribing physician to discuss options:
Minoxidil (topical): Does not affect testosterone/DHT levels. Safe to use alongside testosterone therapy. Produces moderate regrowth in 40-60% of users. Onset at 4-6 months.
Finasteride (oral, 1mg): Blocks DHT production. Effective in 80-90% of users for halting loss, 65% for regrowth. However, may reduce some DHT-dependent masculinizing effects. Side effects in 2-4% of users. Requires careful discussion with your endocrinologist.
Low-dose finasteride or topical finasteride: May offer partial DHT blocking with lower systemic impact. Your tracking data from separate scalp and body zones documents whether this approach preserves hair while maintaining other goals.
For detailed finasteride tracking protocols, see our finasteride progress tracking guide.
Understanding the Trade-Offs
Hair preservation and full masculinization both depend on androgens. This creates a balancing act that is unique to transgender men on testosterone therapy.
| Approach | Hair Benefit | Potential Trade-Off |
|---|---|---|
| No intervention | None | Full masculinization, potential AGA |
| Minoxidil only | Moderate regrowth, no systemic effect | Does not stop progression |
| Low-dose finasteride | Good hair preservation | Mild reduction in DHT-dependent changes |
| Standard finasteride | Strong hair preservation | Possible impact on body/facial hair |
| Dose adjustment | Varies | May slow overall transition timeline |
Your tracking data makes this conversation concrete rather than theoretical. When you can show your doctor exactly how fast your hairline is receding and at what testosterone dose, the treatment decision becomes informed by evidence.
Family History as a Predictor
Your biological family history of male-pattern baldness is the strongest predictor of testosterone-induced AGA. If cisgender male relatives experienced significant hair loss, your risk on testosterone therapy is higher.
This family history check, combined with early tracking data, can identify high-risk individuals before visible recession begins. The earlier you start monitoring, the more options you retain for prevention.
For general AGA tracking protocols, see our male pattern baldness tracker guide.
Start Tracking Before Changes Begin
The best time to establish your baseline is before your first testosterone dose. The second-best time is today.
Upload your tracking photos at myhairline.ai/analyze and begin documenting your hairline from the start of your journey.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Discuss hair loss treatment options with your prescribing physician or endocrinologist, especially regarding potential interactions with hormone therapy goals.