I live in Ireland, although also have access to some facilities in the UK.
I'm 28
I started noticing it when I was... 26? ish?
Yes, I have been taking it for about a year and a half, and it is still currently all I am taking.
Okay.
Good about your age vs the time you noticed loss. You would have had to have been losing it earlier than that to now notice it (it´s not apparent immediately), but two years since noticing is nothing in the scheme of hair loss.
I am assuming androgenic alopecia since that is what most trans women or no-binary people worry about, plus you would likely know if you had alopecia totalis or areata.
Okay. Here are your options prior to HRT:
1) Anti-androgen / DHT inhbitor options
Drop finasteride, take dutasteride. Dutasteride is a 5a reductase inhibitor, like finasteride, but stronger. It typically* blocks around 90% of serum DHT vs 60% of serum DHT for finasteride (DHT being the hormone that is most often thought to miniturise and kill hair). This might work for you. You would likely need to acquire it privately, but could do so from a UK chemist for on average of 24 Brexits (my German keyboard lacks a pound symbol) a month, or 144 Brexits up front (20 Brexits per month of tablets, up to 6 months orderable at one time, with a 24 Brexit prescription fee necessary for every order - hence why you would want to order the maximum amount each time). 0.5mg of dutasteride is stronger than 5mg of finasteride (I am not sure of your dose, if you´re taking 1 mg of finasteride then you may as well be taking 5 mg if you aim to feminise. The main side effects of a higher dose won´t matter to you - see below).
The chemist I would suggest is
this, based on price and reliability.
They will need to issue a prescription via their online survey for you to get the prescription from them. If you tell them all you have told me and there´s nothing else alarming in your history then it´s almost certain they will sign off on it. You will have to tell them your are male to get the prescription, however, as their binary initial, automated questionnaire will cut you off if you say female because dutasteride is contraindicated for cis women due to pregnancy risks. DOn´t even mention your trans status, it will just confuse things and is irrelevant for their purposes.
Side effects for dutasteride are the same as finasteride. Most are tolerable for trans women because, if they happen, it´s just stuff like watery semen or reduced erection strength. I don´t know how that will impact upon you as a non-binary person though, so keep that in mind. Stuff that is in the danger zone anyway once HRT starts. It will not really affect HRT, except progesterone if you take that. They might interact to prevent eachothers effeciency. I don´t remember how. Depression is a possible side effect of both finasteride and dutasteride, but rare. Just keep tabs on it. Brain fog can occur on dutasteride for a while too, just like with finasteride.
I last used this service about four months ago, from Germany, and they mailed to me just fine.
* At some point your going to need a DHT blood test, either through whatever humane medical system Ireland presumably has or privately, to check your DHT levels. Ideally we would have one before your started finasteride / dutasteride and after being on them for a while, but that option is gone now. Why do this? Well, despite what some people will say, HRT is
SO NOT a guarantee of hair loss restoration. The earlier you start, the better, and you are still in early days so hurray, but it is possible but rare for HRT to regrow literally NO hair. The prime reason for this, I believe based on recent investigations and discussions, is a 5a reductase enyzme excess. This means that no matter how much you testosterone is supressed or your 5a reductase enyzmes supressed (they convert testosterone, and other shit, into DHT), your body will have enough 5a reductase enzymes left to make plenty of DHT. I, for example, have essentially 0 testosterone but lots of DHT for a woman, seemingly for this reason. It is as a result of this that I suspect that I have regrown exactly zero lost hair in over two years of HRT. This is a rare outcome, I must stress that, but it´s worth keeping in mind as a fall back source of investigation
in case you don´t get any regrowth results. If this came to pass, we would want to look at you having a androgen receptor inhibitor like bicalutamide, to block the
action of DHT rather than futilely fight against its creation. Spironolactone and cyproterone acetate, anti-androgens, do this to some extent too, but as steroidal, partial agonist inhibitors of the androgen receptors they simultaneously weakly activate the androgen receptors rather than purely block it. And if you were exceptionally vulnerable to hair loss, this might not be sufficient to guard against it.
Again, this is a rare worst case scenario, but worth keeping in mind. Some doctors, like Dr Will Powers in the USA, would actually advise bicalutamide over spironolactone, cyproterone acetate, finasteride, or dutasteride as the anti-androgen component of your regimen, even if you didn´t have hairloss, but realistically you are not likely to find a doctor in the UK or Ireland who would agree to faciliate such a regimen, so let´s go with the most likely to work solution and worry about the fall back solution later, okay? No need to panic. If the main treatment otpion for trans feminisation doesn´t work then there are backup options. That´s the takeaway you should have.
2) Minoxidil. This fucker is an enigmatic hypertension medication which was discovered to aid in hair loss, years ago. It´s commonly called Regaine or Rogaine in the UK and USA. You can buy it over the counter as a topical or take it orally via prescription / import from Oceania (in low doses only - it´s a powerful hypertensive mediation and will mess you up if you are orally taking normal doses). Topical is usually said to be less effective than oral, but much safer and with fewer side effects (oral will increase the thickness of your body hair too, necessitating further laser treatment possibly). It doesn´t really seem to save hair from DHT, merely lengthen the growing phase of its life span, but as a complimentary treatment I have heard it work wonders for many people.
Be warned that if you take it, you may initially lose some hair. This is a good sign. It´ll be the minoxidil prematurely forcing affected hairs into their rest phase, so that they shed, before they come back stronger in 3 to 6 months.
3) Microneedling. You may want to leave this on the back burner because it is the most unreliable treatment here, but it shows most promise for being refined into a game changer in the future. Basically, shoving tiny (1mm) needles repeatedly into the scalp at a density of around 1600 holes per cm squared has been clinically shown to, in conjunction with topical minoxidil, increase hair thickness. It works by in simple terms tricking the skin into sensing damage and directing the repairation process to make new hair follicles. Crucially, microneedling + minoxidil is better than either microneedling or minoxidil in isolation, and reliably so.
I have seen cis men go from totally bald heads to full coverage using this, but I have seen more of them regain nothing from it. Being a DIY, physical treatment to the top of your own head, it´s very hard to get right in a way that it will definitely improve your situation, but even harder to get wrong to make it worse, so... it´s a complimentary option. You´d have to buy a microneedling pen, probably around 100 to 200 Euros, plus a new cartridge for the pen every 2 weeks or so (a couple of Euros each).
I can explain that in more detail if necessary, but honestly there´s a good chance you don´t need to bother using this too in your arsenal at the moment. Better news yet is that there are phase 3 clinical trials for a patented pen and treatment method specifically designed to hit the 1600 holes per cm squared which seem to trigger the WNT pathway and and quorum sensing necessary to induce
new hair growth. Given that it´s just a specialised version of a device that millions of people buy on Amazon already, being using in conjunction with minoxidil and in a particular way, it´s likely that this won´t be a super long approval process for commercialisation. The scientists being this aforemention study claim it can increase hair density by up to 44% on the treated area over 3 months, so it may be a effective cure for most trans women or people who are willing to accept demasculinisation (unlike cis men) since the whole "DHT" cascade typically gets interrupted thereafter by HRT. Typically (andorgenic allopecia can affect cis women too, but it´s basically just the diet version of androgenic allopecia that cis men and pre-treatment trans women tend to get).
Long story short. If you want to try everything then I can provide more information and you can mix it up with minoxidil, but it´s probably too early to worry about that. Just keep it on your back up options and remember that a potentially game changing treatment for trans women may arrive in the future.
4) Don´t bother with PRP, stem cell injections, or "biospy hair transplants". It´s basically all snake oil shit with super marginal if any gains at high expense.
5) Hair transplant. IF your hair loss is localised to one area, and not totally bald, you will likely be able to use transplants to utterly restore the area. It´s costly though and the damage done by it (it causes scars around the back and/or sides of your head, albeit damage which should be virtually invisible due to hair coverage) means I strongly suggest you do not do this, no matter how down you feel, until you have tried all the other things and ensured that your hair loss has stabilised.
Trust me on this. It´s your ultimate fallback option, but that´s all it should be. It could be waste of scar tissue and money for you at this point if you make HRT gains (it probably is). Just keep it in your mind as a "I have a worst case option".
I won´t even explain it or discuss it in detail at this point because you don´t need to consider it yet.
6) Scalp micropigmentation.
Basically you have your head... tattooed with tiny dots which give the illusion of thicker hair (it´s not a coventional tattoo, but the term gives you the idea). It can be used to supplement thin hair or combined with a shaven head look to create a seamless, shaved, female pattern hairline look. Depending on the scale of loss, it could cost a few hundred to a couple thousand euros, last seven years, and only need a couple of hundred euros to top it up every several years. It can be combined with wigs to good effect when used for the shaven look. A shaved head can make applying wigs easier for some, and having a totally thick, shaved, female hairline look can be very affirming for somebody with hairloss potentially. If you want a female hairline, of course.
Once again, I don´t think you will need to do this, but it is yet another "fall back option" to help put your mind at some rest.
Do not mix it with microneedling (which will break the pigment and waste your money) or hair transplants (which will cause scarring which will itself need to be re-pigmented again) though.
HRT treatment:
Oestrogen.
Oestrogen both inhibits testosterone (and therefore DHT for the vast majority of people taking oestrogen therapy) at sufficiently high dosages, and has a directly beneficial role in hair growth. Pregnant cis women, for example, typically grow thicker, fuller hair during pregnancy as oestrogen levels rise.
Just... it´s good stuff, okay? It has a very good chance of helping.
Once oestrogen comes into play, you have the following options to consider for regimens that could help your hair loss:
a. high dose oestrogen monotherapy (to provide oestrogen and supress genital androgen creation - T, and indirectly DHT)
b. high dose oestrogen monotherapy (to provide oestrogen and supress genital androgen creation - T, and indirectly DHT) + bicalutamide (to block the negative actions of T/DHT on the andorgen receptors in your scalp)
c. moderate dose oestrogen therapy (to provide oestrogen) + spironolactone OR cyproterone acetate or a gonadotrophin releasing hormone antagonist to supress androgen creation - T, and indirectly DHT)
All of these can be combined with a 5a reductase inhibitor (DHT creation reducer - finasteride or dutasteride) and/or minoxidil (hair growth cycle aid) and/or microneedling (WNT pathway / quorum sensing activator) as further modifiers.
In the UK, and probably Ireland if it is anything like the UK, they will probably end up putting you on option C. Likely a gel or patch of oestrogen coupled with an anti-androgen of some kind. Other options for oestrogen intake are pills (either swallowed or sublingally/buccally absorbed) or injections, but most European countries seem to be stingy about allowing those options.
Any of these combinations will likely generate results for you.
I know that was a LOT to take in, but the important things to take away are that you have options and you are in a pretty early stage still. If one thing does not work for you, you have room to investigate why it might not be working and then adapt to another regimen. There are a lot of mechanisms listed here to tackle different aspects of hair loss and recovery.
Any questions?
I have one for you. What´s the legal status of self medicating with trans feminine hormones in Ireland?
It´s legal in the UK for comparison (and basically necessary because the UK is a TERF ireland designed to kill trans women), and the answer + your williness to do so will alter the options you have available right now.
But... don´t panic right now, okay?
You are in a good position to turn this around.
