Finasteride for Transgender: How It Works, Cost & Benefits

Many transgender people experience hair loss before starting hormone therapy. Whether you are a transgender woman fighting with scalp hair loss or a transgender man on testosterone therapy, finasteride can be beneficial. 

Finasteride was initially created to treat male pattern baldness and an enlarged prostate. Now, it is extensively used off label to inhibit dihydrotestosterone (DHT), a hormone responsible for baldness.

This article provides insight into finasteride, how it functions for trans individuals, benefits, side effects and how to optimize its effects.

What Is Finasteride? 

Finasteride is a drug that inhibits the 5-alpha reductase enzyme, which transforms testosterone to dihydrotestosterone (DHT). So, finasteride works to inhibit this conversion. 

Link Between Finasteride & DHT

DHT is an active androgen that is responsible for miniaturization of scalp hair follicles. Finasteride lowers DHT levels and thus slows or even stops hair thinning. It also allows hair follicles to heal and form thicker hair. It does not directly promote growth itself but can maintain the hairline and keep it fuller.

How Does Finasteride Work At A Biological Level?

Finasteride specifically inhibits Type II 5-alpha reductase enzyme which is found actively in scalp hair follicles. This results in a dramatic decrease of 60–70% in scalp and blood levels of DHT in most individuals. Reduced DHT means reduced shrinking of follicles which slows down the androgenetic alopecia also known as male pattern baldness.

FDA Approval Status And Off-Label Use

The United States Food and Drug Administration (FDA) has approved finasteride for treating male pattern baldness, androgenic alopecia and benign prostatic hyperplasia. However, its use for the transgender community is off-label. 

How Does Finasteride Actually Work?

Finasteride for MTF (male to female) and finasteride for FTM (female to male) works in the following ways:

• DHT Reduction: Finasteride drastically reduces the circulating levels of DHT by blocking 5-alpha reductase enzymes. Thus, it decreases the overall activity of this hormone.
• Hair Regrowth Potential: Decreased DHT can stimulate hair regrowth in scalp regions which have been impacted by androgenetic alopecia. However, the results differ among individuals.
• Combination Therapy: Finasteride is usually given together with estrogen or other anti-androgens to obtain better effects. 
• Androgenic Effects: DHT plays a key role in inducing androgenic characteristics like male-pattern hair loss on the scalp, excess body hair, and acne. Decreasing the level of DHT will slow or reverse such effects.
• Role in Feminization: In transgender women, decreasing DHT can bring back some of the masculinizing changes induced by testosterone. 

Who Benefits Most From Finasteride?

Finasteride can be helpful for both trangender men and women suffering from hair loss, androgenetic alopecia or prostatic hyperplasia. 

Ideal Candidates Among Transgender Women (MTF)

• Trans women who started hormone replacement therapy (HRT) later in life and still have visible male pattern hair loss.
• Individuals who want to maintain current scalp hair and avoid additional hair thinning.
• Those for whom topical minoxidil alone is ineffective.

Ideal Candidates Among Transgender Men (FTM)

• Trans men on testosterone treatment with early indication of hair loss or hair thinning. 
• Individuals suffering from androgenetic alopecia.
• Individuals with prostatic hyperplasia.

Requirements Prior to Initiation

• Consult with an expert to discuss history and potential drug interactions.
• Blood tests to check liver function and initial levels of hormones.
• Considering possible side effects.

Who Should Avoid Finasteride?

Although finasteride has some amazing benefits but like every other medication, it also has some limitations:

• Individuals who are allergic to finasteride or its components.
• Patients with specific liver diseases, such as cirrhosis.
• Pregnant women due to the risk of birth abnormalities in male fetuses.
• Individuals with a history of severe depression or sexual dysfunction.

Role Of Finasteride in Transgender Women

For many transgender women, maintaining or restoring scalp hair is vital for their gender identity. Finasteride provides a means of treating hair loss without disrupting the feminizing hormone therapy.

• Reducing Scalp Hair Loss: Finasteride can visibly reduce the effects of testosterone on the scalp, especially among those who started estrogen therapy after male puberty changes. It reduces the progression of hairline recession and crown thinning.
• Effects on Body Hair: Some trans women may experience a reduction in body hair growth over time but this effect is not very strong as compared to estrogen or androgen blockers.
• Impact on Voice or Breasts: Finasteride neither changes voice pitch nor breast growth. If any change is observed it might be due to estrogen therapy and genetic predisposition.

Role Of Finasteride in Transgender Men

This drug can also be beneficial for trans men who want to avoid thinning hair during testosterone treatment. In this way they can maintain a fuller head of hair and maintain masculinization.

• Hair Preservation: Testosterone therapy can sometimes cause hair loss in some individuals. Finasteride can preserve scalp hair and prevent hair loss. 
• Maintaining Masculine Traits: When used cautiously, finasteride does not usually reverse facial hair growth, muscle building, or voice deepening.

Finasteride Cost Overview

Finasteride costs vary significantly depending on following factors:

1. Generic Vs. Brand Name

Generic finasteride for trans people is a cheaper option and contains the same active ingredient as the brand-name drugs. A 1-month supply of 1mg generic finasteride for transgender hair loss can usually cost under $20.

In contrast, the brand-name equivalent, Propecia, can cost as much as $100 for a one-month supply.

2. Dosage

Dosage is another important factor when it comes to cost considerations of finasteride. For example:

• For Hair Loss: Usually prescribed at 1 mg once a day.
• For Other Conditions: 5 mg a day for BPH .
  • Always taken by mouth, with or without food.
  • Consistency is important; because skipping doses can reduce its effectiveness.
  • It can take 6-12 months for the medication to properly show its effects. 

3. Insurance Coverage

Finasteride is often included in most health plans when prescribed for benign prostatic hyperplasia. However, prior authorization from your insurance provider is necessary to guarantee coverage.

The use of this drug for treating male pattern baldness is usually considered a cosmetic procedure and is not covered by most insurance companies. Therefore, patients using it for hair loss must pay the full price.

4. Where To Buy?

• Local Pharmacies: Prices can be quite different at various pharmacies. The use of a discount card or coupon can be helpful in getting the drug at a discounted cost.
• Online Pharmacies: Some online pharmacies and telemedicine providers offer competitive pricing for generic finasteride. Many also provide discount offers and free shipping, further reducing total costs.

What Are The Benefits Of Finasteride

Finasteride has several benefits, like:

• Slowing or stopping pattern hair loss.
• Effectiveness for both transgender women and men.
• Simple oral intake.
• A well-established safety profile with decades of user experience.

What Are Finasteride’s Potential Side Effects

The potential side effects of this drug include:

• Common Side Effects: Decreased libido, impotence, and decreased ejaculate volume, particularly in trans men.
• Less Common Side Effects: Breast soreness, skin rash, and mood alterations.
• In Rare Cases, long-term sexual side effects may occur after discontinuing the medication.

How To Improve The Effectiveness Of Finasteride?

To achieve maximum results with this drug one must:

• Begin early therapy before extensive follicle loss.
• Combine with topical minoxidil if authorized by your physician.
• Keep a good diet consisting of proteins, minerals and vitamins.
• Don’t smoke and avoid exposing the scalp to the sun excessively.
• Follow regular medical check-ups to be in contact with your doctor.

What Can Be Taken Instead Of Finasteride?

Finasteride is not the only option for treating hair loss or androgen-induced alteration. There are several alternatives available, ranging from other drugs, non-surgical treatments, surgical procedures, or a combination of these. 

The following comparison enables you to decide what option best suits your requirement.

Medicine	Administration	Effectiveness	Working	Approximate Cost
Minoxidil	Topical	Stimulates hair growth	Used in combination with finasteride	$10–$30 per month
Dutasteride	Oral	Very potent	Blocks both Type I & II 5-alpha reductase	$15–$40 per month
Hair Transplant	Surgical	Very effective	Permanent treatment	$3,000- $15,000
Laser Therapy	Topical using device	Moderate improvement	Non-invasive	$200–$500 per session

Is Finasteride Safe to Use?

Yes! Finasteride is completely safe to use when prescribed and followed by a qualified health care professional. This drug is FDA-approved and has been in the market for decades and is well tolerated. You can also increase the safety with proper dosing and should avoid use in pregnancy.

Finasteride Real User Experiences

Many transgender individuals have shared testimonials on how finasteride has helped maintain their hairline. This drug has really helped them maintain thicker hair while on testosterone.

• One transgender man on Quora described:

• Another user, Gwyn Sage on Reddit have stated that:

“Besides slowing the process of male pattern baldness, Finasteride is an inhibitor of DHT, so it will stop the hair loss, and allows you to grow your hair back if you’ve lost hair at the hairline and crown”.

Does finasteride affect testicle size?

The change in testicle size in trangender people is often attributed to estrogen and anti-androgens. Finasteride is not considered to have any direct influence.

Will finasteride increase estrogen?

Finasteride decreases DHT levels which can indirectly result in a minor rise in testosterone level. Testosterone can be converted into estrogen but this rise is not very significant.

How do transgender men treat hair loss?

Hair loss treatment options include  finasteride, dutasteride and minoxidil. However, if none of this works, one can opt for hair transplants. 

Does finasteride affect bottom growth?

It may have a slight effect to decrease DHT-induced growth, but results vary among individuals. Most trans men still experience normal masculinization.