How Estrogen Hormone Replacement Therapy Impacts Hair, Explained by FOLX
Estrogen HRT impacts every body differently, but what can you expect when it comes to estrogen HRT effects on body hair and more?
Looking for the testosterone version of this article? Click here to learn how testosterone HRT impacts hair.
Body hair and gender are often intertwined in the contemporary world. Many people have socially constructed ideas about how much body hair women are or aren’t supposed to have—cue a Gillette commercial advertising a pink razor! On the contrary, hair is not innately gendered and many women grow body and facial hair in many places with varying patterns. The notion that women are nearly (or completely) hairless is a misconception.
In the same vein, there are also social expectations for what length of hair women should have, how it should be styled, or how much of it there should be. These beliefs about hair and gender are based on an outdated binary system of gender that expects women to be both hairless and have long, flowy hair to achieve optimum femininity.
Transgender women, transfeminine people, and a range of other people who take estrogen HRT are especially faced with these loaded misconceptions about hair and femininity. We at FOLX are here to remind you that having facial and body hair doesn’t make you any less of a woman. While these connotations run deep, facial and body hair is not inherently gendered, and having either of them has no bearing on the authenticity of your gender.
With that said, one of the physical changes that accompany estrogen hormone replacement therapy is body and facial hair thinning. Those on estrogen GAHT (both estradiol and anti-androgens and/or progesterone) can experience hair thinning on the face, chest, abdomen, legs, and arms. Similar to testosterone HRT, estrogen HRT impacts each person uniquely, so it’s unpredictable to know how it will show up in your own body given inherited genetics. In lieu of credible medical research studying transgender people in-depth, we rely on community knowledge for guidance on how to manage expectations when it comes to hair.
You might be asking what are some common expectations to have around hair while on estrogen?
How estrogen impacts hair all over the body
Since estrogen causes the testes to stop producing testosterone, you’ll likely experience hair thinning on the face, chest, abdomen, legs, and arms. Likewise, anti-androgens like spironolactone and progesterone block testosterone to prevent cell growth of dihydrotestosterone (DHT), a metabolite of testosterone and very potent promoter of thicker dark hair growth.
While your body or facial hair won’t completely go away, over time, it may become more manageable to groom. “Genetics will determine your response to any hormone, just like they do for breast development,” FOLX clinician and MD Michelle Forcier explains. “Race and ethnicity are [also] involved, although there aren’t any studies to make any predictions or recommendations based on racial demographics.”
Forcier also says that other factors that influence hair growth include stress, weight changes, and mood, and that a “healthy lifestyle—including diet, exercise, and stress monitoring—are good for skin and hair.” At FOLX, we recognize that a healthy lifestyle comes in many shapes and sizes under the Health at Every Size framework. Health looks different from one person to the next, so trust yourself and stick to the wellness routines that feel good for you.
Though hair can represent many different things, facial and body hair thinning can spark gender euphoria for lots of people who start estrogen. If that’s you, tap into that joy—you deserve it! Enjoy and celebrate the body that you’re coming home to on GAHT. If you love rocking the facial and body hair that you’ve got, we also celebrate you. Remember, body hair or facial hair and femininity are not mutually exclusive concepts, and your gender expression is entirely up to you.
Although body hair thinning may be a change you’re looking forward to, head hair thinning can often be less desirable. This side effect is called androgenetic alopecia, or pattern hair baldness where the hairline recedes to form an 'M' shape. If you want to change this part of your body, there are fortunately treatments available, which will be discussed later in this article.
Changes in hair, even if they are overall positive, can come with some difficult, complicated, and all-around uncomfortable emotions. If this is you, know that you’re not alone.
“For those who have more of a love/hate [relationship with body hair], building new relationships to things about our body that we are taught to hate is what queer and trans folks do best,” explains Andie Gersh, FOLX clinician.
“People in our community are keeping, displaying, and loving body hair in places people have told them they shouldn't and looking gorgeous. This is no easy place to come to in this judgy world, but getting to really look at your body and decide for yourself what you like and what you don't is a journey we should all get to take.”
You may start to pursue new routines and self-care or grooming rituals if your relationship to hair starts to change on estrogen HRT. You might start to consider hair removal as a form of self-care to benefit your mental health or gender vibes. Waxing, shaving, threading, and tweezing can also help alleviate the day-to-day concern about unwanted hair. These techniques are temporary and require frequent maintenance, which might irritate certain skin types.
Because these hair removal methods can grow tedious over time, you might want to consider pursuing a more permanent treatment. While FOLX doesn’t offer these procedures, you can always chat with your clinician for further resources of referrals.
Body hair removal procedures
While estrogen can help thin hair, it cannot completely reverse facial and body hair growth. Many trans women and other transgender people know all too well about how time-consuming daily grooming routines can be, so thankfully, there are alternative options available.
“For those who know the hair has got to go, hair removal technology and accessibility is improving all the time, and finding an affirming hair removal provider is becoming easier and easier,” says Gersh. “Trans and nonbinary folks are also increasingly getting into this field so more and more we'll be able to take care of each other.”
If you feel particularly dysphoric or otherwise uncomfortable about your facial and/or body hair, you can pursue laser hair removal or electrolysis to surgically remove hair. Gersh explains the major differences between laser treatments and electrolysis:
"Electrolysis is the only FDA-approved method for permanent hair removal. However, laser hair removal is increasingly seen as an option for permanent hair removal especially as technology evolves, and is considered by some surgeons to be the superior modality. Laser hair removal traditionally only worked with dark hair but evolving technology can remove lighter hair as well. It used to be that if you have dark skin, then laser wouldn't work but with modern methods that is no longer the case. Laser is faster and generally less painful and can cover large surfaces of body hair very quickly. It also is usually cheaper than electrolysis. However, some blonde, grey or red hairs may need to be treated with electrolysis."
To help get rid of as much hair as possible, Gersh generally recommends starting with laser removals, which tend to be cheaper and faster, then going back for electrolysis on stubborn hairs that keep coming back. This method can save money and discomfort.
“Frequency of visits for electrolysis and laser depends on body location and how fast that hair typically grows,” she adds. “Time between sessions will usually be around four to six weeks for a new cycle of growth to occur and to give hair time to regrow.”
This is not a prescriptive one-size-fits-all solution, and we know that not everyone has the time, resources, and access to pursue these types of treatments.
“Some insurance plans will consider hair removal of either type to be medically necessary and others will not, and some will only cover electrolysis since it is FDA approved for permanent removal,” she elaborates. “They will also sometimes only cover removal of hair on certain parts of the body or only if it is needed for surgery. If you are doing hair removal for surgery, be sure to check with your surgeon about what methods and areas are required.”
Aside from laser hair removal and electrolysis, Michelle Forcier also noted that there are also additional options that can be done at home, including laser hair removal devices and Vanqia, a topical agent used to slow hair growth. We recommend you consult further with your healthcare provider for recommendations on hair removal methods.
Head hair thinning treatments and procedures
Though body hair thinning can accompany gender euphoria, when it comes to head hair, this change can also bring on feelings of gender dysphoria. Particularly, hair thinning can show up as receding hairline, thinning hair, and/or pattern baldness, which are all not reversible. Fortunately, there are ways to combat this side effect if you’re called to action.
Finasteride medication can be used to prevent baldness as it only blocks DHT and not testosterone itself, but it can also slow or decrease secondary hair growth. Additionally, it’s important to know that erectile dysfunction could accompany finasteride. If this is a side effect that you experience, know that FOLX offers medication for ED and existing FOLX members can contact their clinician for more information.
Minoxidil can also be another treatment option for hair thinning. Known commercially as Rogaine, minoxidil was initially created to treat high blood pressure, but has since received FDA approval for treating hair loss like finasteride. The medication works by increasing blood flow to the hair follicle. Specifically, this oral prescription typically only slows or stops further hair loss and can’t reverse existing hair loss.
If oral medications aren’t a long-term option for you in terms of changing thinning head hair, you can always pursue a hair transplant. Hair transplants can help restore the hairline for a more feminine (closer to the front of the skull) and/or androgynous appearance, based on whatever your preference and goals are.
Whether you choose to remove any of your body hair or maintain your head hair, know that every person’s gender and expression are different. Despite what society says about transfeminine people and their hair, what matters the most is how you feel about your hair—and FOLX is here to support you along the way, so don’t hesitate to reach out to us.
Are you ready to sign up for estrogen with FOLX? The process begins here. For existing FOLX members with questions related to estrogen HRT, please schedule a time to consult with your clinician. For non-FOLX members with further questions or concerns, please reach us directly at firstname.lastname@example.org.