Androgenetic Alopecia Among Transgender and Gender-Diverse P
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Transgender and gender-diverse individuals (TGD) undergoing gender affirmation with testosterone, or masculinizing hormone therapy (MHT), may experience adverse dermatologic effects, including acne and androgenetic alopecia (AGA).

In a cross-sectional study of 50 transmen receiving MHT for an average of 10 years, most patients (63.3%) developed AGA, including 31% who developed moderate-to-severe AGA. In this study, researchers examine the proportion of a large population of TGD patients receiving MHT who developed AGA over the course of a mean duration of 3.4 years as well as medications prescribed for AGA among this cohort.

Researchers included all patients who started MHT who were aged 18 years or older at the time of MHT initiation, and whose assigned sex at birth was female. A diagnosis of AGA was defined using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for AGA. Analysis were performed using STATA statistical software.

-- Of 988 patients, the total proportion of patients with AGA increased from 4 of 988 prior to MHT initiation to 31 of 988 after MHT, with 27 of 984 patients developing AGA after starting MHT.

-- The median duration of MHT prior to AGA diagnosis was 1035 days. The incidence of AGA diagnosis was 2 of 984 in the first year of MHT, and 4 of 982 in the second, 10 of 978 in the third, 8 of 760 in the fourth, 2 of 455 in the fifth, and 1 of 20 in the sixth year of MHT, respectively.

-- Among the 31 AGA patients, 22 were prescribed finasteride for treatment, 3 were prescribed topical minoxidil, and 6 were not prescribed medication. The median age of all patients diagnosed with post-MHT AGA was 26 years.

The proportion of patients affected in this study was lower than prospective studies of MHT patients in which 5% to 17% of patients developed AGA due to the ascertainment of AGA being limited to ICD-10 diagnoses in the electronic medical record, patients not mentioning mild cases of hair loss to clinicians, or the relatively young age of patients in this study. The patient cohort examined was overwhelmingly White and may not reflect AGA prevalence among a diverse racial and ethnic population.