Male pattern hair loss is obviously a male chracteristic. Most clearly seen is temple thinning (widow peaks) and recession. This can be difficult to hide, especially from the side or in windy, rainy conditions. Bad hair can ruin all attempts at a female presentation.
Certainly hairpieces or wigs can be worn to cover this male pattern baldness; these “solutions” are simply not what most people want. After all other gender-confirming procedures have been completed, most people want their own growing real hair in the fashion and style of their true gender.
Difference between male and female hairlines
Gender of the hairline
- Hairline is higher
- Hairline is lower
- Inverted U-shape
The female hairline is variable in position. Ideally would be a hairline 5 to 6.5 cm above the brows and usually beginning at the point where the scalp slopes from a more horizontal position to a more vertical position.
In males the average hairline is higher than the average in females.
Another difference is the shape of the hairline. A man usually has receded corners above the temples that give it an “M” shape. Conversely, the female hair pattern is oval shaped, smoother and full around the facial edge.
Male aging pattern
Female aging pattern
An additional difference between male and female hairlines comes with the age. There is a typical male pattern of baldness with a recession of the hairline. How many women do you see walking around with a receding hairline? While biological women sometimes do suffer from hair loss, it is usually an all-over thinning of the hair from the entire scalp and isn’t specifically targeted to one area.
Hair transplants or hairline lowering?
Hair transplants are probably your best option for the temple areas. Scalp advancement techniques (hairline lowering) can be useful, especially if a forehead lift is desired as well or you need a forehead recontouring anyway. Our advice if you need forehead recontouring anyway is to first do a hairline lowering surgery and after do hair transplants to fill the rest of the widow peaks. You will need a lot less transplants by first lowering the hairline and on top the density after hairline lowering surgery is very natural. A natural hairline density can be difficult to achieve with transplants alone.
Advantage of surgical hairline lowering
- Combined forehead recontouring—As most Mtf patients need a forehead recontouring to address their frontal bossing, the incision might as well be in front of the hairline. If you don’t make it in front and you reduce the bossing, a piece of hairbairing skin will have to be removed to thighten the forehead skin which will unevitably higher the hairline more.
- Fast—The procedure is fast and you have an immediate result.
- Cheaper then hair transplants
Disadvantage of surgical hairline lowering
- Scar—There is always a visible scar from a scalp advance. How visible it is will partly depend on luck, partly on the skill of the surgeon and partly on your own tendency to scar. For most patients with a faint scar feel that it is not a problem, but for some it is. Luckily the scar can be hided with hair transplants afterwards (much less then you would need without the hairline lowering).
- Widow peaks are not addressed properly—It is not enough to simply lower the hairline, since the transgender hairline procedure must actually convert a male hairline into a female hairline. Simply lowering the hairline will not shape the outer temple area.
Hair transplants and hormones
Male pattern hair loss occurs in approximately 50% of all men by age 50, but can start as early as the late teens in around 20% of men. Hormones can arrest or seriously slow down this progressive process in most MTF patient. For the MTF patient, whatever hair that was lost prior to the conversion process can be restored to create a more feminine appearance. FUG is commonly performed because these patients are unlikely to ever shave their heads, but the FUE procedure is always an option.
Hair and hormones Most transgender patients are also taking medication – typically oestrogens but also antiandrogens such as cyproterone acetate. However, although many patients and doctors believe this is sufficient to stop further male pattern hair loss, in fact this isn’t necessarily always true. Hormones have a complex dynamic and testosterone, oestrogen and dihydrotestosterone (DHT) are closely related and it is the DHT that crucially cause the male pattern balding. So even though less testosterone may be produced, it is still possible to produce sufficient DHT to cause further male pattern baldness and blocking the DHT (by Finasteride, Propecia, Avodart) is still needed. It may help even produce some regrowth.
FUT or FUE technique of hair transplantation?
Hair transplantation involves taking hair follicles from one part of your scalp and transplanting them into another part where hair is thin or missing. . FUT is commonly performed because these patients are unlikely to ever shave their heads, but the FUE procedure is always an option. There is a limit to how densely the hair can be packed in at one time so more than one procedure may be needed to achieve a good density.
- FUT—This stands for “Follicular Unit Transplant”. This is where a strip of scalp is taken, usually from the back of the head. The hair follicles are then dissected out before being transplanted into the problem areas. My transplants in the picture above were FUT.
- FUE—This stands for “Follicular Unit Extraction”. This is where individual hair follicles are removed one at a time from various places around the scalp and transplanted into the problem areas.
- No shaving—The main advantages are that you do not need to be shaved to harvest the donor hairs
- Faster—A medical team of minimum four to eight people does the removal of the hair roots from the strip, so more hairs can be transplanted in a single session.
- Less damage—the hair follicles are less likely to be damaged
- linear scar at the back of the head
- Shaving—The disadvantage is that your head and donor areas will have to be shaved before the treatment.
- More expensive
- More damage—there is a greater risk of damaging the follicles
- Less hair in a single session—In a single day around 1400 to 1500 grafts can be transplanted. If more grafts are needed, the treatment will be done over a 2-day period.
Proposal request hair transplant
With FUT the receiving part of the scalp does not need to be shaved. Hairs can be placed in between existing hairs.
You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.