Transgender and gender diverse (TGD) patients who receive masculinizing hormone therapy have a higher rate of androgenetic alopecia (AGA) compared with cisgender women, according to study results published in Journal of the American Academy of Dermatology.
Researchers conducted a retrospective cohort study to assess the incidence of AGA in cisgender and TGD adult patients treated at Fenway Health between August 1, 2014 and August 1, 2020. Cisgender women who were receiving testosterone and cisgender men receiving birth control or menopause medications were excluded from the study.
They identified AGA cases by diagnostic code and hormone therapy using prescription data. Poisson regression was used to calculate risk ratios and compare them among populations.
A total of 970 of the 37,826 patients included in the study had AGA. Participants who were TGD received masculinizing hormone therapy were more likely to have AGA compared with cisgender women (IRR, 2.22; 95% CI, 1.57-3.15 vs aIRR, 2.50; 95% CI, 1.71-3.65), TGD participants who received hormone therapy and were assigned female at birth (AFAB aIRR, 4.46; 95% CI, 1.45-12.73), and TGD participants who did not receive hormone therapy and were assigned male at birth (AMAB aIRR, 2.61; 95% CI, 1.16-5.87).
In sensitivity analyses of person-time based on hormone initiation date, TGD individuals who received masculinizing hormone therapy did not have higher rates of AGA compared with TGD who did not receive hormone therapy and were AMAB (aIRR 1.90 95% CI 0.84-4.22). Those TGD participants who underwent feminizing hormone therapy had higher AGA rates compared with patients who were AFAB and did not receive hormone therapy (aIRR, 3.41; 95% CI, 1.15-10.09).
Participants who were TGD and received feminizing hormone therapy were more likely to have AGA compared with cisgender women (aIRR, 1.91; 95% CI, 1.25-2.92).
The rate of AGA was higher among TGD participants who received feminizing hormone therapy compared with cisgender women (IRR, 1.51; 95% CI, 1.03-2.1; aRR, 1.59; 95% CI 1.04-2.42).
Limitations of the study include the inability to determine causation, generalization outside the community health center, and possible undercounting of AGA cases because of dependency on diagnostic codes, which have not been validated for AGA.
“AGA can be a distressing condition for many patients and have significant impacts on wellbeing, especially for gender minority individuals with patterns of hair loss that have been associated with a characteristic male or female phenotype that is inconsistent with their gender identity. […] Regardless of GAHT status, TGD patients should have access to individualized AGA treatment if treatment is desired,” the researchers conclude.
Disclosures: One of the study authors declared affiliation with the American Academy of Dermatology Expert Resource Group on Lesbian, Gay, Bisexual, Transgender, Queer/Sexual and Gender Minority Health. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Dermatology Advisor
Gao JL, Sanz J, Tan N, et al. Androgenetic alopecia incidence in transgender and gender diverse populations: a retrospective comparative cohort study. J Am Academy Dermatol. Published online February 10, 2023. doi:10.1016/j.jaad.2023.01.037