Hair transplant surgery and gender dysphoria: Ask an expert

People within the gender diversity community may experience gender dysphoria as a result of hair growth patterns which are not in keeping with their gender identity. For trans men, the introduction of male hormone therapy will often result in the development of masculine features including facial hair growth and male pattern hairlines. For trans women, however, who already have masculine hairlines, a hair transplant procedure which reshapes the hairline in a more feminine way can have a significantly positive impact on their quality of life. In this article, leading hair restoration surgeon Dr Greg Williams discusses the subject.

How can hair transplant surgery help trans women?

Hair transplant surgery can literally be life changing for trans women by removing the stigma of a male hairline shape or balding crown. It can entail a small procedure to just round off mild temporal recessions or a big procedure that may need to be repeated if there has been extensive male pattern hair loss. The degree of hair loss that has developed in a trans woman will depend on their genetic potential, age, topical and oral treatments used to slow down hair loss pre-transition, and when hormone therapy was started along with what is being used.

Gender affirmation surgery, by removing the production of testosterone by the testes, usually results in a cessation of androgenetic alopecia. Hair transplant surgery is helpful as it allows trans women to better present as themselves, not only in terms of hair but in the fundamental aspect of gender.

How is hair transplant surgery performed?

Follicular units (small naturally occurring groups of 1-5 hairs) are removed from the back and/or sides of the head and implanted into individual incisions in the recipient site. There are two donor harvesting methods - follicular unit excision (FUE) and linear strip excision (also known as strip follicular unit transplantation or strip FUT).

In the FUE technique, the individual groups of hairs are cored out leaving small round scars about a millimetre in diameter. In the strip technique, an ellipse of scalp skin is excised and then this is dissected into the same individual groups of hairs. The wound is stitched or stapled closed and heals with a linear surgical scar. Whilst the FUE technique is less invasive, less painful and heals more quickly, it usually entails shaving the donor area so my preferred harvesting method for women is the linear strip excision.

How long does it take to see results?

Transplanted hairs generally fall out after a few weeks and then take three to four months to start growing. Initially, the new hairs are fine and take another three to four months to develop enough to make an initial assessment feasible. No more hairs would be expected to grow after 8 months post-op but each individual hair should continue to improve in diameter for several months so the final result can take up to eighteen months to mature.

As hairs generally grow at about a centimetre a month, it will take a long time to grow long hair. It often takes a few years before a trans woman will decide on what hair length, hairstyle and hair colour suits them best. In addition, there is a hair density limitation that can be achieved per procedure so some trans women will choose to repeat the procedure in order to increase the thickness of their transplant.

Why choose Dr Greg Williams?

Dr Williams is a qualified plastic surgeon and, as part of his training, worked at the gender identity service at Charing Cross Hospital so he has first-hand experience in the surgical and non-surgical needs of trans women. He has delivered academic lectures on hair transplant surgery for trans women and has published an article on the ethics of treating LGBTQ+.  There are few hair transplant surgeons in the UK, or around the world, who can demonstrate this level of experience and qualification.

If you are considering a hair transplant procedure, don’t hesitate to visit Dr Greg Williams’ Top Doctors profile to book a consultation to discuss your options.