Transgenderism is when the state of one's gender identity (i.e. self-identification as male, female, both or neither) does not match one's born gender. Transgender does not imply any specific form of sexual orientation ?a transgendered individual may be heterosexual, homosexual, or bisexual.

Hairline is an issue for male-to-female (and occasionally female-to-male) transsexuals whether there is hair loss or not. A genetic male typically has an M-shaped hairline while a genetic female have an inverted U-shaped hairline. Even without any hair loss, the difference in hairline can be significant when hair is styled in an up-do or pulled back from the face. With follicular unit transplantation, a male-style hairline can be modified to a female-style hairline in one session.

For a transsexual with existing hair loss, the progress of her hair loss is usually slowed down if she is on estrogen, 5-alpha-reductase inhibitors, and anti-androgens. Correction of hairline and balding area may be feasible if she has not yet reached a Norwood type V or VI baldness before seeking therapy. Timing is therefore crucial.

Being transgendered is very difficult in today's society because many people have difficulty grasping such a concept. Those who are transgendered face prejudice everywhere, including work and home. At UHR, we hire only compassionate and nonjudgmental staff that acknowledge and accept the differences in people regardless of race, ethnicity, sexual or gender orientation. Anyone visiting UHR will be treated with the utmost respect they deserve. In addition, we consider hair transplantation as a medical need for the transgendered; hence, special consideration is given in regard to the fees.

In general, we can divide the hair restoration needs into the following categories:

Part-time, not planning on full transition

The best option is hair transplant to appropriate male hairline, though more aggressively, i.e. lower and flatter hairline. Traditionally, hair transplant surgeons would try to make the male hairline as high as possible and slant the hairline downwards in order to conserve donor grafts. If one doesn't disclose one’s gender-crossing tendency, an ethical hair transplant surgeon will not provide a low hairline. This can lead to unnecessary embarrassment for some part-time girls.

With this hairline, she can grow her hair long to eliminate the need for wigs but still allow normal daily life as a male. Medical therapy using finasteride (Propecia) and minoxidil (Rogaine) following the surgery is strongly recommended to prevent further hair loss due to male pattern baldness (androgenic alopecia).

Part-time, planning on transition

For one who plans to transition, a hairline similar to that described above is probably an appropriate first step. However, if surgery of the forehead (trimming of brow ridge for instance) and scalp reduction/advancement are planned, the transplanted hairline should be higher than that of those who are not planning on transitioning so that no grafts are wasted in the future.

Medical therapy wise, minoxidil (Rogaine) is recommended, but finasteride (Propecia) is only necessary if not on estrogen or other anti-testosterone therapy.

Full-time, before FFS (Facial Feminization Surgery)

Because FFS 1) can move the hairline forward while working on the forehead/brow ridge and 2) can change the shape of lower face which is essential to design a proportionate female hairline, it is not recommended to create a feminine hairline prior FFS. We can, however, provide a male hairline that is flat (instead of slanting downwards towards the front) as a stop-gap measure. A feminine hairline with lateral humps can be created after the FFS to 1) hide the forehead scar from FFS, and 2) provide the best proportion of forehead against lower face.

In turns of medical therapy, minoxidil (Rogaine) is recommended, but finasteride (Propecia) is only necessary if the person is not on estrogen or other anti-testosterone therapy.

Full-time, after FFS or no FFS planned.

This is a great time for hair restoration surgery and hairline feminization. If FFS had been performed, especially if the scar is relatively long, it is important to wait at least 6 months so that adequate blood supply is re-established for transplanted grafts. Without a good blood supply, there can be delayed or poor growth of transplanted hairs.

If there was no previous hair loss, no medical therapy is necessary. If there was hair loss prior transition, minoxidil (Rogaine) is recommended, but finasteride (Propecia) is only necessary if the person is not on estrogen or other anti-testosterone therapy.