Gender affirming care for TGD youth includes social and psychological support and, in some cases, medical interventions. A total score of ≥8 is considered elevated for a Caucasian individual assigned female at birth. Modified Ferriman-Gallwey score evaluation before and after 3 months of minoxidil monotherapy. With his pediatrician’s agreement, he subsequently purchased minoxidil (5% lotion) and applied 1 mL twice daily to the beard area. No signs of male pattern baldness, acne or hirsutism (see Table 2 for modified Ferriman Gallwey score evaluation at baseline). However, due to legal requirements in Australia at the time, he was required to obtain Family Court approval to initiate therapy with testosterone.|The concomitant use of testosterone in these informal reports, however, makes it difficult to know whether it was minoxidil, testosterone or their combination that was responsible for apparent improvement. The choice of medical interventions varies and is often influenced by the desire to acquire particular masculine characteristics and/or avoid certain side effects. Trans and gender diverse (TGD) individuals have a gender identity that differs from their sex assigned at birth. Many individuals worry about the possibility of sexual side effects, including erectile dysfunction, low libido, or ejaculation disorders, when using Minoxidil.|Still, this is not a concern for most individuals using topical Minoxidil for hair loss. However, there is some limited research suggesting that high doses of oral Minoxidil (rarely used for hair loss treatment) could potentially have an impact on fertility by affecting sperm count. The topical formulation of Minoxidil, which is applied directly to the scalp, is not absorbed in large enough quantities to affect systemic processes like sperm production or testosterone levels. Importantly, the side effects don’t seem to be directly related to testosterone levels, but rather, to individual sensitivity to the medication or other underlying factors. This sets it apart from medications like Finasteride, which actively reduces DHT levels, DHT being a key hormone linked to hair loss. Minoxidil acts as a vasodilator (a substance that widens blood vessels) and stimulates hair follicles, but it does not influence hormone production.|Given the legal requirements in Australia at the time, his use of minoxidil helped him to achieve a more masculine appearance while awaiting formal approval to start testosterone therapy, and he was very pleased by this. This likely reversibility might increase the attractiveness of minoxidil for use in TGD adolescents, especially given concerns about potential long-term regret following irreversible masculinizing changes, but it would be important to specifically assess reversibility when used in this context. Secondly, the reversibility of minoxidil therapy was not able to be assessed in this case, since the patient subsequently started on testosterone. At present, it is difficult to accommodate such specific needs, and minoxidil may offer a potential solution. For example, some might wish to avoid impairing their reproductive function or irreversibly deepening their voice but may wish to develop facial hair.|While minoxidil can be an effective treatment for hair loss, there is some concern that it may affect testosterone levels. Despite some skin dryness and irritation, our patient was satisfied with the effect of topical minoxidil in promoting facial hair growth. His outcomes demonstrate the feasibility of using topical minoxidil to augment facial hair growth in transmasculine patients and are likely to be of interest to both other patients as well as clinicians working in this area. It is thus difficult to predict if there is a limit to the amount of facial hair growth minoxidil can stimulate and how this compares to the effects of testosterone alone. Indeed, a recent literature review of potential therapies for specifically encouraging facial hair growth – including in cis-gender individuals – identified only two previous clinical trials (12). If you have concerns about the impact of minoxidil on testosterone levels or any other potential side effects, it is crucial to consult with a qualified healthcare professional for personalized guidance and monitoring. Based on available research and clinical data, topical minoxidil does not appear to have a direct impact on testosterone levels in most individuals.}
It works by widening blood vessels and opening potassium channels, allowing more oxygen, blood and nutrients to reach the hair follicles. Minoxidil is a common treatment used for hair loss and hair regrowth. Therefore, it is possible that further hair growth would have been observed should our patient have continued on minoxidil alone for a longer period.
Due to a desire for facial hair, he was therefore treated with topical minoxidil, an easily accessible, over-the-counter medication that has been used to treat androgenic alopecia for several decades. Unlike other hair loss treatments like Finasteride (which works by blocking the conversion of testosterone into DHT), Minoxidil does not interfere with the hormonal system in the same way. However, one of the most common questions among users is whether Minoxidil affects testosterone levels, particularly since testosterone plays a crucial role in hair loss, especially in men. The results showed no significant changes in testosterone levels or other hormone levels after one year of treatment. The study found no significant changes in testosterone levels after six months of treatment with 5% minoxidil solution. This limited absorption is one of the reasons why topical minoxidil is generally considered safe and effective for treating hair loss.
If you’re using Minoxidil to regrow hair, you can do so confidently—just don’t expect it to influence your hormone levels. In contrast, Minoxidil does not interfere with testosterone or DHT production—raising questions about whether it has any hormonal effects at all. It works by dilating blood vessels in the scalp, increasing the supply of oxygen and nutrients to the hair follicles. Minoxidil was the first medically approved treatment for male pattern baldness, and it remains a trusted option today. I am growing facial hair rather fast, but should I start considering an alternative, such as rosemary oil? I've been using minoxidil since february 2023, and I've recently hit one month on testosterone.
Thirdly, some TGD individuals may wish to masculinize without experiencing all the effects expected with testosterone. In this case report, we describe the use of minoxidil 5% lotion with good effect in a trans male adolescent prior to and continuing after testosterone therapy. His subsequent medical transition, which included bilateral mastectomy at age 18, has continued to proceed well and he currently remains on testosterone therapy under the care of adult gender services.
While more research is still needed, current evidence suggests minoxidil may potentially lower testosterone levels when used long-term, especially at higher doses. In conclusion, we present the case of a 17 year old trans male who was treated with topical minoxidil prior to commencement of testosterone therapy. Previous reports suggest that the effect of minoxidil in promoting hair growth in cisgender individuals is reversible, and that its cessation should lead to regression of hair growth within 3 to 4 months (24). After all, facial hair takes 4-5 years to fully develop as a result of systemic testosterone treatment in transmasculine individuals (11).
These are more likely in people with naturally low blood pressure, since Minoxidil is a vasodilator (it relaxes blood vessels). Minoxidil doesn’t increase testosterone, reduce it, or significantly influence how it’s processed in the body. Other treatments, like Finasteride (Propecia), work by reducing the amount of DHT in the body. DHT is a by-product of testosterone, converted in the body by the enzyme 5-alpha-reductase. Studies suggest that around 60–70% of men see improvement in hair density with consistent use. This supports healthier follicle function and, in many cases, leads to visible regrowth.

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