Just want to add to another commenter about DHT. The consensus is that HRT that adequately supresses DHT production (ideally monotherapy or through use of Cyproterone Acetate (such as Androcur)—note that I’ve read Spironolactone is not especially effective against DHT) can reverse up to 7 years of pattern baldness, but that can take up to 7 years to see the full effect. I started HRT at age 23, so my pattern baldness hadn’t really been bad, and I’ve only been on HRT for 15.5 months, so my results are nowhere near full effect. I currently have medium density, very fine hair, and the only noticeable baldness I’ve experienced is a recession on my temples, which I’m hoping will be fixed with HRT, but I will likely have hair transplantation sometime after FFS (which is a few years out itself).

Do note that minoxidil and finasteride are options available by prescription for treatment of pattern baldness, and I’ve read of many trans women having success with these medications.

As for your current routine, I have recommendations, effective immediately. Get real shampoo and conditioner. This is going to be a women’s brand, and I’d recommend asking others for suggestions. No more of the 3-in-1 shit. Your hair needs to be properly conditioned after shampoo is washed out. I highly recommend getting a shampoo and conditioner meant for your hair thickness (fine, medium, coarse), and note I am not talking about density, but the thickness of individual hairs themselves. I personally use OUAI Fine Hair Shampoo and OUAI Fine Hair Conditioner, both of which are volumizing for my fine hair, and not overly harsh. I also recommend you do not wash your hair every day, as this strips necessary oils from your hair. I wash my fine hair every 3 days, and depending on your hair type, the ideal can be from every other day to once a week or less. This will take trial and error, and likely the introduction of a dry shampoo as a refresh to combat oiliness at the roots (I recommend Batiste). You can find resources on how to figure this out online by searching something along the lines of “how often should I wash my hair?” When not washing your hair, I do not recommend you get it wet (wet hair is much more prone to damage, so you should minimize the time your hair is wet), so I put my hair in a bun, then use a shower cap to keep my hair dry.

Do also note that shampoo should be applied at the roots, massaged into the scalp, and only lightly dragged to ends (if you aren’t very active or you put your hair in a bun when you work out, skip dragging to ends and only apply at roots). You should only focus on shampooing your mids and ends about once every or every other week, which I usually do with a special detox shampoo to help remove excess product from my hair (mousse, dry shampoo, hairspray, etc.). Conditioner should be applied from mids to ends, and not at the roots, as this will make them oily. Leave-in conditioner should be applied from roots to ends for full coverage heat protection (spread with fingers, then comb through with a detangling brush meant for wet hair). Use a heat protectant before every time you use heat on your hair, as it is only effective temporarily. Do not assume using a heat protectant yesterday means your hair is protected today.

Additionally, do not blow dry your hair without using a heat protectant; that will damage your hair. I use the OUAI Leave-In Conditioner while my hair is towel dry but still damp (after getting out of the shower) and apply from roots to ends. I recommend a leave-in conditioner, though you have to make sure the leave-in conditioner acts as a heat protectant, because not all of them do! Also, do not rub your hair with a towel to dry it!!! Gently remove excess water by squeezing it (do not wring or pull your hair while wet), then use a hair towel to put your hair up. Rubbing your hair will pull out more hair and cause additional damage from friction.

Male Pattern Baldness is driven by DHT. If your testosterone is sufficiently suppressed by HRT then banding should completely stop progressing and most likely start reversing to a limited extent.

I think androgen receptor blockers like Bicalutamide might be ineffective in that regard though, and you’d have to add finasteride/dutasteride to block DHT conversion. Someone with more knowledge would have to chime in. Personally I’m doing monotherapy.

If you’re balding for other reasons, then HRT will most likely not stop it and you should investigate the underlying medical issue.

That said it’s perfectly normal to lose a bunch of hair when brushing or in the shower. Hair continuously falls out and regrows. It should only be concerning when that amount suddenly increases a lot.

I’m so sorry, hair loss can definitely be demoralizing. I have alopecia, so I can relate. My doctor put me on oral minoxidil, and it’s making a huge difference. It may be worth discussing with your PCP.

Even if you don’t want to shave and go with wigs full time, toppers are a great option! I bought one when my hair fall was at its worst, and it was a great confidence boost without the work associated with a full wig.

When you’re brushing your hair do you just brush straight from root to tip or are you starting by brushing the ends then slowly working your way closer to the root?

my hair has returned to where it was ~7 years ago now, 7 months on hrt. it should get better if you have a low enough T level

Wigs can be fun 🤩