A randomised, double-blind, placebo-controlled trial enrolled 46 transgender people receiving testosterone therapy with androgenetic alopecia, 23 per arm, and followed with an open-label extension.
At week 24, midfrontal target-area hair count improved by 15.7 hairs per cm² with sublingual minoxidil against placebo (p=0.03). The vertex showed no difference at that point. In the open-label phase, net midfrontal improvement from baseline to week 48 was 12.3 hairs per cm² (p=0.02), and vertex gains reached significance by week 48 at 37.9 hairs per cm² compared with baseline.
Minoxidil was well tolerated with no serious adverse events and — the point that matters most in this population — no effect on testosterone concentrations.
Androgenetic alopecia is a predictable consequence of masculinising hormone therapy, and treating it has been complicated by the fact that the standard alternative, finasteride, opposes the androgenic effects the patient is seeking. A treatment that works without touching testosterone resolves that conflict. The authors note that mild baseline alopecia probably limited detection of change on global photographs and quality-of-life scores, which is a fair reading of why the objective count moved and the subjective measures did not.
- 46 participants — small, and the first randomised evidence in this population
- No effect on testosterone concentrations, which is the key acceptability point
- Vertex response lagged midfrontal by 24 weeks
- Week 48 vertex comparison is against baseline, not against placebo
- Mild baseline alopecia limited detection on photographs and quality of life
The statistics, in plain English
Note the change in comparator between phases. The week-24 result is against placebo, which is the randomised comparison. The week-48 vertex figure is against baseline in an open-label extension, where improvement includes natural variation, continued testosterone effects and expectation. The first number is evidence; the second is a description of what happened.
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