Treatment of androgenetic alopecia in transgender people receiving testosterone therapy with sublingual minoxidil: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND: Transgender people receiving testosterone may experience androgenetic alopecia (AGA). Treatments such as 5α-reductase inhibitors can interfere with masculinization. OBJECTIVE: To assess the efficacy and safety of sublingual minoxidil in the treatment of mild AGA in transgender people receiving full-dose testosterone therapy. METHODS: Participants were randomized 1:1 to receive either sublingual minoxidil 1.35mg twice daily or placebo for 24 weeks, then all received sublingual minoxidil 2.5mg twice daily in an open-label extension phase. Tattoo-directed phototrichograms were performed. Co-primary endpoints were change in midfrontal and vertex target area hair count (TAHC). RESULTS: , p=0.009). Minoxidil was well tolerated, with no effect on testosterone concentrations or serious adverse events. LIMITATIONS: Mild baseline AGA may have reduced detection of change in global photographs and quality-of-life scores. CONCLUSIONS: Sublingual minoxidil is a safe and effective option for promoting hair growth in trans people receiving testosterone.