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

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• Picked for Dermatology (top studies of the week, 8 November 2026): Randomized double‑blind trial, sublingual minoxidil for androgenetic alopecia

Abstract

BACKGROUND: Transgender people receiving testosterone may experience androgenetic alopecia. 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 androgenetic alopecia in transgender people receiving full-dose testosterone therapy. METHODS: Participants were randomized 1:1 to receive either sublingual minoxidil 1.35 mg twice daily or placebo for 24 weeks; all received sublingual minoxidil 2.5 mg 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. RESULTS: Forty-six participants were randomized (23 per arm). At Week 24, midfrontal target area hair count improved by +15.7 hairs/cm2 with minoxidil vs placebo (P = .03) but no difference observed in the vertex. In the exploratory open-label phase, net midfrontal improvement from Week 0 to 48 was +12.3 hairs/cm2 (P = .02) and significant gains in the vertex occurred by Week 48 compared to baseline (+37.9 hairs/cm2, P = .009). Minoxidil was well tolerated, with no effect on testosterone concentrations or serious adverse events. LIMITATIONS: Mild baseline androgenetic alopecia may have reduced detection of change in global photographs and quality-of-life scores. CONCLUSIONS: Sublingual minoxidil was an effective and well tolerated option in this population for promoting hair growth in trans people receiving testosterone.

Abstract as published, via PubMed.