Hello everybody,

I wonder if anybody here has experienced the same thing as I did or who can give advice. I would appreciate it a lot because this is a really distressing situation.

I am 5 years post op now and always used estradiol gel daily. For 4 years I have mild diffuse hairloss and also some mild chronic skin conditions, ecema and dermatitis (in the face unfortunately).
I learned just recently that these symtoms can be a sign of estrogene deficiency. I read it in a book about hormones, no doctor ever told me. I went to my endocrinologist and asked him to increase the dose. He said yes because it was indeed low and he suggested to switch to tablets.

I hoped that similar to pregnant women who have gorgeous hair, this increase in estrogene would be good for hair and skin. For 3 weeks I took the gel along with a tablet and then switched completely to tablets.

The outcome is this: The hairloss has increased tremendously, sometimes I loose around 500 hair a day estimated. This scares me as you can imagine and I dont understand it. Estradiol should do the opposite thing actually.
Could it be that this is a reaction to the sudden switch in medication that will go away soon ? (I really hope that)
Or does the estradiol tablets cause the hair to fall out in masses for some reason I dont know? (sounds illogical to me)

Did you experience similar things or do you have an explaination for this weird and frustrating reaction?


I also read that there is a theory that low testosterone in women can cause diffuse hairloss. My testosterone is very low. Maybe this could be the reason, but I am not really convinced of this theory...

...anyway, have a good day and thank you for your suggestions.

This isn't a Dr's forum, it sounds more like a dietary deficiency with hair loss that profound(12x the expected.) Propecia (and Proscar off label) are regularly prescribed for hair loss, they have major side effects which are common and generally accepted by TS individuals. Without specific labs that you would get from your doctor you are guessing in the dark what the problem might be, including deathly illness at that rate of loss.

From what I have read in support groups online, some scientific articles and texts by doctors, i can imagine several things:
a) the effect is temporary and caused by the hair actually growing more but shedding now to start growing from the root again. Not sure about this, it is just what some people have reported when changing drastically the hormone dosage
b) by switching to tablets you actually did something less positive. Total Estrogen is actually three different kinds of hormones. Estrone E1, Estradiol E2 and Estriol E3. Only Estradiol E2 is having those feminizing effects, Estrone E1 is having little effect in that sense and Estriol E3 has a very low feminizing effect. Too much estrogen can have side effects like increased risks of thrombosis among many other things. So personally I believe the key is to keep E2 high, but keep E1 low to not have a high total estrogen level. E3 is not playing much of a role here. Now, with tablets, the E2 in the tablets is converted to 90% to E1 in the liver. The E2 in the Gel is only converted to maybe 50%. So if you reach a E2 serum level of 100 with tablets, your E1 at the same time will be 900 and your total estrogen level is 1000 (just sample numbers). With gel, if you reach a E2 serum level of 100, your E2 will be 100-200, your total estrogen level is 200-300. This means less side effects at the same dosage. You then can even increase the dosage 3 times and still have less total estrogen in the blood. E1 is a competitive substance at the estrogen receptors, tha tmeans it will prevent E2 from acting in the body, so thats another reason why a high E1/E2 is bad. I personally was on estradiol pills for years and suffered a slow hair loss giving me a more male hairline with time. Ewww.
c) you may have lacked estradiol a bit , but you ralso lacked progesterone and testosterone. Progesteorne is very good in helping hair regrowth as it is a 5-alpha-reductase blocker, a natural variant of finasterid (propecia) and other hair loss prevention medication. Testosterone also is a substance that strenghtens hair, but there should be taken care that if it is going up, that the 5-alpha-reductase is slowed, sind this would create DHT fom the T and DHT is what actually causes the hair loss, not T itself. Again  my personal experience was that when I added more estradiol as gel, but also added micronized progsterone  and a tiny bit of testosterone, my hair grew back to a degree (some came back fully, some is still light and thin)

My suggestion would be to stick to the gel, but if you have a low blood level of E2, maybe increase the dosage and also add progesterone to the therapy, maybe also add a very tiny amount of testosterone. A dosage that would be used for a man for a day should be enough for weeks. Caution - this therapy impreoves hair growth - on the head but also it may do so a bit on other body parts.

Oh and also: Adding Zinc in significant dosages, as well as possibly selenium may help.

Dear Anjaq,

thank you so much for your comprehensive answer and for sharing your experience. That is very helpful. I did not know that so much Estradiol is converted into E1 when taking tablets. I wonder why it is used for HRT at all when it has such bad characteristics. I think I will switch back to the gel as soon as possible and add a bit progesterone and maybe later if it seems necessary also add a bit testosterone.

Woman also need testosterone, which is produced in the adrenal cortex. When the adrenal cortex is faulty, too much cortisol can be produced, which can leading to rapid and fast shedding of hairs. Maybe it's a good idea to do a complete lab test, including cortisol which may be the culprit, because woman who suffer from androgenetic alopecia have elevated cortisol levels as well.

Very good. I did not even want to add the Cortisol issue, as many doctors will even more be opposed to looking into that than they are in respect to bioidentical progesterone. But yes - testosterone is needed and yes, the adrenal glands are amazingly often not working properly in transwomen. I think it is in part because of the antiandrogens, which mess massively with them (specifically Androcur and Spiro) and slo in part because if the hormone therapy is not quite right, the adrenal glands try to compensate by producing testosterone, progesterone, estradiol themselves, but since they can never produce enough, they get a "burnout". Then for a while cortisol may be really high and then at some point they just cannot do it anymore when there is stress or a surgery and then there is a lack of it.