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Ask Dr. GenderFixIt (Tapestry No. 109) (2005)

Ask Dr. GenderFixIt (Tapestry No. 109) (2005)

©2005, 2013 by Dallas Denny

Source: Denny, Dallas. (2005, Fall). Ask Dr. GenderFixIt. Transgender Tapestry, 109, pp. 8-9.






Dear Dr. GenderFixIt:


I’m a man, no mistake about it. Been on T for four years. I’m hairy, a bear, and happy as a clam in most ways, but I’m beside myself. I’m going bald—pretty much have gone bald! Within weeks of my first injection, my hair, which had been beautiful, was greasy, even just after I shampooed it. Soon, I started finding hair on my pillow and in my comb. Six months on, I had a distinct widow’s peak and a thin spot on my crown. For the past year, I’ve been doing a comb-over, something I hate and something I thought I would never, ever do. I was always like, “Those bald guys, who do they think they’re fooling winding three strands of hair around their heads like that?” I even took myself to Hair Club for Men and they told me that within ten years I’ll look something like Captain Picard from “Star Trek: The Next Generation.”


I love being a man, everything about being a man. But I hate losing my hair. It just makes me sick. What can I do?


Just call me Jean Luc.

Dear Jean Luc:

For most of history, it was impossible to cure male pattern baldness, which is the condition that’s causing you to suffer so. In just the past 15 or so years, hope has arisen. I’ll talk about that in a mo’, but first let me say that a lot of guys have hair dysphoria. They have this great head of hair as kids and young teens, and then, in their twenties or thirties, or even in their late teens, it starts going south. They’re appalled—just as you are. Most men deal with it somehow; others try to slow or reverse their baldness. A few men even like it; it’s the Kojak effect. Telly Savalas made baldness sexy—and, in fact, a considerable percentage of women have always found bald men sexy. Male pattern baldness is, after all, a result of high testosterone levels.

MPB, also called androgenetic alopecia, is a hereditary trait, sex-linked on the mother’s side, or the father’s side, or both sides of the family, depending on which website you consult. It’s also hormone-related, for the hair loss is not specifically caused by testosterone, but by dihydrotestosterone, which attacks hair follicles. It’s probably DHT that makes your hair feel greasy.

DHT is made from T by action of the enzyme 5-alpha reductase. This hormone is famous in the intersex literature because its absence results in a child that is apparently female at birth, but upon puberty develops male genitalia. Fascinating stuff, gender. Remind me to tell you the whole guevodoche story sometime. It means “eggs at twelve” in Spanish.

But back to your scalp. Let me say that hair loss in males is not always due to MPB. I would suggest you consult a physician to rule out a pituitary condition, alopecia areata, or (gross!) a fungal infection—but chances are you have MPB.

Thanks to the miracle of chemistry—the science that has given us thousands of cancer-causing wonders like PCBs and, most recently, endocrine disruptors that are causing intersex conditions in creatures as disparate as fish, amphibians, and polar bears—there is some hope for men with pattern baldness. The medications minoxidil (trade name Rogaine) and finasteride (Propecia) have been clinically proven to stop hair loss and cause some regrowth. This is welcome news after 2000+ years of quackery in which hucksters promised to be able to regrow hair, but didn’t (they usually snuck out of town in the dead of night with your money in a sack)..

Minoxidil was originally marketed as a blood pressure medication. It was soon discovered to have the side effect of stimulating hair growth and was remarketed as Rogaine, a hair medication with the side-effect of lowering blood pressure. It is applied topically [that means you put it on your hands (but not with the palms of your hands, for what I hope will be obvious reasons)]. You see how it works in the wonderful world of the pharmaceutical industry. Rogaine comes in 2% and 5% solutions; go for the higher concentration.

Finasteride is a potent antiandrogen which was originally used to treat men with enlarged prostates. Now it is, cleverly enough, called Propecia. Taken orally, it slows the conversion of testosterone to DHT—but is likely to have a dramatic effect on your sex drive, and not one I think you will like.

There are a number of available hair surgeries. The best-known is transplantation, in which small plugs of skin are harvested from hair-bearing areas of the scalp and replanted in thinning or bald areas.

With hair reduction surgery, an inflatable bladder will be implanted under a bald area and incrementally inflated over a period of weeks; the pressure will cause the skin to stretch. You’ll look like Beldar the Conehead for a time, but finally the bladder will be deflated and removed and your plastic surgeon will cut away the now-loose skin of the bald area and pull together and suture the hair-bearing skin on either side. Voila, instant hair!

With flap surgery, a section of skin a few inches long and about an inch wide will be cut free on three sides, leaving the flap with a supply of blood; the flap will then be walked around to a bald area and sutured into place. The hair-bearing areas on either side of the area from which the flap have been taken will be pulled together and sutured, and the skin from the balding area will be discarded.

Both scalp reduction and flap surgery (they’re often used in combination) will require your hair loss to be stabilized; otherwise, you’ll continue to loose hair from the rest of your scalp and will eventually achieve a patchwork appearance. And both require some part of your scalp to have thick hair—not a likelihood if your name is Jean Luc.

Scalp surgeries are expensive, and so is, I believe, finasteride. If money is a problem and minoxidil doesn’t do it for you, you might consider—you probably have figured where I’m going with this—Hair Club for Men. You’ll walk away with instant hair, and most folks will not be able to tell. Look carefully at my photo. Would you have guessed that I’m a member?

Hey Doc, What’s Happenin’?


I’m a twentysomething (ok, 30!) queen, and it’s great being me. I’m pumped full of estrogen and silicone, and I’m sure I’ll pay the price for that some day, but hey, life is good. I headline the best drag show in town, I get plenty of money, and all the sex I want.


I don’t want criticism for my lifestyle—not that you would do that—but something is troubling me. It’s the surgery.


I’ve always wanted the surgery. Finally, a miracle, and it was possible. The deal is, my husband—we can’t be legally married in my state, but still, he’s my husband—came into some money when his aunt died, and he gave me the $20,000 I needed for the surgery. I had decided to go to Thailand, but as the time for departure grew near, I realized I wasn’t making the necessary arrangements. I had my plane ticket and a date with the surgeon, but I didn’t own a suitcase and hadn’t even applied for a passport. Then, just a week before I was set to go, I went on a fabulous shopping spree. Do you have any idea how fast a girl like me can go through twenty thousand bucks? I did crack, I did crank, I bought a pound of weed, I bought liquor for all my friends, I hit the casinos, I dropped more than eight thousand at Macy’s one Saturday—shoes and lingerie and cosmetics and dresses. On the day I was supposed to fly, I was broke on my ass.


My husband could have killed me, and in fact nearly did. The bruises will heal, so no sweat about that, but now I’m broke. I’m heartbroken that I blew my one chance to have surgery. Whatever will I do?


Amanda Dacore (my drag name)

Dear Ms. Dacore:

Far be it from the doctor to criticize your lifestyle. But do be careful, ‘kay?

Here’s something important: there is no one right way to be trans. Surgery is not something you “should” have, or have to have. It’s something you have if you have searched your heart and embraced it. Clearly, you haven’t embraced it.

You might find Holly Woodlawn’s autobiography instructive; it’s called A Low Life in High Heels. In fact, you’ll find she went through something much like you. With money in hand for her surgery, she went on a binge much like yours. From the text, it seems she realized that perhaps it wasn’t what she wanted at her core— but I don’t think she went the rest of the way, to the realization that it’s fine not to want it.

This might get me in hot water with those who construct their transsexual identity otherwise, but surgery is an option. On the plus side, it’s affordable (about as much as a good economy car), easy to obtain (yes, yes, the HBIGDA letters, but it’s not like the bad old days; they’re easy to get), cosmetically excellent (with a good surgeon), functional for hetero and same-sex intercourse, and functional for self-pleasuring (all with a good surgeon). On the negative side, twenty large is a lot of money, there are always risks with surgery, and there are sometimes bad outcomes. Moreover, one must be in good health to go under the knife; if you are HIV-positive or diabetic, finding a willing surgeon can be difficult, and in come cases (depending upon the actual state of your health) impossible. That’s for male-to-female persons. For female-to-males, it’s horrendously expensive, requires multiple surgeries, and yields outcomes that many guys find unacceptable.

You may have heard the old saw that if you don’t have surgery you’re not transsexual, but don’t believe it. All those guys who take a careful and rational look at phalloplasty or metadioioplasty and say no thank to the expense and the pain and the disappointing results—are they non-transsexual? I don’t think so! Sure, if the surgery was cheap and had good results, many of them would have it, but most FTMs will tell you, if you ask, that it’s not the penis that makes the man.

No one has the right to demand that you make drastic changes to your body. It’s your decision, and whatever you decide is the right decision, so long as you’re honest with yourself.

This works both ways, of course. For many transsexuals, both MTF and FTM, genital surgery is an essential part of their identity and they will pursue it at great financial and psychic cost. More power to them as well.