Hair loss that affects men can be devastating. Hair loss in men who believe that they are truly women can be exponentially worse. They do not have the option of shaving their head and their gender identity can be worsened because of it. By being sensitive to this kind of plight is the first step. Those who have undergone psychological counseling and have been deemed stable and interested in pursuing hair restoration, it can be a life-changing positive event for them. Hair restoration using conventional methods of scalp advancement can pose issues if all hormones are not entirely balanced with the incision line possibly becoming exposed over time. As importantly, hairlines that are advanced still have a male hairline shape to them since this is not a simple act of moving a woman’s hairline downward. It is in fact converting a male hairline into a female hairline. How is this different? First, the shape is entirely different. The corners of the hairline along the temple area are rounded downward. This area simply cannot be reproduced with a surgical hairline advancement. If you have had a hairline advancement procedure you probably still need to have the temples rebuilt because they will still be receded. In addition, female hairlines have hairs that are directed principally backward, shaped like a cowlick, with small lateral mounds or peaks. These features do not exist on a male hairline and cannot be adequately reproduced with an advancement procedure. For all of these reasons, in my opinion the best method to achieve the best and most feminine appearing hairline is through transplantation of hair grafts in an artistic and technically precise manner.