Transgender Skin Care: Smoothing the Road to Transition
Whether you are a transitioning (transgender) man or woman, the treatments and surgeries that can help you reach your goals can also be the source of drastic skin changes. Scarring, dry skin, acne, hair loss, and hair growth are the most common side effects you’ll likely face on your way to the life you want . And a dermatologist can help you make a successful physical and social transition.
Hormones Can Wreak Havoc on Your Skin
The first medical step in the process for both male to female (MTF) women and female to male (FTM) men is usually hormone therapy. But hormones affect the skin in many ways.
Male to Female (MTF) Women commonly take estrogen to feminize their features. While estrogen can help the breasts develop, increase body fat and slows the growth of body and facial hair, it also reduces sebum production. Sebum plays an important role in keeping your skin healthy.
If you are already prone to dry skin, estrogen therapy may cause itching and dry skin. There are a number of things you can do to manage this problem, such as avoiding stress and applying unscented moisturizers. If you’re experiencing severe symptoms, you may need corticosteroids and tar cream to reduce the inflammation and itch.
Estrogen also helps reduce body hair. However, it doesn’t completely eliminate facial hair. Laser hair removal, electrolysis, and eflornithine hydrochloride (VANIQA® ) are all options women can consider for further hair removal.
Female to Male (FTM) men take hormonal supplements formulated from testosterone. Unlike estrogen, testosterone increases sebum production. Severe acne is often the result, especially in the beginning.
Hormonal acne causes deep, painful cysts and nodules. As it clears, scars often appear. Topical creams and oral antibiotic medications are the first line of treatment for testosterone-induced acne. But many transgender men ultimately need isotretinoin (brand names: Accutane, Claravis).
Unfortunately, because this drug has been proven to pose potential to harm an unborn fetus, the U.S. Food and Drug Administration requires doctors to register patients by the sex assigned at birth rather than by childbearing potential. Asking a transgender man to register as a female can be psychologically unsettling. Plus, healthcare professionals may be uncomfortable discussing the subject. As a result, many men don’t start this helpful acne treatment.
In addition, testosterone increases body hair. But it may also drive male-pattern hair loss. Topical minoxidil is considered a great therapeutic option with no likely interactions with hormonal treatment.
Every Surgery Leaves a Scar
If you choose to undergo one or more gender-affirming surgical procedures, scarring can be significant. “Top surgery” enhances the breasts of women and removes breasts for men. But surgical scars, especially after mastectomy, are often profound and may lessen a man’s confidence in his ability to “pass” when topless. Treatment options include laser and light source treatments. Corticosteroid medications can also help diminish the appearance of scars.
Safety First When It Comes to Fillers
The traditional female and male face differ in many ways. The female face has a flatter forehead, smaller nose, and more prominent cheekbones, for example. Cosmetic surgery is costly and may not be for everyone.
Neurotoxins and cosmetic fillers are a less expensive and less invasive way to soften a transitioning woman’s features. While it’s a struggle to find safe and affordable solutions to these problems, seeking these treatments from anyone other than a licensed professional can result in severe skin reactions and infection. In the worst case, it can lead to death.
Growing Awareness of Struggle and Success during Transition
As the medical field grows to recognize the struggles and successes of transgender patients, dermatologists are realizing just how much they can help with the transitioning process and follow-up care. A recent study advises dermatologists to talk to their patients openly and respectfully about treatments and procedures they may not have much experience with. Make sure to find a dermatologist who isn’t avoiding issues simply because they’re personally uncomfortable. The more comfortable your doctor is with discussing your care, the more they can learn, and the better the care they can provide for you.
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Specialist doctor from the University Hospital in Gothenburg, alumnus UC Berkeley. My doctoral dissertation is about Digital Health and I have published 5 scientific articles in teledermatology and artificial intelligence.