As the trans men and women continue to overcome more and more cultural and bias-related hurdles that directly affect quality and accessibility of healthcare, they also continue to encounter unique and, to a large extent, lesser-discussed issues that can impact health, quality of life and desired treatment outcomes; one of these issues is certain skin-care issues that emerge through hormone replacement therapy and other transitioning interventions and facilitators. Hormone therapies and gender-affirming procedures can affect the skin and change the prevalence and presentation of routine skin conditions.
Understanding the dermatological issues faced by trans men and women, how they manifest, as well as the everyday and long-term remedies to manage them, can help improve health outcomes, quality of life and confidence for patients in this community.
What Are Some of the Skin Care Issues that Trans Men and Women Experience?
The gender transition process can lead to multiple dermatological issues, based on the nature of the hormone therapy process and more. Some of the primary skin care issues that trans men and women face include, but are not limited to:
- Acne Vulgaris (AV) – AV is a common side effect of testosterone therapy. Symptoms range from mild to severe and may require actual intervention from a dermatologist, depending upon the nature of your hormone therapy and where you are in your journey; however, it is generally treated the same way cis patients treat acne (topical and oral medications, light therapy, drainage and extraction, etc. ).
- Unwanted Hair Loss and Hair Growth – Transmasculine hormone therapy can often cause what is called androgenetic alopecia (male pattern hair loss). It often begins a few years after initiation of testosterone. On the other hand, for transfeminine hormone therapy (therapy for cisgender men undergoing gender reassignment to become women) doesn’t necessarily stop hair growth. Estrogen and antiandrogen treatments generally do not cause cessation of facial hair growth, and other hair-removal interventions, like laser hair removal and electrolysis may need to be administered.
- Pigmentation Issues – Melasma (also known as chloasma) manifests as symmetrical hyperpigmented brown to blueish-gray macules and patches on the sun-exposed skin, especially the face. Transfeminine patients undergoing estrogen hormone therapy are often at increased risk for these pigmentary issues. Treatment for these issues depends on scope and severity, but will require strict use of sunscreen, as well as stringent photoprotection. See your dermatologist to determine the best course of action.
Other common skin conditions that trans persons may experience include lichen sclerosus (crinkled or thickened patches of skin) and HPV-related skin infections, such as condylomas, low- and high-risk dysplasia and HPV-related squamous cell carcinoma. Unfortunately, there is evidence to suggest that the trans community may be at increased risk for HIV, common symptoms of which can be skin conditions like psoriasis, folliculitis, condylomas, seborrheic dermatitis, and dry skin. These conditions should be addressed with the help of your dermatologist for the best possible long-term management and to mitigate other potential health problems.
Everyday Skin Care for Trans Women
For both trans and cisgender women, certain lifestyle practices can make daily skin care easier, such as quitting smoking and/or vaping, cutting back on alcohol, using ample sunscreen, proper diet and exercise and more. Avoid using cheap products or relying solely on social media influencers to guide you in your product decision making. Talk to your doctor about developing a daily skin care routine with which you’re completely comfortable. Make sure you research whatever make-up you’re considering and gauge its potential impact on your skin.
Other things to consider include:
- It’s best to complete facial hair removal as early as possible in the gender reassignment process, as delaying it can damage collagen and skin cells.
- Use alpha-hydroxy acids (AHA’s) to unclog pores and moisturize skin. For most effective use, carefully read directions, avoid getting them on your eyelids, wash your face, wait 15-20 minutes, apply AHA agent and let rest for 15 minutes.
- Work with your primary care physician or dermatologist every step of the way to ensure that you’re not making counterproductive choices or those that can interfere with your transition or overall health.
Finally, it’s important to realize that each person’s skin pigment, texture and sensitivity threshold is different, and what works for others may not be the right option for you.
Everyday Skin Care for Trans Men
Much like trans women, trans men face a unique and distinct set of issues when it comes to their skin care, including but not limited to:
- Slow, Delayed or Patchy Hair Growth – To deal with patchy or sporadic hair and work toward a full and even beard or facial hair, you can exfoliate once per day and shave down stubble once per week. Use a gentle and moisturizing shaving cream that hydrates your skin.
- Acne Caused by Testosterone – To combat acne caused by surges in testosterone that are often caused by hormone replacement therapy, try topical treatments like retinoids, salicylic acid, or benzoyl peroxide. Wash your face twice per day to prevent dirt build-up. Use warm water and don’t scrub too hard. Avoid picking at pimples or breakout spots, no matter how much it itches and make sure you remove all makeup or cosmetics before you go to bed.
- Extremely Oily Skin – To prevent excess skin oil on the face, clean and moisturize twice daily and using warm water and mild soap.
- Folliculitis (Ingrown Hairs) – To prevent ingrown hairs, use downward strokes when shaving your face. Avoid sharing towels or wash cloths whenever possible. Don’t use oils on your skin and don’t pick at the bumps and bathe every day using a mild soap or a variety for sensitive skin.
While each person’s skin care routine is different, according to their skin sensitivity, medications they’re taking and other factors, daily skin care for trans men is usually a matter of accounting for dermatological changes caused be hormone replacement, often akin to those experienced during puberty during adolescence and childhood.
Mental Health, Skin Care and the Trans Population: What’s the Connection?
Mental health effects those with skin issues, as well as trans men and women apart from one another. Skin patients may often feel anxiety, depression and self-esteem issues. While transgender youth AND adults are far more likely to experience serious mental illness (SMI). When these issues are compounded, the impact can be even worse, leading to more and more extreme means of coping, like self-harm or substance use disorder. If you or someone you care about is a trans person struggling with mental illness, or are a cisgender man or woman battling self image-related mental health issues, seek therapy or counseling to help you address the origins and triggers and develop ways to cope.
The Importance of Effectively Addressing Skin Issues for Trans Patients
In addition to the multiple potential long-term health issues associated with dermatological abnormalities in trans patients, these conditions and symptoms can entrench and elevate body dysmorphia and exacerbate other mental health issues commonly found in trans patients. Therefore, it is important for clinicians caring for transgender persons should recognize and address common dermatologic conditions relevant to gender-affirming treatments. If you or someone you care about is considering hormone therapy or surgical intervention, make sure to work with a doctor who understands the physical and psychological implications of the changes you’re going to experience. Good luck!