Transgender and Laser Hair Removal

Transgender men, transgender women, and other gender nonconforming individuals may seek services; a care plan for each patient is best individualized according to their personal needs and transition goals. Transgender woman typically seek hair removal on the face, neck, as well as in the genital area in the case of pre-operative preparation for vaginoplasty. Transgender men typically seek hair reduction on forearm or thigh future graft sites in preparation for phalloplasty. While epilation (plucking, waxing, or Epi-Lady type devices) and the use of depilatories (chemicals) offer temporary measures, laser is a great alternative.

Methods: pros and cons of each

The hair growth cycle consists of three successive stages that include the anagen (growth) phase, the catagen (transitional) phase, and the telogen (resting) phase. Each strand is at its own stage of development. Time in each phase can vary by location, from an anagen phase of one to two months on the body, to two to six years on the scalp. Patterns of hair growth may also vary based on gender and ethnicity. The effectiveness of both methods rely to some extent on the timing of the hair growth cycle, with the ideal response being when hairs are in the active (anagen) growth phase. Both require multiple sessions, and since effectiveness is approximately 85-90%, combined LHR and EHR may offer the best result for many. Lifelong treatment is often required for sustained effect.

Laser Hair Reduction: The use of lasers is considered a ‘medical procedure’ and offers the use of light to selectively target dark, coarse hairs. The pigment in dark hairs absorbs the light to create heat that is transmitted down the shaft to destroy the follicle. It treats larger surface areas and is less time consuming than EHR. Treatments are typically every 4-8 weeks, depending on the treatment location, as the hair growth cycles vary by area. Safety and effectiveness may vary depending on the platform used patient skin type and hair characteristics. LHR is generally ineffective on thin, light, red, blonde or gray hairs. A wavelength of 1064 (Nd: YAG) is the only wavelength considered safe for dark-skinned individuals (Fitzpatrick skin types 5 or 6).

LHR is FDA-approved for permanent hair reduction.

As with any light-based treatment that uses selective photothermolysis, overheating can result in redness, blisters, burns, and subsequent hyper or hypo-pigmentation. The majority of these are infrequent and temporary; however care should be taken with any patient with a history of keloids (test spot on low visibility area) and LHR is contraindicated in conditions that might flare in reaction to light exposure, such as lupus erythematous. It is suggested that patients with a history of herpes simplex outbreaks be aware of the potential for a light-stimulated outbreak (in treatment area) and have antivirals available for self-treatment. Treatments should be avoided when photosensitizing medications are being used. Do not treat areas of active infection.

Relative CONTRAINDICATIONS to laser hair removal:

• History of melanoma, raised moles, suspicious lesions, keloid scar formation, healing problems, active infections, open lesions, hives, herpetic lesions, cold sores, tattoos or permanent make-up in area of treatment, recent use of isotretinoin, tetracycline, or St. John’s wort in the last year, autoimmune diseases such as lupus, scleroderma, vitiligo.
• While not a contraindication to treatment, the following drugs may cause increased hair growth: penicillin, cyclosporins, corticosteroids, haldol, phenytoin, thyroid medications.

Electrolysis involves use of an electric current with a very fine needle-shaped probe to destroy the root of individual hair follicles. There are three types of electrolysis; galvanic (direct electrical current produces a chemical reaction), thermolysis (diathermy: short-wave which produces heat) and blend (combination of galvanic and thermolysis). Since electrolysis involves direct mechanical destruction of the root, it can be used on all hair colors and skin types. Treatments are typically weekly and lasting up to 1 hour, based on patient pain tolerance. Targeting individual hairs may be time consuming and costly, however is very effective when used to treat hairs that have not or will not respond to LHR. Newer technologies/epilators (27MHz frequency) offer a more comfortable treatment and may be safer than older model machines (14MHz frequency). As the frequency is increased, so is the heat produced, resulting in improved effectiveness. Electrolysis is FDA-approved for permanent hair removal. In the US, electrologists are licensed in their state of practice and practice independently.

Some of the same risks associated with LHR also apply: redness, pigment changes, and avoiding areas of active dermatitis or infection. Patients with pacemakers are most safely treated with thermolysis, but should discuss with their cardiologist prior to treatment. Home laser or electrolysis devices have not demonstrated effectiveness and may cause harm.

We understand that this treatment goes beyond just removing unwanted hair for many people. We do our best to provide a safe and welcoming environment and also provide effective treatments. We go beyond being trans-friendly and welcome all of our LGBTQ+ family into our space.