Facial hair removal for transgender women

Smooth skin free from stubble and a five o’clock shadow is much more than a cosmetic goal – for many transgender women it’s a vital milestone in their transition, helping them finally feel comfortable in their own skin. Next to hormone therapy and surgical intervention, facial hair removal is considered a vital medical aspect of sex reassignment . However, for most transgender women, it simply doesn’t go far enough.

Are transgender women a unique target group that requires special treatment? Not really, say the experts. Dr. Müller-Steinmann who works as the medical director at Kiel Dermatology Center, has a unique way to describe it: “If it’s not obvious from the name given when registering, I just ask the patient how they’d like to be addressed – and usually it’s just like any other woman. After the long transformation process, many feel at the end of their tether. They’ve had bad experiences and finally just want to be treated normally and equally.

Creating a supportive environment is important

Nevertheless, it’s all the more important to create a feel-good experience for transgender women: “Unfortunately, there are still many situations where these women are looked at strangely. When they come to us, they’re usually still at the beginning of their external transformation, but they’ve already come a long way and been through a lot psychologically,” explains Maria Schneider, a cosmetician at Laser One in Berlin. “I treat these clients completely normally, so with me they should feel like they’re accepted as women.

Elsewhere, they’re often not accepted for who they are, especially in a professional environment – that requires some sensitivity,” adds Fatima-Zahra Bourakkadi, a beautician at Docure clinic in Berlin. “Caressing the soul” is what Yasemin Apaydin, owner of Yasi Cosmetics, Nuremberg, calls it. “Accepting them for who they are creates a vital basis of trust. I tell the women: I don’t care about your job or your sexuality. You want to get rid of your hair, and that’s what I’m here for!”

Laser hair removal or needle epilation?

Some websites often mention needle epilation as a suitable hair removal method for transgender people, as it’s the option preferred by some health insurance companies. However, this procedure is especially time-consuming as it requires each individual hair to be treated, root by root.

Needle epilation also tends to be associated with higher treatment costs. Moreover, when it comes to facial hair removal it is significantly more painful compared to laser devices: “Health insurers often pay for electrolysis, which can cause serious side effects like burns, lesions, or scars. Laser treatment is much faster and gentler,” says Fatima-Zahra.
According to Yasemin, needle epilation is particularly unsuitable when it comes to removing an entire beard: “Of course epilation works, but my clients always tell me that it’s very painful, which is hard to tolerate for an entire beard. I see it more as a complementary treatment that’s best for a single stubborn hair or gray hair that doesn’t respond to the laser. She also adds: “A man’s beard is harder to remove than a transgender woman’s beard. Therefore, using an advanced laser such as the Alma Soprano Titanium is a sufficient solution for these patients.”

Besides facial hair, which other areas should be treated?

At the beginning of the treatment, in the first sessions, the focus is on removing hair from immediately visible areas. For instance the face, the neck, and, if necessary, the hands. “That’s usually followed by the décollete or chest, abdomen, genital area, and legs – in other words, it goes from top to bottom,” says Fatima-Zahra. Women’s financial situation also plays a major role here, because “body hair removal is never covered by health insurance companies, even though these regions are also important in order to really feel like a woman – and present yourself as one,” explains Dr. Müller-Steinmann. “In my experience, many of these women are in a difficult professional and financial situation, so hair growth is an additional burden. It would be preferable for the health insurers to reconsider this matter.”

When should the patient begin treatment?

Hair removal should start relatively early in the transition process. Fatima-Zahra: “We recommend starting treatment when the hormones begin to take effect, which is very different for every woman. Reassignment surgery comes later in the process, so women really gain a lot of femininity here. ” Hormones do affect hair growth, but it’s unlikely that they will make the treatment unnecessary by eliminating the beard completely.

incidentally, hormones do not generally lead to side effects from laser treatment. The women do not become more sensitive to light, and no pigment disorders or related problems have been observed. “The hormones tend to support laser treatment,” says Maria, “because the hair becomes finer as the process goes along. A man’s beard, for example, is harder to remove than a transgender woman’s beard. ” Yasemin Apaydin, however, always offers a test treatment and starts with a lower energy setting during the first session. “If the client tolerates it well, I increase the intensity during the next treatment session.”

*Insurance policy coverage

The legal situation surrounding insurance coverage is particularly tricky. In recent years, there have been repeated verdicts stating that health insurers have to bear the costs of laser treatment at cosmetic institutes as well. In practice, however, every single case requires its own individual application and approval. The chances are better when being treated by a doctor, “but whereas in the past the costs for laser hair removal in the face/neck area and on the hands were adequately compensated by health insurers, for some time now we’ve had to bill this service using a special code in the physician fee schedule (GOÄ), which doesn’t even let us break even. In my view, this makes performing the treatment under health insurance coverage completely unattractive for dermatologists,” reports Dr. Müller-Steinmann.

The bureaucracy makes it harder for these patients

“Most of our clients are already aware that the health insurers are unlikely to cover the costs,” says Maria Schneider. “The women take this big investment upon themselves, because the situation is just so stressful”. In addition, it requires extensive bureaucratic, time-consuming work: “I often find that these women simply don’t have the patience and strength to fight the authorities. It’s tough enough for them to fill out the complicated application. Moreover if they do, they are all the more disappointed when it’s rejected,” says Yasemin.
“You need nerves of steel for this, and many simply don’t have them in this situation. They’ve gone through a lengthy ordeal, are still in difficult circumstances, have suffered through many bad experiences. They just want to finally be allowed to be women.”

In addition to recognizing laser hair removal as a modern method with few side effects, Fatima-Zahra Bourakkadi believes it would be an important step for the health insurance companies. “It will be highly beneficial to cover the treatment regardless of the practitioner, so women can choose somewhere they trust instead of simply being assigned a practitioner. A universal, modern regulation would be really helpful.”

What is the best way for clinics to advertise these treatments?

For transgender women, Word of mouth is hugely important : “It’s a very close-knit community. If a client has a good experience with the treatment, she’ll recommend it to others, and new clients will keep coming,” says Fatima-Zahra. It makes sense to actively draw attention to this service on your website, because there’s still very little information online about laser hair removal for the transgender community. Speaking directly to women can help to alleviate their fears, because now they know they can just be themselves here.

“Take the leap,” encourages Maria. “It’s so exciting to see how the whole person changes as a result of the changes in the body. I’ve noticed how much happier and more self-confident she becomes, the more she presents as a woman. And it’s really nice to accompany her on this journey.”

The co-author, DÖRTE BOSSE, is a cosmetician and clinical training manager at Alma Beauty. Article originally posted on DACH, BEAUTY FORUM, magazine issue 5/2020 in Germany.

*For our international readers please note insurance and health regulations differ from one country/territory to another. All of the above is relevant only to Germany in particular.