Gender Transitioning And Skincare: Taking Care Of Your Changing Face

Working closely with a team of medical professionals is commonplace during the gender confirmation process, but understanding how plastic surgeons and dermatologists can work together to help during and after your transition can take some of the stress out of the process.

While plastic surgeons can perform many of the more invasive procedures that make up a transition, dermatologists can offer non-surgical solutions and treat the skin concerns that inevitably arise. Side effects of hormone therapy often show up on the skin in the form of acne, uneven texture, hyperpigmentation, and unwanted hair (to name a few). To better understand the skin concerns and treatment options available, The AEDITION asks the experts.

How Hormone Therapy Affects the Skin

Hormone therapy is often one of the first medical treatments that both male to female (MTF) and female to male (FTM) patients go through. There are different groups of hormones used, and each of them has specific effects on the body that can also impact the patient’s skin.

Male to Female Hormone Therapy

Transgender women are often prescribed estrogen, which helps feminize features and slows the growth of facial and body hair. “In those transitioning from male to female, estrogen or anti-androgens, like spironolactone, are often used,” explains Samer Jaber, MD, a board certified dermatologist and founder of Washington Square Dermatology in New York City. “In the skin, estrogen decreases sebum production, decreases body and facial hair, and can change or darken moles.”

Reduced sebum production can make skin feel drier, which may necessitate a more hydrating skincare routine, but patients may also seek treatment for another side effect of estrogen: increased pigmentation. “Melasma or hyperpigmentation on sun-exposed areas of the face can worsen in patients on estrogen therapy,” Dr. Jaber notes.

Female to Male Hormone Therapy

On the other hand, transgender men are generally prescribed testosterone. This hormone is responsible for bodily changes ranging from the thickening of vocal cords to redistribution of body fat. It affects the skin by increasing sebum production and can also make skin feel a little thicker to the touch. “Transgender men who take androgen treatment see increased oiliness to the skin and increased facial and body hair,” explains Michael Somenek, MD, a double board certified facial plastic and reconstructive surgeon in Washington D.C. and member of the AEDIT Adviosry Board.

Needless to say, more sebum (read: oil) means more of a chance for breakouts. “The increased oil production tends to produce acne and can be a significant undesired effect of testosterone therapy,” he shares, adding that it “usually peaks by six months.”

How to Adapt Your Skincare During Hormone Therapy

Based on what we outlined above, it should come as no surprise that transgender women will generally want to curate a skincare routine that focuses on moisturizing the skin and reducing any hyperpigmentation that arises as a result of hormone therapy. Hyaluronic acid and ceramides are both effective hydrating ingredients, while actives that brighten (think: vitamin C), inhibit tyrosinase (like azelaic acid), and/or increase cell turnover (hi, retinol and retinoids) can address uneven skin tone.

Transgender men, meanwhile, will likely be looking for products that can decrease oil production, treat acne and blemishes, and calm inflammation. Some of the most tried-and-true over-the-counter acne ingredients include salicylic acid and benzoyl peroxide, and patients can unclog pores and exfoliate the skin with alpha hydroxy acids (AHAs) and polyhydroxy acids (PHAs). Diet and lifestyle changes may also help manage acne symptoms, particularly when it comes to stress.

In either case, your dermatologist will work with you to find the right combination of OTC and prescription skincare to manage skin concerns that will likely continue to evolve over time.

Scar Minimization After Gender Confirmation Surgery

Scarring is a concern after any procedure (cosmetic or otherwise) and gender confirmation surgery is no exception. In fact, Dr. Jaber says post-op scar care is one of the common reasons transgender patients consult his practice, yet the process of minimizing scarring actually begins as soon as a procedure ends.

Immediately following surgery, Dr. Somenek provides post-op instructions for scar care, like the application of silicone patches or gels to promote proper wound healing. During the healing process, it’s important to keep the incision site out of the sun to prevent discoloration. Sunscreen is also encouraged for additional protection.

Scars can take up to a year to fully heal, but, if you are not pleased with the results, there are in-office treatment options that reduce their appearance. Lasers can be very effective in reducing visible scarring. For more extensive scarring, dermabrasion and even a scar revision surgery may be available.

The Role of In-Office Treatments & Procedures

Gender confirmation procedures come in many different forms. At his practice, Dr. Somenek says they “commonly include” rhinoplasty, chin augmentation, jawline reshaping (“to create a more defined or softer contour”), fat grafting (“to restore lost volume that can balance the face”), and blepharoplasty (“to feminize the eyes”). “Depending on which facial features need to be refined, the list can be as small or extensive for any particular transgender patient and is very much individualized,” he shares. Injectables — such as neurotoxins (i.e. Botox®, Dysport®, Jeuveau®, Xeomin®) and dermal fillers — can also be employed for facial feminization and masculinization, while hair removal solutions (think: laser hair removal and electrolysis) can be used to treat unwanted hair.

This is where the relationship of a patient’s entire medical team becomes important. Dr. Somenek says that dermatologists are “real allies” to plastic surgeons when working with transgender patients. Gender confirmation procedures are deeply personal, and your practitioners will be there to guide you as to the best way to achieve the results you are seeking through the surgical, non-surgical, and at-home treatment options available.