By: Dr. Deanne Mraz, MD, FAAD and Dr. Rhonda Klein, MD, MPH, FAAD
“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.” -- Excerpt from the Hippocratic Oath, an oath stating the obligations and proper conduct of doctors.
As Dermatologists, we know that beyond being the body’s largest organ (and critical piece of our immune systems), skin and hair are culturally something we associate with youth, beauty and good health. Nothing makes us happier than helping our patients safely define what looking and feeling their best means for them. As a practice we pride ourselves on delivering comprehensive care for everyone, including transgender patients. While the dermatologic issues for transgender patients are not unique to them, the complexities of how we treat them may differ for this patient group. We work closely with our patients’ doctors as a team for the safest and most effective results.
Acne
Most transgender patients are on HRT (Hormone Replacement Therapy) and acne is commonly triggered by hormonal fluctuations. A highly effective treatment for severe, cystic acne that is resistant to other therapies is isotretinoin (Accutane).
We often supplement systemic (pills) and topical acne treatments with laser and light based therapies like LightStim as well as aesthetician services including HydraFacials, which are a great ongoing maintenance element of a treatment plan.
Androgenetic Alopecia
Taking testosterone can cause androgenetic alopecia aka hormonally-triggered hair loss. Finasteride (Propecia) can be effective, however similar to the issues with Accutane, there are concerns with Finasteride’s link to birth defects in developing male fetuses. Unless a transgender male has a chance of being pregnant or makes the decision to go off of testosterone in order to become pregnant, Finasteride can be taken daily for the treatment and prevention of male pattern hair loss.
Facial Sculpting
We can use neuromodulators (aka Botox) and injectable dermal fillers to masculinize or feminize facial features in transgender patients.
Neuromodulators work by blocking nerve impulses to the muscles that create these movements, causing them to relax, which will soften your expressions and sculpt the face and neck by decreasing unwanted muscle mass. Fillers can be used to soften a face and sculpt high cheekbones and fuller lips.
Body Sculpting
We can use our body sculpting modalities to define muscle, reduce fat, and contour overall body shape. A few of the most impactful ones are:
Muscle Toning with Emsculpt – non-invasive HIFEM® (High-Intensity Focused Electromagnetic) technology induces powerful muscle contractions not achievable through voluntary contractions, these are called supramaximal contractions. These contractions activate deep remodeling of the muscle’s inner structure resulting in an average increase of 16% in muscle mass. The Food and Drug Administration (FDA) has cleared Emsculpt for the improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen, and strengthening, toning, firming of the buttocks.
Fat Reduction with CoolSculpting/SculpSure/Kybella/Tumescent Lipo– reduce stubborn pickets of fat (for example that stubborn armpit roll that affects many women)
Augmentation with dermal fillers and fat transfer to create a more feminine body contour
Laser Hair Removal
For transgender female patients, laser hair removal can be a game-changer in eliminating 80% of unwanted body air in the treated areas – because of this, Laser Hair Removal is often recommended prior to sexual reidentification surgery.
LHR works by targeting melanin and damaging the hair follicle. The laser passes over the skin and finds the pigment deep within the hair follicle called melanin, and then heats up the melanin and in turn, damages the hair follicle – after several treatments (6-8, spaced 4 weeks apart) it can no longer grow hair.
Hyperhidrosis
Hormonal fluctuations can also cause Hyperhidrosis or excessive sweating – a condition we can treat with a variety of modalities, including neuromodulators. The U.S. Food and Drug Administration (FDA) has approved this treatment for the underarms; however, several studies have shown efficacy when used elsewhere on the body, including the palms, soles, and scalp, for hyperhidrosis. Botulinum toxin injections temporary block a chemical in the body that stimulates the sweat glands. Most patients notice results 4 to 5 days after receiving treatment and results last for approximately 3 to 6 months.
Changes in Skin
For all patients on HRT it is important to closely monitor skin lesions as hormones can cause pre-cancerous spots to grow more rapidly.
It’s also common to see changes in the skin – a change from oily to dry, new sensitivities, rashes etc. We work with our patients to curate a personalized skincare regimen using products available in the office and Rx to deliver results.
We are doctors because we love to help people – and that means all people. If you or someone you know is looking for support during gender transition, please give us a call to schedule a consultation (203) 635-0770.
Dr. Rhonda Klein, MD, MPH, FAAD + Dr. Deanne Mraz, MD, FAAD