Excess hair, hair removal methods, and barriers to care in gender minority patients: A survey study

Background In gender minority patients, electrolysis and laser hair removal may be necessary to reduce facial and body hair in individuals seeking a more feminine appearance and/or modified gender expression. These procedures may also be required preoperatively for some gender-affirming surgeries. Aims To identify (a) the frequency of unwanted facial and body hair, (b) the use of various hair removal methods, and (c) associated barriers to care in gender minority patients. Methods An online-based patient survey was distributed via social media on Facebook(R), YouTube(R), and Instagram(R) in fall 2018. Respondents were at least 18 years old and self-identified as a gender minority. Results In total, 991 responses were recorded with a completion rate of 77%. Considering excess hair, 84% of transwomen on feminizing hormone therapy (FHT: estrogen and anti-androgen therapy), 100% of transwomen not on FHT, and 100% of nonbinary individuals on FHT reported excess facial/body hair. Laser hair removal (18%) and electrolysis (17%) had similar rates of use in this cohort and were more commonly reported for nonsurgical gender-affirming purposes than preoperative preparation. Cost was the most frequently cited barrier to care. Conclusion As the majority of transwomen and nonbinary people on feminizing hormone therapy had persistent excess facial/body hair, routine use of gender-affirming hormones is not sufficient to fully eliminate unwanted hair. There remains a critical need to advocate for more comprehensive insurance coverage for laser hair removal and electrolysis in gender minority patients.