Creating safe spaces

Hair removal is one of the most important treatments for transgender patients. Ellen Cummings explores how clinics can provide a supportive treatment experience

P ursuing semi-permanent hair removal can be a big step for any patient, and none more so than transgender people. Hair is an important part of how people express their identity, but having body hair in unwanted places can have harmful psychological effects – particularly for some male to female (MTF) transgender patients who may have dark or thick hair on visible areas like the face, arms and legs, which is typically seen as being unfeminine.

This feeling of misalignment between inner identity and outward expression is called gender dysphoria. Cleo Madeleine, communications officer at charity Gendered Intelligence, explains, “Gender dysphoria is an umbrella term used for the feelings of discomfort and distress caused when a person’s internal sense of gender identity does not align with their body. It can compound social isolation and seriously impact mental health, and healthcare and support are very hard to access. It might seem like a small thing, but access to hair removal could make the difference between somebody being able to leave the house or being trapped at home.”

Hair removal can be a significant stage in the transitioning process for trans patients, especially when other stages are hard to access. “The wait to see a gender clinic on the NHS is between four and five years. That’s how long someone goes from seeing their GP to seeing someone who can prescribe them hormones,” explains Sam Marshall, educator at Be Trans Aware and a committee member on the British Beauty Council’s Diversity, Equity and Inclusivity Council.

Marshall continues, “It’s about doing little things that can help [until they can access a gender clinic]. A trans person could change their name and pronouns, adjust the way they dress, and grow or cut the hair on their head. Hair removal is another step they can take. Everything adds up to help to relieve the dysphoria.”

CARRYING OUT TREATMENT

As with any other treatment, it’s vital that laser operatives are educated before carrying out laser or IPL treatments on transgender patients – and that both parties are clear about any risks and the expected outcomes.

Taryn Green, business success manager at Laseraid, says, “There are no major contraindications for laser or IPL treatments for trans patients undergoing treatment, although we do advise patients that they might need more sessions as hormones affect hair growth – but this does not mean they won’t have a satisfactory treatment. An excess of testosterone means hair growth will be quicker and more stubborn to treat, but MTF transgender patients on hormone therapy will get great results due to the decrease in testosterone and the introduction of oestrogen.

“As for surgeries, [you should] make sure the patient has cleared everything with their surgeon if the treatment area is where they have had surgery. There can often be nerve damage to the area, so extra care needs to be taken to ensure safe results as patients cannot give feedback on treatment temperature.”

Green says the most effective wavelengths for treating hair removal are 755nm (Alexandrite) and 1064nm (Nd:YAG), and many solid-state lasers have both wavelengths to target the widest range of hair colours and types.

“755 works best on lighter skin types, and 1064 is best for darker skin types, up to a skin type VI,” she adds. “They also have the ability to adjust pulse width – meaning we can adjust the amount of time we deliver the energy to the hair follicle to ensure effective, safe results for all hair types. Diodes will also work well on dark, coarse hair. IPL is usually not recommended in treatment for hair removal on skin types above III.”

Aftercare advice is the same as it would be for cisgender patients undergoing laser or IPL treatment – avoiding heat exposure, cooling and inflammatory topical products and, of course, SPF use is vital to protect the vulnerable skin.

GETTING EDUCATED

Visiting a clinic can be intimidating for prospective transgender patients who are considering laser or IPL hair removal for the first time. Marshall explains, “Most people don’t consider whether the clinic, restaurant or train they’re walking into is safe, but trans people do have to consider whether they’re going to be attacked or harassed.”

Simple acts like displaying a Pride or trans flag and listing your business as “LGBTQ-friendly” and a “transgender safe space” on Google My Business are easy ways for prospective transgender patients to know that your salon or clinic is a safe option for them.

But actions speak louder than words when it comes to being a truly supportive treatment setting. Marshall comments, “There’s no point in marking yourself as a safe space, but not really understanding the dos and don’ts around trans etiquette. It all comes down to education.

This has to be the whole team – it can’t just be that one person does a bit of training, then on their day off, a patient walks in and gets misgendered. It’s about understanding the patients and what they go through, not assuming anything and not asking inappropriate questions.” Madeleine agrees that becoming a safe space is a whole team effort, “From simple things like checking pronouns, to more difficult issues like managing gender dysphoria during hair removal, the most important thing is to provide an open, reassuring atmosphere from the start, and not to worry too much if you get it wrong – just apologise and move on.”