Electrolysis in Transsexuals
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Preface
Electrolysis is in some respects more of an
art than a science, and so this booklet represents a consensus of opinion
based on input from several electrologists who have experience of treating
transsexuals, as well as from transsexual women who have undergone
electrolysis.
Contents
1 Transsexualism and
Gender Reassignment
2 Electrolysis in Transsexuals
2.1 General
2.2 Treatment Timescales
2.3 Which Method?
2.4 Technique
2.5 Pain Control
2.6 After-care
2.7 Genital Electrolysis
3 Other Epilation Methods
3.1 Laser Epilation
3.2 Tweezer Electrolysis
3.3 Home Electrolysis Kits
3.4 Radiation Treatment
1 Transsexualism and Gender
Reassignment
Transsexualism is a medical condition (a form
of Gender Dysphoria ) in which a person is born with their gender, or
'brain sex', opposite to their physical (genital) sex. So a male-to-female
transsexual is a person born with a male body but a female brain and hence a
female identity. This condition causes a great deal of emotional pain and
suffering, and frequently leads to suicide. The only feasible treatment is to
modify the person's body to bring it in line with her gender identity and
enable her to live in the female role, as it is not possible to alter her
'brain sex'.
Transsexualism is quite different to
transvestism and homosexuality, and should not be confused with either.
Transvestites are men who dress as women for sexual or emotional relief, but
do not have female brains and possess a normal male self-identity, and have no
wish to 'change sex'. Gay men and lesbians are attracted to people of their
own sex but are normal men or women with no desire to 'change sex'.
For a person diagnosed as transsexual ('TS')
by a properly qualified specialist, a process of Gender Reassignment takes
place. The steps of the process are:
- Diagnosis made by an appropriate
specialist.
- Counselling and/or Psychotherapy
as required.
- Hormones to change the body shape
and characteristics.
- Electrolysis to remove facial (and
possibly other) hair.
- Real Life Test , living in the new
gender role.
- Surgery to change the genitals.
Possibly other surgery too, such as breast augmentation or facial cosmetic
surgery.
There are a number of obstacles to a
successful gender reassignment, perhaps the greatest being the need to work
and function socially as a woman prior to the surgery taking place. The
patient must undergo a 'Real Life Test' (RLT), living in the new role for at
least a year, to demonstrate her ability to function as a woman, as well as
obtaining approval from two specialist psychiatrists.
Hormone therapy is generally started before
RLT, as most patients need the changes that hormones give in order to 'pass'
in their new role. Male-to-female hormone treatment causes development of
breasts, usually rather small, as well as redistribution of body fat and a
general feminisation of the figure, hair and skin. Body hair is often reduced
but not removed, and hormones seldom have any large effect on facial hair,
electrolysis being the only effective method for removing this. Hormones will
not alter a male voice (nor will genital surgery), so speech training is also
required.
The genital surgery involves removal of the
male genitals and the construction of female genitals (excluding uterus and
ovaries, of course) using material from the male genitals. Present
state-of-the-art surgical technique produces a very good approximation to
natural female genitals, with full sexual sensation.
The condition of Transsexualism, and the
process of Gender Reassignment, are more fully explained in the booklet "Transsexualism:
A Primer" available from the Looking Glass Society.
2 Electrolysis in
Transsexuals
2.1 General
Almost invariably, male-to-female
transsexuals require electrolysis treatment to remove facial hair, prior to or
shortly after their change of gender role. In rare cases this has been
obtained on the NHS, but at the present time it is hard to obtain any treatment
on the NHS for transsexualism and most clients will pay for electrolysis
privately.
The usual standards of good practice, such as
sensitivity and confidentiality, apply as strongly to transsexual clients as
to any other clients. Transsexuals are often very self-conscious about their
facial hair, and indeed about any physical feature that reminds them of their
hated masculine past.
A sympathetic and skilled electrologist is in
a position to make a very positive contribution to the quality of the client's
life, and conversely transsexual clients are usually very co-operative, and
punctual for appointments, as the removal of male-type facial hair is so
important for them. Furthermore, transsexuals tend to be long-term clients
requiring a large amount of treatment, so a willingness to treat them makes
'good business sense'.
2.2 Treatment Timescales
A typical transsexual, who has developed to
adulthood with a male body, will have a typical male facial hair pattern and
strong, deep-rooted hair. A large amount of treatment will almost inevitably
be required, many hundreds of hours spread over a 2--3 year period, is not
unusual; up to five years may be required in some cases. Regrowth may be
strong and rapid, necessitating a relatively large amount of treatment per
week to make any progress: 4 hours per week is not unusual, of which maybe
half could be spent on regrowth in the early stages.
Hormone treatment alone does not have a
significant effect on facial hair, but coupled with electrolysis it affects
the regrowth rate substantially. Transsexual clients who start electrolysis
prior to hormones should be advised that progress may be slow until hormones
(preferably with antiandrogens) are started. Regrowth rate generally
diminishes further once the testes are removed, either as part of Gender
Reassignment Surgery (GRS) or in a separate preliminary procedure (Bilateral
Orchidectomy).
It has occasionally been suggested that it is
necessary for transsexual clients to have their facial hair cleared at least
to the point of being able to stop shaving before GRS goes ahead. This is not
true: while any transsexual will wish to be cleared as fast as possible, for
the majority electrolysis will take longer than the 'Real Life Test' and will
continue after GRS, and there is no reason to delay GRS while electrolysis is
completed.
Body hair is usually reduced quite
significantly by long-term use of feminising hormones, but some transsexuals
may still require some body hair to be cleared by electrolysis. This will not
be discussed in detail here as the methods are no different from those used on
natural-born women; although the hair may well be stronger than in
natural-born women and extra care may therefore be required.
2.3 Which Method?
The first question, and one which always
raises controversy, is which method of electrolysis to use in a transsexual
client: diathermy, or blend (galvanic is just too slow, and flash thermolysis
is inadvisable on the face due to the high risk of skin damage).
The best consensus of opinion that the
authors were able to obtain (from electrologists experienced with transsexual
clients, and from transsexuals themselves) is that in general diathermy
produces a quicker result, even taking into account that diathermy may give
a higher regrowth rate, but most clients find diathermy more painful than
blend, and generally it provokes a greater skin reaction.
Therefore, it is probably best to use
diathermy where possible, provided of course that the client can tolerate it.
Some clients have been treated with blend on the most sensitive areas (e.g.
top lip) and diathermy elsewhere; many have found that with appropriate pain
control and after-care they can tolerate treatment entirely by diathermy. Some
clients find diathermy too unpleasant and prefer the generally slower but less
painful blend method throughout their treatment.
Another criterion may be the presence of
badly distorted follicles. Most transsexuals are likely to have shaved
regularly for several years (this in itself should not distort follicles), and
some will have used more drastic techniques such as plucking, which may well
cause distorted follicles. Severely distorted follicles are not amenable to
treatment by diathermy, as it is impossible to place the needle tip at the
hair root. Blend can be used for affected areas of the face, as the lye
produced in this method is able to reach the hair root even if the needle is
not.
So, to summarise, a suggested check-list for
deciding on the method to use might be as follows:
- For any distorted follicles, choose blend.
- Otherwise, choose diathermy to begin with.
- If the client experiences an unacceptable
level of pain or skin reaction, switch to blend for the affected areas.
- If the 'kill rate' is abnormally low, it
may be worth trying blend instead of diathermy; choose whichever method
works better.
2.4 Technique
Great care must be taken in treating
transsexuals' facial hair: it will normally be true male-type, deeply-rooted
and thick terminal hair. The power levels required to effectively epilate this
type of hair will be very much higher than for other clients and care must be
taken to avoid skin damage. The skin may be made more vulnerable by the
effects of high doses of feminising hormones.
It is also worth noting that male-type
'virgin growth' hairs may have particularly large bulbs, which may produce
friction as they slide through the follicle (which is a significantly smaller
diameter than the bulb). This can produce an illusion of traction, which in
turn can lead to accidental over-treatment. If there is genuine traction, the
hair will not move at all and should be re-treated; if it moves a little and
then appears to have traction then this suggests that the hair is in fact
adequately treated but jamming in the follicle, and it should simply be pulled
out.
Care must be taken to avoid overtreating any
given area: spacing the treated follicles rather widely may be advisable. A
degree of pain and skin irritation is inevitable owing to the power levels
required for male-type hair, but careful preparation and after-care can
minimise these problems, as described in more detail below. Some clients have
reported finding gold-plated needles significantly less painful than stainless
steel, presumably due to sensitivity to elements in the steel such as nickel.
If a client experiences unusual levels of pain or skin reaction it may be
advisable to try a gold-plated needle.
There is no hard-and-fast rule for treating
different areas in a particular sequence. It is best to be guided by the
client herself: she will probably have a very definite opinion as to which
areas of her face are most urgently in need of treatment, and provided that
each patch is given an adequate recovery time between treatments, the client's
wishes should be followed.
Most clients find the area around the mouth
to be the most obtrusive; some also consider the neck a 'priority area' as
hair stubble or shaving rash on the neck can be very noticeable. Neck hairs
often lie at a very shallow angle to the skin, making probing rather awkward
and making a reaction more visible.
It is also worth mentioning the 'sideburns'
typical in male facial hair growth. Women have fine hair in this area, similar
to scalp hair rather than the thick beard-like terminal hair characteristic of
the male. Clearing this area outright gives a result which 'looks wrong', but
careful application of electrolysis, accompanied with the effects of the
hormones, can actually convert the male-type growth to a good facsimile of the
female pattern. The method is as follows: the client must first grow her hair
in this area to a length of about 8--10mm. Then for each hair in the sideburn
area, look closely at it and determine whether it is a coarse male-type hair
or a finer vellus hair. If it is vellus, it should not be treated. If it is a
coarse terminal hair, it should be deliberately under-treated: apply rather
less power than normal, and remove the hair even if there is traction. The
effect of this is to deliberately fail to kill the follicle outright, but to
damage and weaken it. Over time, this produces the desired effect.
2.5 Pain Control
Owing to the nature of male-type facial hair,
many TS clients find electrolysis an unpleasantly painful process. Protracted
sessions (two hours continuous treatment is not unusual) repeated frequently
over a period of years can be traumatic for many clients, especially as pain
threshold has been found to decrease under hormone treatment, whilst
electrolysis without hormone therapy is frequently ineffective. The problem of
pain for TS clients undergoing electrolysis should not be underestimated; pain
that is severe enough to make the client flinch makes the electrologist's task
very difficult and may lead to skin damage if the client cannot avoid moving
while the needle is inserted. The pain and its consequent problems can be
eased by three possible methods: topical anaesthesia, analgesics and
sedatives. Generally these are prescription-only drugs and it will be
necessary to liaise with the client's GP to have them prescribed for the
client.
Topical anaesthesia is
best provided with EMLA Cream 5 %; the 30g surgical pack is recommended as the
5g tubes are inconveniently small. The cream is best applied to the area to be
treated at least an hour (some clients require longer) before treatment
commences, with reapplication as necessary to maintain a cover of cream until
the start of treatment. An 'occlusive dressing', generally a plastic film
similar to cling-film, can be used to reduce the amount of cream necessary but
is usually inconvenient on the face. Most clients find reapplication of the
cream every 20--30 minutes a better method. The cover of cream can be left in
place until each patch is due to be worked on, and then cleans off easily with
isopropyl alcohol, 'medi-wipes' or similar pre-treatment cleansing method. The
anaesthesia typically lasts between half and one hour after the cream is wiped
off, then progressively reduces.
The drawback of this method is that EMLA
cream has limited penetration into the skin, thus the deeply-rooted hair
follicles found early in treatment may be poorly anaesthetised. The cream
works better once the original hair has been destroyed, as re-grown hair is
finer and shallower. EMLA cream treatment can be supplemented with analgesics
or sedatives if required. In really extreme circumstances an injected local
anaesthetic (such as xylocaine) may be used, but this will of course pose the
logistical problem for the client of having a qualified medical practitioner
administer the injection and then travelling to the electrologist before the
anaesthesia wears off.
Analgesics such
as co-proxamol or dihydrocodeine can be used to supplement the effect of EMLA
cream, and should generally be taken around an hour before treatment starts.
These are prescription-only drugs; mild 'over-the-counter' analgesics
(aspirin, paracetamol, co-codamol, ibuprofen etc.) are generally ineffective.
Clients should be made aware that some people become drowsy on such medicines
and may be unable to drive.
Sedatives may
assist some clients when treating the most painful areas such as the upper
lip, simply by improving the client's ability to tolerate pain. Lorazepam
(1--2mg) or other benzodiazepines have been found to work well in some
clients. It should be stressed that sedatives should only be used when really
necessary; also the client must be warned that she will most likely be unfit
to drive after taking the sedative. Lorazepam is best taken about one hour
before treatment starts.
2.6 After-care
Application of a normal after-care cream is
appropriate, typically a witch-hazel based product. Some clients find a
subsequent application of calamine lotion beneficial. In many clients this
will be all that is required, and any inflammation will be tolerable and will
disappear spontaneously after a few days at most, but a few clients experience
either severe inflammation and swelling, or skin infections.
Some clients experiencing severe inflammation
have found an improvement by taking a non-steroidal anti-inflammatory drug ('NSAID',
e.g. Voltarol 50mg) and/or an antihistamine before commencing
treatment. Topical antihistamines (e.g. Mepyramine Maleate cream 2 %) may
prove useful after treatment. In most clients the inflammation is manageable,
but in very rare cases it proves intractable, and the client may have to
switch to a different method of electrolysis. Voltarol (diclofenac sodium) is
prescription-only but many oral antihistamines (e.g. Dimotapp LA, which also
contains a vasoconstrictor) and also mepyramine maleate cream are available
over-the-counter. In any case, the client is best advised to discuss choice of
medications with her doctor.
Clients prone to skin infections after
electrolysis can be given a topical antibiotic cream; Flamazine (silver
sulphadiazine in a soothing cream base; prescription-only) has been used to
good effect in many clients --- this is intended for treating burns, and is
therefore appropriate after electrolysis.
The usual after-care advice to clients should
be given (no makeup for 24 hours, do not touch the area, and so on), although
a sympathetic electrologist must understand that a transsexual woman will face
greater appearance problems than all but the most extremely hirsute
natural-born women and may 'bend the rules' somewhat. In particular, advice to
a TS woman not to shave the area will very probably not be heeded; instead it
is better to advise no shaving for at least 24 hours and then to shave very
lightly with an electric razor only (a blade razor will probably tear the
small 'pimples' which often appear when such coarse hairs are epilated).
Similarly, a blanket ban on makeup will probably be impractical; the client
should be advised to leave the area alone for as long as possible and then to
use a waxy 'post-electrolysis' cream (e.g. 'Apr ès') under their normal
concealer and/or foundation (most transsexuals require rather liberal use of
concealer until electrolysis has progressed quite far); a few (usually blonde)
transsexual clients may have sufficiently unobtrusive facial hair that a
tinted after-care cream might be sufficient.
2.7 Genital Electrolysis
No discussion of electrolysis in the
male-to-female transsexual would be complete without some notes on the removal
of hair from genital skin prior to gender reassignment surgery (GRS).
This is always a sensitive topic with clients
and electrologists alike. Not all electrologists would necessarily feel
comfortable treating such an area, and a transsexual client will probably feel
intensely embarrassed about merely possessing male genitalia, let alone
allowing someone else to see them. However, it must be said that genital
electrolysis contributes greatly to a satisfactory outcome of the surgery, and
some clients become quite desperate in their search for an electrologist
willing to treat this area.
The precise method of surgery used depends
upon the surgeon performing the procedure; but all methods of GRS place
potentially hair-bearing tissue from the penis and/or scrotum in locations
where hair would be undesirable and problematical (inside the vagina, under
the clitoral hood, and perhaps inside the labia). For this reason, clients are
well advised to seek the advice of their chosen surgeon as to which parts must
be epilated, and then to obtain the necessary electrolysis well in advance of
surgery (to allow the skin to recover).
Genital electrolysis can be exceedingly
painful, and the comments made above regarding pain control and after-care
apply to genital sites as well as the face. In addition, it must be emphasised
that hygiene before and after treatment is paramount, as there is a high risk
of skin infections from genital electrolysis. Some clients report using
Betadine liquid to good effect, before and after genital electrolysis.
With genital electrolysis, the technique is a
little different from other body areas. The hair is essentially the same type
as found in the 'bikini line' area, although the follicles are sometimes
surprisingly shallow, particularly on scrotal skin. It is safe to use rather
high power levels in this area, to assure completion of epilation prior to GRS
(the skin will, of course, be inaccessible post-operatively) --- it is not
necessary to totally avoid marking the skin, as the skin will never be visible
after GRS. The 'flash thermolysis' method, diathermy at a very high power
level and short duration, is highly effective: properly performed, it gives a
very low regrowth rate, rapid treatment, and is often less painful than slower
methods.
Some electrologists have reported good
results with insulated needles, helping to confine the tissue destruction to
the deeper parts of the follicle and limiting the risk of scarring from the
flash method. Scrotal skin in particular may be difficult to probe: the skin
itself is soft, wrinkled and rubbery in texture, and the follicles can be very
'tight' in some clients. Careful attention to stretching the skin around the
follicle being treated is essential, and some electrologists find a relatively
stiff needle, such as some of the one-piece designs, helpful as it may be
necessary to push the needle into the follicle considerably more forcefully
than with any other site on the body, and a highly flexible two-piece needle
may be prone to bending.
3 Other Epilation Methods
This section describes a variety of methods,
other than professional needle electrolysis, which are sometimes tried by
transsexuals wishing to remove their facial hair. The consensus of informed
opinion is that at present, needle electrolysis is the only technique
suitable for permanent removal of facial hair in transsexuals; this section is
included for information only, to enable electrologists to give good advice to
clients contemplating other methods of epilation.
3.1 Laser Epilation
Two methods of hair removal by laser have
recently arrived on the market. Both are new technologies and no long-term
data is yet available on their safety and efficacy. Some clients have reported
good results, however 'horror stories' also abound, and these treatments must,
at present, be regarded as experimental and approached with caution, and
treatment provided without proper medical supervision (e.g. at certain private
clinics) should be avoided under any circumstances.
The great advantages claimed for laser
treatment are its speed, as each discharge of the laser can treat numerous
hairs, and the lack of a needle which some clients find painful or disturbing.
Some clients have claimed good results with laser epilation of the genitals
prior to surgery, and some laser clinics are certainly willing to treat the
genital area.
The permanency of laser epilation is
uncertain at present; indeed, the US Food and Drug Administration specifically
prohibits laser companies from claiming permanency. While this may not be a
major problem for facial treatment (re-treatment, or treatment of subsequent
regrowth by electrolysis would be possible), it is a cause for concern for
genital epilation, as re-treatment of skin that post-operatively forms the
interior of the vagina is clearly not possible by any method.
In the 'pure laser method', a wavelength of
laser light is chosen that is strongly absorbed by melanin. The reasoning is
that melanin should be very much more concentrated in hairs than in skin, so
the laser light causes selective heating of the hairs, including the root, to
a temperature at which protein coagulation occurs, killing the hair follicle.
The principal problem with this method
relates to pigmentation and the distribution of melanin. Some clients with
very dark hair and pale skin report good destruction of hair with no skin
damage; conversely there have been problems with darker-skinned clients as the
melanin in their skin causes a dangerous degree of general heating of the
skin, causing scars and possible destruction of sebaceous glands (leading to
intractably dry skin); and pale-coloured (or grey) hair contains little or no
melanin and therefore cannot be treated effectively by this method.
In the 'dye method', a light-absorbing
compound is applied to the face and the surplus is then wiped off. The
intention is that some of this compound will remain in the hair follicles,
increasing the absorption of laser light. The main problems are that the
method is indiscriminate: any pore or indentation in the skin will be filled
with the compound and thus heated when the laser is discharged; severe damage
to skin has been reported. Furthermore, the compound tends not to penetrate
deeply into hair follicles, leading to surface heating which may scar the skin
and does little to destroy the hair follicle.
3.2 Tweezer Electrolysis
A variety of variations on this theme have
been marketed, and new ones appear each year, accompanied by a great deal of
marketing 'hype'. The intention is that current is passed down the hair itself
from a tweezer-like electrode, and no needle is used. It can readily be
demonstrated from electrical theory and some simple bio-electrical
measurements, that it is quite impossible to transfer enough energy into the
follicle by this method to destroy it, even at the maximum voltage permitted
by law. Clinical trials have supported this conclusion, finding that tweezer
electrolysis quite simply amounts to nothing more than plucking the hairs, and
is a waste of the client's money.
3.3 Home Electrolysis Kits
These items are widely available on the
retail market, and are generally very simple, low-powered, galvanic
electrolysis units. In practice the power levels developed are quite
insufficient to treat male-type hair, and again these products are quite
useless in the treatment of transsexuals. In addition, the needles supplied
with these units are generally not disposable, non-sterile, poor quality and
excessively large in diameter. In the opinion of the present authors these
kits are a recipe for permanent skin damage.
It should be stressed to the client that
destroying male-type facial hair without causing skin damage is a skilled and
delicate process which should only be entrusted to a reputable electrologist
with proper equipment and prior experience of treating transsexual clients.
3.4 Radiation Treatment
There have been attempts in the past to use
ionising nuclear radiation to kill hair follicles. This is now regarded as
unworkable and unsafe: at a radiation level that is considered adequately
safe, epilation is seldom permanent, while radiation of a sufficient intensity
to permanently kill facial hair poses an unreasonably high risk of skin cancer
in the future.
Citation: This
booklet may be copied unchanged in its entirety and distributed for any
non-commercial purpose promoting the understanding and well-being of
transsexual people.<http://www.looking-glass.greenend.org.uk>
