Gender-Affirming Hormone Therapy Among Transgender and Gender Diverse Patients Receiving Laser Hair Removal Prior to Gender-Affirming Surgery

Dear Editor, 

Preoperative laser hair removal (LHR) of donor tissue sites prior to gender-affirming surgeries (GAS), such as vaginoplasty or phalloplasty, is performed to prevent post-surgical hair compli-cations.¹ Hair removal on the face and chest are considered key for gender transition among transfeminine individuals. Gen-der-affirming hormone therapy (GAHT) can affect hair growth. Therapies may include estradiol, spironolactone, finasteride and testosterone. Diminished hair growth has been reported with feminizing hormone therapy in transfeminine individu-als, while testosterone promotes hair growth⁴ and is associated with reduced anxiety and depression in transgender men.^2,3 Transmasculine individuals receiving testosterone demonstrate increased body hair that has been shown to more closely re-semble cisgender men as compared to transgender men and cisgender women not receiving this medication.^2,4

Little data exist on the prevalence and type of GAHT received among transgender and gender diverse (TGD) patients pursu-ing LHR. Currently, TGD individuals may face poor access to gender-affirming dermatologic care, and few data exist on hair removal procedures for genital GAS.^5,6 In this study, we aimed to characterize GAHT in TGD patients presenting for LHR.

In this single-center, retrospective chart review we identified study participants among patients presenting to the University of Minnesota Department of Dermatology between 01/01/2017 and 11/30/2020 using gender dysphoria (ICD-10 code F64.9) in combination with current procedural terminology 17999 and cash-based hair removal institutional codes. We excluded dupli-cates, research opt-outs, and patients without a LHR procedure. Two research staff conducted the review, while one board-certified dermatologist resolved discrepancies. Descriptive outcomes included patient demographics, intended GAS, and current or prior GAHT, including treatment duration. GAHT ad-ministration route (eg, oral, subcutaneous, transdermal, or gel) data was not available.  

Three hundred eighty-three patients were identified prior to exclusions, and 66/383 (17.2%) met study criteria. Of these 66 patients, 23 (35%) were female, 21 (32%) transgender female/male-to-female, 12 (18%) male, 6 (9%) transgender male/female-to-male, 2 (3%) other, and 2 (3%) chose not to disclose. Intended GAS included 39 (59%) vaginoplasty, 17 (26%) phalloplasty, 1 (2%) facial feminization surgery, 5 (8%) other, and 7 (11%) unre-ported. Of the 66 patients, 41 (62.1%) were receiving feminizing hormone therapy: 26 (63%) estradiol + spironolactone, 9 (22%) estradiol/estrogen only, 2 (5%) estradiol + leuprolide acetate, 2 (5%) ≥ 3 medications, 1 (2%) spironolactone only, 1 (2%) pro-gesterone only. Fourteen (34%) of the 41 patients on feminizing therapy had treatment duration data, ranging from 1 month to 8 years. Of the 66 patients, 17 (25.8%) were receiving mascu-linizing hormone therapy: 17/17 (100%) on testosterone, with reported durations ranging from 2 to 12 years. Eight (12%) of the 66 patients had missing data for GAHT type.
 

This study demonstrates that the majority (88%) of  TGD patients pursuing LHR at one academic health center were already  receiving GAHT, although the duration varied from months to years. Therefore, this may be a unique hair removal population as hormone therapy is likely being utilized at LHR initiation.  The influence of hormone therapy on LHR efficacy is unclear. Dermatologists will play a key role in understanding the effects  of these therapies on this patient population in the future.  Future studies should investigate the impact of GAHT on LHR.