Transgender People Gain Mental Health Boost from Gender-Affirming Hair Removal

For transgender and gender-diverse individuals, gender-affirming procedures can be a huge step towards feeling comfortable in their own bodies. These medical undertakings can involve anything from chest reduction to silicone injections.

A recent research letter published in JAMA Dermatology looked explicitly at the mental health impact of gender-affirming hair removal. Author Michelle S. Lee and her colleagues used data from the 2015 U.S. Transgender Survey.

Researchers had asked 27,715 individuals surveyed in the extensive report about everything from harassment to employment. In the “Transition-Related Health Care” section, researchers inquired about points such as therapy, puberty-blockers, and procedures. The latter, which served as Lee’s source, dove into the different procedures transgender men, women, and non-binary people may consider undergoing.

People assigned female on their original birth certificate gravitated towards chest surgery reduction or reconstruction, and hysterectomies. In contrast, gender-affirming hair removal (GAHR), such as electrolysis, was the most common among participants who were assigned male on their original birth certificate. In fact, 41% of people in this group had had GAHR, and 49% wanted it someday. Non-binary participants were less likely to have already had GAHR compared to transgender women, 13% to 48%, but more likely to want it, 54% to 47%.

The Mental Health Benefits of Gender-Affirming Procedures

Given those numbers, it's no surprise that Lee reports GAHR has immense mental health benefits. The researchers linked it to a decreased risk of severe psychological distress in the past month and smoking or suicidal intent in the past year. 

These results can be attributed, at least in part, to gender-affirming care’s role in diminishing gender dysphoria—a condition people may experience when the sex they were assigned at birth is not the same as their gender identity. It can create depression, anxiety, and low self-esteem, among other mental health conditions, says Ernesto Lira de la Rosa, PhD, a psychologist and an advisor for the Hope for Depression Research Foundation.

“The various medical procedures, legal steps, such as legally changing name and gender, and treatments like voice therapy and laser hair removal are performed to reduce gender dysphoria,” says KT Hiestand, PhD, a psychologist at Hiestand Psychological Services.

“It is common to experience gender dysphoria for transgender women related to the absence of or small breasts, genitalia, the presence of facial or body hair, a deeper voice, masculine facial structure, broad shoulders, lack of hip to waist ratio, large hands and feet, and height.” 

Hiestand explains that facial hair can be particularly problematic as it is easily visible and may identify the individual as transgender rather than passing as a female. While shaving can help with this, the continual appearance of hair can “continue to cause gender dysphoria until completely removed,” he explains. 

In the U.S. Transgender Survey, for other procedures, such as voice therapy, vaginoplasty, and facial feminization surgery, almost the same percentage of people—or even more among transgender women—say they wanted these, but much lower numbers who had had these procedures. While hair removal may be more common to undergo due to its less invasive nature and potentially lower cost, it is far from accessible.

Insurance Rarely Covers Hair Removal

The research letter reports that only 4.6% of insurance providers cover GAHR. This can be attributed, in part, to these companies declaring hair removal medically unnecessary. “If hair removal procedures are deemed not medically necessary, then insurance companies may deny coverage for these procedures,” says Lira de la Rosa.

Not only can this negatively impact someone’s mental health, but it may prevent them from undergoing gender confirmation surgery. As Hiestand explains, some surgeons require people to have genital hair removed first.

There is no replacement for hair removal, but Lira de la Rosa and Hiestand have a few ideas for managing gender dysphoria if a procedure is not currently available to you:

• Give yourself or get a professional wax, as it removes hair considerably longer than shaving
• Wear a face mask—as the pandemic continues, this keeps you safe and hides unwanted facial hair
• Lean on understanding loved ones, and people with similar lived experiences for support
• If possible, seek out a transgender-affirming mental health provider—many professionals offer low-cost or sliding scale services
• Check-in on your mental and physical health regularly

GAHR on its own is far from a total solution, but it was associated with lower rates of past-month severe psychological distress, past-year smoking, and past-year suicidal ideation. Lee’s team didn’t find a significant link between GAHR and the risk of alcohol binging in the past month or a suicide attempt in the past year.

A push for widely accessible gender-affirming care is necessary as policies continue to threaten and make it unavailable for many people.

“It is imperative that we continue to change the system that often engages in discriminatory practices,” says Lira de la Rosa. “There are also many states currently writing legislation that increases barriers for trans individuals. Some states have already passed legislation that outlaws providers from providing gender-affirming treatment to minors. These laws and bills are not based on science and facts, rather on discrimination and transphobia.”

A lack of transgender-affirming providers provides another barrier with transgender individuals worried about seeking medical care out of fear of mistreatment or judgment, adds Lira de la Rosa.