INTRODUCTION
Physical characteristics that can contribute to gender dysphoria in transgender patients, including facial and body hair, hormonal acne, and post-surgical scarring, can be addressed through dermatologic interventions.1,2 While perceived gender-incongruence has been associated with an increased risk for suicide, anxiety, and depression, current literature suggests that gender-affirming care can markedly improve mental health outcomes in transgender individuals.3 As advances in laser therapy and energy-based devices show promise in the achievement of gender-congruent physical features, dermatologists are uniquely positioned to support transgender patients.1,4 This review explores the emerging applications of laser therapy and energy-based devices (EBDs) in the dermatologic care of transgender patients.
Laser Hair Removal
Laser hair removal (LHR) serves as a valuable tool for both cosmetic and medical approaches to gender-affirming care. LHR can effectively target hair follicles through the process of photothermolysis, in which absorption of laser wavelength transmissions through melanin results in follicular destruction and subsequent reduction in hair growth.4,5 LHR therapy often utilizes long-pulse alexandrite, diode, or Nd: YAG lasers, operating at 755 nm, 810 nm, and 1064 nm, respectively.1,4,5 It is important to note that LHR may be less effective for lighter-haired individuals, given that its mechanism targets the follicular melanin.4 In addition to hair pigmentation, skin pigmentation is also an important consideration when selecting lasers for LHR. Compared to lasers with shorter wavelengths, the Nd:YAG laser is less readily absorbed by epidermal melanin, making this laser more suitable for patients with darker complexions.4
From a surgical perspective, LHR is useful in both pre- and postoperative settings in gender-affirming care. In transmasculine patients undergoing phalloplasty, hair removal is recommended from autografted donor tissue, often from the patient's forearm or thigh, prior to the procedure to prevent intraurethral hair growth and infection.4 Similarly, pre-operative hair removal is recommended for transfeminine patients undergoing vaginoplasty to avoid postoperative complications such as folliculitis and calculus formation at the follicle.4 Careful monitoring for hair regrowth following surgery may be warranted, particularly in the context of concurrent testosterone therapy, given the association between testosterone therapy and increased hair growth.4,6
From a cosmesis perspective, LHR can further support efforts to mitigate gender-incongruent features. Hair on exposed body regions, such as the face, can contribute to gender dysphoria, anxiety, and depression.1,4 Consequently, LHR of visible body regions to achieve gender-congruence highlights a valuable role of this technology in caring for transgender patients.
Hormonal Acne Management
Acne has been associated with detrimental impacts on psychosocial wellbeing and self-esteem, and these effects may be further compounded in transgender patients.1 A survey study on the experiences of acne in transgender patients revealed heightened feelings of anxiety, depression, dysphoria, and concerns for rejection.7 In particular, transmasculine patients undergoing hormonal therapy with testosterone may be at increased risk of hormonal acne development due to an associated increase in sebum production.6,7 Recent evidence suggests that transfeminine patients may also experience acne following estradiol treatment, broadening the traditional focus of hormonal acne beyond testosterone therapy.8 Guidelines recommend standard acne management for transgender patients, with laser therapy and EBDs showing additional promise.1
EBDs can directly target sebaceous glands, thereby addressing a key component in acne pathogenesis.9,10 Current evidence suggests that a 30% to 50% reduction in sebum is necessary to achieve a 50% reduction in acne severity.9 A systematic review found that EBDs, including radiofrequency devices and photodynamic therapy, can achieve up to a 35% and 40% reduction in sebum production, respectively.9 For lasers, the 1450-nm diode laser achieved up to a 48% reduction of sebum.9 Recent evidence suggests that 1726-nm laser devices can also substantially improve acne, with one study achieving a 91.5% treatment success rate (n = 104) following 52 weeks of therapy.10 Of note, more research is needed to specifically study these therapies in transgender patient populations.
Scar Management
Surgical procedures function as a core tenet of gender-affirming care, but may carry a risk of postoperative cutaneous complications.11 For transmasculine patients, top surgery can allow for masculinization of the breasts via bilateral subcutaneous mastectomy, while transfeminine patients may opt for breast augmentation procedures.11,12,13 A cross-sectional study of transgender patients revealed that hypertrophic scarring, keloid formation, and
Laser Hair Removal
Laser hair removal (LHR) serves as a valuable tool for both cosmetic and medical approaches to gender-affirming care. LHR can effectively target hair follicles through the process of photothermolysis, in which absorption of laser wavelength transmissions through melanin results in follicular destruction and subsequent reduction in hair growth.4,5 LHR therapy often utilizes long-pulse alexandrite, diode, or Nd: YAG lasers, operating at 755 nm, 810 nm, and 1064 nm, respectively.1,4,5 It is important to note that LHR may be less effective for lighter-haired individuals, given that its mechanism targets the follicular melanin.4 In addition to hair pigmentation, skin pigmentation is also an important consideration when selecting lasers for LHR. Compared to lasers with shorter wavelengths, the Nd:YAG laser is less readily absorbed by epidermal melanin, making this laser more suitable for patients with darker complexions.4
From a surgical perspective, LHR is useful in both pre- and postoperative settings in gender-affirming care. In transmasculine patients undergoing phalloplasty, hair removal is recommended from autografted donor tissue, often from the patient's forearm or thigh, prior to the procedure to prevent intraurethral hair growth and infection.4 Similarly, pre-operative hair removal is recommended for transfeminine patients undergoing vaginoplasty to avoid postoperative complications such as folliculitis and calculus formation at the follicle.4 Careful monitoring for hair regrowth following surgery may be warranted, particularly in the context of concurrent testosterone therapy, given the association between testosterone therapy and increased hair growth.4,6
From a cosmesis perspective, LHR can further support efforts to mitigate gender-incongruent features. Hair on exposed body regions, such as the face, can contribute to gender dysphoria, anxiety, and depression.1,4 Consequently, LHR of visible body regions to achieve gender-congruence highlights a valuable role of this technology in caring for transgender patients.
Hormonal Acne Management
Acne has been associated with detrimental impacts on psychosocial wellbeing and self-esteem, and these effects may be further compounded in transgender patients.1 A survey study on the experiences of acne in transgender patients revealed heightened feelings of anxiety, depression, dysphoria, and concerns for rejection.7 In particular, transmasculine patients undergoing hormonal therapy with testosterone may be at increased risk of hormonal acne development due to an associated increase in sebum production.6,7 Recent evidence suggests that transfeminine patients may also experience acne following estradiol treatment, broadening the traditional focus of hormonal acne beyond testosterone therapy.8 Guidelines recommend standard acne management for transgender patients, with laser therapy and EBDs showing additional promise.1
EBDs can directly target sebaceous glands, thereby addressing a key component in acne pathogenesis.9,10 Current evidence suggests that a 30% to 50% reduction in sebum is necessary to achieve a 50% reduction in acne severity.9 A systematic review found that EBDs, including radiofrequency devices and photodynamic therapy, can achieve up to a 35% and 40% reduction in sebum production, respectively.9 For lasers, the 1450-nm diode laser achieved up to a 48% reduction of sebum.9 Recent evidence suggests that 1726-nm laser devices can also substantially improve acne, with one study achieving a 91.5% treatment success rate (n = 104) following 52 weeks of therapy.10 Of note, more research is needed to specifically study these therapies in transgender patient populations.
Scar Management
Surgical procedures function as a core tenet of gender-affirming care, but may carry a risk of postoperative cutaneous complications.11 For transmasculine patients, top surgery can allow for masculinization of the breasts via bilateral subcutaneous mastectomy, while transfeminine patients may opt for breast augmentation procedures.11,12,13 A cross-sectional study of transgender patients revealed that hypertrophic scarring, keloid formation, and
