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TransMed
Hairy Subjects
by Sheila Kirk, M.D. |
All of us, Female To Male, Male To Female are concerned with hair
someplace on our bodies. We want it in certain places but not
in others. We want it certain lengths, certain colors and with
certain manageability. Some of us can't get what we want; others
don't want what they get. It's a wonder that even with all that
is possible with medications and surgical procedures that we can't
satisfy everyone all of the time. But we can't!
I want to look briefly at various hair-bearing locations and give
insight into what is possible for members of our community. Let's start at the top--the Scalp. Both genetic
males and genetic females can experience baldness to varying degrees.
For the FTM individual it may only be an occurrence once testosterone
therapy has been initiated although baldness of a male pattern
does take place in about 20 million genetic women in the U.S.
even without testosterone therapy.
For those on testosterone
the bald pattern resulting with hormones is a male confirmatory
marker--but many would like not to have that effect. Some genetic cause is most probably responsible for this
difficulty in a great many instances. There are studies reporting
the fact that some male populations in the world have no baldness
whatever.
One notable study deals with a male population
in the Caribbean born with ambiguous genitalia and raised as females
until puberty when male genitalia develop, along with deep voices.
It was found that they had genetic absence of an
enzyme system that converted testosterone to dihydrotestosterone -- the
hormone that attaches to receptors on hair follicles. As a result
the hair follicles do not weaken and shrivel as when the enzyme,
5 alpha reductase, is present. Hence, hair is thick, luxuriant
and present into old age.
This observation led to discovery of medication that could block the reductase system and
thereby allow for the hair follicle to remain intact. One such
drug is Finasteride and is marketed as Proscar. It has been developed
recently in a pharmaceutical product called Propecia and is about
1/5 the dose of Proscar. Proscar was developed to halt prostate
enlargement. In this dosage about 60% of individuals taking it
can experience hair growth and very little in the way of side
effects. Although for genetic men, libido can lessen and impotence
can develop. For genetic women, development of a masculinized
foetus in a pregnancy could be a problem. But this is not generally
a concern for FTM individuals.
Could either Proscar 5mg or the 1/5 dose of Proscar marketed as
Propecia be effective in a feminizing regimen for the MTF individual?
That's a question with no answer at this time. Both medications
reduce dihydrotestosterone and thereby will affect the reductase
system to inhibit hair loss and allow hair follicle regeneration.
We know that blood levels of free testosterone will increase by
10% with the lower dose medication Proscar. Will that increase
interference with the feminization process? There are no reported
studies to give us an answer at this time. We may need to look
at testosterone levels in genetic women using Propecia to get
a clue, for nothing about genetic males using this medication
while using estrogen is known at this time.
Other pharmaceutical approaches resembling this approach are in
the making. An example is a cream or lotion applied directly to
the scalp that acts in attaching directly to the dihydrotestosterone
receptors and functions more efficiently to prevent hair loss.
No one really knows how it works but an old standby, Rogaine,
is a liquid placed directly on the balding regions of the scalp.
The medication is known as minoxidil and was developed originally
as a drug to combat hypertension or blood pressure elevation.
Taken by mouth it can be a problematic drug. If used as a liquid
application to the head in small amounts, it can act beneficially
in both genetic males and females in limited numbers with no effects
to various body systems even though absorbed through the skin.
Results are variable but in the early clinical trials, genetic
women had better success than genetic males both on investigator
and patient evaluations. The product is still available and should
be monitored by a physician. Success rates still indicate it is
helpful but perhaps only in less than 50% of those who use it
and to variable degrees.
There are surgical techniques to be considered and most of the
time MTF individuals will be candidates for this approach. Two
methods that are in common use are hair follicle grafts and scalp
advancement. Hair follicle grafts or plugs always seem to be a
little less desirable because the area treated is usually only
sparsely filled in by this hair planting procedure. To cover large
areas on the scalp, this technique doesn't seem to be feasible.
The more involved and more extensive approach to elimination of
baldness will be the advancement of scalp hair to a more forward
or anterior position. This can provide a much improved hair line
and once again bangs or otherwise styled hair combing can make
the hair line very natural and attractive. It has utility also
in filling the hair deficits in the temporal areas of the scalp
so common to the male. There are clinics everywhere that advertise
their techniques and plastic surgeons are very capable and trained
in all the surgical methods that exist to solve this problem.
The Face
Hair on the face is primarily a concern for the MTF
individual. While many FTM people want to be clean shaven--they
still want the option to shave or not. Beards and moustaches are
very acceptable to them. It's the MTF who need and want freedom
from facial hair and they approach this problem with all degrees
of knowledge and energy. Some wax, some pluck or tweeze, some
employ self-electrolytic techniques. All these provide only temporary
removal of facial hair. For permanent removal, electrolysis is
the only proven and acceptable choice.
But just what electrolytic procedure to consider and what therapist
to employ? Those decisions can be very hard choices. The discussions
and even arguments that have been exchanged over this are noteworthy.
In reading the experiences of the therapist and the clients, it
may not be easy to make decision. When considering what is available
to us, standard techniques and laser techniques, several considerations
are important. Standard electrolysis has been with us quite a
while--over one hundred years. But it takes time to clear a face
of beard with this approach particularly a dark and heavy one.
And it can be costly and for many a very painful experience.
But
the proof of it's efficiency is definite and real, if the electrologist
is capable and experienced. Sometimes that capability is lacking.
Sometimes the operator is not skilled in managing the male beard
and hair root destruction is not effective. The opposite is equally
possible. Destruction can be so enthusiastic that skin tissue
is destroyed as well and scar and pitting develop in the healing.
So it would seem that the potential problem with standard electrolysis
is not in the method but in the therapist. Selection of the right
one is paramount.
Laser electrology is still in development and while
those using it exclusively are most enthusiastic, not all their
clients agree with them--and therapists using standard electrolysis
are vigorously opposed. Even the FDA, the Federal Drug Administration,
has limited acceptability of the procedures and the machines in
current use.
Advantages it would seem center around speed of removal
of hair. Several hours of treatment can cover large areas. But
permanency seems to be a problem and -- more importantly -- tissue destruction
while attempting hair bulb death seems to be a growing concern.
Therapists are generally physicians or very experienced technicians
who are supervised by physicians. Accidents still take place even
when such skill is employed. It seems that as one reads the literature,
which is by and large anecdotal (that not based on control studies
but rather on personal experience), the concerns are two-fold:
the method used to remove hair as well as the skill of the operator.
Perhaps more time is needed to observe Laser Electrology. There
is a saying in medicine not often spoken but certainly known to
most physicians; "Be not the first by whom the new is tried
nor the last to lay the old aside." A nice, neutral, in the
middle of the road position.
The Torso & Extremities
Some genetic males are covered with hair--over their backs, chests
and abdomen. And often consider this along with heavy extremity
hair as a sign of "real" masculinity. No doubt many
FTM individuals feel the same But the amount of chest and leg
hair that the FTM person will grow once on testosterone will be
directly related to the number of hair follicles that reside in
the skin in these regions. Hence, chest hair may be sparse while
leg hair may be quite heavy. It's really the "luck of the
draw" and one must wait and see how much and where the hair
growth will thicken and increase.
Needless to say the MTF person wants none of this and must rely
on any and all methods possible to eliminate growth in these regions.
Temporary approaches such as waxing, depilatories and shaving
are possibilities and electrolysis, both standard and laser techniques,
have been utilized with success. The electrolytic process can be
long, painful and costly in these areas but rewarding to the persistent.
Variable success is realized with hormone therapy in the MTF in
lessening and eliminating extremity hair. In the experience of
many, use of estrogen and an antiandrogen over a prolonged period
of time has considerable success in limiting extremity hair--particularly
on the legs.
This is merely an overview of possibilities open to you. however,
you have to explore carefully to determine what is best for you
and your needs. Interview several surgeons who specialize in hair
transplant. Also, interview several electrologists and get an
overall view of their techniques and results. In addition, talk
to several electrolysis clients (if possible, people in support
groups who are being treated by the electrologists you speak with.
They can give you fairly accurate evaluations of those hair removal
professionals. You shouldn't be treated repeatedly in the same
places. Some reoccurrence of hair is to be expected but if too
much your therapist is not killing enough hair follicles.
You can expect some help with your medications to either support
hair growth or limit it somewhat, depending on what regimen you
are involved with and what your capacity is to respond. Approach
this aspect of your care with education, a sense of realism and
patience.
Sheila Kirk, MD is a Transgender Medicine Specialist, board-certified in
Obstetrics and Gynecology and in practice in Pittsburgh, PA. She is on the board of the Harry Benjamin International Gender Dysphoria
Association. She is also a well-known author and leading authority on transgendered medical care and research. Dr. Kirk
provides international and national consultations and referrals to the TG
community and health care professionals who assist in their care.
She can be reached the following ways:
E-mail: SheilaKirk@aol.com
Phone: (412) 781-1092 Fax: (412) 781-1096
mailing address: Sheila Kirk, P.O. Box 38114, Blawnox, Pa 15238-8114
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