Transgender and gender diverse people can experience increased depression, anxiety, suicidal ideation, and suicide from gender dysphoria (GD).1 GD occurs due to a discrepancy between a person’s gender identity, assigned gender, and physical characteristics.2 Gender affirming medical care, including dermatologic care, can increase body-gender congruence and decrease negative outcomes associated with GD.3,4,5
Transgender and transmasculine men report chest hair is an important component of their gender identity and expression.6Transmen typically experience an increase in chest hair after starting testosterone therapy but have less chest hair than cisgender men.7 However, studies in transmen examining identity and body hair elsewhere are limited. JDD authors James T. Pathoulas BA, Chloe J. Walker MD, Kelly E. Flanagan MS, Isabel M. Pupo Wiss BS, Dustin Marks MD, and Maryanne M. Senna MD developed a survey to evaluate the role of body hair in gender identity and sexual expression among transmen.
This study was deemed exempt by the Massachusetts General Brigham IRB. An anonymous online survey was posted in transmale-focused Facebook and Reddit pages. The survey was open to those over age 18 who identified as a gender minority and lived in the United States between December 2020 and February 2021. Only complete surveys by those who identified as transgender men or transmasculine were included in the results. Body hair was rated on a modified Ferriman-Gallwey Hirsutism Scoring System (FGS).8 Gendered characteristics of the FGS were eliminated and a section on perineal and perianal hair was created.
A total of 444 of 508 surveys (87.4%) submitted by transmen or transmasculine-identifying participants were complete and included in analysis (Table 1). Participants were mostly Caucasian (77.3%) with an average age of 28.3 ± 9.1. Almost all participants reported current testosterone therapy (90.0%). Most transmen (88.3%) felt that body hair was an important factor contributing to positive self-image. Almost two-thirds (65.8%) of transmen reported that body hair was part of their sexual expression.
A majority felt that hair on the legs (78.8%), chest (68.7%), and arms (65.1%) was an important component of gender identity and expression. In contrast, most did not consider genital, perianal, or back hair to be as significant (Table 1). Compared to their current hair density, participants, on average, desired significantly greater hair density on their chest (Δ+66.7%, P=0.00), arms (Δ+28.0%, P=0.00), and legs (Δ+13.9%, P=0.00) and decreased perianal hair density (Δ-24.2%, P=0.00) as rated on the FGS (Table 2).
A minority (2.5%) reported use of treatments to increase body hair density. The most reported treatment was topical minoxidil (1.8%). Most participants (62.2%) reported that they would feel comfortable discussing body hair enhancement with a physician. However, only 22.7% had done so. The most common method by which participants heard of body hair enhancement was social media (4.9%). Only one participant reported seeking care from a dermatologist for body hair enhancement.
Transmasculine and transgender men report that body hair is important to their gender identity, and sexual expression. Most desire substantially increased hair on the chest and extremities despite current testosterone use. However, few are treating with therapies beyond testosterone and almost none have consulted a dermatologist for body hair enhancement.
This study has several limitations including reliance on a self-reported online convenience sample. However, it is among the first reports of body hair density, gender identity, sexual expression, and treatment in transmen. Transmen are generally open to discussing body hair with their physician. We recommend dermatologists introduce this topic during visits relevant to gender transition, as it can legitimize patient concerns and open dialogue. While body hair enhancement in transmen remains a nascent area of study, it represents an opportunity for dermatologists to contribute to improved care for transgender and gender diverse people.
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4. Marks DH, Peebles JK, Dommasch E. Hair reduction for transgender persons: what dermatologists should know and how they can help. JAMA Dermatol. 2019;155(5):525. doi:10.1001/jamadermatol.2019.0149
5. Marks DH, Hagigeorges D, Manatisâ€Lornell AJ, Dommasch E, Senna MM. Excess hair, hair removal methods, and barriers to care in gender minority patients: A survey study. J Cosmet Dermatol. 2020;19(6):1494-1498. doi:10.1111/jocd.13164
6. Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes & Endocrinol. 2017;5(4):301-311. doi:10.1016/S2213-8587(16)00036-X
7. Motosko CC, Zakhem GA, Pomeranz MK, et al. Effect of testosterone on chests and abdomens of transgender men. J Am Acad Dermatol. 2019;81(2):634-636. doi:10.1016/j.jaad.2019.01.030
8. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21(11):1440-1447. doi:10.1210/jcem-21-11- 1440
Pathoulas, J., Walker, C., Flanagan, K., Wiss, P., Marks, D., & Senna, M. (2021). Body Hair and Identity in Transgender Men: A Cross-Sectional Survey. Journal of drugs in dermatology: JDD, 20(12), 1356-1357.
Content and images used with permission from the Journal of Drugs in Dermatology.
Adapted from original article for length and style.