ironhammer

In the grand tradition of Not Seeking Medical Attention or Opinion Because of Dysphoria or Fear, tragically often we only find out about basic shit through word of mouth. I attended a virtual conference by a dermatologist with some general info and recommendations for trans people; here’s a quick overview of some stuff you might or might not know. 

I’m not a doctor, this is a small list, read up on shit from reputable sources, seek medical counsel, etc.

about skin cancers (applies to everyone, actually)

• indoor tanning use by trans folks is pretty common; you should know it increases by 4 your risk of developing melanomas. regardless, you should know the ABCDEs of melanomas.
• you might not pay much attention to what happens to your mortal shell because fuck bodies, so you might not track for how long a skin lesion lasts, for instance. when you have small wounds that just won’t close, or open/reopen on their own, that’s basal cell carcinoma. it’s very common on the face. the treatment is pretty simple (they scoop it out! no complicated bullshit), but you GOTTA get it checked soon. yesterday. it grows. (nb: it can also be treated with a topical cream, but you won’t know for sure if it’s all gone. if you wanna go that route, it’s best if it’s in its early stages)

about skin care/concerns for trans women on hormones

• estrogens and antiandrogens tend to make your skin drier/relatively more fragile, so you might be at a slightly higher risk of irritation or infection than before HRT.
• moisturize a lot; it’s not the same as atopical dermatitis, but the creams are usually good for this.
• short showers with lukewarm water help (not too cold, not too hot)

about skin care/concerns for trans men on hormones

• testosterone will make you greasier. probably only slightly. it’s okay
• generally, starting in the 3rd/4th month of T you might get the famous second puberty acne. the kind of delivery you’re using for T (injection, cream, etc) does not influence this. your blood levels do not influence this. you don’t need to change your dosage.
• retinoids will make your skin produce less sebum (they will help dry it up, basically).
  
• if you had acne as a kid, you might have been on isotretinoin of some kind: it will work for this too. however, trans men on isotretinoin are at risk of pregnancy even if they no longer menstruate. (cis women on isotretinoin have to use a condom in addition to hormonal contraceptives, but the latter fucks up what you’re doing with T). it’s safe other than that, but really, condoms.

about hair loss

• androgenetic alopecia behaves the same way on cis and trans men, and the treatments are the same
• yeah, you might get this one if you’re on T. 
• minoxidil helps with hair growth. usually a lotion. pretty straightforward. on cis men, it’s used to treat high blood pressure and “male pattern” hair loss. NB; minoxidil has gotten popular with pre-T trans guys to develop thicker body hair. seems to work? be careful if you have blood pressure concerns, I guess. 
• finasteride helps block T locally on your follicles, but does not diminish your blood levels. it’s not recommended you use it before you’re done developing secondary sexual characteristics due to HRT (sometimes 3, 5 years. that’s up to your body). you can get this as a lotion or pills. finasteride is generally used to treat an enlarged prostate or hair loss in cis men, btw.
• [Note for people in Spain: atm of writing (october 2020), Seguridad Social dermatologists will counsel you on this, but the cost of minoxidil/finasteride is not covered. It’s not prohibitively expensive, though.]
  

about hair removal

• important preoperational step if you’re having genital sex reassignment surgery. if you’re getting skin grafts (like for phalloplasty), that area will also have to be depilated. this usually starts some weeks before surgery, but your doctors should advise you on this (in some countries, as well as with some insurance companies in the US, the cost is covered if the surgery is covered. check.)
• laser hair removal is not permanent; best results if you have lighter skin with dark hair (very light hair, regardless of skin tone, might not be affected at all by laser hair removal). can be uncomfortable
• electrolysis is more permanent, is recommended for all skin tones/hair colors, will definitely hurt (but you should be anesthesized; at least here in Spain.)
• in my non medical opinion you wanna definitely consult trans women about this specifically before committing, because they Know. also, a dermatologist.

about implants

• calcium hydroxylapatite and hialuronic acid are currently the most common substances used in soft tissue fillers for cosmetic surgery (such as enhancing some traits in face feminization/masculinization)
• might be dumb to point it out, but implants and intramuscular injections don’t work together. if you inject your hormones into an implant, they won’t do much for you.
• non-medical silicone will fuck you up in every possible way, including migrating places it shouldn’t be. the internet is full of horror stories for botched injections, you know this one

bonus round: venereal diseases + screenings (this one’s for everyone)

• HPV, or the human papillomavirus: there’s different strains, but the two biggest problems you might have that are caused by this are 1) genital warts, 2) cervical cancer. they’re from different strains of HPV, and different vaccines exist covering some strains, but not others. 
• you could be a carrier of HPV and not have adverse effects, which is why you gotta get tested before sharing fluids with your partner(s) and potentially fucking them over. seriously, HPV is super common. also, use protection.
• [Note for people in Spain: atm of writing (october 2020), Seguridad Social covers HPV vaccines for girls, and for adults with HIV.]
• if you’re a trans woman who’s had vaginoplasty, you can develop tumors in your vagina. you need to do cervical cancer screenings.
• if you’re a trans man and you have not had The Surgeries tm, you gotta do your screenings too: breasts, cervix, the works.
• you know about condoms and about how you should be using them. due to environmental/social risk factors, trans women have an outsize representation in people with HIV (and, to a lesser degree, so do trans men). there’s also PrEP (pre-exposure prophylaxys), which is for people at a high risk of getting HIV; you take it daily and it lessens your chances.

As a neat aside, the dermatologist at this conference mentioned that in the last few years trans issues have been brought up more and more at international conventions/conferences he’s been to! Someday soon doctors might actually get training about trans people at medical school, wouldn’t that be neat.