Transitioning skin - the nuances of supporting skin on HRT
At Skin Ritual we are strong advocates for inclusivity, and believe that skin care is not specific to any gender binary. Everyone deserves to look good and feel comfortable within themselves.
You’ll notice that our clinic, while a very zen and calming space, is also deliberately gender neutral. This reflects our approach to skin and skin treatments as well.
So with that being said, in this article I will break down the basics of treating and understanding skin that is going through the hormonal transition process.
When researching for evidence to support this article I came across a lot of terminology used specifically to refer to transgender people noting their transition from their assigned sex at birth to the gender they identify with. This tends to make things less wordy when explaining, and I will be using these terms throughout the article.
Gender dysphoria - a feeling of distress that occurs when someones gender identity differs from their sex assigned at birth
Gender binary - a system of gender classification in which all people are categorised as being either male or female.
AFAB - assigned female at birth
AMAB - assigned male at birth
FTM - female transitioning to male
MTF - male transitioning to female
HRT - hormone replacement therapy
HRT (Hormone replacement therapy)
HRT is one of the first steps a transitioning person can take in their transitioning process, and it is subsidised by the government.
For FTM, hormone replacement therapy comes in the form of testosterone to suppress oestrogen, usually done by injection or patches.
For MTF, hormone replacement therapy is medication to suppress testosterone production and induce feminisation. Most commonly oestrogen (in patch or pill form) is combined with an anti androgen (pill).
For transitioning people, HRT is crucial to helping with gender dysphoria and helping people to feel more at home in their own body - but its effects on the skin can be intense.
The effects of HRT can start within 1 month of medicating, but can take up to 5 years to reach their maximum effect.
FTM HRT Effects On Skin (Female to male)
With the rise of testosterone and the suppression of oestrogen in the body, we see a number of changes including: facial & body hair growth, a redistribution of body fat, deepening in voice, bleeding cessation, scalp hair loss, changes to mood and sex drive, growth of external genitalia etc.
When it comes the skin, the rise in testosterone and androgens leads to a rise in sebum (oil) production. This results in an increased risk of developing acne.
Small studies suggest that acne severity often peaks in the first 6 months of testosterone therapy, and may gradually improve over 1-2 years.
One study of 21 FTM adults found that 94% had facial acne and 88% had back acne after 4 months of testosterone therapy, an increase of pre HRT rates of 29% and 17% respectively.
This increase in acne for transgender males is sometimes nicknamed the "second puberty".
What can we do?
Often because the acne is hormonally triggered and quite severe, the best course of action is an oral medication (accutane, doxycycline etc). When a client is using an oral vitamin A, we support the skin with gentle and hydrating (but not occlusive) products and ingredients. We also try to get as many antioxidants into the routine as we can to support the skin in healing itself and functioning to the best of its ability.
Key ingredients would be: hyaluronic acid, niacinamide (B3), panthenol (B5), a host of skin repairing peptides, DNA repair enzymes & willow herb.
Sometimes the risks of isotretinoin outweigh the benefits, particularly for people who are predisposed to, or suffer from mental health disorders.
When isotretinoin is not an option the key ingredients would be - a vitamin A product, Niacinamide, salicylic acid, mandelic acid, willow herb and hyaluronic acid.
Along with a supportive skincare routine, peels are usually effective in keeping breakouts at bay, and reducing inflammation. Once the acne has calmed down and the skin is no longer breaking out, we usually recommend a course of skin needling to remodel the acne scarring and refine texture.
MTF HRT (Male to female)
For MTF clients the HRT transition process is equally as intense.
Changes in the body include - breast growth, fat redistribution, decreased muscle mass, decreased body and facial hair, decreased balding, changes to sex drive, smaller testes, changes to mood, softer skin, changed sweat and odour patterns.
Within the skin we see a drop in sebum (oil) production, a rise in melanocyte stimulation (increasing development of pigmentation) and increased epidermal (outer layer of skin) thickness.
Due to the drop in testosterone and therefore a decrease in oil levels, it is normal to experience dry, itchy and cracked skin.
Another skin condition that arise during transition for MTF is melasma (a pigment disorder). Melasma triggers are still relatively unknown, but what we do know is that it is interlinked with changes in oestrogen levels. MTF clients with darker skin types have an increased risk of developing melasma.
What can we do?
To support the skins moisture retention, ceramide production and barrier function key ingredients are - hyaluronic acid, oil based cleansers, lipid rich formulas, retinals, occlusive hydrating agents like jojoba and shea, all forms of vitamin B & C.
In regards to mitigating the risk of melasma, we need to make sure the routine has plenty of ingredients that inhibit the pigmentation process.
Key ingredients are - niacinamide, L-ascorbic acid, retinoids, liquorice root, tranexamic acid & green tea extract.
A supportive skincare routine combined with treatments, along with good nutrition, and drinking at least 2 litres of water a day is the best course of action. Essential fatty acid supplements can also be helpful.
As I mentioned earlier we believe skin health is non binary, and everyone deserves to feel comfortable and at home in their skin. When I started researching for this article I was surprised to see no skin clinics or spas mentioning transgender skin or the steps they're taking to foster inclusivity.
We would like to clearly state that skin ritual is a safe space, for everyone.
Not everyone has the budget for skincare and treatments, which is why education is so important, and the reason why Skin Ritual continues to offer free consultations.
If we can support people through these big life transitions and give them the tools to live in their healthiest skin, then we’re doing our jobs right.
If you need help supporting your skin through any journey, you can book a complimentary skin consultation with us here: https://www.skinritual.co.nz/book