Black Trans Skincare
Your body, skin and skincare routine has a significant impact on self-harmony when it relates to your identity, and for transgender individuals who align their physical appearance with their gender identity, it becomes a crucial part of a transitional journey.
While gender affirmation surgery and hormone therapy offer transformative results which enable closer alignment between physical appearance, characteristics and gender identity, it can also bring a host of skin concerns that Black transgenders can’t always access the right solutions for.
To understand these changes and how Black trans men and and women can deal with them, we tapped into the expertise of Consultant Oral, Maxillofacial & Aesthetic Surgeon Dr Natasha Berridge and Consultant Dermatologist Dr Mary Sommerlad, to share how to look after your skin and hit desired goals.
“For many, the first stage of medical transition following a diagnosis of gender dysphoria is starting gender-affirming hormone therapy (GHAT). This is so transmales and transfemales can achieve the changes consistent with their embodiment goals and gender identity,” explains Dr Berridge.
Hormone Therapy - Oestrogen
Oestrogen or anti-androgen hormones are taken by transfemale individuals to develop the body's physical, mental and emotional changes. Dr Berridge states, “Exogenous oestrogen and anti-androgen affect the soft facial tissues, redistribute the facial fat to the cheek regions, reduce oiliness and soften skin.” As for the body, hormone therapy will help to redistribute fat to the hips and reduce muscle mass and hair fining. While oestrogen hormone therapy can align with gender-affirming goals, it can also impact your skin.
One being dry skin - oestrogen therapy can impact oil and collagen production, reducing its levels and causing skin to become dry and flaky. Introducing a rich moisturiser into your routine will help alleviate the dryness and hydrate skin. In some cases, eczema may arise, so treating skin with sensitivity and managing your lifestyle and diet is vital.
Hormone Therapy - Testosterone
“Transmale individuals will generally take exogenous testosterone, a powerful androgen, which affects the soft facial tissues, reduces cheek fat, diminishes facial skeletal bone growth and speeds the development of facial hair,” says Dr Berridge. As for the skin, increased testosterone can increase oiliness, increasing your chances of developing acne. This can go hand in hand with an increase in dark marks and hyperpigmentation. It may peak within the first six months, but research has shown improvements within the one to two years following. In line with facial hair growth, it is essential to master a gentle yet effective shaving routine that won’t result in breakouts or ingrown hairs which can be common in Black skin due to the curly growth pattern of Afro hair. Therefore, always ensure your skin is clean and damp before introducing a high-quality single blade razor. To reduce unwanted friction and irritation, try using a shaving cream or gel and shave in the direction of the hair growth to avoid ingrown hairs. Finish your shaving routine with cool water and then a post-shave balm.
Check out our gender transition glossary
Building a Skincare Routine
As Dr Berridge has highlighted, hormone therapy significantly impacts your skin’s behaviour, which can manifest itself in concerns such as acne, hyperpigmentation, eczema, and dry skin. Adapting your skincare routine to treat these concerns alongside your new and emerging skin type is essential. Some at-home skincare tips Dr. Berridge recommends include:
Cleansing with a gentle cleanser rich in antioxidants to help protect against environmental aggressors.
Exfoliating to help remove dead skin cells and unclog blocked pores. Retinol is a good all rounder that speeds exfoliation and promotes collagen production.
Moisturise using a lightweight, oil-free serum and moisturiser rich in hyaluronic acid and ceramides. Niacinamide (link) is an excellent choice for stressed, sensitised skin, as it supports the skin barrier and maintain hydration.
Protecting skin from harmful UVA/UVB rays by applying at least an SPF30 daily.
Post Gender Transformation Skin Concerns
Post-Op Scarring
Scarring is a normal and expected process the body goes through after any operation, especially post-gender affirmation surgery, where scarring may be sizeable depending on the type of surgery. You may find significant scarring on the chest (top surgery) or genitals (bottom surgery), and in people of colour, keloids and hyperpigmentation are highly likely. As Dr Mary Sommerlad explains, “Scarring post-surgery can be hypertrophic or even keloidal in people with skin of colour.” Keloids, particularly post-surgery, can grow in size, feel itchy, uncomfortable or burn in some cases, but there are treatments to help manage their appearance and discomfort. When treating scarring, she advises you to seek an expert's help as soon as the body is healed and your surgeon signs you off.
“I recommend a combination of intralesional steroids therapy ( an injectable treatment designed to reduce scar tissues directly beneath the skin) and fractional laser therapy (a non-invasive laser to resurface skin gently without causing damage) suitable for all skin types such as ND: YAG laser,” says Dr Sommerlad.
Hair Growth and Removal
Hair growth and removal is part of any genital reconstruction surgery, whether vaginoplasty (a procedure to construct female genitals) or phalloplasty (a method to construct male genitals). To achieve a successful transformation, skin is used from other body parts, including the forearm, thigh, abdomen, lower back or bum. For this stage of the operation to happen, hair must be removed pre-surgery; otherwise, you’ll run into risks like infections, irritation, warts or the formation of tiny bumps under the skin – related to vaginoplasty surgery – or urinary infections and stones following phalloplasty surgery. In these instances, seeking medical help is imperative, but to avoid this, hair removal treatments such as laser hair removal and electrolysis are “definitive ways to remove hair permanently, but they require patience,” says Dr Sommerlad.
While laser hair removal and electrolysis are highly recommended, they come with side effects that you must be aware of for skin of colour. As Afro hair is coarser, more sessions will be required before you should see a significant difference. Equally, both treatments can cause skin sensitivity, irritation, redness and, in rare cases skin pigment changes or more hair growth. These effects are often temporary but can be managed with efficacious and gentle aftercare.
Chest Binding
Chest binding is a common practice to help flatten the appearance of the chest area. While elastic, compression, or soft materials are recommended for binding, continued compression can affect the skin. Common skin concerns that can arise with chest binding include acne, itching, skin infections, swelling, scarring and lack of skin elasticity (often a long-term side effect) due to the lack of airflow around the area. All side effects can be treated, but treating the area with a gentle, effective, and considered approach is recommended.
To minimise the side effects of chest binding, we recommend:
Use specialised binding materials or products that won’t cause skin irritation
Find the right size to avoid breathing and skin difficulties
Maintain good hygiene, wash skin daily and apply moisturiser
Stretches and movement will help reduce discomfort and improve blood flow
Genital Tucking & Packing
Genital tucking involves folding the penis and testicles into a position for it to appear flatter under clothing. Compression materials can be used to achieve this, but similarly to chest binding, the lack of airflow can cause skin concerns such as itching, rashes, infections and hyperpigmentation around the groin area. To treat these skin concerns, use specialised binding materials and hypoallergenic fabrics, barrier creams and moisture absorbing powders to reduce friction and irritation.
In other instances, you may want to pad out the chest or genital areas. Packing materials must be soft and hygienic, allowing good airflow to avoid skin irritation or infections.
Gender-affirming surgeries and hormone therapy are magnificent for trans individuals to feel comfortable and confident in their skin. But as the physical body transitions, paying attention to how the skin changes is very important.