Note: Some images depict small amounts of blood.
Hair is an item of significant concern for trans people during transition: hair, its style, and its presence or absence in various areas can be a factor both in one’s experience of gender dysphoria as well as how one’s gender is seen and attributed by others. The most widely known form of hair management is laser hair removal or electrolysis used by trans women and transfeminine people for the permanent removal of unwanted facial and body hair, including from the genitals prior to vaginoplasty. Trans women may also experience male-pattern baldness from years of prior testosterone exposure, making use of treatments such as minoxidil to stimulate scalp hair regrowth (although a degree of scalp hair regrowth has sometimes been reported as a result of HRT alone).
However, a much wider variety of possibilities for hair restoration, alteration, and management – including many I’d never heard of until now – are available for both trans women and trans men through surgical means. Bared & Epstein (2019) provide an enlightening summary of these techniques and the results that can be achieved.
Hairline lowering via scalp advancement is a commonplace part of facial feminization surgery (Garcia-Rodriguez, Thain, & Spiegel, 2019), but this can also be achieved by transplantation of hair to the hairline from other sites, and the authors detail the specific parameters that are sought when feminizing the hairline via hair transplantation:
A soft, heart-shaped hairline design with rounded recession in the frontal-temporal region is often used to feminize the hairline and achieve a natural appearance to the hairline. To aid in the creation of a natural hairline appearance, often a subtle widow’s peak is created slightly off-center. Rounding of the hairline is then performed posteriorly and laterally along the frontal-temporal region, connecting to the temporal points.
Using hair transplantation, a full beard can be created to a specified design, potentially including the sideburn, cheek, mouth, goatee, and mustache areas:
The authors state that in their experience, “the scalp hair transplants to the face have a high regrowth percentage and, if properly performed, patients can achieve a natural outcome” and that “patients are always made aware of the possibility of undergoing secondary procedures after approximately 1 year if further density is desired.”
Hair transplantation can also be used to create and reshape eyebrows into a typically or masculine shape:
The masculine eyebrow shape is generally less arched but comes to a lateral widening at the peak of the brow, whereas the feminine eyebrow shape is more rounded and arched.
Additionally, large-scale hair grafting (“procedures of 1800 grafts to as many as 3000 grafts are indicated”) can be used in trans men to create chest hair, which can also serve to cover up scars from chest reconstruction surgery:
These potential areas, depending on patient goals, can include the upper and central chest, ranging laterally and inferiorly (particularly to conceal mastectomy scars) and even continuing caudally in a vertical direction into the abdomen and even upper pubic region. The keys to achieving a natural result, besides careful acute angulation of the recipient sites, is to have a crossed-hatch pattern of hair growth toward the midline, that is, the sternum.
Such procedures could be particularly beneficial to trans men given previous findings that even with testosterone, not all trans men will develop as much chest hair as cis men. This review helps to affirm that medical progress for trans people is still happening, and new methods are always being developed for the improvement of body image and the effective treatment of bodily gender dysphoria. ■
