Lived Experience of Hirsutism in Transfeminine Individuals

Hirsutism is commonly associated with gender dysphoria in transgender and gender-diverse individuals, with many seeking permanent hair removal. Little research has examined how hirsutism impacts life and stigma in gender minority groups.

To examine lived experiences of hirsutism and hirsutism treatment in transgender and gender-diverse participants.

This qualitative study included semistructured interviews with transgender women and nonbinary adults assigned male at birth across 3 clinical settings in Atlanta, Georgia, from February 7 to June 26, 2023.

Self-reported hirsutism.

Interviews exploring experiences of hirsutism and hirsutism treatment were analyzed via thematic analysis.

Among 18 participants who completed the study, 17 were transgender women and 1 was a nonbinary individual assigned male at birth (mean [range] participant age, 38 [22-68] years). Fourteen participants self-rated clinically significant hirsutism levels, and only 1 reported having a diagnosis of hirsutism from a clinician. Participants described experiences of discrimination and rejection related to hirsutism and admitted avoiding social and romantic interactions in anticipation. Hirsutism was also reported to interfere with feminine gender expression and resulted in gender dysphoria. Many individuals went to great lengths to conceal visible hair in public, keeping razors or tweezers readily available for facial hair removal. Barriers to permanent hair removal included appointment burden, clinician attitude, lack of transgender-inclusive hair removal services, cost, and lack of insurance coverage.

In this qualitative study, transgender women and nonbinary adults assigned male at birth described experiencing hirsutism-related stigma and facing barriers to permanent hair removal. Multilevel changes aimed to reduce stigma, educate clinicians on hair-removal options, expand transgender-inclusive hair-removal services, and advocate for insurance coverage for permanent hair removal are required to reduce barriers to access medically necessary permanent hair removal for gender dysphoria.