Dermatologists can have an advocacy role to ensure access to health care services, such as hair reduction, for transgender patients, according to researchers in JAMA Dermatology.
The only FDA-approved method for permanent hair removal is electrolysis, which is more versatile than laser hair removal but requires several treatments. Laser hair removal is approved for permanent hair reduction, not removal, but it can treat a larger surface area in less time.
“The use of gender-affirming hormones (medications to align secondary sex characteristics with gender identity) alone is often insufficient to eliminate unwanted hair,” the researchers wrote.
Further, hair reduction is required for gender-affirming surgeries such as vaginoplasty, phalloplasty or scrotoplasty, and metoidioplasty.
“There may be greater familiarity with electrolysis among health care providers working within the gender-diverse community because it was historically the only method of permanent hair reduction prior to the advent of [laser hair removal],” the researchers wrote.
However, they added, no studies have suggested that electrolysis is more effective than laser hair removal in preventing postoperative complications.
To develop evidence-based guidelines for preoperative care, more study is needed on hair removal, including comparisons between laser hair removal and electrolysis in transgender people.
States differ on transgender health insurance coverage, even though Section 1557 of the Affordable Care Act disallows gender-identity discrimination in most public health and private insurance programs.
“In total, 17 states and the District of Columbia have removed exclusions in Medicaid or adopted policies that openly cover health care costs related to gender transition, though 11 states’ Medicaid policies explicitly exclude coverage for certain health care procedures on the basis of gender identity,” the researchers wrote.
Standardized insurance coverage of hair reduction, particularly in nonsurgical indications, is lacking. Insurers often do not cover facial and body hair reduction, so it is unaffordable and inaccessible to many. Moreover, many plans that cover preoperative hair reduction require a board-certified dermatologist or qualified treating health care provider to perform the procedure in a medical setting, which limits access because it typically occurs in salons or medical spas.
“As facial hair represents a substantial component of gender expression, facial hair reduction serves a critical role in gender affirmation and should be recognized by insurers as a medically necessary gender-affirming surgical procedure, in line with the position statement of the World Professional Association for Transgender Health,” the researchers wrote. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.