A person with gender dysphoria experiences anxiety,
uncertainty or persistently uncomfortable feelings
about their birth gender from a very young age
(often as early as 4 years old). They feel that they
have a gender identity that is different from their
anatomical sex. This may lead to a fear of
expressing their feelings and a fear of rejection,
which may lead to deep anxiety, chronic depression
and possibly attempted suicide.
Sometimes a person, with
undergoes hormone and
surgical treatment to
physically change their sex
and this is called
condition can affect male
and females; however as an
electrologist you are more
likely to treat a male to
What treatment is required for
a male to female transsexual?
Hormone therapy - The introduction of the
hormones oestrogen and progesterone, and
normally three months later anti-androgens, will
cause physiological changes to occur which
Development of small breasts
Increase and redistribution of body fat
Improved condition of scalp hair
Improvement in skin tone
Softening of the beard and hair growth
Decrease in the size of the testes may occur
Electrolysis - Obviously, this is a vital part of transition.
The permanent removal of facial hair is essential and it is
better if it can be treated before the operation. Body hair;
on the other hand can be controlled by waxing or shaving.
Psychotherapy - Counselling or psychotherapy is an
essential element of the treatment for most people, to be
able to deal with their emotions and anxieties.
Speech therapy - Some people are satisfied with a self-modified
voice, but if they wish to live successfully as a
woman, it is vital that their voice is modified quite
dramatically. Only supervised speech therapy and lots of
practise can achieve this.
Deportment - Despite their feelings, some people have
great difficulty producing believable female body language
and therefore deportment sessions will be required.
Real life test - This is essential prior to surgery and
entails the person living in their chosen gender role for a
period of time. (Frequently 2 years under the NHS or more
likely 1 year if treatment is private). The person has to
prove that they can function in their new role, hold down a
job (paid or voluntary work) and have a ‘normal’ social life.
The idea is to identify anyone who just can’t cope with the
Facial reconstruction - The main area requiring surgical
treatment is the Adams Apple although other surgery such
as nose and chin reshaping are common.
Breast implants - The use of female hormones promotes
breast growth, but in some cases this is very minimal. For
some individuals breast implants are important.
Final stages of gender reassignment surgery - Under
general anaesthetic, the testicles, and erectile tissue of the
penis are removed. An artificial vagina is created and lined
with the skin of the penis, where the nerves and blood
vessels remain largely intact. Tissues from the scrotum are
used to create the labia, and the urethra is shortened and
Treating a gender dysphoria client
The presence of the beard poses the greatest
concern for most male to female transsexuals.
It is psychologically better to have the beard
treated before the final operation takes place.
It will be a long and slow process and timings will
vary depending on the density and strength of the
growth, sensitivity of the skin, client’s pain tolerance
The treatment usually takes a minimum of 2-3 years
when treating for two-four hours per week, and may
take a further 4 years after surgery.
Treating a gender dysphoria client
When treating a gender dysphoria client you will need to be
very sympathetic, sensitive and reassuring in your approach.
It has often taken many years to get to the stage where the
individual can proceed with the electrical epilation treatment.
Transsexual clients who start electrolysis prior to hormones
should be advised that progress may be slow until hormones
(preferably with anti-androgens) are started.
Re-growth rate generally diminishes further once the testes
It may be necessary to liaise with the client’s consultant to
decide on the best way to proceed with treatment.
Which method of electrical epilation
The consensus of opinion is that in general,
diathermy produces a quicker result; even taking
into account that diathermy may give a higher re-growth
rate. However most clients find diathermy
more painful than blend, and generally it provokes a
greater skin reaction. Treatment using short wave
diathermy tends to result in pigmentation problems
due to the high levels of oestrogen being
Factors to consider
Another factor to consider is the presence of badly distorted
follicles. Most transsexuals will have used more drastic
techniques such as plucking, which may well cause distorted
Severely distorted follicles are not agreeable to treatment
by diathermy. Blend can be used for affected areas of the
face, as the lye produced in this method is able to reach the
dermal papilla even if the needle has not.
It is often advisable to use cataphoresis at the end of each
session to neutralise the effect of the sodium hydroxide
produced during the blend method.
A suggested check-list for deciding on the
method to use is as follows:
For any distorted follicles, choose blend.
Otherwise, choose diathermy to begin with.
If the client experiences an unacceptable level of
pain or skin reaction, switch to blend for the
If the re-growth is abnormally high, it may be
worth trying blend instead of diathermy; choose
whichever method works best.
Technique used for treating
transsexual facial hair
Higher current intensity required - care must be taken to avoid
The skin may be made more vulnerable by the effects of high
doses of feminising hormones.
Hairs may have large bulbs, which may produce friction as they
slide through the follicle, causing an illusion of traction, which
in turn can lead to accidental over-treatment.
Care must be taken to avoid over treating an area: widely
spacing the treated follicles is often advisable.
Gold-plated needles are considered significantly less painful
than stainless steel.
Technique used for treating
transsexual facial hair continued
There is no particular rule for treating different areas in a
particular sequence. Be guided by the client, they will have an
opinion as to which areas are most urgently in need of treatment.
Most clients find the area around the mouth to be the most
obtrusive; some also consider the neck a 'priority area' as hair
stubble or shaving rash on the neck can be very noticeable.
The 'sideburns' typical in male facial hair growth are very coarse,
and clearing this area totally gives an unnatural result as most
females have a fine amount of growth present in this area. Treat
the coarse hair growth, however not the finer growth, to produce
a more natural result. You may also need to use a lower current so
that some of the coarser hair growth turns into finer growth
therefore producing a natural result.
Owing to the nature of male-type facial hair, many
transsexual clients find electrolysis an unpleasantly
painful process. Two hours of continuous treatment
repeated frequently over a period of years can be
traumatic for many clients, especially as pain
threshold has been found to decrease under
hormone treatment, whilst electrolysis without
hormone therapy is frequently ineffective. The pain
can be eased by three possible methods: topical
anesthesia, analgesics and sedatives. Generally these
are prescription-only drugs and it will be necessary
to liaise with the client's GP to have them
prescribed for the client.
Application of a normal aftercare cream, typically a witch-hazel
based product is recommended. Some clients experience severe
inflammation and have found taking a non-steroid anti-inflammatory
drug and/or an antihistamine (before commencing
treatment) reduces the inflammation. In all instances, the client
is advised to discuss choice of medications with their doctor.
The usual aftercare advice should be given, however in
particular, advise not to shave the area for at least 24 hours
and then to shave very lightly with an electric razor only (a blade
razor will tear the small pimples which often appear when coarse
hairs are epilated). Similarly, advising not to wear make-up will
probably be impractical; the client should be advised to leave the
area alone for as long as possible and then to use a waxy 'post-electrolysis'
cream under their normal concealer/foundation.
This is always a sensitive topic with clients and electrologists
alike. Not all electrologists would feel comfortable treating such
an area, and a transsexual client will probably feel intensely
embarrassed about possessing male genitalia, let alone allowing
someone else to see them. However, genital electrolysis
contributes greatly to a satisfactory outcome of the gender
The precise method of surgery used depends upon the surgeon;
however, potentially hair-bearing tissue from the penis/scrotum
is placed in locations where hair would be undesirable and
problematic (inside the vagina, under the clitoral hood, and
perhaps inside the labia). For this reason, clients are advised to
seek the advice of their chosen surgeon as to which parts must
be epilated, and then to obtain the necessary electrolysis well in
advance of surgery (to allow the skin to recover).
Genital electrolysis continued
Great experience is needed to perform genital
electrolysis; the technique is a little different from
other body areas. The hair is essentially the same
type as found in the bikini line area, although the
follicles are sometimes surprisingly shallow, and the
tissue is very soft. It is not necessary to totally
avoid marking the skin, as the skin will never be
visible after the surgery. The 'flash thermolysis'
method is highly effective as it gives a very low re-growth
rate, rapid treatment, and is often less
painful than slower methods.
Information obtained from:
Electrolysis in Transsexuals Second
Edition, November 1997