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Gender reassignment


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Treatments for clients going through gender reassignment

by Clare Hargreaves-Norris

Published in: Education
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Gender reassignment

  1. 1. Gender Reassignment NVQ Level 3 Beauty Therapy Clare Hargreaves-Norris
  2. 2. Clare Hargreaves-Norris Introduction 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.
  3. 3. Clare Hargreaves-Norris Transsexuals Sometimes a person, with gender dysphoria, undergoes hormone and surgical treatment to physically change their sex and this is called transsexualism. This condition can affect male and females; however as an electrologist you are more likely to treat a male to female transsexual.
  4. 4. What treatment is required for a male to female transsexual? Clare Hargreaves-Norris
  5. 5. Clare Hargreaves-Norris Hormone Therapy  Hormone therapy - The introduction of the hormones oestrogen and progesterone, and normally three months later anti-androgens, will cause physiological changes to occur which include:  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
  6. 6. Clare Hargreaves-Norris Treatments  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.
  7. 7. Clare Hargreaves-Norris Other treatments  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 stresses.
  8. 8. Clare Hargreaves-Norris Surgery  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 repositioned appropriately.
  9. 9. 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 etc.  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. Clare Hargreaves-Norris
  10. 10. Treating a gender dysphoria client continued  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 Clare Hargreaves-Norris are removed.  It may be necessary to liaise with the client’s consultant to decide on the best way to proceed with treatment.
  11. 11. Which method of electrical epilation is best? 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 prescribed. Clare Hargreaves-Norris
  12. 12. Clare Hargreaves-Norris 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 follicles.  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.
  13. 13. Clare Hargreaves-Norris Check-list 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 affected areas.  If the re-growth is abnormally high, it may be worth trying blend instead of diathermy; choose whichever method works best.
  14. 14. Clare Hargreaves-Norris Technique used for treating transsexual facial hair  Higher current intensity required - care must be taken to avoid skin damage.  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.
  15. 15. 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. Clare Hargreaves-Norris
  16. 16. Clare Hargreaves-Norris Pain control 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.
  17. 17. Clare Hargreaves-Norris Aftercare advice 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.
  18. 18. Clare Hargreaves-Norris Genital electrolysis 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 reassignment surgery. 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).
  19. 19. 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 Clare Hargreaves-Norris painful than slower methods.
  20. 20. Information obtained from: Electrolysis in Transsexuals Second Edition, November 1997 Clare Hargreaves-Norris