Understanding skin changes from gender affirming surgery

Gender affirming surgery offers transformative potential for many in the transgender and gender diverse community, enabling a closer alignment between physical appearance or physical characteristics and their gender identity. As with any surgical procedure, these operations can result in skin concerns, but they can often be managed effectively with the right care and knowledge.

We’ve funded research and worked with leading experts in transgender healthcare to create a guide on what skin conditions may be experienced from gender-affirmation surgeries.

This research dived into published studies of skin conditions that may occur during the transition journey. After screening over 500 research papers and following a robust quality assessment, this study evolved into a paper, which signposts to the most reported skin changes during different stages of transition. We appreciate this may mean that there are some limitations in the article including age and ethnic groups.

Transition journeys are very much an individual experience, and some symptoms may be experienced that don’t appear here, and some that are included in the article may not be experienced at all. These limitations are here due to the very limited research which has been done in this space to date. This is why we feel it is important to provide more resources and information for those who may need it.

Post-surgery scarring

Scarring is a natural part of the healing process following any surgery, such as chest reconstruction (top surgery) or genital reconstruction surgeries (bottom surgery). As the body repairs, it can form scars that vary in size, colour, and texture. In some instances, keloids may develop which are a type of thick, puffy scar that can grow slightly larger than the original wound. They’re a natural part of some people’s healing process, especially if they have a darker-skin type, or have had surgery in a high-tension skin area such as the chest (Claes et al., 2018; Robles & Berg, 2007)¹ .

What skin concerns can arise with scars and keloid formation?

Some people might experience itching, burning or discomfort with scars or keloids. While most scars and keloids don’t cause problems beyond how they look or feel, there are ways to make them less noticeable and manage discomfort. If you’re due to undergo surgery, you may wish to discuss surgical scar prevention and management with your healthcare professional. However, it is also widely accepted in the trans+ community that scars can be celebrated as a form of reclaiming your body.

^{1. Claes, K. E. Y., D’Arpa, S., & Monstrey, S. J. (2018). Chest surgery for transgender and gender nonconforming individuals. Clinics in Plastic Surgery, 45(3), 369–380. https://doi.org/10.1016/j.cps.2018.03.010}

Hair growth following surgery

Hair removal and growth is an important consideration as part of both vaginoplasty and phalloplasty surgeries. Vaginoplasty is a procedure to construct female genitals, while phalloplasty surgery is used to construct male genitals. Both procedures often use skin from other parts of the body such as the forearm, thigh, or abdomen, and sometimes the lower back or buttocks if additional grafting is needed. The skin used should have the hair removed before surgery to prevent hair from growing inside the newly constructed genital area.

What skin concerns can arise from vaginoplasty?

If hair grows inside following surgery (intravaginal hair growth), it can lead to irritation and infections. There’s also a possibility of forming keratin granulomas, which are small, hard lumps under the skin, resulting from a build-up of keratin (Dreher et al., 2018²; Yeung et al., 2019³). These lumps can vary in size and might feel like tiny bumps to the touch.

Additional concerns such as warts (intravaginal condyloma) and lichen sclerosis, a skin condition which causes thin, white patches, have been noted following vaginoplasty surgery (Yeung et al., 2019)⁴. Regular check-ups with your healthcare professional can help with early detection and care of these concerns.

What concerns can arise from phalloplasty?

If hair grows inside following surgery (urethra hair growth), this could potentially lead to urinary retention and an increased likelihood of urinary infections and stones forming (Zhang et al., 2016)⁵.

^{2. Dreher, P. C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S., & Rumer, K. L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clinical Anatomy, 31(2), 191–199. https://doi.org/10.1002/ca.23001
3. Yeung, H., Kahn, B., Ly, B. C., & Tangpricha, V. (2019). Dermatologic conditions in transgender populations. Endocrinology and Metabolism Clinics of North America, 48(2), 429–440. https://doi.org/10.1016/j.ecl.2019.01.005
4. Yeung, H., Kahn, B., Ly, B. C., & Tangpricha, V. (2019). Dermatologic conditions in transgender populations. Endocrinology and Metabolism Clinics of North America, 48(2), 429–440. https://doi.org/10.1016/j.ecl.2019.01.005
5. Zhang, W. R., Garrett, G. L., Arron, S. T., & Garcia, M. M. (2016). Laser hair removal for genital gender affirming surgery. Translational Andrology and Urology, 5(3), 381–387. https://doi.org/10.21037/tau.2016.03.27}

Pre-surgery hair removal treatments

Hair removal techniques are typically used prior to both vaginoplasty and phalloplasty surgeries to help prevent skin and health issues. Laser hair removal and Electrolysis are two common methods for permanent hair removal, each with their own considerations and possible effects on skin.

Laser hair removal targets and destroys hair follicles using concentrated light beams, making it effective for dark hair and fair skin combinations and suitable for larger areas. Electrolysis, on the other hand, involves individually treating each hair follicle with an electric current, making it effective for all hair and skin types but also potentially a little more uncomfortable and time-consuming.

What skin concerns can arise with hair removal treatments?

Both hair removal methods come with potential skin concerns. Laser Hair Removal may cause skin irritation, redness, and in rare cases, pigment changes, especially in those with darker skin tones. Electrolysis can also lead to skin redness and swelling. These skin concerns are generally minor and temporary and can be easily managed with proper aftercare.

Feeling comfortable in your skin

Experiencing changes to skin at any time can be both euphoric and uncomfortable. With knowledge on what changes may happen, and where to seek support, we hope to bring comfort back to skin, as quickly as possible.

Everyone’s body reacts differently, so if you’re undergoing or considering gender affirming surgery, talking to a healthcare professional is the best way to manage any potential concerns.