Facial hair plays a meaningful role in gender affirmation for many transgender and gender diverse (TGD) individuals, influencing both physical presentation and psychosocial well-being. Prior research on facial hair in gender-affirming care has typically focused on binary identities or on isolated aspects of hair management, with little exploration of the comparative use and satisfaction with both facial hair growth and removal interventions in TGD populations.
In a national survey of transmasculine adults, over 85% reported facial hair as important to transition, though dissatisfaction with density was common and 44% had pursued enhancement methods, most often topical minoxidil.1 In a prospective cohort study, 36% of transmasculine individuals initiating testosterone also used minoxidil, with most noting improved upper lip and chin hair density.2 Conversely, transfeminine and nonbinary patients often seek facial hair reduction, as estrogen rarely eliminates growth.3 Laser hair removal and electrolysis are frequently required prior to gender-affirming surgeries and may reduce dysphoria, though cost and insurance coverage remain barriers.4,5
We sought to address these gaps by surveying a broader TGD population. This study was approved by the Temple University institutional review board. A brief, anonymous survey was administered between September 2024 and January 2025 using QR code flyers placed in dermatology and gender-affirming care clinics. Eligible participants were TGD-identifying adults aged 18 or older. Respondents were asked questions regarding the importance of facial hair for gender affirmation, history of hair growth or removal interventions, perceived effectiveness, satisfaction with current facial hair, insurance or financial burden, and adequacy of support. The survey instrument was validated by peers, although no formal validity assessment was performed.
Among 24 respondents, 79% (19/24) rated facial hair as moderately to extremely important for gender affirmation. Effectiveness and satisfaction were originally assessed using 5-point Likert scales (none, slight, moderate, very, extremely). For analysis, responses of none to moderate were categorized as “limited,” while very or extremely were categorized as “high.” Minoxidil (topical or oral) and biotin were the most used growth methods. However, only one respondent rated any growth method as highly effective. Hair removal was more common and often multimodal, with shaving (92%) and laser hair removal (83%) being the most frequently reported [Table 1]. Four respondents rated the effectiveness of removal methods as high, while eight rated it as limited. The majority (79%) of respondents reported limited satisfaction with their current facial hair status in relation to their gender identity.
Financial and systemic barriers were common. Nearly all (96%) of respondents reported having at least some degree of difficulty managing facial hair–related costs. When asked whether they felt adequately supported in managing facial hair in relation to their gender identity, responses were mixed: nine (38%) said yes, five (21%) said no, and ten (42%) were unsure [Table II].
These findings highlight the importance of facial hair in gender affirmation and the use of both growth and removal methods across TGD populations. Satisfaction with current facial hair was generally limited and was further compounded by cost and insurance barriers that affected most respondents. These patterns emphasize the need for increased awareness of gender-affirming hair care, better clinical guidance, and broader insurance support for both facial hair growth and removal services. Dermatologists, increasingly recognized as key members of gender-affirming care teams, may encounter facial hair related challenges in practice but often lack structured guidance or education on TGD patient experiences.6 This study is limited by self-reported data and small sample size. Nonetheless, future research should include larger samples and further examine the comparative effectiveness of interventions and systemic barriers limiting dermatologic access for TGD individuals.