Qualitative Study Describes Hirsutism-Related Stigma and Treatment Barriers in Transfeminine Adults

A qualitative study in JAMA Dermatology examined lived experiences of hirsutism and its treatment among transgender women and nonbinary adults assigned male at birth. Researchers conducted semistructured interviews across three clinical settings in Atlanta, Georgia, between February 7 and June 26, 2023, and analyzed the interviews thematically. The 18 participants included 17 transgender women and one nonbinary adult; mean age was 38 years, with a range of 22–68 years.

Fourteen participants self-rated their hirsutism as clinically significant, but only one reported a clinician diagnosis. Participants described discrimination and rejection related to visible hair, as well as avoidance of social and romantic interactions in anticipation of these experiences. Hirsutism interfered with feminine gender expression and contributed to gender dysphoria. Many described efforts to conceal visible hair, including keeping razors or tweezers readily available.

Reported barriers to permanent hair removal included appointment burden, clinician attitudes, limited transgender-inclusive services, cost, and lack of insurance coverage. The findings highlight concerns clinicians may address when discussing hair removal and gender dysphoria. The authors called for clinician education, expanded inclusive services, and insurance coverage. However, the small, geographically restricted qualitative sample cannot establish the prevalence of these experiences or the effectiveness of proposed access improvements.