My goal as a Gender Affirming Care provider is to guide my patients to the most effective option for dealing with their dysphoria. Whether Cis-identifying or Trans-identifying, any patient can seek Gender affirming care to ease their discomfort.
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The section below offers education on determining in which case to select Electrolysis work or Laser Hair Reduction by demystifying and clarifying how and for whom Laser Hair Reduction is the best course of action
Laser Reduction Option
Many people ask why they might choose to go forward with the process of Electrology vs Laser Hair Reduction for their gender-affirming care needs. Simply put, both options offer different use cases depending on the needs of each client. It is most importantly noted that Electrolysis is the only method of FDA-cleared permanent hair removal. Laser treatments only qualify as a reduction in hair size and do not qualify as a method to permanently remove hair. Laser Reduction will often initially reduce the size and intensity of an individual hair follicle and, in some cases, cause the follicle to temporarily cease production. This reduction is temporary to some degree and may result in the hair regrowing to full strength after some period of time, determined mostly by a patient's individual physiology. For most patients, the reduction will remain to some degree over a near-permanent period of time, for example, if the hair was initially reduced to 40 percent of its thickness, the hair in the area will likely remain reduced near permanently to about 60 percent after re-strengthening.
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There are some cases where reduction is the better option for a client to achieve the goals they desire for their gender affirmation. The only method recommended for facial hair or surgery preparation is Electrology, as that requires total permanent removal with no chance of regrowth. Through explaining the science and practice behind Laser Reduction below, I will provide situations where Laser Reduction may be the more appropriate action.
Photo Absorption
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Laser Reduction works on a principle of Photo Absorption, the principle that governs light's ability to bounce off of specific objects and create colors which we view. The same way plants absorb selective wavelengths of light and reflect some in the green spectrum, which makes them appear green. White light is comprised of all colors, and objects that are lighter or whiter in color reflect almost all of those spectrums of light back for us to view, whereas black objects absorb all colors within that spectrum and lead to no colors being reflected back. When an object absorbs energy, it must return that energy to the surrounding environment as a principle of physics, and in most cases, light energy is mostly dissipated as heat! This principle is the one that, on sunny days, makes black pavement hot enough to cook an egg, but the white car sitting on top simply warms to the touch.
Photo Absorption and Hair
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With the basic understanding of the underlying mechanics, we can see how this directly applies to Laser Reduction and how the process attempts to treat follicles.
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Lasers are very potent, high-energy light; they affect objects using the same photo absorption principle described above. Lasers attempt to target the hair shaft with this intense energy burst, which forces it to absorb energy and then dissipate it quickly as heat into the surrounding tissue in the follicle. This heat is the treatment that attempts to deal sufficient damage to both the Papilla and Root Sheath, which are what grow the hair shaft in the Epidermis. The hairs treated by Laser Reduction will fall out naturally, and then the Papilla and Follicle will reduce in size, reducing the regrowth of the hair in density and size.​
Problems with Laser Reduction
Problem 1 --
Decreasing effectiveness of treatment
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Laser Reduction rarely gets sufficient treatment to the surrounding tissue to fully kill the hair and will take several treatments to treat follicles comprehensively. As the hair regrows back thinner and smaller with less melanin, which means it will absorb less energy. This means that the level of Photo absorption treatment reaching the surrounding follicle tissue that grows the hair diminishes exponentially with each treatment. Without fully killing off the Papilla and Root sheath within the follicle, the hair will most likely regrow and become stronger over time. Perhaps not back to full strength, but likely back to some extent close to original strength.
Problem 2 --
Skin and Hair Contrast
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Unlike Electrology treatments that directly target the tissues microsurgically, the Laser treatment is applied broadscale to the entire epidermis. This poses a problem for clients whose skin may tend to absorb the Laser light energy. Those clients with darker skin may have the majority of the energy absorbed by the melanin in their skin versus the melanin in their hair shafts, leading to burns and damage to the epidermal tissue. In severe cases, this can cause scarring. This contrast principle is defined by a subjective scale called the Fitzpatrick Skin Type, which is an important metric to be aware of for your skin. Lighter Skin (Fitzpatrick Skin Types I-III) are okay candidates for laser, while Darker Skin (Fitzpatrick Skin Types IV-VI) are not.
Problem 3
Paradoxical Hypertrichosis
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Paradoxical Hypertrichosis is, as the name implies, Paradoxical (opposite of expected) and Hyper (Lots of) Trychosis (Hair Growth), which is a condition where, after receiving laser reduction, clients get significantly more hair growth than before. This happens more commonly with clients in the higher melanin ranges, where the skin is prone to absorbing light. What triggers this phenomenon is the skin and follicles that are currently inactive and not growing hair, absorbing light energy, and getting damaged alongside active growth follicles. This triggers the body's localized healing response, bringing blood, nutrients, and hormones to these inactive follicles and feeds them enough to turn them into active growth follicles. Paradoxical hypertrichosis can become apparent a few months after the treatment that triggered it, which means your susceptibility to the condition may not be known before several more treatments have occurred and even more new follicles have been stimulated.
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Paradoxical Hypertrychosis is rare, but within my own practice, I have worked with more clients than I had expected based on the reported rates. This leads me to believe many people do not report their experiences with the condition, or it is misdiagnosed as hormonal changes (PCOS or Perimenopause).
So, Who is Laser Reduction Best For?
With a more fundamental understanding of the science behind Laser Hair Reduction, the problems associated with it, and potential risks we can analyze exactly which cases an Electrologist might recommend what option for.
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As Electrologists, we do not personally recommend Laser Hair Reduction for surgery preparation, especially PI surgery prep. The chances of regrowth later in life and internalized hair growth are just too high. Some clients with PPT surgery preparation may use Laser Hair Reduction, understanding the risks, since this surgery has a minimal amount of tissue internalization and can mostly be treated even post-surgery. Blend Electrolysis is the best option for surgery preparation as it maximizes treatment of the uniquely shaped and very deep follicles on this tissue.
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We do not recommend Laser Hair Reduction for facial work as rates of Paradoxical Hypertrichosis are higher in this area due to increased blood flow, as well as the fact that regrowth will make constant treatment of the area a lifelong concern. Blend Electrolysis is recommended for facial hair removal in order to ensure the treatment is permanent and efficient.
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We do not recommend Laser Hair Reduction for clients with blond hair, as the process is entirely ineffective on hair that lacks melanin.
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For clients with minimal tanning or lighter skin who are seeking a rapid reduction in large areas of the body, we caution them to make their own choice, but would not rule out Laser Hair Reduction.
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We can recommend Laser Hair Reduction for a specific client very consistently, and that is for:
Trans clients who have begun HRT and are taking a hormone blocker for androgens or have surgically taken care of their androgen production. If these patients also have thick dark, preferably black hair, and very light to pale skin, then they are actually a perfect candidate for Laser Hair Reduction, as the very rapid gains in dysphoria management will be much more efficient than Electrolysis can manage over large areas of the body, such as the back, torso, arms, and legs.