Diversifying Your Consultation

As with all our patients, our transgender and non-binary patients are on their own unique journey. But importantly, these patients’ aesthetic treatments form part of their gender affirmation process.

This specific group of patients undergo several processes impacting their ability to harmonise their internal and external worlds. Practitioners must take some time to research the transition process to understand the uniqueness of these patients’ experiences and what the reassignment surgery process involves. This is NOT just another revenue stream; if you believe it is, you should not be treating these patients. 

How important is this? The Standards of Care for the Health of Transgender and Gender Diverse People of the World Professional Organisation for Transgender Health indicate that gender affirmation and actualisation processes, such as medical treatments, including aesthetics, can minimise the significant negative mental health impact of gender dissonance. This is a big responsibility for practitioners.

As practitioners, we are aware that patients who regularly have aesthetic treatments tend to self-scrutinise more than those who do not. They value self-care and the maintenance of their appearance, and they appreciate the positive impact it has on their psychosocial function. For transgender and non-binary patients, their level of self-scrutiny is far more intense for reasons that have a much greater impact on their psychosocial function as well as their psychological well-being.

My experience 

So how do I know so much about this? Many years before I became a medical practitioner, I qualified as a beauty therapist, makeup artist, wig maker, barber, and hairdresser.

I went on to open a studio in London that specialised in transgender and non-binary makeovers and photography. In addition, I provided makeup and hair styling classes as well as fashion styling and deportment classes. I have helped many people feminise or masculinise convincingly.

Some of my customers became lifelong friends, and I have supported them through navigating their new world and their lifelong journey to be accepted and un-noticed. This may sound bizarre to you, but this is arguably the best result your transgender and non-binary patients could have. The goal is to enable them to continue their normal daily life in the world, work, socialising, and relationships, not being challenged about their gender. The best result is for them to be able to blend into everyday life without raising an eyebrow of a passer-by or a group of teenagers at the bus stop.

Of course, there are always a few exceptions. But care must be taken if you have a patient requesting an extreme look.

Where are they on their journey? What lifestyle factors are driving this request? An ethical judgement should be made based on the information you are given and the impact your treatment will have on this patient’s life.

Often transgender and non-binary patients will report feeling misgendered from a very early age. Some will attempt to override these feelings and become the adult they are expected to become before finally beginning the journey to becoming the person they feel they are. 

This journey may have involved bouts of severe depression, including attempts to end their own life. They may have explored situations in life they felt great shame over, which triggered the abandonment of trying to become themselves. Some people yo-yo between trying to become themselves and retreating into the familiar albeit uncomfortable life that they have been living for years. There are very often broken marriages and family breakdowns, leaving them isolated and alone, which negatively impacts their mental health. These patients are often victims of stigma, social exclusion and marginalisation, causing huge emotional distress. This is despite the introduction by Parliament of the Core Training Standards for Sexual Orientation (2006) and the Equality Act (2010).

These issues are often barriers to general health care and can drive these patients to access treatment from untrained professionals. This highlights further the importance of medical aesthetic practitioners treating this patient group with an understanding of how difficult it has been for them to make the appointment in the first instance. It is important to understand this because when a transgender or non-binary patient comes to you, generally, it has taken this individual a lot of courage to reach this point.

Another unique consideration is to assess whether the patient is fully committed to this stage of their journey. Or identify if this treatment is part of a cycle of beginning to transition and then losing courage and returning to their existing life. Why? Because this impacts the type of treatment you offer. A long-lasting full transformation or a subtle enhancement that can be reversed easily. 

Some patients have a good support network and have been able to begin and continue with the process of becoming themselves in a very straightforward manner. This makes the assessment and administration more straightforward. Some practitioners may feel uncomfortable or find these sorts of intimate conversations difficult. But it is imperative when treating transgender and non-binary patients to establish these facts. 

Consultation considerations: main points
Establish your patient’s pronoun and use it. This helps patients feel more comfortable and relaxed.

Consider the hormonal treatment your patient is on and the effect on the skin’s anatomy and physiology. Be aware that transmasculine patients undergoing testosterone therapy may present with severe acne, further compromising their mental health and psychosocial function.

Identify your patients’ journey and what stage they are at. 

• How long have they been on their journey? 
• Have they had any treatments before? 
• Do they live full-time as the gender they identify as? 
• Are they aiming for gender reassignment surgery? 
• What sort of support do they have?
• Have they undergone or are they planning to undergo any facial reconstructive surgery in the near future? 

 
Remember, very often, for transgender patients, facial modifications are of a higher priority than the gender reassignment surgery and very often come before the surgery.

Are you, as a practitioner, competent enough with your facial anatomy knowledge and technical ability to feminise or masculinise features with aesthetic treatments?

If you do not have the necessary knowledge and skills, only attempt these treatments with the appropriate training from specialist practitioners such as Dr Vincent Wong.

For practitioners to offer optimal care, educational resources can be accessed to familiarise themselves more fully, treat appropriately and understand transgender and non-binary patients. These courses are designed to reduce care inequality and discrimination, increasing understanding and consultation techniques. These are available from various bodies, including the RCN and Royal College of Physicians, and independent providers such as Future Learn (Online) Transgender Health Care: Caring for Trans patients.

Transgender and non-binary patients undoubtedly bring their unique set of challenges but can be some of the most rewarding patients to treat. They are frequently the most appreciative patients with the highest level of patient satisfaction. Educated caring practitioners and their treatments often become integral to these patients’ positive, life-changing journeys.