This piece is part of our series exploring the ins and outs of transitioning and how trans and nonbinary people define it for themselves.
Just as the COVID-19 pandemic made landfall in the United States, ingrown stubble was taking over my life. A few months prior, my doctor abruptly informed me that I was no longer her patient because I now lived on the other side of the country. Without viable health insurance to see a new white coat here in New York City (let alone one who understood proper care for trans people), I lost access to the medication that had relieved all the skin woes of my teenage years: the sweet, teal estrogen pills and the rather drab-looking testosterone blockers.
Five months later, I was still without estrogen. I was exceedingly privileged to be working from home during the global pandemic's historic rates of unemployment, and became obsessed with a stay-at-home game of I Spy, compulsively inspecting fields of coarse black hair blooming on my chin, gumdrop-size pimples prairie-dogging across my forehead, and oil slipping down my nose. I felt like I was de-transitioning, losing the clear skin I'd cultivated since I started hormone replacement therapy (HRT) five years back. It was a realization of how much estrogen had done for my mug.
I was able to get into an LGBTQIA+ community health clinic for a new set of scripts, and lo and behold, my skin was back, baby! I had a newfound appreciation for the contributions of HRT toward my mental health. And I'm far from alone.
Ready for your new skin, courtesy of estrogen? HRT can have a big impact often positive, sometimes less so on your complexion, so let's hop right into it.
How Estrogen Can Change Your Skin
Vera Blossom, a Filipina trans woman from Las Vegas, experienced something similar when she lost her health insurance. 'When I didn't have access to estrogen for two and a half months, that was when I really noticed how it was helping my skin', says Blossom, a journalist and beauty enthusiast.
The changes we experienced while on and off estrogen highlight HRT's rather speedy reduction of the skin's natural oil, called sebum. 'Many trans women note that their skin feels softer, firmer, more elastic, and more hydrated after starting estrogen and/or progesterone', says Howa Yeung, a dermatology professor at Emory University in Atlanta, who has researched the effects of feminizing HRT on the skin.
That's not all: 'It helps with acne and increases collagen', says Brian Ginsberg, a board-certified dermatologist based in New York City, specializing in issues experienced by trans patients.
So when will trans women's faces start enjoying these positive effects? According to Ginsberg, the effects can begin to appear as quickly as a month after initiating HRT.
Despite estrogen's perks, not all potential reactions are positive. (Blossom, for example, also eventually encountered an unanticipated side effect: She says it made her 'face look kind of gray.') Here's a rundown of what new estrogen- takers might experience:
First, increased dryness can be wrought by the hormone. And Ginsberg says, especially for those already prone to dry skin, the hormone 'can take them in a bad direction, [and cause] an overwhelming sense of dryness.' As for whether estrogen has potentially disparate effects on skin tone, 'there's been mixed data', he adds. 'Some data says that darker skin tones are more prone to oily skin. You might think they're more tolerant to estrogens, having a higher baseline of oil.'
Another potential side effect of HRT is melasma, defined by Yeung as 'a common skin disorder with blotchy darkening of the cheeks, chin, and forehead.' As many as one-half of cisgender women who are pregnant or taking contraceptive medications may develop melasma, Yeung says. He adds that 'melasma is influenced by genetics and sun exposure [and] occurs more commonly in patients of color, including patients of East or South Asian, Hispanic, and African American descent.'
However, given the lack of research, it's unknown whether trans women on HRT experience the condition at similar rates.
Other issues some may face while on estrogen include developing fragile nails, Ginsberg says, which you may start experiencing 'several months' in.
Like me, Blossom experienced frustrating complexion concerns after going off hormones. Her face, she recalls, went from feeling 'good and glowing', courtesy of the hormones prescribed to her in 2018, to feeling 'thick and hard' when she became uninsured and subsequently stopped estrogen in 2019. 'My skin was just red and dry. It was horrible. I tried all these masks, but I did not feel like myself', she says.
Ginsberg says he is unaware of any current research on the experiences of those like me and Vera; that is, what happens when trans women take breaks from HRT.
Your daily skin routine can be a great opportunity to catch the development of any complexion concerns early, which is key for melasma. Consulting a board- certified dermatologist as soon as possible is key, says Yeung.
For melasma, he recommends avoiding the sun as much as possible and applying daily mineral-based, broad-spectrum SPF 50+ sunscreen that ideally has zinc oxide and titanium dioxide as active ingredients and iron oxide as an inactive ingredient. Medical treatments are available too, so speak with your dermatologist to find out if they're right for you.
Beyond looking out for medical issues, a daily routine is important for cultivating the general health of your skin. Caring for our skin when medically transitioning should not be dogmatic, says Ginsberg. 'There aren't skin-care routines unique to hormone use. You need to reflectively respond to what your skin [needs] at the moment', he explains. 'If your skin is dry, use gentle products. If your skin is oily, you don't want to neglect moisturizing. But you don't want to use products that are too heavy or clogging.'
How Estrogen Can Change Your Hair
People taking estrogen will notice that it aids with hair loss and thinning on our faces and bodies while thickening it on our heads. (Thank God!) Estrogen's effect on hairiness peaks around six months after starting the HRT, says Ginsberg, although he's seen it take longer and 'it's really hard to predict' the extent to which you'll lose hair. Five years into my transition, whiskers still poke through my chin after five o'clock the nerve!
Blossom has experienced her own issues with facial hair management since being on HRT. However, she says it doesn't seem to be directly linked to the molecule's effects, but rather to a change in her behavior when it comes to the use of cosmetics. After she started taking hormones, Blossom began shaving every day, in contrast to her prior tendency to let her facial hair grow out, only using a razor once every two months. The outcome? It was rough on her face.
'I get super clocky', says Blossom, meaning that others may presume she is trans, not cis. 'And that doesn't feel good. Getting knicks is the only way I feel dysphoric when shaving.'
Shaving is somewhat of a double bind for trans girls. It, at once, causes some of us to feel more affirmed and less affirmed in our own skin. A close shave removes our stubble, yet also presents the risk of razor burn, an annoyance caused by razor-chopped hairs curling back under the skin and growing under the surface. 'For the most part', says Ginsberg, 'estrogen is going to shrink the size of the hair, making it less likely to [for you to get] razor burn.' But, among folks like Blossom, 'who have drier skin, it can be more sensitive and more likely to get inflamed.' It's not an ideal situation when the legitimacy of our womanhood seems so often to be determined by others, based on our looks.
I'm anxious about how others perceive me if my chin is riddled with marks that leave me open to scrutiny. But my own self-perception is also not so forgiving. Throughout my childhood, I absorbed images of swashbuckling Chad-types lathering their jaws white in advertisements. I can't help but feel my femininity to be heretical when I perform a masculine-coded ritual day after day. Some mornings, I speed through the shaving process like my breath depends on it, passing on shaving cream or hastily dragging the blade. As a result, the already-promised crimson knicks and rosy burns are spread by my own doing.
There are strategies that a trans woman or transfeminine person can employ to give their skin a fighting chance against the razor. There are non-razor options, such as laser, electrolysis, or hair-removal creams, either by prescription or over-the-counter.