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Diversity is Good Business: Treating the Transgender Client

Contact Author Danné Montague-King, DMK

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With Caitlyn Jenner’s recent revealing as a transgender woman and undergoing the process of transitioning, she has inspired and compelled individuals to embark upon their own gender journey. This has led to a swell of new business in the skin care industry marketplace, as these clients often need esthetic services to refine their look or compliment their surgical procedures. This article will discuss treatments and recommendations for the transgender client, but first it is necessary to define the identity of the client and more importantly how to approach them in the best, most reassuring manner.

Understanding the Difference

Transgender is a catch-all term for modern times and is often confused with the term transsexual. Transgender refers to an individual who identifies or expresses themselves with a gender opposite to which they were born. This doesn’t necessarily mean they are transsexual, which involves medical assistance to transition to the gender to which they identify.

Clients that identify as transsexual will most likely be interested in hormone therapy, gender conversion surgery or both. Hormone therapy can greatly impact their skin condition. Some that undergo hormone therapy do not opt for surgery, which requires additional psychiatric evaluation.

Hair Removal or Grooming

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Male-to-female transgender clients are often interested in hair removal services, with permanent hair removal and waxing being two desired treatments. Conversely, female-to-male transgender clients often are interested in growing facial hair for a more masculine visage. This will happen eventually with hormone therapy, though the degree will differ on an individual basis. For transsexual clients, all genital hair must be permanently removed before surgery. This is most often done via electrology, as it is still the only real permanent method.

Skin Care Treatments

Male-to-female transgender clients may seek skin resurfacing and full-body skin refining treatments. Extremities such as hands and arms must be treated with resurfacing procedures that are not invasive such as retinoid/AHA combos, pigmentation inhibitors and the new methods that stop melanogenesis at the Golgi apparatus where it begins.

Female-to-male transgender clients may experience breakouts or back acne as part of the initial hormone readjustment. Importantly, tretinoin and other acne drugs could interfere with their cortisol levels and hormone cascade. Therefore, benzoyl peroxide-free acne treatments will be especially valuable here.

Body Contouring

Most transsexual clients will be on hormone therapy, which can result in weight gain. Male-to-female transsexual clients desire body contouring and weight loss treatments that do not interfere with the desired curves. This could be done with cryotherapy. Further surgery such as jaw shaving and submalar implants could be considered along with breast and buttock enhancement.

Conversely, female-to-male transsexual clients are ideal for body sculpting around the hips and the waistlines while they work out their upper body for muscle tone and a more masculine silhouette.

Hand Treatments

Male-to-female transgender clientele are often interested in treatments that smooth the appearance of their hands. The client’s own fat can be transferred to the backs of the hands, disguising masculine ropey veins, and smoothing the hands to a more feminine contour. Few surgeons do this procedure, most preferring fillers. In my experience, fillers are unpredictable. They can migrate and are often more trouble than they are temporarily worth. Fat transfer is somewhat permanent if the procedure is done properly and the adipose fat cells are not killed off during the process. Around 30% of the cells will survive over time and two to three touch-ups later can ensure long-lasting results. There is twilight anesthesia involved, but performing enzymatic hand treatments a day (or sooner if working directly with the surgeon) will lock the fat into place and nourish it with fresh oxygen from their own body, kind of like an internal protein-rich plasma treatment.


Fillers in general also lock into place and survive much longer in healthy skin that has achieved homeostasis via treatments. Many male-to-female transgenders want to remove deep masculine lines in the frontalis (men’s stress point) and imagine botulinum toxin will eradicate the problems immediately despite the three to 10 day time it takes to kick in.

Despite its miracles, botulinum toxin does not refine coarse, large-pored skin or solar keratosis common to men who have spent most of their years in the sun and are now deciding to give into their feminine self. Therefore, a removal of the redundant cuticle (a draining of the hardened sebum that forces the aperture of the pore open) and a general tightening of the tissue is recommended before injectables.

Makeup Training

Transgender clients will most likely have varying degrees of makeup skills. Some might have experimented with drag makeup, which while glamorous and skilled might not serve a woman well in her daily lifestyle. Meanwhile, others might be ineffective in applying basic makeup; therefore, a compromise between both mindsets will give you a happier client.

Silicone-based makeup with no oil and high pigmentation content has the most coverage with minimal application and no oils to attract bacteria or the frequent ladies room visits to powder down an unfeminine shine. It feels that nothing is there, yet it hides everything while the skin takes on a different structure during hormonal changes. Many transgender people have heavy beard lines while testosterone is still predominant. This type of makeup is an ideal cover if a neutralizer tone is used first, then the main skin tone applied over it. The same goes for broken capillaries, hyperpigmentation and other skin anomalies.

Privacy and Acceptance

Privacy in your clinic or salon is important. I recommend giving the client a chart to fill out detailing their expectations, medical history and prescription drugs, if applicable.

Treat the client as the gender they exhibit when visiting your spa or salon. If a client appears to be dressed as a man or a woman, treat them how you would that gender. If you are ever unsure about pronouns, feel free to ask them. They will most likely be happy to tell you which ones to use.

Once you get to know them and guide them to their “better-appearing self,” it will become easier and a huge sense of accomplishment will be yours along with the extra income this special client brings in.

With your patience, your effort and most importantly your understanding, you will have a long-time client. Remember that this is a major lifestyle adjustment and often a lonely journey. Your role will include supporting, counseling and acting as a sounding board to your client. Professional treatments and inclusion into your space will ensure a long-term client whose gratitude will have no boundaries.

Constant care through emotional times will not only increase a valuable client base, but it will also earn you infinite love and gratitude from people on a very lonely journey.

Giving Confidence

In our field, the focus is confidence from the outside in based upon the principle that when people are free from skin anomalies that make them want to hide, such as acne, scarring or premature aging, they feel empowered to go out and face the world with a fresh, new perception of themselves.

We provide services that help people along their individual pathways to success and fulfillment. As the first global ambassador for the Harvey Milk Foundation, I can only say there is no better way to elevate our profession than to change lives by giving them confidence from the outside in. Champion the rights of every human to be exactly who they are.

Danné Montague-King is the founder of DMK Skin Care, which is based on his “remove, rebuild, protect, maintain” concept. He is a known educator, author and presenter.

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