trans

Insurance and medically necessary electrolysis

by

Our office sees a lot of clients that require electrolysis for medical conditions. Generally speaking, insurance companies specifically exclude all electrolysis from coverage. However, there is one area where insurance companies are increasingly allowing coverage – hair removal prior to vaginoplasty and/or phalloplasty. If you have a medical need for another reason, read on.

We’ve had trans clients get approved by several insurance companies in Western New York, including Excellus, Bluecross/Blueshield, MVP, Aetna, and private underwriters through companies that provide benefits directly, like StarBucks.

Our office does not take insurance directly and, to our knowledge, the only office in the state that does, is at Mt. Sinai, but we can still help you get reimbursed if you choose to do your electrolysis here. To the insurance companies, we’re simply an out of network provider, which means that you’ll pay us, we’ll give you an invoice to submit to the insurance company, and then the insurance company will reimburse you.

Prior to having electrolysis, you’ll need to contact your insurance company’s customer service department and tell them that you’re having surgery and that you have a medical need to get the hair removed prior to surgery. The insurance company will want the same documents that you need to qualify for surgery – ie, the two letters required by WPATH guidelines, as well as a “letter of medical necessity” from your surgeon, stating that it is required. Your surgeon knows what this letter is and how to write it. We have also occasionally been asked to submit one from our side of things in addition to your surgeon’s letter, and, thus already have one prepared.

After you submit this information to your insurance company, they should give you a letter stating that you have prior authorization to get the work done. You may need to argue with your insurer some, since you do have a need which conflicts with their exclusion policies, and, at least one insurer has been steadfast in their refusal to cover pretty much anything trans related.

Once you’ve received your prior authorization, you can start coming in to get work done. Again, you pay us, we give you an invoice, and then you submit that invoice to the insurance company for reimbursement, after which, they send you a check. You need to be timely with submission of your invoices, however, or the insurance company may deny reimbursement even with prior authorization.

For people seeking medically necessary hair removal for other reasons. You have an uphill fight with your insurance company, but it’s possible that you may get similar reimbursement coverage if you are persistent enough.

Genital surgery preparation for trans people

by

Since the inclusion of coverage for SRS/GRS/GCS genital surgery for trans people, the number of people seeking surgery has increased immensely.

In a recent discussion between an international group of professional electrologists, including our own Keri and Natalie, we have become concerned that many surgeons are telling their patients NOT to bother with hair removal or that they only need three months worth of removal before surgery, because we’re seeing an uptick in post-operative clients seeking hair removal. Particularly for trans women seeking vaginoplasty using the penile inversion technique, postoperative hair can be quite challenging for the electrologist and very distressing for the client, since the hair is now inside of the body and pointed at an angle away from the surface.

Hair concerns for trans women after genital surgery:

Imagine someone laying on a bed as we look down from an overhead view, imagining being able to see through the pubis and into the neo-vagina:

Anterior view of neo-vagina with hair growing inside after genital surgery
Anterior view of neo-vagina with hair growing inside after genital surgery

What we see here, is the skin that was used to make the vagina now has hair growing, pointing inward. This hair can cause pain during vaginal penetration (including dilation), bleeding, infections, etc. Sometimes, depending on the angle and length of the hair, it can also grow to hang out of the vaginal opening, increasing dysphoria. Because the hair is now inside the vagina, removal requires the use of a speculum to spread open the vagina, specially angled lighting just to try to see the hair, probes bent back upon themselves to try to insert at a proper angle, and a lot of patience on the part of the electrologist and client as they attempt to treat the hair. Because of the difficulty involved, most electrologists are not capable of doing the work and most surgeons will tell their patients that it is simply unfortunate and that nothing can be done about it.

Why does this happen? For starters, while surgeons may be quite knowledgeable and skilled in the practice of surgery, most don’t really understand the process of hair removal that well. A mechanic may know how to rebuild your engine, but that doesn’t mean they will do a good job painting your car. Even if a surgeon DOES fully understand the process, many of them fail to effectively communicate with their patients, giving misleading or ambiguous preoperative instructions (advice on how many sessions, how early to start, illustrations of what areas to cover, etc are often poor). Because of their failure to convey good information, many MTF surgeons see poor outcomes with patients that had some removal, so some surgeons now instruct their clients not to bother with any hair removal at all before surgery, promising they’ll either scrape or cauterize all of the hair during surgery. The reality, is that nobody is 100% perfect and there is only so much time available during surgery to remove hair, and often hair ends up being left behind to grow.

Here’s the bottom line: to ensure that no hairs are left dormant and untreated, it takes approximately 10-14 months for all of the hair in the genital area to go through a full dormancy cycle. This means that, at a minimum, you should give your electrologist at least a year, preferably two years, to remove all of your hair prior to your surgical date. Yes, we understand that you want surgery as soon as possible and some surgeon you’ve contacted can get you in six months from now… but you really should wait, so that your hair can be properly removed, if you want to be sure that you don’t end up with postoperative internal hair. Also, laser is NOT approved for permanent REMOVAL of hair, only for “permanent REDUCTION” of hair. We frequently see hair that grows back after laser, sometimes years later. Five or ten years from now, laser can put you in the same situation as if you did no hair removal at all.

If you want to be absolutely certain that you will not have hair in your vagina, it is imperative that you start electrolysis, and only electrolysis, at least a year before your intended surgery date.

 

Hair concerns for trans men after genital surgery:

Phalloplasty usually involves taking skin and tissue from the forearm or thigh and then using it to make a penis. Often, it is not possible to extend the urethra through the penis without also making an urethra from the skin as well. Hair on the penis can generally be worked on after healing, since the skin is still at the surface, however, the skin being used for the urethra should be perfectly hairless before surgery. Like in the case of trans women above, once it is inside the body, it is tremendously difficult to work on internal hair and it can cause very similar problems – discomfort, bleeding, infection, stricture, etc. To our knowledge, nobody is even attempting to removal hair from the urethra after surgery, but fortunately, FTM surgeons seem to be much better in understanding, illustrating, and communicating pre-surgical needs.

Thus, the best plan of action is to come in at least one year, preferably two years, before your intended surgical date.

Non-facial trans hair removal issues

by

While trans women are concerned about their hair appearing too masculine, particularly their facial hair, and it triggering their own dysphoria or having to deal with it in social situations or rejection from strangers, there are two other areas to consider as well.

The first is the breast area, particularly for trans women that haven’t started hormone treatment yet. Once the breast buds start to develop, this area can become particularly sensitive and, while HRT will likely reduce body hair, there’s no guarantee that it will reduce body hair to the cis female norm, particularly the heavier, terminal hairs. Some of the hair in this area is very androgen sensitive and HRT will likely reduce a lot of it, but hair around the areola tends to be driven by adrenal production rather than androgen production. While these hairs can be targeted at any point, you may wish to consider having them done prior to starting HRT if you haven’t done so already, as the pain will be greatly less.

The other area is the genitals. At least 6 months prior to SRS/GRS, most vaginoplasty surgeons recommend removing hair from the shaft and base of the penis, as well as the scrotum and perineum. They will scrape the skin during surgery, but the likelihood of removing all of the follicles is small. If all of the follicles are not destroyed, when the skin is reused in the neovagina, the result can be internal hair, causing pain, discomfort, bleeding, an increased risk of infection, and general unhappiness with the results for the patient and her partners.

At Emancipated Electrolysis LLC, taking care of our trans clients needs in an affirming way is one of our primary missions. For more information about permanent hair removal or to book an appointment, contact us at hairinfo@EmancipatedElectrolysis.com or call us at 585-270-5230 and finally be freed from unwanted hair.

Transgender beard removal

by

Perhaps the most difficult job in electrolysis, is the removal of an androgenic beard, whether caused by PCOS in cisgender females, or the testosterone in a trans person or cisgender male.

Unlike menopausal facial hair growth that many women experience, a true beard is very resilient, with a firm follicle structure and coarse, dense hair.

Proper settings and insertions are vitally critical in such a situation, and androgenic beards are best handled by people that already have experience in doing them. They simply aren’t the same as when grandma wants to have a few hairs on her chin removed and you aren’t going to get very far if the electrologist treats them as such. Many electrologists simply aren’t aggressive enough in their treatment and are content to routinely treat the same hair over and over again, becoming comfortable with the idea that their job is some sort of ongoing maintenance, rather than something to finish. Most electrologists don’t like to work longer sessions as the dirty little secret is, they make more money off shorter ones.

Many people seek to have laser first, and that is fine, if all you are looking to do is reduce your hair. Sometimes, it is recommended to start with laser and then finish with electrolysis as a means of saving money. At best, that approach may save some time, but it isn’t likely to save much money, as the remaining hair will be thinner and more frail, with a deeper and more traumatized follicle that takes a longer time to individually treat than if laser had never been done. We feel that, given the price of laser and the costly contracts many salons try to hook people on, we can help people more effectively for less than what it would cost to have laser first and then finish with electrolysis.

At Emancipated Electrolysis LLC, the proper treatment of androgenic beard hair is so important to us, it is what we specialize in. Yes, we are more than happy to work on grandma too, but we get the most enjoyment out of helping those with the most serious hair removal needs. While most electrologists shy away from such projects, we thrive on them. Whether you are trans, have PCOS, or are a cisgender male, we are your safe, supportive, private resource to put a permanent end to your beard problems.

Email us at HairInfo@EmancipatedElectrolysis.com or call us at 585-270-5230 to schedule a free consultation, and finally be freed from your unwanted hair.