Lived experiences of hirsutism and hirsutism treatment were examined in 18 transgender women and nonbinary adults assigned male at birth, recruited from 3 clinical settings in Atlanta, Georgia, between February and June 2023, using semistructured interviews analyzed via thematic analysis.
Participants described hirsutism-related stigma (discrimination, social and romantic avoidance, gender dysphoria), extensive concealment behaviors, and major barriers to permanent hair removal—including cost, lack of insurance coverage, appointment burden, clinician attitudes, and absence of transgender-inclusive services. Only 1 of 18 participants had ever received a clinical diagnosis of hirsutism, despite 14 self-rating clinically significant levels.
Very small sample (n=18) from a single city (Atlanta, GA), limiting generalizability. Self-reported hirsutism without clinician-confirmed grading for most participants. No quantitative outcome measures or comparator group.
Clinicians should proactively screen transgender women and nonbinary individuals assigned male at birth for hirsutism, as the condition is severely under-diagnosed in this group. Advocacy for insurance coverage and referral to transgender-inclusive permanent hair removal services are important steps to reduce significant barriers these patients face.
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