Skin care for transgender women

I'm pleased to announce we are now offering an instructional video covering makeup and skincare called Becoming You: The Fast Track to Your Female Face. It's a major expansion of the materials below.

When I started my transition, I undertook a crash course on cosmetics and skin care. The following advice is based on my trial and error. I remember going to the drugstore and looking at the cosmetics, thinking, Oh my God, how am I supposed to decide? That coupled with the fact I was totally paranoid that I'd see someone from work or something made me reluctant to stand there and comparison shop or read labels.

So, I started doing my homework before I went. I trotted down to the local bookstore and started looking at books on cosmetics. It was almost as confusing as the cosmetics aisle itself. Seems like every model and celebrity had some book, not to mention the infomercials and all the conflicting information I was finding in fashion magazines.

If the canvas is bad, the paint doesn't matter

It didn't take me long to figure out the incredibly obvious: if your skin isn't in the best shape, you're facing an uphill battle. I'm pretty sharp that way. It's the canvas you're painting on was the standard metaphor. I guess everything has a cliched catch-phrase, kinda like "woman trapped in a man's body."

I'm a 30-year-old white MTF transsexual with very fair skin. Not only is my skin sensitive to a lot of chemicals, it's also on the oily side. Oh, and I burn almost the instant I step into direct sunlight. Lucky me. Your skin is probably different in one way or another, so not all of this may apply to your skin type. My recommendations work well for me, but your mileage may vary. However, you might find some useful tips for yourself.

What I learned

Things you don't need to waste money on:

  • wrinkle creams
  • rejuvenating creams
  • eye-lift creams
  • astringents
  • toners with irritants

I want to pass without make-up, or with very little on. The healthier you are, the easier this is. After all, make-up can only make up for so much.

Best thing you can do for your beauty:

  • Stop smoking. Now.
  • Exercise.
  • Eat right.
  • Use sunblock.
  • Have a skin care routine you can live with, and stick to it.
  • Don't feel you have to have skin care line loyalty. There are good and bad products in every line. Are all your clothes from the same maker?
  • You don't always get what you pay for. Cheap products often work as well as really expensive ones.
  • Keep an open mind about changing your skin care routine, etc.
  • Be wary of ads (they just love claims and catch-phrases) and celebrity spokespeople.
  • It's almost impossible to create the illusion of healthy skin. It needs to be healthy on its own.
  • A lot of transsexuals have large pores, which is a fairly masculine skin characteristic. I found that hormones helped a bit with this problem.
  • Don't forget your lips when applying sunscreen.
  • Fashion magazines can be hit or miss. I've gotten some good tips from them , but watch out-- a lot of stuff they recommend is hopelessly trendy and best only once you've mastered the basic and feel comfy experimenting.

What works for me

Here's my twice a day routine.

  1. Wash face. I use Clean & Clear Sensitive Skin Foaming Facial Cleanser. Use tepid to warm water. Never ever hot (it can bring up broken capillaries). Never cold (closes pores when they need to be open). Rinse well. If I've been wearing makeup, I make sure it's all off around the eyes. While it's best to remove it all with soap and water, sometimes mascara can be a bit stubborn, so I run a little eye makeup remover under my eye so I won't get a lot of flak at work. Then I rinse that remover off.
  2. Blot lightly with a towel- never scrub or wipe. Leave skin damp.
  3. Use a toner. I use Neutrogena Alcohol-Free Toner on a cotton square, which I brush on in upward strokes per instructions. Feels nice. You always want to clean by working in the opposite direction wrinkles form (usually upwards).
  4. Inspect. Look for ingrown hairs and try to help them out gently. Same with blackheads or blemishes.
  5. Put minoxidil on hairline.
  6. Moisturize. I use a moisturizer with SPF 15 in the morning, and a moisturizer with AHA in the evening.

All this takes about five minutes longer than I used to take in guy mode. No biggie.

Your skin and hair removal

Transsexuals have a unique skin problem to deal with: hair removal. Laser and/or electrolysis can really take a devastating toll on your skin in a number of ways. You are doing nothing short of burning skin and frying collagen, but hey, it has to be done. See my hair removal section for tips on how to make the whole process as painless and as low-damage as possible.

Also, if you are really serious about transitioning and have not started hair removal, START NOW! I wanted to be done when I went full-time, because I heard several friends say how horrible it was to try to cover up their facial hair, which they had to grow out for electrolysis, plus they weren't supposed to wear make-up after. It's the hardest part of the whole transition, I think, because it can be prolonged, painful, and expensive. The sooner you start, the sooner you're done.

Let me talk briefly about my skin care regimen as it involved electrolysis. When I first started, I had very thick facial hair. The redness and swelling were so prevalent as I got it cleared that people asked what was wrong with my skin. "Shaving rash" was my typical answer. I did not have the option of starting hormones when I started electrolysis, which most certainly added to the amount of time it took. I did about two hours each week for about three and a half months before my whole face was cleared at once. Then I averaged about 4 hours a week (17 hours a month to be exact) for the next six months just to keep up. I wouldn't recommend doing more than about two hours at once-- I did a couple of marathon sessions that left me looking like I scraped my chin or swollen enough for co-workers to say I looked like I'd been slapped around.

Try to avoid shaving if at all possible. If you can get in often enough to keep up with new growth, you'll save yourself time. The longer a hair is allowed to grow after it surfaces through the skin, the stronger the root gets. For me that meant going in 2-3 times a week for a while. Shaving can irritate the skin, especially if it's raw from electrolysis already. Watch out for shaving creams, too. Many contain menthol or other skin irritants which will only make matters worse. Your best bet in my opinion is an electric foil razor.

Immediately after electrolysis, my electrologist would swab my face with witch hazel to clean off any blood and disinfect the open skin. Then she'd rub in a great product called Simply Smooth, which is made for use after electrolysis and is very soothing. It also has a light beige tint which covers some of the redness. Her usual routine was to then apply aloe vera gel with menthol to clients' faces, but this burned my skin terribly. Instead, I would bring my own generic drugstore aloe vera gel and would liberally dab that on as much as possible.

No makeup!

You shouldn't use makeup on your face for at least 24 hours after electrolysis, but I found my face needed about 72 hours to recover. Also, while I found EMLA cream to be an indispensable part of my pain-management, I found it would make a couple of layers of skin in the creases between my nose and corners of my mouth peel every time. I eventually found that by covering these lines with scotch tape before applying EMLA, I could avoid this peeling.

No sun!

It's imperative to stay out of the sun after electrolysis. I found that anything besides aloe vera gel burned my skin, even the mildest moisturizers. Sunscreen REALLY burned, so I did everything I could to stay indoors after zapping. I find it best to do zapping on Friday after work so my face can recover over the weekend. Plus, that way I was going home in the dark (avoiding the need for sunscreen)

Also, I find that being in the sun (especially once I started hormones) made me freckle like crazy. I found it best to avoid this, because freckles (especially on my upper lip made me look like I still had facial hair there), plus, very pale skin tends to look more feminine in general, so it helps me pass.

A reader writes: The "average" application of any skin product gives approximately half of the listed SPF rating. This occurs since much more product is applied when testing the SPF by the manufacturer to give a rating. To get an effective protection of 15 SPF, I look for products that are listed as having a 30 SPF.

Ingrown hairs

You're going to want a good pair of tweezers. Don't bother with those lame two-dollar jobs they have in big jars- go for the good ones. You might want to buy a pair of forceps like the ones your electrologist uses. Ask him or her what kind they use, or even buy a pair from them.

Some pointers about tweezers: between zapping sessions, you're going to have the occasional ingrown hair that's about to pop out. You'll see that sucker just under the skin, and you're going to want to get it out. Resist this temptation with all your might! If you go digging for ingrown hairs, you stand a very good chance of damaging your skin. Your best bet is to keep your skin exfoliated so those hairs can pop out more easily on their own. Plus, as the hairs start getting weaker, even the slightest tug will bring them out root and all, which means they have to regrow before they can get zapped, which means it'll be that much longer till you're done.

I find that if they're just below the surface, I could get them out by scratching LIGHTLY. Be sure to have your nails totally clean if you're going to do this, and NEVER scratch or squeeze hard enough to dig into the skin or draw blood. That would fall under the category of skin damage. Also, sometimes you'll have what look like blackheads or hairs that pop out. They call these tombstones-- it's usually bits of hair and gunk that didn't get pulled out when that follicle was zapped. Sometimes even an entire unattached hair will push its way out. You get to the point where you can sort of tell if it's a live hair or one of these tombstones. If you gently pull on one of these with a pair of tweezers, it comes right out. If there's any tugging at all, stop pulling and let your friendly zapper take care of it.

Alpha-hydroxy acids

OK, let's talk about Alpha-Hydroxy Acids (AHA's). It comes in five "flavors": glycolic, lactic, malic, citric, and tartaric, with the first two being most common. They essentially dissolve the bonds that hold the top layer of skin cells in place. These cells are what cause clogged pores, as well as dry skin, inhibiting moisturizer absorption etc.

By the way, AHA should not be confused with that 80's one-hit wonder band, a-ha. AHA is much more useful and versatile.

Beta-Hydroxy Acids (BHA) is almost always salicylic acid and unlike AHA, keeps on exfoliating even after it would be good for it to stop. Therefore you should avoid it and stick with AHAs.

Some people can't use AHAs for long periods, and most skin care people would probably suggest using one for half a year to a year, then using it half as often.

How to use Čem:

  1. Read the instructions carefully.
  2. Don't use them on your eyelids.
  3. Clean up.
  4. Wait 15 minutes. Why? Soaps tend to be alkaline which neutralizes acids. By waiting for your face's acid balance to return to normal, your AHA will work better.
  5. Put on your AHA.
  6. Let it work 15 minutes.
  7. Apply your foundation, sunscreen, moisturizers, etc.

Don't use other scrubs or washcloths in conjunction with AHAs

Concentrations: AHA's have to be dissolved in water to make a cream, so Lots of AHA products are listed as percentage of a 70% solution. The rest is water and stuff used for dissolving the AHAs. So an 8% concentration is probably closer to 5.6% of the total.

Higher levels are used for skin peels you see offered at spas and salons (sometimes called "lunch peels"). These are done at concentrations higher than you can buy at the store, but be sure to find someone you trust to put one of these on your face. This is very different from a face peel you get from a dermatologist or plastic surgeon, which uses phenol acid or a laser and is a major procedure that leaves you scabbed over for quite a while.

Some recommendations

red = my favorite

Facial cleanser

  • Clean and Clear Sensitive Skin Foaming Facial Cleanser



  • Body Shop Foaming Gel Scrub for Normal to Oily and Oily Skin
  • Fashion Fair Gentle Facial Polisher for all skin types
  • Physician's formula Beauty Buffers Exfoliating Scrub
  • Sea Breeze Exfoliating Facial Scrub


Alpha-hydroxy acid

Decent prices:

  • Artistry by Amway Moisture Essence Serum with AHA $26.00/1 oz.
  • Color Me Beautiful Refining Toner $13.00/6 oz.
  • Paula's Choice 8% Alpha Hydroxy Acid Solution $10.00/4 oz.
  • Trish McEvoy Glycolic Lotion $37.00/2 oz.
  • Alpha Hydrox Enhanced Creme All Skin Types $9.50/2 oz.

More expensive, but worth a look:

  • Elizabeth Arden Alpha-Ceramide $55.00/1 oz. (with this you get several bottles of increasing concentrations, so your skin gets used to AHAs.)
  • MD Formulations Facial Lotion with 12% Glycolic Compound $45.00/2 oz.
  • MD Formulations Forte I Facial Lotion with 15% Glycolic Compound $45.00/2 oz.
  • MD Formulations Smoothing Complex with 10% Glycolic Compound $35.00/.5 oz.
  • MD Formulations Night Cream with 14% Glycolic Compound $60.00/2 oz.

You gotta be kidding prices:

  • La Prairie Age Management Line Inhibitor $100.00/.5 oz
  • La Prairie Age Management Serum $125.00/1 oz.
  • La Prairie Age Management Intensified Serum $140.00/1 oz.


Body Moisturizer

  • Lubriderm Moisture Recovery Creme (body)



  • Aveda Skin Firming/Toning Agent
  • Body Shop Honey Water and Tea Tree Oil Freshener
  • Clarins Toning Lotion for Dry to Normal Skin
  • Neutrogena Alcohol-Free Toner



  • Almay Oil Control Lotion for Oily Skin SPF 15 $7.40/4
  • Clinique Zero-Alcohol Sun Block SPF 25 $15.00/4
  • Cover Girl Protective Skin Nourishing Moisturizer SPF 15 $5.35/4
  • Origins Silent Treatment SPF 15 $15.00/1.7
  • Paula's Choice Essential Non-Greasy Sunscreen SPF 15 $10.00/6


Fade Cream

  • Black Opal Advanced Dual Complex Fade Gel $8.00/.75
  • Flori Roberts Chromatone Fade Creme Plus Gold $15.00/4
  • MD Formulations Forte Skin Bleaching Gel with 2% Hydroquinone in a Base Containing 10% Glycolic Compound $30.00/1.5
  • Murad Advance Age Spot and Pigment Lightening Gel $40.00/1.7
  • Neostrata Gel for Age Spots and Skin Lightening $11.00/1.6

A friend sent along some additional thoughts:

Your article made me think of the following:

1) Lubriderm now sells an SPF 15 version of their great skin lotion!!!! - just the thing for us pale ladies who freckle and shy from the sun.

2) There are two prescription fade creams that are great for freckles and skin discolorations caused by take estrogen. Since we keep our estrogen state close to pregnancy levels all our lives, we are prone to "pregnancy mask" like skin discolorations. The medications are: Solaquin Forte 4% and Benoquin. Both are manufactured by ICN Pharmaceuticals in California. But, the Benoquin is IMPOSSIBLE to get these days. The company lists it but does not manufacturer it. Benoquin saved my BUTT, quite literally many years ago when I needed to fade my skin graft scars.

3) There are prescription dermatological agents to control contact dermatitis and acne. Cleocin is available in a lotion, which I like and a toner. Using either can replace toner in one's skin care regimen.

4) Prescription only Retin A is great for keeping skin smooth. It stimulates new skin growth, promoting collagen and elastin formation. It must be used very, very, very sparingly for best results. Using too much irritates the skin and causes redness. Long term use is almost like a mild chemical peel. I used Retin A many years ago for acne and noticed what great things it did for the general texture of my skin.

5) Collagen injections can do wonders for small depressions in the skin. They don't work for everyone though. For me that filled in a scar on my right cheek that I had since birth. Collagen also filled in acne marks that I had. The results have lasted for me. I gather that they don't last for 50% of those who get them.


The one book I cannot recommend highly enough is Paula Begoun's Don't Go to the Cosmetics Counter Without Me (3rd edition). If you buy only one book, buy this one. In it, she rates over 10,000 products, including a list of her picks for best foundations, mascaras, etc. Paula's even got her own website:

You might also consider our program Becoming You: The Fast Track to Your Female Face, with over four hours of tips and practical instruction.