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Questions for SRS/GCS Patients

A note from Cynthia...
I became an Electrologist because I wanted to be of service to people. I became an Interfaith Minister for the same reason. I thought my days as an Electrologist were behind me and I could concentrate on being a Hospice Chaplin until a Professor of mine suggested I go to Gold Rush. For those of you who have never heard of it, Gold Rush was a convention put on by the Gender Identity Center in Denver, Colorado.  

I attended and I was horrified by some of the Electrolysis work I had seen. I saw a beautiful woman walking down the hall in a lovely gown while sporting what I thought was a beard. I thought that perhaps this is what my son meant about people dressing “ironic.” I’m older. I didn’t get it but I thought kudos to them for being able to express themselves as they like.

Well, as she got closer to me, I realized that she did not have a beard. She did not have one hair on her face. What I was seeing was hyperpigmentation, a darkening of the skin. She had been burned and her skin had been overworked. That discoloration will never go away. It might lighten up or lessen over the years, but it will always be visible.

My heart broke for her.

Someone had done that to her. The only way that degree of damage could have been inflicted was that her Electrologist did not understand the damage they were causing and was completely incompetent, or they had done it intentionally.

When I worked in New York, I had colleagues that had no idea what they were doing. They had taken a short 90-hour course to learn the basics and then spent years practicing on clients in salons hoping to hone their skills as Electrologists. Is that what happened? Incompetence?

I also had colleagues both in Connecticut and New York who, for whatever reason, when they did not want to work on a client, would raise the electrical current hoping to make the client so uncomfortable that they would leave and never come back. Is that what happened here? Malicious Intent?

I don’t know why that lovely lady had such terrible hyperpigmentation, but I did know that it was caused by one of those two reasons. Either way, I found it criminal.

I do not profess to be an expert in my field. I certainly do have a great deal of education and training to back up what I say, believe and think about Electrolysis and Skin Care.

I had a wonderful teacher, Mrs. C, who pushed me to investigate and prove my theories while learning Electrolysis. I also had an Electrologist that worked on me to clear my face who not only understood my hormonal imbalance, but also understood how to treat my curly hair without damaging my skin as others had done before her. I had a magnificent Professor that said, “Do something about it or leave it alone” after having listened to me vent and harp for an entire semester about Electrolysis and the Trans Community.

So, here I am, hoping to "do something about it" by educating and informing.

There is so much information out there about Electrolysis and Gender Confirmation Surgery, some of it is useful and insightful and some of it is just plain nonsense.

Because Colorado is not a licensed or regulated state when it comes to Electrolysis, it is very important when interviewing an Electrologist that you ask informed questions about the process, not just “How much?”

Whether you decide to come here to Hey, Gorgeous or go elsewhere is not the issue to me. I want you to be knowledgeable, confident and empowered to advocate for yourself and your unique hair removal needs.

My goal is to educate you so that you are able to make those informed decisions concerning your treatment. I hope that you find the following information useful and beneficial.

If I have left anything out or you need clarity, please feel free to contact me.
Graphic of hair loss
How long does the hair stay away compared to other hair removal methods?
2. How many treatments do I need? How long will it take?
Starting Electrolysis on the surgical site early in your transition is paramount. Electrolysis is a process. It takes time. Hair grows in cycles and each hair needs to be treated several times. The surgical site is broken down into three sections, the shaft, the scrotum and the perineum. Each of those areas has varying degrees of hair growth, and they are in very different cycles. For example, the hair on the perineum will not grow as long as the hair on the scrotum. The hair on the scrotum will grow longer than the hair on the shaft. This illustrates different cycles of growth. 

It is important that you know what your surgeon’s requirements are for hair removal. Not all surgeries are the same. Their specifications for hair removal and the order of importance of that hair removal will differ depending upon how they create your vagina. Some surgeons invert the penile tissue to form the vagina, others use the scrotal tissue, some ladies may need a skin graft, etc. Knowing what your surgeon wants will allow your Electrologist to form a better treatment plan for hair removal.

There are other factors that must be considered when thinking about the length of time it takes to become hair free and that is the amount of hair one has. Some ladies need less time than others because they have less hair.

The average amount of hours it takes to clear the surgical site is 55 hours. I have cleared someone in 33 hours over the course of a year, which is, frankly, not a lot of time. I have also worked on someone who needed 120 hours to clear. It comes down to genetics.

Another contributing factor that determines the amount of time permanent hair removal takes is how much surface area has to be cleared. The greater the area, the longer the time.

People often confuse the number of sessions with the number of cycles that need to be cleared. When you hear that it will take 5-7 clearings, they actually mean 5-7 growth cycles being cleared, NOT 5-7 sessions. Cycles deal with the time it takes the hair to grow in the sense of weeks and months. Hours deal with the amount of time it takes to clear those cycles over a of time. Sessions deal with appointments.

It takes an average of 55 hours over the course of a year (or more) to clear the surgical site. I work in no longer than 3-hour blocks of time (sessions). I hope that helps to clarify the confusion between these different words.
3. Is it okay if not all the hair is cleared?
Once the neovagina is created, there is no safe way to remove any hair from that skin graft. Hair growth in the vagina is painful and uncomfortable. Dilatation or vaginal sex will be near impossible. It is vital that you follow your surgeon’s dilation protocols after surgery to maintain width and depth of the vaginal cavity during the healing process. 

​Hair removal is not just about your vagina. You must remember that the neourethra will also be constructed. Hair growth in that area can impinge or block your urethra causing bladder infections or worse.

I know some ladies who were told they wouldn’t need hair removal, only to later regret not having it done. There are some surgeons that contend that hair removal is not required.

Realize that many trans women don’t follow up with their original surgeons, so the surgeon may not realize that their methods are not as effective as they expect.

If your surgeon says hair removal is not required, you may want to talk to some of their former patients to make sure their experiences match this.

Many people have told me “my surgeon scrapes.” Wonderful! For what reason are they scraping? Are they scraping to cauterize hair follicles or are they scraping to remove excess adipose tissue? Two very different reasons with two very different outcomes. Talk to your surgeon.

This is about your life and well-being. Think not only of having the surgery done; think about the long-term outcome of that surgery. If you are having a No-Depth surgery, then hair removal is not overly important. However, if your goal is to have a working, functioning vagina capable of vaginal intercourse, please take the time to have hair removal done properly. ​

If you decide that Electrolysis is the route to take, I recommend starting at least 10-12 months or longer before surgery. There are no shortcuts to permanent hair removal. Sorry. ​

I also recommend that clients come in for 2 to 3-hour weekly sessions when they first start treatment. This allows for the entire area to have its first clearing quickly. After that, the sessions get shorter and then the concentration turns to removing the new growth cycles. Eventually, you should only be coming for checkups every few weeks to catch any straggler hairs that may have come back.

Although some surgeons say it is safe to stop treatments 2 weeks before surgery, I find it ideal to stop 4-6 weeks before surgery to allow your skin to heal properly.
4. Can I have a more intense treatment that takes less time?​
Over my 20+ years of doing Electrolysis, I have been asked countless times to “burn the hair out.” 

I could. But I won’t. And neither should anyone else. Working at too high of a current will only damage your skin. It does not speed up the process of hair removal, as hair grows in cycles.

Again, the only thing that is accomplished by increasing the timing and intensity of the current is to damage the skin.

I believe that the setting being used should be high enough to have smooth epilations without causing scabbing or damage to the skin. You should be able to go to weekly sessions without having to wait for your skin to heal.

Skin is very unforgiving. If you have ever burned yourself, you will have noticed that several weeks later, your skin still looks discolored. That is because it is still healing.

For me, Electrolysis is not just about hair removal, it is about keeping your skin healthy and intact.

I truly believe that most Electrologists work diligently to get results. They are conscientious and steadfast in their beliefs on how Electrolysis should be performed.

By the same token, I have had countless women tell me horror stories about previous experiences with Electrolysis. They have reported feeling as though they were being burned or that their skin would stick to the needle or they felt a stabbing sensation.

If your skin is sticking to the needle during an Electrolysis session - the setting is too high. You will damage your skin if you continue at that level of intensity.

If you smell flesh burning during an Electrolysis session – you are being burned. The setting is too high.

If you feel as though you are being repeatedly stabbed during an Electrolysis session – know that you are being stabbed. Proper insertion of the needle will not feel “stabby.” It should be smooth.

If, after the current has been applied to the hair follicle during an Electrolysis session and the hair is not removed, epilated, tweezed out of that follicle – you are at risk of infection. Unlike Laser, once the hair follicle has been treated, the hair must be manually removed. It will not fall out on its own.

If blood is repeatedly drawn during an Electrolysis session – get out of there. They don’t know what they are doing. You are at risk.

In my experience Electrolysis cannot damage your skin but an inexperienced, clumsy Electrologist could. The notion that the higher the current the more effectual the treatment is ridiculous. There are a great many nuances and considerations that must be made when having electrolysis done. A good electrologist will understand this and your treatments will be productive.

I have been to many Electrologists over the years. The most effective ones were those who kept the current at appropriate levels for the area, had the knowledge and were experienced in the different modalities and when to implement them. There is no magic magnifier for us to see the root of the hair. We find it by feel. It takes practice and skill.

Again, I am very aware that there are few Electrologists that will work on the surgical site. I am truly sorry for that. I want you to understand that some things should be deal-breakers, like stabbing and burning. You deserve more than a hack Electrologist.

There are no short cuts with Electrolysis. It takes as long as it takes. The trick is to start your hair removal early, at least one year before surgery.

In order to have the best outcome from your surgery, your surgeon needs to have your skin intact and healthy. Be kind to yourself.
5. Should I shave? When?
Now, I did say that there are no shortcuts with Electrolysis, but this is more of a trick. I recommend shaving the area 4 days before your treatment in order for me to work more efficiently. I find that this ensures that the hair I see is actively growing, thus potentially cutting down on the number of treatments you will need because I’m not treating dead hair. 

I have many clients who swear that using lotion instead of soap or shaving cream provides a closer shave and keeps your blade sharp for a longer period of time. I don’t know if that is true but they have asked that I pass that along to you.

Now, another Electrologist might prefer that you leave the hair longer. It is up to them what makes for easier hair removal for them during treatments. Ask your Electrologist what they would like you to do before your session.
6. Is there something I can use to numb the pain?
Absolutely! In all my years of experience, I have only had three people able go without numbing cream on the surgical site. I am still amazed and awestricken by them. However, for the average human, I recommend that you use a 5% lidocaine cream, lotion or ointment in the area. You can either get a prescription from your doctor or you can go online to purchase something. I don’t recommend any particular brand over another. Doing so is beyond my scope of practice. 

To get the maximum results from your numbing cream, it is important that you follow the manufacturer’s instructions. If you are unsure, call your Electrologist and ask for guidance.

Here is a compilation of advice from clients of mine and some personal observations.

Clean the area well before applying the cream. Rub some lidocaine cream into the skin and wait a few minutes then reapply a liberal amount. Cover the area with plastic wrap making sure that the area you wish to numb is well covered. It will take about 90-minutes for the area to be well numbed. Leave the plastic wrap on and allow your Electrologist to remove it as they work. Once air hits the area, the lidocaine begins to lose its effectiveness. It will be uncomfortable driving with the plastic wrap but you will see the benefits of leaving it on until you get to your appointment.
7. What is a session like?
Communication with your Electrologist is essential! You are in a vulnerable and intimate situation with them and they with you. You are in each other’s space; you will be entwined for a very long time. Having a good rapport and the ability to speak honestly and frankly is so important.  

Not all personalities work well together. I have on several occasions told prospective clients that I thought we were not a good match to work together. They found it shocking but they also knew it was true.

If you are relaxed and comfortable and trust your Electrologist, you are more likely to be able to work through the discomfort of Electrolysis. You are more likely to speak up if you are feeling dysphoric and need to take a break or stop the session altogether. You are also more likely to keep appointments and stay on track to reaching your end goal. And it also helps the time pass faster for both of you.

8. What about laser hair removal?
Laser can reduce the amount of hair you have but it does not remove the hair permanently. Laser does not work on light, white or ginger hair. Laser treatments are done once a month whereas Electrolysis can be done weekly. 

I recommend Laser for your chest, back, legs and even your face but not on the surgical site. The likelihood of having regrowth is too great a risk for a surgery you have waited for eons to have.

I know that the cost of Laser is very appealing, but personally, I would not risk doing it on the surgical site. My vagina is too important to risk it becoming furry, and yours is too.
9. What is sugaring?
Sugaring is a paste traditionally made from lemon, sugar, and water. Sometimes essential oils and/or honey are used as well.

It is true that Sugaring is gentler than waxing, but keep in mind that lemon juice is acidic and an improper ratio of lemon juice could cause a chemical burn. Some essential oils may also be irritating, so if you decide to still use Sugaring as your hair removal method, have the salon or spa do a test patch.

And it’s not Permanent.

Questions to ask your Electrologist
1. Ask about Universal Precautions.
Universal Precautions refers to the practice of avoiding contact with bodily fluid and the contamination and transference of bodily fluids to others as well as the work area. 
2. Ask if the Electrologist wears gloves.
In this day in age, there is no excuse for not wearing gloves! It is the first barrier of dense for infection control. 

3. Ask if their probes (needles) are disposable or if they sterilize them between use. 
Some Electrologists keep your needle for you between sessions. Hopefully, at the very least, they will use a glass bead sterilizer to kill microbes. They should do it in front of you. Glass bead sterilizing can be effective if the beads are heated to at least 300 degrees Celsius. It is up to you to decide whether this is a safe practice or not. 

You should also be able to see them insert the probe into the holder in front of you. If you go in for a treatment and a needle is already in the holder, Beware. 

Here at Hey, Gorgeous we use sterile, disposable (one-time use) probes pre-packaged from the manufacturer. After your treatment, I dispose of the needle in a Sharps Container. This is another layer of Universal Precautions.
4. Check to make sure they have a red medical waste disposal container.
It may seem trivial but it is very important. It shows that your Electrologist understands Universal Precautions and is committed to keeping you and others safe. 

If you don’t see a Sharps Container, then they probably don’t have one. That should raise questions. Are they reusing needles? Are they “sterilizing” them in between use or wiping them down with alcohol? Are they throwing them in the trash?
5. Ask if they sterilize or sanitize their forceps (tweezers).
There is a big difference. Wiping down tweezers with alcohol after use is not enough to kill all organisms. Sterilizing can involve chemical baths, dry heat or moist heat. 
6. Ask if they wipe down their treatment tables and equipment after each client. What do they use? 
I am aware that there are not many Electrologists around, and even fewer that work on the surgical site but please, never trade your safety and well-being for a session. Your health is too important. Look around. If something does not look or feel right, or you feel unsafe, get up and leave. You have every right to stop a session at any point.

I say this with all the love in my heart for you, my sister: You are a grown-ass woman.

Take care of your business. And your business is taking care of yourself and knowing what is best for you! ​

If you choose Electrolysis, choose an Electrologist that you trust and with whom you can make a connection. Your journey is long. Gather to you as many cheerleaders as you are able. Don’t just choose someone or some service because of the cost. I know it is easy for me to say, I am not living your life and working through your struggles. All I can say is Be Safe. Advocate for yourself. Don’t settle. ​

Please reach out if you have further questions about the process. I am more than happy to help. I wish you all the joy and luck on your quest.

- Cynthia