# Investigating Experiences With Scarring Among Transgender and Gender Diverse People: Mixed Methods Study

## TL;DR

This study explores how transgender and gender diverse people experience scarring from gender-affirming care and other causes, highlighting the physical and psychological impacts.

## Contribution

The study is the first to systematically analyze scarring experiences specific to transgender and gender diverse individuals using online forum data.

## Key findings

- Scars from gender-affirming procedures like mastectomy and hormone administration were most frequently discussed.
- Scarring was linked to psychological distress, gender dysphoria, and negative body image among TGD individuals.
- Visible scarring was identified as a barrier for TGD people trying to blend into society.

## Abstract

Scarring has been shown to have adverse health effects on marginalized patient groups. However, experiences of scarring among transgender and gender diverse (TGD) people have not yet been thoroughly characterized.

This study aimed to investigate the impacts of scarring related to gender-affirming care and other causes among TGD people.

Anonymous data were extracted from Reddit, a popular online platform organized into “subreddit” groups based on identities and interests. A combined total of 604 posts and comments that explicitly reference physical scarring were extracted from r/FtM, a subreddit for transmasculine people (449 posts and comments) and r/MtF, a subreddit for transfeminine people (155 posts and comments). Applying inductive thematic analysis, all posts and comments were coded and codes were sorted into overarching themes.

Among the 604 posts and comments, the scars most discussed were secondary to gender-affirming care procedures, including mastectomy (n=338 posts and comments), hormone administration (n=102 posts and comments), and hair removal (n=38 posts and comments). Nongender-affirming care-related scars, such as those due to self-harm (n=43 posts and comments), were discussed less often. A total of five overarching themes emerged through thematic analysis: (1) concerns about physical outcomes related to scarring; (2) psychological distress related to scarring; (3) societal perceptions of scarring; (4) strategies to prevent, conceal, and minimize scarring; and (5) positive experiences with scarring.

For TGD people, scar complications, visibility, and permanence represent major concerns. While many TGD people ultimately accept scarring as an unavoidable consequence, scarring both related and unrelated to gender-affirming care can present a significant psychosocial stressor for TGD people. Scarring can result in physical health complications, gender dysphoria, and negative body image; visible scarring is also a barrier for TGD people who wish to blend into society. Clinicians should improve communication regarding scarring outcomes and scar-care procedures. Future research should focus on the development of scar prevention, care, and reduction techniques for TGD people.