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

Background: 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. .

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

Methods: 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. .

Results: 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.

Conclusions: 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.