JMIR Publications

ABSTRACT

Background:

Scarring has been shown to have adverse health effects on marginalized patient groups. Although transgender and gender diverse (TGD) people are at increased risk of scarring related to gender-affirming care (GAC) and other causes, the psychosocial impacts of scarring among TGD people have not yet been studied.

Objective:

This study investigates the impacts of scarring among TGD people through content analysis of threads extracted from online forums.

Methods:

Anonymous data were extracted from Reddit, a popular online platform organized into ‘subreddit’ groups based on identities and interests. 122 threads (i.e., user posts plus associated comments) that explicitly reference physical scarring were extracted from the two most active TGD subreddits, one for transmasculine people (69 threads) and one for transfeminine people (53 threads). Applying inductive thematic analysis, these threads were coded and sorted into overarching themes. 

Results:

In the 122 threads, the scars most discussed were secondary to GAC procedures, including mastectomy (51), hair removal (13), hormone administration (12), and other GAC procedures (23). Non-GAC-related scars, such as those due to self-harm (7) and acne (6), were discussed less often. Six overarching themes emerged through thematic analysis: 1) anxiety due to uncertainty prior to scarring, 2) stressful physical health impacts of scars, 3) negative impacts of scars on body image, 4) social stressors related to scars, 5) strategies to prevent, conceal, and minimize scars, 6) positive experiences with scars.

Conclusions:

For TGD people, scar complications, visibility, and permanence represent major concerns. While many TGD people ultimately accept scarring as an unavoidable consequence, both GAC-related and unrelated scarring 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.