TransMasc Healing Guide

A few years ago, I co-wrote this guide to HRT and piercings for transgender and gender non-conforming individuals, designed to be a simple introductory guide for trans folks and those taking HRT to understand some of the effects of these processes on getting pierced and healing piercings. Since publishing that blog post, I’ve gotten tons of awesome messages and emails with follow-up questions, primarily about the healing process as hormones affect things, but also just general questions trans folks might have about healing piercings. I’ve realized that there is a need for resources that more specifically cover the trans experience when it comes to body piercing and body modification. So, today is the second half of a two-part series on specific aftercare considerations and healing considerations for transgender clients!

This second half of the series will be for trans-masculine individuals. We will cover how testosterone and similar hormones can affect the process of getting and healing piercings. We will also discuss some unique lifestyle elements such as binding, acne medications and treatments, and packing, and how this can affect piercings and healing. This blog post is for anyone who sees themselves reflected in the topics discussed and who can benefit from this education, regardless of gender identity or gender presentation.

Hormones and Piercings

Of course, perhaps the primary area to look at is hormones. HRT is a fantastic medical process that allows us to take hormones and induce changes to our secondary sex characteristics, aka a second puberty. These changes allow us to better align our bodies with our gender identity, and starting HRT is an exciting time! Testosterone is the primary hormone for transmasculine individuals and can result in such changes as thickening skin, changing skin texture, hair follicle development and hair growth. Skin often becomes more oily due to an increase in the production of sebum, as well as changes to our sweat glands and body odor. Many folks on T report being sweatier. All these changes can have an impact on our piercings, as they all impact our skin! Existing piercings may become irritated, and struggle with moisture irritations, and new piercings may have a trickier time during initial healing. You may find yourself needing to try simpler jewelry or experimenting with different styles and pieces to find what is comfortable for your body through these changes. The process of getting pierced or tattooed may also feel different once you are on T. Muscle and fat redistribution, as well as weight loss or gain, are also not uncommon. These changes may lead you to need different sizes, lengths, shapes, or styles of jewelry for some of your existing piercings, commonly navel, cheek, oral, or nipple piercings.

Acne is an unfortunate side effect when taking testosterone, and perhaps one of the effects I see impact piercings the most. Not everyone deals with acne or a major change in skin type from T, which is great. But for those that do, breakouts, often including cystic acne, can lead to low-level inflammation across the face, including the chin and T zone. This can lead to major irritation for oral piercings, nose piercings, and eyebrow/bridge piercings. This increase in oily skin can also lead some piercings to struggle with moisture irritations, prolonged healing, and drainage problems. Most topical acne treatments may help the skin, but irritate the piercings. Finding a balance of aftercare that works for you, medical treatment that assists the acne and skin, and jewelry that is easiest to work with will be essential.

Bottom growth is another side effect of testosterone, which tends to be a very positive effect for most folks. This is an increase in size, shape, and texture in the anatomy of the vulva, most notably the clitoral glans and hood. This growth is often extremely gender-affirming, and an exciting time! But it can come with migration and irritation for existing genital piercings. New genital piercings should wait at least a year if not longer before being done, to allow this growth to stabilize first.

Hormones cause a lot of amazing changes in our bodies when we take them, and many of these changes are focused on our skin. We must remember that when we are taking HRT, literally all of the skin on our body is receiving new messages from our hormones to change how it functions- produce more sebum, thinner hair, and different collagen amounts. These changes can absolutely affect our piercings and potentially cause things to take longer to heal, be more difficult to heal or deal with unexpected irritation or issues. We see the exact same flare-ups with cisgender clients going through puberty, pregnant clients, and clients on some hormonal medications. This is a normal part of dealing with fluctuating and changing hormones, and a good reputable piercer will be able to guide you through any issues your piercings have, and get you to healed, healthy, happy piercings!

Acne and Piercings

We touched on acne above, but it can be such a prevalent issue for transmasc folks I think it also deserves its own section. This is perhaps one of the primary changes that I see cause issues for clients. The increase in oil and sebum production coupled with hormonal acne can lead to some major skin struggles on the face, torso, and buttocks. I mostly see this impact piercings on the face, particularly bridge, eyebrow, nostril, and lip piercings. Oil production in the T zone can create struggles with moisture irritations and drainage, as well as sometimes contribute to migration in these placements. Nostril piercings can struggle with the dreaded bump, and oral piercings can have some variable swelling that can be tricky to stay on top of. Hormonal acne often presents as deep cystic acne, which can also come with low-level inflammation which can cause issues for existing piercings.

Many doctors are now suggesting coupling scripts for testosterone with topical acne treatments. Generally, the first line of treatment for this acne would be hormonal birth control, but these medications could limit the effectiveness of HRT. Many doctors now are utilizing topical retinol, topical acne treatment, and even topical DHT blockers in acne-prone areas to control acne. This is a newer approach to treatment that there is limited documented research on, but I do think in the next 10-20 years we may see it become standard to prescribe acne medication with testosterone. This speaks to just how prevalent of an issue this can be. Topicals are awesome, but often very harsh on piercings and some can even damage jewelry. Please be cautious with the use of any topicals directly on or around piercings, and apply them gently. If acne is causing you to struggle with your piercings or in general, consider discussing with your doctor if adding an acne medication may be right for you.

Binding and Nipple Piercings

Many transmasc clients are also binding. Binding is a process wherein an Individual wears specific garments designed to compress their chest to create a more masculine, flatter shape on the chest. Binders and nipple piercings often do not play nice with each other. Binders are often made of thick, non-breathable fabric that can allow moisture to collect in the area, cause chafing, and put intense pressure on the piercings. This can cause irritation, moisture issues, migration, and rejection. For healed and established piercings, as long as you are being mindful of the material and type of binder, and try to minimize pressure on the piercings, some folks can safely bind, but checking the piercings after every wear is important. However, many folks even with well-healed piercings experience irritation and issues. One trick is to try wearing a hard vented eyepatch over the nipples- some folks may sew these into the binder and others may just adjust them below after wearing. However, even with this, at the first sign of irritation or issue, please follow up with your piercer and get advice on your piercings. Binding with new piercings is not suggested, as the risks for migration and irritation are extremely high.

We can’t talk about this risk of migration and rejection without discussing the risk of scarring. The scars left behind from migration and full rejection of nipple piercings can have an impact on future top surgery plans. If you intend to get nipple grafts this scarring can present issues for the graft adhesion and success. I personally have scarring from multiple nipple piercings over the years that had many surgeons advise me to forgo grafting. As much as I know this is disheartening to hear, it's also important to be honest and transparent about the risks. Please consider your long-term transition goals when you decide on your short-term piercing goals!

Packing

Packing is the process of wearing a packer, a silicone penis, in clothing to help with gender presentation and affirmation. And I felt it deserved it’s own section here because piercing your packer can be so intensely affirming for so many clients! And many folks don’t realize this is something you can do! Since this is simply a silicone packer, if you feel comfy you can get some cheap jewelry online and pierce it yourself at home. But if you’d like to have full experience, most piercers love the opportunity to do something gender-affirming like this for clients. I personally keep some lower-quality pieces in stock to utilize for piercing packers, and this is not a service I charge for. It’s awesome to get to have the full appointment, discuss goals and plans, and help create an experience that empowers. This I think is at the heart of why we pierce.

And there you have it, folks, a brief guide to some of the unique healing considerations for trans masculine clients! I hope this blog post was able to provide some insightful and helpful information unique to your experience with piercings. Body modification has to be one of my favorite forms of gender expression and gender affirmation, and I love that we have this ability to customize our bodies.

With so much love and trans joy,

<3 Lynn