FAQ Quick Links
- Does it hurt? Pain management options and advice.
- How does it work? An overview of electrolysis modalities.
- What about laser hair removal?
Does it hurt?
For most people, yes. How much varies widely from person to person—everyone has different skin, and different nerves! Some people can sleep through it, some find it mildly uncomfortable, others may benefit from painkillers and/or anti-anxiety medications.
Note that different modalities of electrolysis may be more or less painful for you; we'll work with you to find what works best.
Pain Management
We are electrologists, not physicians, and by California law may not apply, provide, or prescribe medications.
Options to ask your doctor about
You can discuss with your doctor pain management options such as over-the-counter ibuprofen (Advil), acetaminophen (Tylenol), and topical lidocaine (usually 5%) products. Your doctor may also give you the option of higher dosages than are listed for non-prescription use.
Your doctor may prescribe you pain medications such as gabapentin (a nerve pain medication), or anti-anxiety medications like xanax which may help you feel more comfortable. Some people are able to get prescriptions for even stronger medications such as codeine.
Please talk to your doctor before taking any new medications. Doses which are too high, especially in combination with each other, can have severe adverse health effects.
We caution clients not to drive while taking strong pain medications, and to follow all instructions given by your doctor and pharmacist.
Distractions and emotional support
Many people find wearing headphones and focusing on the music significantly helps reduce the perception of pain.
You are welcome to bring an emotional support person to be with you during treatment (we do require they wear a mask, which we can provide). Sometimes just having a partner or friend hold your hand makes a big difference.
Gwen's mind games for pain management
When I have my own electrolysis appointments, I usually try to take my attention away from the pain by trying really hard to focus on multiple other things at once. Your brain can only be aware of so many things at a time, so this can really help if you can manage it. Things I like to focus on:
- The music I'm listening to (music with headphones is key for me).
- Parts of my body that are far away, like how my individual toes feel, or even how the skin under each of my toenails feels.
- I imagine myself somewhere else—like a beach or a grassy field—and focus on the imagined physical sensations in that place. The five-senses grounding exercise (five things you can see, four you can hear, three you can feel, two you can smell, one you can taste) can be used here to "unground," by applying it to fictional senses in your imagined space.
- To get extra distance, while imagining myself sitting or walking in the fictional space described above, I daydream about another fictional space. That is to say, I daydream about myself daydreaming.
Practicing mindfulness meditations can help improve your ability to control your attention and focus. To be honest, electrolysis is one of the things that finally got me to start practicing mindfulness, after years of therapists recommending it for mental health reasons.
Besides that, for certain areas I'm able to "pull" the pain to a different spot, to trick my brain into reinterpreting it. For example, for work on my lips, I'm often able to convince my brain that the pain is actually in my gums instead, which helps me because I'm one of those people who enjoys flossing their teeth. For my upper lip near my nose, when the overlapping nerve centers trigger a "buzzing" sensation in my eyes or an automatic tear response, focusing on the sensation in my eyes helps a lot (because the eye sensation doesn't hurt, it just feels weird).
Ultimately, you'll want to try different things and figure out what works best for you. Don't be afraid to take breaks if you need them!
Caffeine
Most electrologists and laser techs will tell you that caffeine increases pain sensitivity. We've found no medical literature which backs up this claim, however, anecdotally, it does seem to have a negative impact (even if it's just from increasing anxiety levels, which might make the pain harder to ignore).
We therefore recommend you don't consume more caffeine than usual the morning of your appointment, especially right before you come in. This includes chocolate (sorry). You can decide for yourself, we're not your moms.
IDK if I can do this?
We get it. It sucks, and we all wish we didn't have to deal with any of this. We also know it especially sucks to pay money for something unpleasant (we wish we didn't have to, but we have our own rents to pay).
If you're a trans person facing an amount of hair removal that feels monumental, try to keep sight of your end goals, and remember that generations of trans people have gone through this before you. Including us (some of us are still going through it). You're stronger than you think.
If it's still too much, there are other options, such as electrolysis places that offer lidocaine injections (like this one). We can't do that, because we don't have medical degrees or licenses, but we get it if you want to go to them instead of us. Sometimes dentists are open to providing patients with numbing injections before electrolysis appointments, which may also be an option for you prior to seeing us.
How does it work?
Electrolysis is a method of permanent hair removal approved by the FDA, which encompasses three modalities.
All modalities work by inserting a small metal probe into a hair follicle, and running an electric current to destroy the follicle beyond its ability to produce another hair.
Electrology probes are not like the needles used by medical professionals to draw blood or administer medication. Rather, electrology probes have rounded tips to avoid puncturing the skin, and the probes are always inserted into the existing openings of the hair follicles. You usually will not feel any pain from the insertion of the probe into the follicle.
Different electrologists tend to have conflicting strongly-held opinions about which modalities are most effective at removing hair follicles, and which are least damaging to the skin.
Our observation is that all modalities are eventually effective, but some modalities (such as flash) have much higher regrowth rates than others, which comes with the potential for greater skin damage due to the necessity of repeated treatments.
At Cat & Mouse we specialize in galvanic electrolysis and blend. We may use manual thermolysis for clients who are particularly sensitive to direct current. We strongly prefer using blend for surgical prep, due to its relative efficiency and reliable efficacy.
Summary of Modalities
| Galvanic Electrolysis | Manual Thermolysis | Blend | Flash Thermolysis | |
|---|---|---|---|---|
| Best for | Facial hair | Body hair | Surgery Prep & Body | Fine hair |
| Regrowth rate | Low | Low | Very Low | High |
| Clearing speed | Slow | Medium | Medium | Fast |
| Skin damage risks* | Low | Moderate | Moderate | High |
While flash thermolysis can clear a large area in a single treatment, the regrowth rates are so much higher than for blend and galvanic that the overall time it takes to permanently remove the hair is often far longer. Furthermore, the repeated application of flash to the same follicle over multiple growth cycles can be quite damaging to the surface of the skin.
*Ideally, clients will experience little to no visible cosmetic damage, but the risk is always there (especially if client aftercare instructions are not followed). Note that all modalities can cause pitting, scars, and discoloration, but some are more prone to certain skin defects than others. Repeated applications of high-intensity flash in particular tend to lead to waxy patches lighter in color than the surrounding skin (Gwen can provide evidence on her own face). Whether this is noticeable or considered to be a problem will vary by skin tone and client priorities; it is generally much less noticeable on older clients with pale skin, when minor imperfections are less noticable amidst natural aging patterns.
We recommend either galvanic or blend for facial hair removal.
Pain
For coarse hair, most people find galvanic less painful than blend, and many people find galvanic to be the least painful of all modalities.
Different people have different nerves, and individual pain reactions to different modalities can vary widely. Gwen finds flash to be far more painful than any other modality, but other people have the opposite experience.
For fine hair, flash can be set on a low enough setting that it's almost painless, which is part of why flash is very popular among electrologists catering to white cisgender clients.
Frustratingly, we've known many hair removal specialists who don't realize how much more painful the same modalities can be for coarse hair. To add insult to injury, when clients are trans women with coarse hair, some electrologists turn to transmisogynistic myths like "women have a higher pain tolerance than men" to explain this away (this myth isn't even true for cis people—it originates from the fact that people get flooded with endorphins during childbirth, and is not applicable at any other time).
Galvanic electrolysis
Galvanic electrolysis works by running a low-amperage (up to 1.0 mA) direct current through the probe to convert the saline (salt water) in your hair-producing germ cell matrix into sodium hydroxide (commonly known as lye). This chemically destroys the follicle.
Galvanic electrolysis is "true" electrolysis in that it uses the literal process of electrolysis you might have learned about in a chemistry or physical science class.
Multi-needle galvanic is a variety of galvanic electrolysis which uses multiple probes to simultaneously treat many hair follicles at once. This method typically runs a lower intensity current per hair for a much longer duration (minutes instead of seconds).
Thermolysis
Thermolysis (or "diathermy") works by instead running an alternating current at a high frequency (6 MHz — 40 MHz, at specific frequencies set by the FCC), which in effect turns the probe into a tiny radio antenna. The rapidly alternating electromagnetic field causes molecular dipoles—such as water molecules—to spin very quickly, producing heat which destroys the follicle.
Manual thermolysis is the term for thermolysis run for one to three seconds at a moderate current intensity.
Flash thermolysis, or simply "flash," uses a very high intensity pulse of thermolysis that lasts for a fraction of a second. Flash thermolysis can treat a large number of hairs in a single session, but as a trade-off has a much higher rate of regrowth, and those repeated treatments can be much more damaging to the skin.
Our observation is that flash thermolysis can work for the fine (thin) facial hair that many cisgender women get after menopause, but is less effective for removing the coarser hair common to people who have gone through a testosterone-dominant puberty.
Blend
The blend modality combines the two in a carefully calculated balance. This produces an effect greater than the sum of its parts, as the heat of the thermolysis causes the sodium hydroxide of the electrolysis to become several times more caustic than it normally is at body temperature. This ensures even the most stubborn hair follicles will never produce another hair.
More Information
Another excellent electrologist local to Pasadena, Charlotte Lai at Aurora Electrologist, has very well-organized documentation on the benefits and pitfalls of the various electrolysis modalities on her website. Charlotte only uses single-needle galvanic electrolysis. She has a reputation for doing excellent work, especially with clients who have had significant scarring from other electrologists. We're happy to recommend her services to clients who for any reason don't wish to book with us.
What about laser hair removal?
We don't offer laser hair removal.
Laser works well for some people, and less well for others. It's commonly claimed that laser only works well for people who have dark hair and light skin. This isn't exactly true anymore; modern alexandrite laser machines are capable of treating all skin types, and some people with dark hair and light skin still don't experience good results (Gwen was one of them). Some clients even experience "paradoxical" hair growth due to laser, where laser treatments actually cause increased hair growth in up to 5% of cases.1,2,3 Paradoxical hair growth is more common with IPL than diode laser treatments, but may occurs with either.3
- N. Baah and A. H. Chacon, “A paradoxical phenomenon: Intense pulsed light-induced hypertrichosis, a brief review,” Dermatological Reviews, vol. 2, no. 2, pp. 106–110, 2021, doi: https://doi.org/10.1002/der2.42.
- M. Radmanesh, “Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy,” Journal of Dermatological Treatment, vol. 20, no. 1, pp. 52–54, 2009, doi: 10.1080/09546630802178224
- E. F. Bernstein, “Hair Growth Induced by Diode Laser Treatment,” Dermatologic Surgery, vol. 31, no. 5, pp. 584–586, 2005, doi: 10.1111/j.1524-4725.2005.31168
Permanency
Sometimes laser is permanent, but it usually isn't. Laser is rarely completely permanent.4,5 The "permanency" of laser usually lasts six to eighteen months. Sometimes you only find out when it starts growing back a year later, or three years later, or five years later. This is true for both forms of laser (diode and IPL, or intense pulsed light), but IPL is by far the less effective of the two.
- R. D. Farhadieh, N. W. Bulstrode, B. J. Mehrara, and S. Cugno, Plastic Surgery - Principles and Practice, 1st Edition. Elsevier, 2021. (p. 54)
- A. Faurschou and M. Haedersdal, “Photoepilation of Unwanted Hair Growth,” in Laser and IPL Technology in Dermatology and Aesthetic Medicine, C. Raulin and S. Karsai, Eds., Berlin, Heidelberg: Springer Berlin Heidelberg, 2011, pp. 125–146. doi: 10.1007/978-3-642-03438-1_9
Pre-operative hair removal
Because of the uncertainty, we strongly caution clients not to do their surgery prep with laser hair removal. If that hair comes back, there's not much that can be done to fix it after the fact. For vaginoplasty this can lead to significant discomfort. For phalloplasty, if the donor tissue is used to construct the urethra, it can cause medical emergencies.
Facial hair removal
However, for facial hair, maybe that's an okay risk trade-off. When it works, laser certainly yields faster results than electrolysis, and that can make a difference for people experiencing significant gender dysphoria early in their transitions.
Unfortunately, many people who get laser first end up in the position of having to pay for both laser and electrolysis later down the road, and there's no real way to know if that'll be you until you do it. On top of that, laser regrowth tends to be trickier for electrologists to treat. It's often less pigmented and harder to see, and also often grows in weird directions. That translates to us working slower than we would be able to otherwise, which translates to more sessions, and more money.
Body hair removal
For those seeking to remove large sections of lighter body hair (such as on their legs, chest, or back), laser is often fairly effective where electrolysis can be very slow and prohibitively expensive. Unless you have cash to burn or a very good insurance plan, electrolysis isn't a great choice for leg hair.
With laser people typically have to get "maintenance" treatments every so often (it can vary from twice a year to once in a decade) to deal with regrowth. This may be fine for leg hair, but obviously poses a serious problem in the pre-operative case.