Jenni's Journey

Innovations in aesthetic treatments are allowing transgender clients to achieve the results they want through non-invasive procedures. When client Jenni came to Tinkable Aesthetic Clinic in 2021, she only wanted some laser hair removal; however, she tells Aesthetic Medicine editor Anna Dobbie, how she has since found a new lease of life through her professional relationship with company director and aesthetic nurse prescriber, Rachel Fox

Jenni first realised that she wanted to transition around the beginning of the year. “I’ve got a problem with my pituitary gland – that’s where I believe it started. My hormones are all upside down,” she comments, “then during lockdown, it got really bad.”

When she first approached Tinkable clinic for some esteem-boosting tweakments, she was still in “male mode” as John, and her mental health was in a bad state. “I was coming home, locking the door, closing the curtains and not going out,” she describes. “Then, in March 2022, I went away for a weekend – when I came back, that was when it hit me, this was what it was going to be. It was a reality check.”

Jenni first spoke to her GP, who connected her with an NHS gender identity clinic. However, she decided to approach online private worldwide transgender clinic, GenderGP: “They ask you loads of questions and assess your mental health, how you are, what things you understand and what you don’t understand.”

On their five-point scale for gender dysphoria, Jenni scored the full five. Because of her medical problems which caused her levels of the hormone prolactin to be unusually high, she wanted a shared agreement with her GP. However, despite being prescribed Hormone Replacement Therapy (HRT), at the last minute her GP pulled out, meaning she had to start the process again and eventually received HRT in mid-May.

“Originally my testosterone blocker was going to be an injection but because I didn’t have anyone to administer it, I went for nasal spray and some HRT patches,” says Jenni. When she got back in touch with Tinkable, her original clinician had left: “I had a choice of two people – one was Rachel. It was probably potluck because to see Rachel was good for me on that day. I am delighted with how it worked out!”

INITIAL CONSULTATION

“Jenni came to us as John,” Rachel remarks. “She’d had previous treatments at other clinics, and she’d had a couple of treatments with us, but I’d not met her. She then started having laser hair removal treatments. At that point, one of our practitioners said, ‘this is going to potentially be a permanent thing - is this really what you want, because, in a few years, you might decide you want a moustache?’ That’s when the conversation opened up about Jenni transitioning. She’s had some degree of counselling. Although we’re trained in psychological assessment and potential diagnosis on a very small scale, we had to make sure that she was sound of mind to consent to the potential changes that we were hopefully going to achieve with her.”

Rachel then asked Jenni how she could help, what she was trying to achieve and whether it was a long-term goal, at which point she opened up about wanting to transition in every way. “We had to then find out from a medical point of view, what interventions, treatments or procedures she’d already had,” Rachel adds.

“Rachel sat me down and asked me exactly what I wanted, if it was something I was sure of, and I said that yes, I know exactly which path I wanted to go down. She replied, ‘We’re not going to give you any treatments now, I’ll do a package plan to try and sort out what’s best for you. I’m going to leave two weeks for you to think about what you’re doing before we go anywhere. It’s a big step for you - you’ve made a decision, it’s not for me to decide, but I want you to make sure it’s what you want’. It was another two or three weeks before I got back in touch for another chat.”

Jenni’s treatment history with Tinkable (Jan-Jul 2022)

“We started on midface working deep down and we gradually made our way up through the layers of the skin using a multilayering technique,” comments Rachel. “In essence this means you start at the deepest fat layer and work your way up to the superficial fat layer and beyond. It’s almost like putting the foundations in so you can build. Teoxane’s Tesoyal® Ultra Deep allowed us to provide structural support with high lifting capacity. In the most superficial layers, we used volumising dermal fillers, Teoxane RHA®3 and RHA®4, which allowed us to add volume in more dynamic areas or more mobile areas. We finished using Teoxane RHA®1 for more fine dynamic wrinkles that were used in the superficialto-mid dermis. The Teoxane range allows me as a practitioner to have an exceptional toolbox that has a solution for every indication, so from deep depressions to the finest of lines there is a product.”

“We did facial contouring, so we built her cheeks to create the illusion of slimming her face,” Rachel adds. “Males have a wider set jaw, so building cheeks creates the illusion of a more love-heart shape. I have to say, Jenni’s face lends itself to that quite nicely.

“Men’s expression lines on their forehead are much stronger than women,” Rachel continues, “so we administered botulinum toxin treatments to her forehead and skin boosters, to see if we could change the integrity of the skin slightly, so it had a softer appearance. It was just sculpting and contouring, to begin with. There are certain limitations - we can’t change things like a protruding Adam’s apple, but it’s been quite an exciting journey.”

After starting HRT and having a few treatments with Rachel, Jenni was ready to introduce herself to the world. “Everything was going well. I was looking good, I felt good, and the treatments were very good,” Jenni says.

“People that had worked with her for years had to stop calling her John and refer to her as Jenni,” Rachel adds. “Jenni was taking hormone treatments, so her breasts started to grow, which she was completely delighted with.”

“I had already told family and friends in April, but at the end of June, I thought, ‘That’s it, here we go, here’s Jenni’. I’ve been very, very lucky because I haven’t lost any friends, and everyone has been very good to me. I’m quite outgoing and positive -Ididn’t think I would be but I am. I’m amazed how well it’s gone, I’m proud of myself.”

THE JOURNEY TOGETHER

When Rachel first met Jenni in April, they chatted for an hour or more, but the consultation process continued throughout the journey at every point that the two met: “Jenni and I went out for dinner one night, purely because, to treat somebody well, you’ve got to know where they’re coming from, you’ve got to try and understand their motivation, where they’re trying to get to and what their concerns are.

“I believe it’s been quite a lonely journey for Jenni because although she’s got a lot of friends, as she’ll say herself, her interests have now changed. Although she’s not lost any friends during the process, she just feels quite lonely. When she went on her own to her first Pride event, which was a huge thing for her, I was quite concerned. I told her to be careful and keep in touch, because it’s a whole new world for her.”

Rachel has also acted as a consultant as Jenni learns and develops her style. “Her daughter is a beauty therapist, and Jenni is obsessed with nails. I say to her that she’s more of a girly girl than I am. She loves her hair products. She came in once over the summer and she’d got some black sandals on -Isaid ‘Jenni, no, no, not black sandals, not with a summer dress!’ I’m very straight talking to my clients, whatever journey they are on!”

Rachel had another client who had underlying health issues that compromised how much treatment she was able to administer: “Although he was trying to transition, it was very difficult for us to intervene because he was on antibiotics a lot of the time and, if your body is already compromised, we’re not going to start putting botulinum toxin and fillers in.

“We didn’t get very far with that journey and the contact fizzled out a bit. I think that, in that case, his health issues were the priority rather than the journey. It’s quite an intense client group; they need the time and support.”

Jenni says the only invasive surgery she would consider would be male-to-female reconstruction, but that would depend on a few factors, like her health and age. She is also seeking a diagnosis of gender dysphoria from her GP on top of the one from her private clinic.

A representative of GenderGP has suggested that Jenni act as an ambassador for trans women. “I met up with a local trans woman yesterday from a website I’m on. She told me she dresses for her therapist but struggles other times. I said: ‘Well, if you can do it for your therapist, then you can do it for everyone else’. I told her to stay positive.

If you act normal around people, they act the same back. If you stop being shy and have a positive attitude, people are just fine with it.”

When the lady mentioned surgery, Jenni steered her towards considering aesthetic treatments instead: “If you go for things like fillers and botulinum toxin, it’s not permanent. If it’s not what you want, you can say ‘no, not that’. If you go for surgery, that’s it done. I told her to speak to a practitioner or a clinic, and just see what they can do – you’ll be amazed”.

Looking to the future, Rachel believes there are always new advancements in the field: “We found that with botulinum toxin and fillers, we can get to a certain point. We’ve pushed skincare and there are also a lot of skin boosters coming to the market that improve the integrity of the skin. We want to give that softer look, having your lips and cheeks filled is less effective with a masculine complexion. We like everything in keeping, otherwise, you end up making someone look unnatural. We wanted her to look as feminine and natural as possible because if not, it sounds awful, but you can end up with results that look harsher and more exaggerated. She wanted to appear as a woman and so that was our primary concern.

“I haven’t got the time to wait. Not that I want to race, but my age is against me. I know exactly where I want to go in life. I live like this 24/7 - it’s normal for me now.”

Jenni’s advice to those at an earlier point in their journey is, if they have any doubts, to seek professional help: “First talk to the GP because they will tell you where to go and who to see.”

SUCCESSFUL RESULTS

“If you see pictures of me from before my journey, it’s unreal. I’ve always looked quite feminine anyway. I’ve got a smallish face. I’m fineboned with a small frame – five foot seven, and quite slim. I’ve never had much facial hair, so I go once a month for hair removal.

“A doctor told me that when you decide what to do and you are happy with yourself, your body and your mind sort of matchup. My breasts started to grow before HRT. I don’t use any breast forms, just a slightly padded bra.

“I’ve not stopped,” Jenni concludes. “I’ll continue having treatments as far as botulinum toxin and fillers are concerned. I had quite a bit to start with and slowed down now because it’s just topping up, but I will have some more. I will take advice from the practitioners about it as well. It’s been so subtle, not over the top. That isn’t from me, that’s from my practitioner, knowing basically how to do her job well.”

Rachel recommends allowing around twelve months for a full facial aesthetics transformation: “After that, you’re refining, you’re maintaining - that’s the same for any of our clients, male or female. We get them to the point that they want to be and how they feel comfortable and then we have to maintain that. Obviously, as a practitioner, you then have to look after their face and look for things that may cause problems in the future, little areas of depression or little indentations that suggest at some point we may need to do something. It’s not a beginning and end - it’s a journey.

“I was walking down the high street one day, and I double took this lady that passed me because I thought, ‘Oh, she looks lovely. I’ve got goosebumps telling you now because it was Jenni. It was a real eureka moment!”