Podcast with Patricio Battani (2024-01-18 15:03 GMT-8) - Transcript
Attendees
Dr. Crystal Beal (they/themme), Patricio Battani
Transcript
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Dr. Crystal Beal (they/themme): On the backwards. Hello everyone. Welcome back to the queer See Me podcast. Thank you so much for joining me today. I'm super excited to have you we met in Alaska which is weird because neither one of us live there.
Patricio Battani: Yes. Definitely. I'm so excited to be here. But yeah, it was a weird chance meeting but a very good one.
Dr. Crystal Beal (they/themme): Yes, can you tell our audience who you are your pronouns are you identify and then we'll go like what you do next?
Patricio Battani: Sure, so, my name is Battani. I'm pronouns indifferent. So I don't really use any pronouns specifically just whatever. And identify as queer in both gender and sexuality. So a lot of people refer to this trans non-binary if we want to get very specific but I don't know. I'm just kind of hanging out on the outskirts, I think.
Dr. Crystal Beal (they/themme): I really enjoy visual representations of gender. And so I feel like hang out on the outskirts gives a very visual impact and one of my guests in collegial people. I worked with one time described her. Tinder and I don't actually remember. their pronouns but describe the gender as
Dr. Crystal Beal (they/themme): a field with different boxes in it, and then there's a cat that wonders into the boxes and out of the boxes and there's a whole fourth dimension of movement. It was really, but it was so visual and fun. So thank you for sharing that. yes and you work directly within the field of gender-affirming care. So tell our audience what you do?
Patricio Battani: So I actually am an electrologist. So technically I have a master's degree in public health. And so I spent the last 25 years doing HIV work and while I was at a previous employer. We had started the trans navigation program and the one thing that came out of it was the fact that we had no electrologists here, Hawaii. And right now there are four so for the entire state And somebody once told me that Hawaii has the most trans people. In the US but I don't know how true that really is. But okay, it's really full so.
Patricio Battani: But yeah, so I started an organization. It's called Isis for Hawaii electrolysis, and I went to electrology school because I jokingly said one day in a meeting that if we can't find anyone else to do I'll just do it myself. that turned into actually doing it myself. So I've been doing that we're going on three years this year.
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: And so I've been doing that and then we started a school so that we could actually have more people to actually do this because I went from 30 clients to 150 in less than a year. So, yeah, it's a little insane about 90% of the people we do electrology for are doing it is gender affirming care. but in the kind of side of that now we're also doing a whole bunch of other things that are gender affirming kind of
Patricio Battani: I don't want to call it cosmetic care, but most people would refer to as cosmetic. But yeah.
Dr. Crystal Beal (they/themme): but aesthetic, I don't know why that word has last negative connotations to me and it feels to bridge the gap between I don't know if it's a gap but I feel like gender affirming Aesthetics, right and…
Patricio Battani: Yeah.
Dr. Crystal Beal (they/themme): it's interesting. It's such a complex and nuanced thing right because dinner dysphoria is real and It also exists within the culture of white supremacy in the patriarchy which has put these unrealistic ideal standards of beauty on all of our bodies.
Patricio Battani: right
Dr. Crystal Beal (they/themme): And so it can be very like the complex for sure to pick those things apart and sometimes they can't be separated but for whatever reason I feel like cosmetic has these kind of negative connotations of rich white ladies getting their poop.
Patricio Battani: Yeah.
Patricio Battani: I agree there is some real negative connotation especision within Hawaii. it is a Space and a very recently colonized space and so that's something that we do take into consideration to that, beauty is kind of right Supremacy ideology, wait and stuff like that. And so one of the biggest things that I do try to do in practice is, obviously consensual touching and then also in addition to that, kind of hearing people out about their concerns of hair and explaining to them the purpose of and in just being like we have here for a reason and most of that reason is to keep us warm keep germs out of us. And so I think sometimes we do think it to that kind of medical.
00:05:00
Patricio Battani: functionality helps them to understand that, we're not doing this because of that beauty standard we're doing this because one you have dysphoria about it and two, I'm just here to help you. survive at this point
Dr. Crystal Beal (they/themme): yeah, right and Pretty comes in all shapes since I use is right I think in queer and…
Patricio Battani:
Dr. Crystal Beal (they/themme): trans faces at least in the ones I move in that it's such a celebrated reality and I love that and as someone who plays very hard into those ideal standards of beauty and my presentation I like awesome very happy to celebrate people who are like, I just wanted to look like this. Great, it's your* body. Let's do that. but I love when rate we can have that interaction with our clients with our patients to really acknowledge all of those things that are moving in this space when we're doing these things. yeah, so it's for whatever reason
Dr. Crystal Beal (they/themme): So much of cosmetic surgery is gender affirming versus people I feel like maybe the difference is potentially there has been last intentional examination of the lake. Standards being put on our bodies versus the things that we want internally for our bodies. And so I feel like that Aesthetics term separates it a little bit for me and just as these are tender affirming aesthetic procedures. And so yeah,…
Patricio Battani: right
Dr. Crystal Beal (they/themme): and let's dive a little deeper for our listeners who are used to me getting on tangents about vocabulary.
Dr. Crystal Beal (they/themme): about hair removal in general and I know your specialty is with An trellises machine or electrology you always add you stay at differently than I'm used to hearing it. So can you first explain the pronunciation to me?
Patricio Battani:
Patricio Battani: There's nothing wrong way of that. So there's electrons this which is like act of and then you're like electrology which is I think that's kind of the best way to describe it. you kind of get funky…
Dr. Crystal Beal (they/themme): Okay.
Patricio Battani: because both of those terms also refer to a chemical reaction that Happens for nickel plating too. So
Dr. Crystal Beal (they/themme): I forgot. Yes God. Yes.
Patricio Battani: I mean, It's the same chemical concept. It's just two very different things so
Dr. Crystal Beal (they/themme): Different applications. Yeah, and I don't know how much information you have around laser hair removal too because I would love to kind of if you could give an overview of each and then maybe the different point out highlight the differences for our listeners because most of our listeners are referring providers, So this is really important for them to understand when they're patients are trying to understand.
Patricio Battani: So what the best part is like and I'm glad that they're referring providers because a lot of times it gets interchanged and it's frustrating. So electrolysis, whatever you want to call it is permanent hair removal. It's the only form of permanent hair removal that the FDA has cleared and it's been around for over 150 years. I mean It started out as removing ingrown eyelashes. That's how it started.
Dr. Crystal Beal (they/themme): and ground
Patricio Battani: Yeah, and so Most states won't allow you to do that now, but you can do everything else. And so one of the biggest things is electrology is inserting a small probe and the probe is the size of a hair Whatever the size of the clients hair follicle is and then we insert that and we release a specifically timed amount of energy that energy either causes the chemical reaction which is a galvanic it lie and destroys the cells or it's the Moses which is radio frequency which heats up and so those are the two main ways. There's one called the blend which is both And so, each electrologist does. Whatever one they do and some of people only do one something, we do all three. It just depends on what type of hair someone has and stuff like that.
Patricio Battani: So that's basically electrolysis. it's for everyone. There's no limitations on anything like that. The one thing I would do is if you're referring and the patient has moles or has any type of skin abnormalities to make sure that when you make that referral you're also putting in there that you're okay with the electrologist Care on those areas as well. So I have a mole on my face. I have to have a physician sign off on that and so that would just be helpful to know, especially if we're doing kind of areas where donor tissue is involved. So kind of the vaginal plastic donor tissue, a lot of people don't realize that they have moles down there. So having a physician inspect that area first and here's moles and stuff like that. And so that's a big thing.
00:10:00
Dr. Crystal Beal (they/themme): You I'm gonna interrupt you.
Patricio Battani: laser hair
Dr. Crystal Beal (they/themme): I don't want to lose our total train of thought and part of it might depend on the surgeons desires too, but I'm wondering would you typically recommend And removable for particularly if it's gonna be used for donor tissue, so you wouldn't necessarily want the mole on the donor site and…
Patricio Battani: right
Dr. Crystal Beal (they/themme): would you recommend removal before hair removal of the mole or would you do more removal after hair removal?
Patricio Battani:
Patricio Battani: I mean, that's up to the surgeon. I mean if it's some I would assume they would remove it before I mean that would be ideal, but yeah, it's about checking that little and making sure that it's one not cancerous or potentially cancerous and that we're just kind of it just because we as electrologist cannot make that decision to treat that,…
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: it's better to have someone say yes. I've seen this I look it's fine with me. So yeah.
Dr. Crystal Beal (they/themme): Okay.
Patricio Battani: But usually if I see something I will tell the client you have a mold down here in this area. You need to speak to Most primary care.
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: People are just making the referral and they're expecting surgeons to look in most people coming to electrologist before they even have a surgical.
Dr. Crystal Beal (they/themme): Really in the surgeon? Yeah.
Patricio Battani: So that's kind of a big thing. With laser is there's two types of …
Dr. Crystal Beal (they/themme): noted
Patricio Battani: There's different types of actual laser. So there's Alexandra there is yeah and all of those things so those kind of Like lasers,…
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: I call them the few lasers because the applicator looks like a gun. They're the ones that kind of fry the hair.
Patricio Battani: And so what that's doing is it's actually looking for the melanin in the hair to destroy that so that's why they're not effective on white blood or red hair. They just can't do anything about it. And so those are relatively effective in terms of if you have the proper skin tone versus hair color. So, if you're white and you have dark hair, that's the ideal for some, lasers you cannot have a darker skin tone. You cannot be I kind of later and on the Fitzpatrick scale just because it could cause burning.
Patricio Battani: There's another type of laser called IPL or intense post light. And so that's just kind of the same thing, but it's just a really intense light rather than kind of a focused laser if that makes sense. So the IPL is now one of the big things I feel has done is it's kind of paired up with radio frequency to create heat and…
Dr. Crystal Beal (they/themme): Yep.
Patricio Battani: so they have not something called Elite Hair Removal and that actually is painless. It's actually really great. I use it for some of my clients and it has done wonders and so, having a combination of those two things The one thing about laser hair reduction is that it is just reduction. It's not gonna remove everything and there is a possibility that the hair may come back. And so that's the whole thing.
Patricio Battani: Which is why electrology should be the recommended form for donor tissue. So anything especially with vaginal policy if we're going to do inversion you really need to do electrology on it. that's just kind of the end game there because we do have folks, here in Hawaii that I seen who have intervaginal hair that have said, I have laser though, and I'm like, this and there's nothing we can do about it. Once it's inside, unfortunately.
Dr. Crystal Beal (they/themme): Yeah. Yeah,…
Patricio Battani: so
Dr. Crystal Beal (they/themme): I'm gonna Circle back just because you've said so many valuable things. I want to make sure the listeners hear them when the most common lasers in practice and aesthetic practices and more Dermatologists sometimes have more options because they tend to have more Advanced Machinery, but most common you can get a group on for it lasers. Don't treat blonde red white or gray hair right?
00:15:00
Patricio Battani: correct.
Dr. Crystal Beal (they/themme): And also don't treat people with darker skin. and so yeah,…
Patricio Battani: mostly
Dr. Crystal Beal (they/themme): and so that's the most common ones and then there are some practices that do house and Energy devices to classify. Let's just throw all of them in there. and that cancer people with darker skin and that can and treat other hair colors, but those are a little bit harder to find and I also often find that they don't tend to do pricing packages in this ads competitively as the lasers that are less applicable to less body types and…
Patricio Battani: right
Patricio Battani: right
Dr. Crystal Beal (they/themme): just to give general information about shopping for hair removal for people and then I think kind of
Dr. Crystal Beal (they/themme): How you present?
Dr. Crystal Beal (they/themme): a reduction you say any news 8 has the chance of coming back and I say it's Me Permanent meaning you will probably have to touch it up every six to 12 months. Yeah, and…
Patricio Battani: Yeah, yeah, definitely.
Dr. Crystal Beal (they/themme): and completely agree. It's so if the tissue we're doing hair removal on is going to end up ternally. Having a more permanent solution because retained and hair can cause significant dysphoria and distress for people it can also cause some actual physical presentation symptoms. So irritation and amount odorous discharge and so definitely striving to have complete hair free of that donor site and electrolysis is going to be
Dr. Crystal Beal (they/themme): a more successful treatment
Patricio Battani: Yeah, so in going kind of back to the hair color elite is the only one that can effectively treats blonde and white hair red hair just tends to not be treatable with a laser just because The way it works, but you can be effective especially if it's strawberry blonde it was a little bit more blonde than it is red. So that's the only one that I know of personally that can actually do those hair types and it is safe for every skin tone Elite is and the way we do both electrology and Laser here is we offer it.
Patricio Battani: So in Hawaii, they're supposed to cover it by Insurance standards. And of course Insurance never does it requires this huge amount of paperwork just to even get it covered and then they don't pay us because we're not MediCal providers. And so that's something that we're dealing with here. So what we do often is for those folks who have the insurance that won't cover it. We offer those services that a dramatically reduced rates. Our whole organization is volunteer based in the last three years. We've not gotten paid a dime and so, we do this because for the people that sounds very political for the people but our goal is The closing that gap on care because even though it's the law. It's still there and so
Patricio Battani: either one of these Solutions in hair, especially if someone seeing specifically trans folks or specifically seeing a lot more trans folks. It would be ideal for you if you're in private practice or even in practice in a larger kind of corporate setting. to advocate for having an electrologist on your staff have a laser in your practice because when we look at huge conglomerates kind of on the West Coast they're kind of the best.
Patricio Battani: Like symbol or whatever example of an enclosed system, I'm not saying that they're the best system or anything like that. I'm just saying it's just that they're structure is ideal,…
Dr. Crystal Beal (they/themme): There anything about okay?
Patricio Battani: because everything is inside of Kaiser, and so that's the one thing you don't have to go to a million different places to get care. we do live on an island but traffic in Hawaii if you've ever driven in Hawaii and then incredibly more horrible. And so it takes hours to get from the West Side to our office. And there's nobody on the west side, and so there's a lot when it comes to these. specifically hair removal services just
00:20:00
Patricio Battani: I encourage people just to look into having someone even part time if you're at a federally qualified Health Center do it. I'm sure there's a grant out there and if you need help, just call us. We will definitely help you write the grant. But it's just those types of things. It's just an advocacy and there's a lot of states that are unlicensed.
Dr. Crystal Beal (they/themme): I'm so sorry. Someone's knocking on my front door. I'll be right back. the bathroom…
Patricio Battani: Okay, that's right.
Dr. Crystal Beal (they/themme): if you
Dr. Crystal Beal (they/themme): come upstairs.
Dr. Crystal Beal (they/themme): Sorry, it was like my hazelnut milk delivery. So Brandon and Yes, so definitely. encouraging clinics and health systems and fqhcs to incorporate hair removal into the primary care setting and would be a huge part of increasing access for Trans and gender diverse folks and
Patricio Battani: Primary care, I mean it is technically,
Dr. Crystal Beal (they/themme): yeah, so I think that if you providers have questions about how to incorporate that or what that might look like you can reach out to his and I will have all the links you'll be here with the podcast, and I would love to talk a little too about Kind of how to help set realistic expectations for our patients if we're referring them. or even if we get lucky enough to have advocated successfully and get it incorporated into our office and so for
Dr. Crystal Beal (they/themme): electrolysis if someone's going for electrolysis, let's say facial hair first. Let's do that typical average number of sessions and how far apart their space and how long each session is kind of expected course.
Patricio Battani: so there's no way for us to tell you how many sessions it really just depends on the density of the hair that kind of stuff and if you were plucking or had waxing so anything that could damage the hair follicle could also prevent, removal
Patricio Battani: and so there's a lot of factors there. I typically tell people because they're always gonna ask. It's gonna take as long as it takes that's the end of the day so 12 to 18 months is going to be the bare minimum at that point because hair grows in cycles and we just have to catch the cycle, specifically on the face the antigen phase hair which is the beginning here where we need to treat to effectively kill off the hair, there's only a small percentage of hair in that stage on the face and so those types of things
Patricio Battani: so I always tell people within the first three months you should see a significant reduction in the hair removal some electrologist will tell you 50% I don't say that because again that has to do with how long we're doing that kind of stuff how quick your electrologist is that sort of thing. So when it comes to tightening wise of how often you should do it, I recommend weekly if there's somebody who has a full beard, Let's do it weekly. Let's get as much as we can. How I usually do it is I work on one side. And then clear that area and then go to the next side so that area has time to heal and do a little sense of things who are not doing too much damage to the skin because we are shooting electricity and putting chemicals into the skin. So, we do have to have that kind of
Patricio Battani: kind of downtime but I've done eight hours sessions. I've done two hours. I typically do just an hour with folks. But if somebody for example comes from one of our neighbor islands where they're only coming every so often. I will do two or three hours with them because it's pointless to come here for one hour. You just had to file all the way here take a day off that kind of stuff. So, we can do as long as you want, especially if you have a medical director or someone that can do kind of injectable Lidocaine with EPI and stuff like that. So that way there's just less pain. One of the things that I would tell patients is this is not a painless procedure. By any means of that word. I don't want people out there telling freaking people out and telling them it's so painful.
00:25:00
Patricio Battani: It should be painful but it should be manageable. it should never feel like your face is being burned off. And so that's an expectation that needs to be kind of set because a lot of states are unlicensed. And so they're electrologists don't have to have a license and who knows where they went to school or what, they could have gone to the University of YouTube and just decided to do this. So it's just one of those things and in no way am I telling other electrologists how to run their practice but it's just we have certain parameters about how we do what we do to preserve the skin integrity and that's incredibly important especially with donor tissue, if we're down there frying tissue, where we may be causing infections which could lead to all sorts of applications.
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: So, that's just kind of what the expectation would be. the person should be doing if're doing a medical they're doing it for medical reasons or what I call medically necessary. There should be photos, there should be documentation. There should be charting. Those types of things and so, at bare minimum we should know when they came to the visit what settings you use what probes eyes you use and how long it was, we do a much more robust.
Patricio Battani: Documentation so because we just have an EMR so that's just easier for us. so just kind of setting those expectations especially if you've never had electrology and I would encourage every person to go out if you're gonna send someone to do something don't try …
Dr. Crystal Beal (they/themme): Right. Yeah.
Patricio Battani: and I'm not saying you have to go get a whole session just call it I'll just say hey, I refer people, for transcare and I know that you do it. Can I please come in and have a short 15 minute session or something so I can feel what it feels and that's the best way, because I get people who are so scared that is gonna hurt so much that when I start they're like, this doesn't even hurt at all and I'm like, that's good, so it's one of those things that
Patricio Battani: managing expectations for clients is different. We're obviously every client but kind of letting them know that always something this is a marathon not a Sprint like this is here for the long day.
Dr. Crystal Beal (they/themme): Yeah. Yeah.
Dr. Crystal Beal (they/themme): So minimum 12 to 18 months weekly hour-long sessions average expectation if accessibility works that way for electrolysis for facial hair. And yeah, I think with most of the hair removal methods there is some discomfort and I usually help people to do depending on their existing health conditions either Tylenol or Ibuprofen about an hour before a session like half an hour to an hour before a session and then
Dr. Crystal Beal (they/themme): over the counter topical numbing or I prescribe compounded topical numbing as well. And then yes, if you're working with them medical clinician, there's inductible blocks and things like that. You can do to help with pain control as well. And then for I know different lasers work differently, but General expectations that someone was doing their face treatment
Patricio Battani: So lasers, you can only do laser once every four to six weeks and that depends on the type of laser. And so you're looking at probably even four to five sessions before you'll start to see a significant reduction after the first and second session, but maybe four to five sessions sometimes even six before you're seeing full clearance if that makes sense. but they're much quicker, and so a laser session on the face probably takes about 10 minutes, and so well depending on the person but most places will put on topical numbing cream for that stuff like that. So the appointments usually about an hour half hour to an hour that is so laser
00:30:00
Patricio Battani: Yeah, Alexandrite all of the kind of like gun lasers. They feel like someone is snapping you with a rubber bands.
Dr. Crystal Beal (they/themme): I'm just gonna say I think it feels like someone's like slamming a nail into my jaw bone, but
Patricio Battani: That's the best way that's gonna
Patricio Battani: Okay, I mean, everyone feels things differently.
Dr. Crystal Beal (they/themme): Yeah, I feel like anytime. It's over a bony surface. I'm good that hurts. Yeah.
Patricio Battani: Electrons is the same way, and so the face is obviously one of the worst places to get on Trials on because over the bone so over the jawline the upper lip is absolutely insane.
Dr. Crystal Beal (they/themme): Get all those nerves from your teeth. Yeah.
Patricio Battani: Yeah, and so the one thing kind of going back about topical numbing creams. It's interesting that you say that because recently there was research that found that we actually have nerve endings inside of the follicle. And so there is kind of this. New research coming out that maybe the topicals aren't going to be helpful, so that's the thing. You're still gonna feel It's just gonna be numb so it's …
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: that's kind of an expectation because people put that on I think they're not gonna feel anything. That's absolutely not true and…
Dr. Crystal Beal (they/themme): No, yeah.
Patricio Battani: they also need to recognize that once that topical starts to dry.
Patricio Battani: it's done, you're metabolizing it and there are obviously fast metabolizer slow, with my sessions. I always tell people we can stop whenever you need to you just have to say something. So yeah don't endure.
Dr. Crystal Beal (they/themme): And if you do it at a medical facility, because where I've had some of mine done and I'm often times doing it in combination with other things as well and they will pretreat me with an oxycodone. And so you have to bring a driver obviously can't drive myself home after I've had a narcotic and…
Patricio Battani: Yeah.
Dr. Crystal Beal (they/themme): I've already gone through all the consent process and procedure prior to being altered but they'll all come I think have to be there 45 minutes early and then they'll give me my little pill and my little water crop and leave me in my room, and for me that was essential because I actually believe it or not prior to that right here removal somewhere else that would not do that and they were doing some other laser stuff for me too, and I
Dr. Crystal Beal (they/themme): After two sessions, I never made it back every appointment. I made I would either no show or cancel because I was so stressed out about how uncomfortable it was gonna be.
Patricio Battani: Yeah.
Dr. Crystal Beal (they/themme): And so yeah, I feel like clinicians. I just want to be really clear. I think and we've actually talked about this before I think someone needs to go through the consent process on altered. They need to understand what the procedures gonna be like an altered And then if they are gonna medicate with medications that are gonna affect their cognition. They need to have a support person there to get them home. But yeah, I'm really comfortable with patients having and stronger medication for hair removal sessions…
Patricio Battani: What?
Dr. Crystal Beal (they/themme): because I as you just said try it yourself and I am like f*** this noise.
Patricio Battani: Yeah. it's very real the same with pain and me so there are some places that will actually put you completely under so that means a little excessive in my mind just because anytime we're putting someone on there.
Dr. Crystal Beal (they/themme): The other risk of anesthesia. Yeah.
Patricio Battani: It's very big breasts. but again, that's not my place to tell anyone what to do. So the biggest thing is doing you need to do to be comfortable because if you're jumping in my chair, you're going to make that needle move and I'm gonna burn you we're gonna have some other issues. you may push the needle into the skin, because we're not penetrating skin at all, …
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: there should be, no to minimum blood involved, sometimes you accidentally post someone it's a thing. But yeah, so we're not penetrating. Let's get in any way.
Patricio Battani: And so, there's just a real risk there, and I have some clients who will kick their legs and do all these things and I just have to stop and…
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: be like look, I can't continue. it's one of those things. So, we started selling kind of a higher dose of lidocaine cream just because …
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: we're not Physicians so we do have a medical director, and we finally just got our Malpractice insurance. So yay on that so, now we can start doing the bigger things, but, previously we were just getting some tattoo cream, sometimes too parlors have Russian tattoo creams that are maybe not so legal, but
00:35:00
Dr. Crystal Beal (they/themme): Patients can order things internationally that's totally fine clinicians prescribers. I do a compounded BLT. It' became lidocaine touch a cane and talk to your compounding pharmacy that you work with the most often. They might already have kind of a preparation that they use for that. usually you can do a 10 10 20, if you start putting more than 30 or 40 percent and to a cream it gets gritty and so you kind of have to 10 10 20 is the most a lot of times 10 10, but those are kind of and things to do in When you do the combination because they all have kind of different Half-Life there is a little bit longer duration there but yeah, I personally really need the narcotic and it doesn't necessarily make it hurt a whole lot less because it is kind of nerve pain. Sometimes it just makes me not care, and…
Patricio Battani: Right, right.
Dr. Crystal Beal (they/themme): let me show up to the appointment. have the procedure done and…
Patricio Battani: right
Dr. Crystal Beal (they/themme): also exactly what you're saying not move all over the table or curse my provider or fling an arm at them not intentionally trying to hit them but kind of not that stress response. And so yeah, I completely agree any opportunity you can experience as a clinician that you're gonna recommend to patients. I love recommending providers do that. And I do think this is one of those things that like A pre procedural benzo or procedural narcotic you you're not prescribing it 90 every 90 days, your prescribing and…
Patricio Battani: right
Dr. Crystal Beal (they/themme): 12 for a three month. That's three month period because it's one a week, right and…
Patricio Battani: right
Dr. Crystal Beal (they/themme): providers. This is a very different thing and also obviously talking to patients about the risk of dependency and all these things. But I think these are appropriate uses of these medications and I wouldn't ask about were you calling it Elite? Okay. So…
Patricio Battani: Yes. it's
Dr. Crystal Beal (they/themme): what is kind of the expected? how frequently can you do that one with duration? what's the details on that one?
Patricio Battani: So Elite is just a combination of radio frequency and IPL. So it's just IBO was ready.
Dr. Crystal Beal (they/themme): Okay.
Patricio Battani: The concept is that the IPL is acting and the way that I feel acts to do hair damage and that the radio frequ. Follicle in addition to that. So that's the combination of the both helped to kind of get rid of hair. What I've noticed is you don't see kind of a like sometimes when you get laser you get patches of hair that it's gone. I've noticed that this is more of a gradual. lessening of hair and the hair slowly stops growing. That's just kind of a personal experience of what I've seen on clients.
Patricio Battani: And so that's the biggest thing. So Elite is just kind of like laser. So it's every four to six weeks depending on what the practitioner I would say four just because dealing with folks I shouldn't say dealing working with folks who are experiencing gender dysphoria waiting for weeks is not easy. …
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: I have one client who every week can I come in this week?
Dr. Crystal Beal (they/themme): Okay. connect pronouns
Patricio Battani: No, boo, you have to stop I can do the electrologist. So the one beauty is that with laser you have to wait six weeks between that and electrology so you can't do that with the elid. I found that I can do electrology…
Dr. Crystal Beal (they/themme): s
Patricio Battani: because they're still viable hair. So that's the concept is that when you're going through and just kind of frying all the hair they bulbs aren't there and so it's just not effective and treatment. I've noticed that with Elite.
Patricio Battani: you can treat one side of the face one week and do electrology on it and then switch, in the four weeks or whatever. But yeah, so it's really up to the practitioner and I think it's really specifically with folks who are dealing with a facial hair dysphoria is Finding what combination of these things works, I started off kind of very anti laser because of course it wasn't permanent. you just kind of getting that way and then I realized if I can reduce the hair significantly is not going to matter whether it's coming back if we're still doing electrolysis just because we're going to treat that hair anyway, but they're gonna see a result and they're gonna be much happier.
00:40:00
Patricio Battani: And so, they're gonna feel better about it. But I also just have people who feel better getting into the chair and even if you clear one little spot on the face because they can't handle the pain they will literally sit there and rub that spot and I'm just like quit touching your face.
Dr. Crystal Beal (they/themme): We just did some drama to the skin, please worship Him.
Patricio Battani: But I don't know there's this beauty in when you do that and they're looking in the mirror and that you Euphoria. that's why you do it. it's kind of amazing. If you've never seen anyone experience gender Euphoria you're there in that moment. it's amazing. Yeah.
Dr. Crystal Beal (they/themme): It's so good. and so this has been a lot of really useful information. I think one of the other things like referring clinicians should know is how counsel their patients on how to prepare. And so very specifically I think about when should they stop waxing lacking at the lady? right and that kind of counseling. So what should that they tell their patients?
Patricio Battani: So if you still using an epilator. Put it away. That's from the 90s stop it because all it's doing is tearing hair out. so…
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: if you have a client They should not be plucking and they shouldn't be doing any kind of thing. That's gonna pull the hair out.
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: The follicle is gonna make it harder for us. The one big thing is as we tell people do not Stop it now. Because you're just gonna end up with those 90s eyebrows where the hair stops growing completely and it just damages the skin.
Patricio Battani: And it those types of practices can create a lot of ingrowns a lot of damage to the skin, especially if the waxer is not great at their job. They can burn the skin and then we have an issue because we can't work on it. And so those types of things we just tell people to stop doing with waxing. I was tell people it should be six weeks just because again the hair cycle with plucking with fine, we can just start immediately and that kind of stuff every electrologist who is in care should be doing the consultation, I don't care who says they don't or whatever. I just believe that we're all taught it. It's hot in the schools. we should be doing it because that's how we're gonna answer the questions, it should not all primarily on the provider to answer these questions.
Patricio Battani: We should be the ones answering the questions. All of these things are in my consultation, you should stop doing laser. It's gonna take six weeks. The only thing you should be doing is shaving and I have to have enough hair that I can pull the hair up. So it has to have enough length. So, for a lot of folks who grow hair very quickly, So that's three days without shaving now some electrologist tell people just to stop shaving all together. which everyone does what they can do. I just know that a lot of my folks.
Dr. Crystal Beal (they/themme): No.
Patricio Battani: There's no way they can do that.
Patricio Battani: Even with masks at this point, they're just not willing to do it or…
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: they have jobs, we're in a very heavy military place so they have to be clean shaven. And so, I've had to adjust my schedule to be open on Sundays for example, so that the military folks can stop shaving Friday night, and have enough growth and so that's just kind of What we would do so we would kind of go there but just kind of stop doing everything…
Dr. Crystal Beal (they/themme): Yes.
Patricio Battani: but shaving if you do want to wax it should be hard wax is often pulled with The grain of the hair off of X is pulled against it anytime.
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: We're pulling against the follicle. We can distort the follicle.
Patricio Battani: And damage all sorts of stuff. So, most of it's about preserving the Integrity of the follicle for us just because that's where we do our work so it just depends if we're going to donor tissue specifically if we're doing kind of genital donor tissue. We need to make sure that that person does not do anything. They don't technically need to shave down there either unless they want to sometimes it's easier if they do just because it can be very generally in that. him
Dr. Crystal Beal (they/themme): And to clarify for our listeners, this would also be true for fallopasty donor sites. So forearms die abdomen hair removal and again like you want to cause as little trauma as possible to that skin and pre Harvest and so not using any of the lake potentially harmful hair removal methods And yeah, I think my hair removal person told me nothing but shaving for four weeks before I showed up for my appointment. And so I totally agree with you everyone should get a consult with their hair removal person and get to learn more from them because us as referring providers are not gonna know all of the intimate details, but I think being able to tell your patients you're gonna have to stop waxing sugaring threading epilating clocking and for at least four weeks before you go to a session helps them.
00:45:00
Dr. Crystal Beal (they/themme): Understand because people get so excited and so if they come to you for their console and then have to wait another six weeks because they did some hair removal that means you can't access what you need. and so I think that's a good bit of information to give our patients and especially for a donor tissue, I think counseling around not doing any of those things that are going to damage the skin or damage the follicles so that the hair removal can be more successful and…
Patricio Battani: And I think it would be really great…
Dr. Crystal Beal (they/themme): yeah is really
Patricio Battani: if referring folks could. Kind of explain the hair cycle a little bit. So the people can understand that this hair is gonna regrow, …
Dr. Crystal Beal (they/themme): Yeah. Will you tell us…
Patricio Battani: or look like it's regrowing
Dr. Crystal Beal (they/themme): how you explain the hair Cycles? So we have a little…
Patricio Battani: sir
Dr. Crystal Beal (they/themme): because med school was a long time ago, and I remember very little about it.
Patricio Battani: so I was tell people there's actually four stages, So a lot of people say there's three And it's whatever. So the first stage at the antigen, that's the growth phase. That's because what we're trying to get to the dermal papilla. So that little area at the bottom where it attaches and gives nutrients and that kind of stuff. So that's when the hair still attached. And so that's when we can effectively treat it. next stage is
Patricio Battani: collagen and that's when the hair starts to detach and starts to kind of die off and it's ready to start moving into its final resting stage that just sounded really weird. I know resting stage, but's so that sometimes if we catch it early Cottage in we can effectively Trader intelligent is the last days that means the hair is ready to come out and the final stage is actually called exigen but it's also what antigens restarts. And so that's where the discrepancy between three and four happens. some people say there's three Cycles because that engine restarts but Exogen is when the hair actually comes out.
Patricio Battani: The beauty of saving is if you have Intelligent Hair A lot of times you're just gonna pull that hair out with the razor. So it's not gonna cut it because it's not attached to anything and it's just gonna pull right out and it's exfoliating as well. So that's how I describe it to folks and I always tell people there's two types of regrowth there's a parent regrowth and So a parent regrowth is I've treated an area and you're starting to see hair grow again. Now remember it's a cycle every hair Cycles the same time, not even a group of hair may not cycle at the same time. And so just kind of going and saying that that's a parent regrowth that stuff we have in treated.
Patricio Battani: There's actual regrowth which is stuff that we have treated that's coming back for whatever reason either. It was in early collagen or Lake cottage and we just didn't get it right, or for some reason we just didn't hit it in the right spot and usually actual regrowth happens at that three month Mark, that's four to six week Mark when we have hair regrowth and I always tell people my favorite thing I hear all the time is I'm growing more hair. you're not. you're born with every hair follicle you're ever gonna have. it's your hormones that are indicating when to grow hair what kind of hair to grow and so, the different types of hair like Bellas versus terminal and so especially with folks who are experiencing PCOS and here's autism and things of that nature. I always try to explain to them
Patricio Battani: you may see more hair growth because you have an antigen issue that is telling your hair to actually grow. So, we normally only see female presenting folks with PCOS, but it's just that kind of thing. But yeah, I mean at the end of the day it really just depends on hormones, it depends on that kind of like where you are now when someone's on estrogen
00:50:00
Patricio Battani: It actually kind of makes the hair a little bit finer, especially over the body and it can happen with the face. And so that happens and usually Peaks around the two-year Mark. So that's also something to kind of be inconsideration on that as estrogen kind of like as you build that Reserve. I don't know it's not a reserve but as estrogen kind of builds up in the body you may actually start having different skin reactions as well. I've had people come in everything's fine and then they start estrogen and now we're having histamine reactions. And so those are things that I describe in our consultation and just kind of say Hey, these are the things that are possible happening. So, it's very simple.
Dr. Crystal Beal (they/themme): Have you seen I feel like one of the things that I've kind of noticed and this is just like a clinical observation clinicians. This is not evidence or research based by any means but it seems like estrogen can sometimes speed up the loss of pigment and in hair for my patients as well. Have you noticed that or I'm curious if anyone else has noticed that
Patricio Battani: It's rare that I have anyone that's just starting estrogen or any type of hormone. And so I don't know that I've seen that but they verbalize that to me I'm getting way more white hair and…
Dr. Crystal Beal (they/themme): Okay. Yeah,…
Patricio Battani: I'm like you are getting older too. So, like that.
Dr. Crystal Beal (they/themme): but it seems to happen really quickly with the initiation of estrogen. It's kind of interesting. I don't know. I would be interested I could maybe try to come up with a theory behind it. But anyways, I want to respect your time and you've been such a great guest but is there anything else you would like referring clinicians to no or talk to their patients about anymore like hot potatoes for you?
Patricio Battani: Yeah, okay. There's a couple of things one come and meet us We're part of your team, at that point you're referring someone to us. We're not part of your team. And so you need to know who we are. There are plenty of electrologists out there who aren't comfortable treating trans folks. I just did a study room finishing a study of that. And as a part of that study, I got a call from the president of Association telling me that I needed to stop sending out the survey because it was making people uncomfortable and we were just asking whether or not they Treat trans people so that's very real out there. So who you're sending people to. Know whether or not they're good listen to your clients and patients when they come in and say you send me to this person and it is not working, Trust me.
Patricio Battani: It happens. So just know who we are. The second thing is that sometimes electrologists and estheticians and folks who are more like trade quote unquote people.
Dr. Crystal Beal (they/themme): Not in the way.
Dr. Crystal Beal (they/themme): We usually talk about trade on the ship.
Patricio Battani: Right. …
Patricio Battani: they could also be that too. We know that's what they do whenever but it's funny to me that we kind of get seen as an uneducated those types of things, then we kind of get put in these boxes when the reality of the situation is that most electrologists probably know more about Hair and skin then you do as a primary care position…
Dr. Crystal Beal (they/themme): yeah.
Patricio Battani: because that's what we study. unless you're a dermatologist, and even then I've sent people back to dermatologist with me. I folliculitis. You need to go see someone about that.
Patricio Battani: So, we can be a line of defense for that kind of skin abnormalities and stuff like that. But also remember that medical school just my mother always told me medical school was learning how to work on a car. They're the same thing. there's no real Academia behind that concept, we know how it works and now it's just about plugging the right things in the right places. And so that always kind of stuck with me because that's how she taught me to be respectful of everyone in the sense that Your mechanic knows way more about cars and Physicians. Wait. No way more about bodies then and so it's one of those things where
Patricio Battani: We're on a team. Yes. I understand. You went to medical school and spent 900 years studying and I have a great appreciation for that trust me because I could never do it. And so it's just one of those things though that we would on the flip side. If you could give us that same appreciation, most of us did training for this, it's only 600 hours. But we do have to license. We do have to sit for exams. and we are taught there is very specific things. We're taught so It's just we're part of your team. bring us to the table and interact if I send you an email saying hey you're patient is Off the flipping wall, Please understand that
00:55:00
Patricio Battani: Something's not right there. And I'm coming to you as their primary care physician as somebody who has their trust because they may not trust me to intervene on our behalf and say hey what's going on here because you may get answers that we don't. and that's when like you said,…
Dr. Crystal Beal (they/themme): Yeah. Yeah.
Patricio Battani: they don't show up and unfortunately we lose money because of that so
Dr. Crystal Beal (they/themme): And I say the same thing about vetting your referral sources all of the time. I think one of the absolute requirements for Primary Care Providers, is that you at the bare minimum our transparent about not having vetted someone you're referring someone to so if you have not found safer referral sources for your patients with intersectional identities that you're very transparent that you're like, I'm referring you to someone. I don't know anything about whether or not they're inclusive or affirming what their body like any of that stuff and…
Patricio Battani: prep
Dr. Crystal Beal (they/themme): so bare minimum requirement. I think that next step is absolutely what you're saying. You have vetted referral resources, and I know clinicians you're really busy. So this is always a great project for a student if you have a pre-med student…
Patricio Battani: right
Dr. Crystal Beal (they/themme): if you have a pre Health student, if you have social work students Masters and public health students, and it's also if you have a gender care navigation team at your facility, this is something that they can be working on. Also, probably your local lgbtq. Nonprofit has done some of this work and has a resource list on their website.
Patricio Battani: So let me even have electrologists.
Dr. Crystal Beal (they/themme): Yeah, but yeah, absolutely that should be required and so we
Dr. Crystal Beal (they/themme): For all of people listed on our website, they have filled out a form so it's self-ested and right and we're clear about that. We haven't talked to everyone that this is self attested but there's definitely been people we have not put up on our website what they put in the self attested form. And I also typically we look at everyone's website and…
Patricio Battani: right
Dr. Crystal Beal (they/themme): there's definitely been people who I've looked at the website and I've been and so I think that's essential and I think it goes even further than just being trans inclusive providers. because I think it's really really important to honor those intersectional identities. So don't refer someone with darker skin to a place with hair removal that can only work on light skin, don't refer a patient with a bigger body to a surgeon who doesn't do surgery on bigger body. those are really traumatic experiences because again, We're so excited to get our care we have been waiting. years for this and you're finally getting to go to that appointment and it's finally happening and then you get there and You're too black.
Patricio Battani: Yeah.
Dr. Crystal Beal (they/themme): You're too fat and that's not great.
Patricio Battani: the nice thing is really important because Know that you're electrologists are esthetician or whoever you're sending them to actually has a chair that can support them.
Dr. Crystal Beal (they/themme): Yep.
Patricio Battani: my chair only goes up to 500 pounds, so I have a secondary chair that is kind of like it's broken, but it's a Large exam table for people who weigh over 500 pounds. So if I ever need to use that I have it and so those are just the huge things and currently I'm working with some colleagues on creating a gender affirming electrology program where we're going to actually train people or…
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: and so that we can kind of like unquote certified people that have been trained, so that we can say we know that they've gone through this,
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: This thing and they understand putting your hands on someone's throat near the Adam's apple could be triggering, you…
Dr. Crystal Beal (they/themme): Yeah. Yeah.
Patricio Battani: so those types of yeah.
Dr. Crystal Beal (they/themme): So I think that's so important who you're sending your patients to exactly and you said and then I think that intersectionality is so important and knowing where you're sending your patients as well and it's always a sign to me right when I go to a facilities website and they have these things already on their website, our exam table supports up to this weight entry doors are this wide we have handicap accessible bathrooms, right. We have a gender-neutral restroom. if people are putting that stuff up on their website. It is a really good queue to me about where they are in their journey of inclusivity and affirming practices. And so I think clinicians that's important to remember and I think yes. doctors don't be assholes. I think was the last point there.
01:00:00
Patricio Battani: Yeah.
Dr. Crystal Beal (they/themme): Yeah, and every member of The Care team has Where each a human and so we all have exactly the same worth as humans and value as humans and we all bring different assets to the table and it's like right it is the joining of those assets that brings enough variety to the table to actually serve all of our patients because our patients are various and Broad and we as individuals don't get to be culturally competent in every culture and so it's important that we welcome each other kindly and respectfully and that we really acknowledge each other's strengths and skills, and hopefully you felt when I was like, how do you describe your hair? So I go because I don't know how to describe what
Patricio Battani: Yeah, and that's just like, I say that because I've noticed that I get a lot more respect from folks because I have a master's in public health. And so they see that as someone who has the only thing that says that I've had time in the academy and that doesn't make me any smoker whatever so it's just weird. So I see some folks being treated a little bit differently than I get treated just because I have more of a baseline knowledge of how medicine works or how these things work. and I'm just really trying to
Patricio Battani: make sure that everyone who's doing this work, especially those of us who are doing it in service to trans folks like One that we're doing at the right way and two this is my community and I don't want anyone to ever feel like what I've ever had to go through, that's kind of the thing, growing up I grew up in the 90s.
Dr. Crystal Beal (they/themme): Yeah.
Patricio Battani: So it was one of those things,…
Dr. Crystal Beal (they/themme): Okay.
Patricio Battani: and I've been called Everything But a child of God and I just don't want people To ever experience that and so especially from someone you're supposed to be trusting and…
Dr. Crystal Beal (they/themme): Yeah. Yeah.
Patricio Battani: if we can come together and be part of a wider team, that would be wonderful and…
Dr. Crystal Beal (they/themme): right
Patricio Battani: like I said if anyone has any questions or needs any help, please just don't hesitate to call us.
Dr. Crystal Beal (they/themme): amazing. Thank you so much for your time today.
Patricio Battani: Yeah, thank you for having me.
