End of Medical Exemptions for Grooming Impacts Black Soldiers

The US military has revised its grooming standards to remove medical exemptions for male facial hair, a policy change that may put careers at risk for thousands of service members. According to the updated guidelines, all soldiers must be clean-shaven on duty when in uniform or civilian clothes, with temporary exemptions for medical reasons and permanent exemptions for religious accommodations. 

The Army is the latest service branch to update its guidelines about beards: Soldiers with skin conditions will no longer be granted permanent medical waivers that allow them to avoid shaving. The Air Force and Space Force updated their guidance on grooming waivers in January, as did the Marine Corps in March. 

Defense Secretary Pete Hegseth, who ordered the guideline review, focused on grooming and appearance. In a Feb. 7 townhall with troops and department employees, he said, “It starts with the basic stuff, right? It’s grooming standards and uniform standards and training standards, fitness standards, all of that matters.”

Hegseth compared not enforcing grooming standards to the “broken windows” theory of policing: “I’m not saying if you violate grooming standards, you’re a criminal. The analogy is incomplete. But if you violate the small stuff and you allow it to happen, it creates a culture where the big stuff, you’re not held accountable for.”

The policy changes are particularly significant for soldiers who grow beards because they suffer from pseudofolliculitis barbae (PFB), an often-painful genetic condition that causes ingrown hairs. PFB produces flesh-colored or red follicular papules, which can be itchy, tender, and may bleed when shaved. Even if they heal, the lesions may lead to postinflammatory hyperpigmentation, scarring (including keloid scarring), and abscess. 

Although the updated standards affect all service members with beards, they draw ire from those who claim the rules disproportionately affect men of African descent. Up to 60% of Black men have PFB, according to the American Osteopathic College of Dermatology. According to the US Department of Defense (DoD) 2023 Demographics: Profile of the Military Community, service members who self-identify as Black or African American make up 17% of the total DoD military force (N = 2,034,426). Of 1,273,382 active-duty members, 18% are Black. Of 1,038,909 active-duty enlisted members, 20% are Black, and 9% of 234,473 active-duty officers are Black.

“Almost 65% of the US Air Force shaving waivers are held by Black men. And PFB is one of the most common reasons,” DanTasia Welch, MS, told Federal Practitioner. She, along with Richard P. Usatine, MD, and Candrice R. Heath, MD, wrote a recent review of the impact of PFB that was published in Federal Practitioner. 

“It is almost exclusively found in men of African descent,” Usatine said. “That just means if you have a policy that affects people with this condition, you are basically aiming that policy directly at Black men.”

“Pseudofolliculitis barbae, a lot of that just has to do with your shaving technique is what we’ve determined,” Steve Warren, an Army spokesman, told reporters in early July. “A vast majority of minority soldiers, African American soldiers, are within the standards all the time.” 

Usatine disagreed: “[PFB] is genetic, and whether you shave with or against the direction of the hairs, the problem is still there, and you can't just shave it away by ‘shaving correctly.’ They're going after one racial/ethnic group who has this problem, because almost everyone that has the problem is of African descent.”

The most effective management for PFB is to discontinue shaving. Grooming techniques and topical medications can be effective in treating mild-to-moderate cases of PFB, but more severe cases respond best to laser therapy. The Army, Navy, and Marine Corps advise laser therapy as a treatment option, but it has drawbacks. It is expensive and coded as a cosmetic procedure, and patients also may not have access to specialists experienced in performing the procedure in people with darker skin tones. Some patients may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons. 

A survey of Air Force members with 10,383 responses suggested that the men who had medical shaving waivers experienced longer times to promotion than those with no waiver. Most in the waiver group were Black or African American. 

The branches have handled the rule change in different ways. The Air Force, for example, which began tightening its standards on uniform and shaving waivers in January 2025, grants long-term shaving waivers only to airmen or guardians who have severe cases of PFB following consultation with medical practitioners. Air Force Surgeon General Lt. Gen. John DeGoes said in a video that the department’s 2020 (now expired) policy allowing 5-year shaving waivers did not give clinicians enough clarity on diagnosis by not differentiating between PFB and shaving irritation.

“They are 2 different things,” DeGoes said. “Ensuring a standardized approach to managing PFB is essential. And it is crucial that we provide consistent and effective care to our service members, enabling them to meet grooming standards while managing their condition.”

The new grooming policies leave many service members in an uncomfortable quandary: Keep the beard, run the risk of getting kicked out; keep shaving and put your skin and health at risk for complications; or receive laser treatment and have to deal with lack of beard hair after leaving the military.

Simply changing the rules isn’t enough. Candrice Heath, MD, told Federal Practitioner, “You need to always strike a balance. One of those points that’s always raised is about the facial equipment that's needed to protect during times of war.”

Heath called for more research funding to develop equipment, so people can have some facial hair if needed. “There is an opportunity to not just say, hey, this is an issue, but there's an opportunity for innovation here, to really think about it this problem in a different way, so that we are solution-focused.”

The US military has revised its grooming standards to remove medical exemptions for male facial hair, a policy change that may put careers at risk for thousands of service members. According to the updated guidelines, all soldiers must be clean-shaven on duty when in uniform or civilian clothes, with temporary exemptions for medical reasons and permanent exemptions for religious accommodations. 

The Army is the latest service branch to update its guidelines about beards: Soldiers with skin conditions will no longer be granted permanent medical waivers that allow them to avoid shaving. The Air Force and Space Force updated their guidance on grooming waivers in January, as did the Marine Corps in March. 

Defense Secretary Pete Hegseth, who ordered the guideline review, focused on grooming and appearance. In a Feb. 7 townhall with troops and department employees, he said, “It starts with the basic stuff, right? It’s grooming standards and uniform standards and training standards, fitness standards, all of that matters.”

Hegseth compared not enforcing grooming standards to the “broken windows” theory of policing: “I’m not saying if you violate grooming standards, you’re a criminal. The analogy is incomplete. But if you violate the small stuff and you allow it to happen, it creates a culture where the big stuff, you’re not held accountable for.”

The policy changes are particularly significant for soldiers who grow beards because they suffer from pseudofolliculitis barbae (PFB), an often-painful genetic condition that causes ingrown hairs. PFB produces flesh-colored or red follicular papules, which can be itchy, tender, and may bleed when shaved. Even if they heal, the lesions may lead to postinflammatory hyperpigmentation, scarring (including keloid scarring), and abscess. 

Although the updated standards affect all service members with beards, they draw ire from those who claim the rules disproportionately affect men of African descent. Up to 60% of Black men have PFB, according to the American Osteopathic College of Dermatology. According to the US Department of Defense (DoD) 2023 Demographics: Profile of the Military Community, service members who self-identify as Black or African American make up 17% of the total DoD military force (N = 2,034,426). Of 1,273,382 active-duty members, 18% are Black. Of 1,038,909 active-duty enlisted members, 20% are Black, and 9% of 234,473 active-duty officers are Black.

“Almost 65% of the US Air Force shaving waivers are held by Black men. And PFB is one of the most common reasons,” DanTasia Welch, MS, told Federal Practitioner. She, along with Richard P. Usatine, MD, and Candrice R. Heath, MD, wrote a recent review of the impact of PFB that was published in Federal Practitioner. 

“It is almost exclusively found in men of African descent,” Usatine said. “That just means if you have a policy that affects people with this condition, you are basically aiming that policy directly at Black men.”

“Pseudofolliculitis barbae, a lot of that just has to do with your shaving technique is what we’ve determined,” Steve Warren, an Army spokesman, told reporters in early July. “A vast majority of minority soldiers, African American soldiers, are within the standards all the time.” 

Usatine disagreed: “[PFB] is genetic, and whether you shave with or against the direction of the hairs, the problem is still there, and you can't just shave it away by ‘shaving correctly.’ They're going after one racial/ethnic group who has this problem, because almost everyone that has the problem is of African descent.”

The most effective management for PFB is to discontinue shaving. Grooming techniques and topical medications can be effective in treating mild-to-moderate cases of PFB, but more severe cases respond best to laser therapy. The Army, Navy, and Marine Corps advise laser therapy as a treatment option, but it has drawbacks. It is expensive and coded as a cosmetic procedure, and patients also may not have access to specialists experienced in performing the procedure in people with darker skin tones. Some patients may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons. 

A survey of Air Force members with 10,383 responses suggested that the men who had medical shaving waivers experienced longer times to promotion than those with no waiver. Most in the waiver group were Black or African American. 

The branches have handled the rule change in different ways. The Air Force, for example, which began tightening its standards on uniform and shaving waivers in January 2025, grants long-term shaving waivers only to airmen or guardians who have severe cases of PFB following consultation with medical practitioners. Air Force Surgeon General Lt. Gen. John DeGoes said in a video that the department’s 2020 (now expired) policy allowing 5-year shaving waivers did not give clinicians enough clarity on diagnosis by not differentiating between PFB and shaving irritation.

“They are 2 different things,” DeGoes said. “Ensuring a standardized approach to managing PFB is essential. And it is crucial that we provide consistent and effective care to our service members, enabling them to meet grooming standards while managing their condition.”

The new grooming policies leave many service members in an uncomfortable quandary: Keep the beard, run the risk of getting kicked out; keep shaving and put your skin and health at risk for complications; or receive laser treatment and have to deal with lack of beard hair after leaving the military.

Simply changing the rules isn’t enough. Candrice Heath, MD, told Federal Practitioner, “You need to always strike a balance. One of those points that’s always raised is about the facial equipment that's needed to protect during times of war.”

Heath called for more research funding to develop equipment, so people can have some facial hair if needed. “There is an opportunity to not just say, hey, this is an issue, but there's an opportunity for innovation here, to really think about it this problem in a different way, so that we are solution-focused.”

The US military has revised its grooming standards to remove medical exemptions for male facial hair, a policy change that may put careers at risk for thousands of service members. According to the updated guidelines, all soldiers must be clean-shaven on duty when in uniform or civilian clothes, with temporary exemptions for medical reasons and permanent exemptions for religious accommodations. 

The Army is the latest service branch to update its guidelines about beards: Soldiers with skin conditions will no longer be granted permanent medical waivers that allow them to avoid shaving. The Air Force and Space Force updated their guidance on grooming waivers in January, as did the Marine Corps in March. 

Defense Secretary Pete Hegseth, who ordered the guideline review, focused on grooming and appearance. In a Feb. 7 townhall with troops and department employees, he said, “It starts with the basic stuff, right? It’s grooming standards and uniform standards and training standards, fitness standards, all of that matters.”

Hegseth compared not enforcing grooming standards to the “broken windows” theory of policing: “I’m not saying if you violate grooming standards, you’re a criminal. The analogy is incomplete. But if you violate the small stuff and you allow it to happen, it creates a culture where the big stuff, you’re not held accountable for.”

The policy changes are particularly significant for soldiers who grow beards because they suffer from pseudofolliculitis barbae (PFB), an often-painful genetic condition that causes ingrown hairs. PFB produces flesh-colored or red follicular papules, which can be itchy, tender, and may bleed when shaved. Even if they heal, the lesions may lead to postinflammatory hyperpigmentation, scarring (including keloid scarring), and abscess. 

Although the updated standards affect all service members with beards, they draw ire from those who claim the rules disproportionately affect men of African descent. Up to 60% of Black men have PFB, according to the American Osteopathic College of Dermatology. According to the US Department of Defense (DoD) 2023 Demographics: Profile of the Military Community, service members who self-identify as Black or African American make up 17% of the total DoD military force (N = 2,034,426). Of 1,273,382 active-duty members, 18% are Black. Of 1,038,909 active-duty enlisted members, 20% are Black, and 9% of 234,473 active-duty officers are Black.

“Almost 65% of the US Air Force shaving waivers are held by Black men. And PFB is one of the most common reasons,” DanTasia Welch, MS, told Federal Practitioner. She, along with Richard P. Usatine, MD, and Candrice R. Heath, MD, wrote a recent review of the impact of PFB that was published in Federal Practitioner. 

“It is almost exclusively found in men of African descent,” Usatine said. “That just means if you have a policy that affects people with this condition, you are basically aiming that policy directly at Black men.”

“Pseudofolliculitis barbae, a lot of that just has to do with your shaving technique is what we’ve determined,” Steve Warren, an Army spokesman, told reporters in early July. “A vast majority of minority soldiers, African American soldiers, are within the standards all the time.” 

Usatine disagreed: “[PFB] is genetic, and whether you shave with or against the direction of the hairs, the problem is still there, and you can't just shave it away by ‘shaving correctly.’ They're going after one racial/ethnic group who has this problem, because almost everyone that has the problem is of African descent.”

The most effective management for PFB is to discontinue shaving. Grooming techniques and topical medications can be effective in treating mild-to-moderate cases of PFB, but more severe cases respond best to laser therapy. The Army, Navy, and Marine Corps advise laser therapy as a treatment option, but it has drawbacks. It is expensive and coded as a cosmetic procedure, and patients also may not have access to specialists experienced in performing the procedure in people with darker skin tones. Some patients may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons. 

A survey of Air Force members with 10,383 responses suggested that the men who had medical shaving waivers experienced longer times to promotion than those with no waiver. Most in the waiver group were Black or African American. 

The branches have handled the rule change in different ways. The Air Force, for example, which began tightening its standards on uniform and shaving waivers in January 2025, grants long-term shaving waivers only to airmen or guardians who have severe cases of PFB following consultation with medical practitioners. Air Force Surgeon General Lt. Gen. John DeGoes said in a video that the department’s 2020 (now expired) policy allowing 5-year shaving waivers did not give clinicians enough clarity on diagnosis by not differentiating between PFB and shaving irritation.

“They are 2 different things,” DeGoes said. “Ensuring a standardized approach to managing PFB is essential. And it is crucial that we provide consistent and effective care to our service members, enabling them to meet grooming standards while managing their condition.”

The new grooming policies leave many service members in an uncomfortable quandary: Keep the beard, run the risk of getting kicked out; keep shaving and put your skin and health at risk for complications; or receive laser treatment and have to deal with lack of beard hair after leaving the military.

Simply changing the rules isn’t enough. Candrice Heath, MD, told Federal Practitioner, “You need to always strike a balance. One of those points that’s always raised is about the facial equipment that's needed to protect during times of war.”

Heath called for more research funding to develop equipment, so people can have some facial hair if needed. “There is an opportunity to not just say, hey, this is an issue, but there's an opportunity for innovation here, to really think about it this problem in a different way, so that we are solution-focused.”