On the decision to cast Clayton, a trans woman, as the character, the film's director, David Bruckner, explained: "We felt a kind of anticipation around the fans to reimagine the character. We knew we wanted Pinhead to be a woman. Jamie was just the right person for the role.

Hulu's 2024 Hellraiser reboot introduced a female Pinhead, and the change brings Hellraiser closer to Clive Barker's original book. The Hellraiser reboot movie includes a female version of Pinhead, but this change to Hellraiser movie tradition actually closer to the character's original depiction.