Examining Dermatological Care for Transgender Patients

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Two posters presented at the American Academy of Dermatology 2023 Annual Meeting examined certain aspects of care for patients who are transgender, as treatable skin diseases in this population can be overlooked and not managed, despite how they can have a negative impact on patient quality of life.

One study, conducted by researchers at the University of Texas Health Science Center San Antonio-Long School of Medicine, looked at the predominant skin conditions in female-to-male (FTM) transgender patients.¹ It was carried out at the Pride Community Clinic (PCC), a student-run free clinic that provides primary care and hormone-replacement therapy (HRT) services to lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+).

The authors noted that HRT may include dermatological adverse effects, as changing levels of testosterone or estrogen can affect sebum production, stimulate melanocytes and other skin cells, and alter epidermal linings.

A retrospective chart review of FTM adult transgender patients was conducted, using the clinic’s RedCap database from September 2017 to June 2022. The analysis included patient medications, skin conditions, and treatment.

Fifteen patients were analyzed, and all 15 reported dermatological conditions. Of these, 12 received a diagnosis of acne vulgaris after starting HRT. Four of these patients improved after initiating doxycycline.

Two patients were told they had alopecia after starting HRT and both were started on finasteride.

One patient reported a painless dark skin lesion in the epigastric region that was associated with an undiagnosed gastrointestinal disorder.

“Given these patients already face significant life stressors, significant skin conditions can contribute to that burden and adversely affect their mental health,” the authors noted.

Areas for additional research include how skin conditions can manifest in the male-to-female population and how other gender-affirming procedures can create certain skin conditions that require specialized care.

In the second poster, researchers from Stanford University, Howard University, and Emory University compared prescribing patterns for isotretinoin, which is used to treat severe acne, in transgender patients compared with cisgender patients.²

Isotretinoin carries the risk of severe birth defects, and patients who take it are monitored in case they become pregnant. This can be “distressing” for transgender men, the authors noted.

An online Qualtrics survey including demographic questions and clinical scenarios was emailed to 10,525 US dermatologists in the United States in December 2021. The clinical scenario described a patient with severe acne, for whom isotretinoin would be indicated. The survey randomized gender (transgender or cisgender man or woman).

Dermatologists were asked what treatment they would recommend in a free text response. The results were analyzed using chi-square, Mann-Whitney U, and independent T-tests.

Specialists were significantly more likely to prescribe isotretinoin to cisgender men (55.15%) than cisgender women (40.90%) (P = .012). They were also significantly more likely to prescribe isotretinoin to transgender men (53.5%) than cisgender women (P = .031).

In addition, dermatologists were significantly less likely to prescribe isotretinoin at any stage to cisgender women vs cisgender men (P = .029). They were also significantly less likely to prescribe isotretinoin at any stage to cisgender women than transgender men (P = .023).

These results indicate gender differences in prescribing patterns for acne treatment, said the researchers, who added that the findings cannot only be explained through teratogenicity concerns and deserve further study.

References

1. Alfaro M, Tran L, Quach E, Ren Y, Nguyen T, Garcia S. Predominant dermatological conditions in female-to-male transgender patients at Pride Community Clinic. Presented at: 2023 American Academy of Dermatology Annual Meeting; March 17-21, 2023; New Orleans, Louisiana. Poster 41697

2. Zadu A, van Egmund S, de Vere Hunt I, et al. Prescribing patterns for acne in transgender compared to cisgender patients. Presented at: 2023 American Academy of Dermatology Annual Meeting; March 17-21, 2023; New Orleans, Louisiana. Poster 42975