Prescribing isotretinoin for transgender youth: A pledge for more inclusive care

Abstract

As the transgender community has become increasingly visible in public life, a greater awareness of this group's unique health needs and obstacles to optimal medical care has developed. Unfortunately, transgender youth face multiple barriers within the health care system, including access to equitable and gender‐affirming care. As dermatologists who care for children and adolescents, we must be aware of the challenges facing transgender youth and work to correct the disparities that exist for this vulnerable group. An initial step in supporting our transgender patients is to advocate for changes to the iPLEDGE system for prescribing isotretinoin (and other Risk Evaluation and Mitigation Strategy systems), specifically requesting a change to its gender‐binary categorization model that compromises an individual's right to self‐identify. By promoting a gender‐neutral patient categorization that is based instead upon reproductive potential, a simple change to the iPLEDGE program allows us to safely treat all of our patients requiring isotretinoin, while preserving our transgender patients’ rights to self‐determination and self‐identification.

Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations

“…7 These issues have been raised in the past, with several articles from 2016 to 2019 urging for gender-neutral registration. [10][11][12][13] A gender neutral patient categorization model of iPLEDGE is also supported by both the American Medical Association (AMA) and American Academy of Dermatology (AAD). 14,15 However, despite the pleas from clinicians and patients, no change has yet been made to iPLEDGE.…”

COVID-19 Pandemic Leading to the Accelerated Development of a Virtual Health Model for Isotretinoin

“…In addition, transgender female to male patients may prefer a blood draw for serum beta hCG testing over a UPT. As we pledge to provide inclusive care within the framework of the binary iPLEDGE program, serum beta hCG testing is a more inclusive and less stigmatizing option for meeting the iPLEDGE requirements for patients with reproductive capability ( Boos et al, 2018 ).…”

Dermatologic care of sexual and gender minority/LGBTQIA youth, Part 2: Recognition and management of the unique dermatologic needs of SGM adolescents

“…Humbly and effectively approaching this clinical dilemma with transgender patients has been extensively reviewed elsewhere, and pediatric dermatologists can assure their patients that iPLEDGE's gender binary registration system is recognized by multiple medical organizations as problematic and insensitive to the transgender community . Importantly, advocacy efforts are under way to revise this classification system to one that is gender neutral and based on reproductive potential . Despite these barriers, isotretinoin remains one of the most effective treatments for severe acne in transgender youth .…”

“…56,57 Importantly, advocacy efforts are under way to revise this classification system to one that is gender neutral and based on reproductive potential. 53,55 Despite these barriers, isotretinoin remains one of the most effective treatments for severe acne in transgender youth. 58 Dermatologists can help transgender patients and families navigate these barriers and obtain the treatment necessary to improve acne and its psychosocial impact.…”

“…Lastly, dermatologists must discuss that the U.S. iPLEDGE Risk Evaluation and Mitigation Strategy for isotretinoin currently requires patients to be registered and categorized based on sex assigned at birth, and some patients may find this unacceptable until a more gender‐inclusive system is implemented. Humbly and effectively approaching this clinical dilemma with transgender patients has been extensively reviewed elsewhere, and pediatric dermatologists can assure their patients that iPLEDGE's gender binary registration system is recognized by multiple medical organizations as problematic and insensitive to the transgender community . Importantly, advocacy efforts are under way to revise this classification system to one that is gender neutral and based on reproductive potential .…”