Transgender adolescents and acne: A cases series

Abstract

We describe the difficulties of treating acne in a series of female-to-male transgender adolescents, including concerns about potential hepatotoxicity with concomitant use of testosterone with isotretinoin or tetracyclines. Acne is a foreseeable adverse effect of testosterone treatment in transgender adolescents, so monitoring for acne is advised. The treatment of acne in transgender adolescents is important given that severe acne and transgenderism are associated with higher rates of depression and suicide.

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

“…For transgender patients with severe, nodular, or refractory acne, oral isotretinoin may be required, though specific concerns more relevant to the transgender population should be addressed when prescribing this medication . First, it is important to remember that depression, anxiety, suicidal ideation, and other mental health disorders are more common in transgender youth compared to cisgender youth .…”

“…prescribing this medication. 46 First, it is important to remember that depression, anxiety, suicidal ideation, and other mental health disorders are more common in transgender youth compared to cisgender youth. 47 While the link between isotretinoin use and mental health comorbidities and suicidality remains unclear, 48 transgender patients should be screened, monitored, and treated for mental health disorders when considering isotretinoin treatment.…”

Acne: a side‐effect of masculinizing hormonal therapy in transgender patients

“…Cholestatic jaundice, peliosis hepatis and haematoma were historically associated with oral preparations using 17‐alkylated androgens, which are therefore no longer used. Nonetheless, frequent monitoring is still warranted in patients receiving a combination of any formulation of testosterone with isotretinoin …”

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

“…One of the most effective treatments for severe inflammatory or scarring acne is isotretinoin; this efficacy has also been documented in young transgender males. 11,12 However, given its terato- Lack of provider competency in gender expansive and genderaffirming health is recognized by transgender youth and their caregivers as a barrier to care for this population. 16 Although recommendations for creating a supportive and inclusive health care environment for transgender youth are available, 3,5 even the most welcoming dermatology practice will have problems providing gender-affirming care to patients requiring isotretinoin or other REMSregulated medications as a result of needlessly restrictive patient identification options.…”

“…One of the most effective treatments for severe inflammatory or scarring acne is isotretinoin; this efficacy has also been documented in young transgender males . However, given its teratogenic risk, isotretinoin therapy is closely regulated by the Food and Drug Administration (FDA) via the iPLEDGE program .…”