Transgender patients with acne need culturally competent, comprehensive care
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Dermatologists should be aware of clinical and mental health parameters when treating transgender patients for acne, according to a recommendation statement.
“Transgender persons who undergo masculinizing hormone therapy experience a wide array of dermatologic effects as they initiate and maintain testosterone therapy,” Rakan Radi, MD, of the department of dermatology at Emory University School of Medicine in Atlanta, and colleagues wrote.
They suggested that for transmasculine individuals receiving testosterone therapy, acne is a common adverse event. The effects can be detrimental to body image, mental health and quality of life. Similarly, acne treatment for transfeminine patients requires specific and tailored care.
It is recommended that dermatologists take steps to provide clinically and culturally competent care to this specific patient population. The current paper outlines steps to meet those goals.
A gender-inclusive medical history should be undertaken, along with an assessment of reproductive potential and a discussion of contraception. For transmasculine patients, these assessments should precede prescription of treatment with drugs that have teratogenic potential.
Turning to therapeutic options, mild acne in transgender individuals may be treated by topical retinoids including adapalene, tretinoin, tazarotene and trifarotene. Moderate comedonal and inflammatory acne may also be treated by these interventions.
While all of these therapies have potential teratogenic effects, the researchers stressed that these teratogenic effects of tazarotene “should be emphasized” for transmasculine patients.
Other possible treatments for mild to moderate acne are topical benzoyl peroxide and topical antibiotics, including clindamycin and erythromycin.
Topical antiandrogen therapies such as clascoterone may be used for both men and women with acne. This drug may also reduce unwanted testosterone action in the skin of transmasculine patients.
For patients with moderate to severe acne, first-line options include oral doxycycline and minocycline. Oral erythromycin, azithromycin, amoxicillin and trimethoprim-sulfamethoxazole also may be considered.
The authors noted, however, that teratogenicity should be discussed with transmasculine patients with reproductive potential being treated with oral antibiotics.
Spironolactone has yielded improvements in both acne and feminizing effects for transfeminine patients. Conversely, this drug may block masculinizing effects of testosterone in transmasculine patients.
“Culturally competent and comprehensive acne encounters involve inclusive history taking, routine collection of sexual orientation and gender identity data and patient-centered physical examination,” the authors concluded. “As multiple acne medications may be teratogenic, providers should conduct a thorough assessment of reproductive potential and provide counseling accordingly.”
Dermatologists are encouraged to read the document thoroughly for information not only on these treatment options, but also for guidance on managing reproductive issues in this patient population.
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Radi R, et al. Am J Clin Dermatol. 2022;doi:10.1007/s40257-021-00665-w.
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