Prescribing Patterns for Acne in Transgender Compared to Cisgender Patients

Transgender individuals face important dermatologic health issues and may experience healthcare discrimination. Isotretinoin is commonly prescribed for severe acne. However, iPledge’s binary gender classification system deterred some transgender patients from receiving isotretinoin, leading to recent gender-inclusive modification of iPledge’s classification system[1,4]. This study aimed to identify differences in dermatologists’ prescribing patterns for acne treatment depending on patient gender identity. An online survey including demographic questions and clinical scenarios was emailed to 10,525 dermatologists in the US (December 2021). The survey included a clinical scenario describing a patient with severe acne, for whom isotretinoin would be clinically indicated; the patient’s gender was randomized to transgender or cisgender man or woman. Dermatologists were asked their treatment recommendations in a free-text response. Responses were coded in SPSS and analyzed using a chi-square test. 585 dermatologists completed the survey (response rate 5.6%). The most common treatments included isotretinoin, antibiotics, topical treatment adjustment, and spironolactone. Dermatologists recommended isotretinoin as the primary treatment for the scenario with the cisgender man 55.1% of the time, transgender man 53.4%, transgender woman 46.2%, and cisgender woman 40.9% of the time. Differences between recommending isotretinoin to cisgender men versus cisgender women, and between cisgender women versus transgender men, were both statistically significant (p=0.012 and p=0.031 respectively). Prescribing patterns for acne treatment with isotretinoin differ based on patient gender identity with dermatologists less likely to choose isotretinoin for acne in cisgender women compared to cisgender or transgender men. These findings cannot solely be attributable to teratogenicity concerns and deserve further study.