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Kuperman Wilder L, Orsi V, Chebi G, Balague MA, Cabral Campana L. Two years of innovative dermatological care: the first public health consultation service for the transgender and gender diverse community in Argentina. An Bras Dermatol 2024:S0365-0596(24)00139-9. [PMID: 39004597 DOI: 10.1016/j.abd.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/18/2024] [Accepted: 03/18/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The LGBTQI + community encounters distinct healthcare challenges due to discrimination and inadequate understanding of their needs. Dermatologists play a crucial role in addressing this by fostering inclusiveness, recognizing individual concerns, and adopting tailored approaches, thereby promoting a more equitable healthcare system. OBJECTIVE To address the need for an inclusive healthcare space, the authors established the first dermatological practice exclusively for transgender and non-binary patients. This article presents a comprehensive two-year experience in a public hospital. METHODS The authors conducted a retrospective and descriptive study, analyzing the medical records of 114 patients evaluated at a specialized dermatological practice between June 2021 and May 2023. Key variables assessed included self-identified gender, age, residence, access to private healthcare, human immunodeficiency virus status, hormonal treatment, surgical interventions, consultation motives, employment stability, and family support during gender expression transition. RESULTS The present study included 114 patients, 49.1% trans men, 39.5% trans women, and 8.8% non-binary individuals. Trans men, on average younger than trans women (p < 0.001), predominantly sought care for body modification-related concerns, particularly acne and androgenetic alopecia. In contrast, trans women exhibited a more diverse range of consultation motives typically unrelated to hormonal or surgical procedures. STUDY LIMITATIONS This study is retrospective and limited in geographic scope. Additionally, the patient population lacked diversity in terms of Black ethnicity. CONCLUSIONS The pioneering dermatological practice for transgender and non-binary patients exemplifies healthcare equity and cultural competence. Effective LGBTQI + healthcare requires addressing unique dermatological concerns while fostering inclusiveness and continuous learning within the medical community.
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Affiliation(s)
| | - Valeria Orsi
- Dermatology Department, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Gonzalo Chebi
- Institute of Calculus, Faculty of Exact and Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina
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2
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Taylor MA, Ituarte B, Thomas S, Adams J, Wei EX. A cross-sectional analysis of publication trends regarding care of transgender patients in leading dermatology journals. Arch Dermatol Res 2024; 316:415. [PMID: 38884829 DOI: 10.1007/s00403-024-03162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/11/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Mitchell A Taylor
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68105, USA
- School of Medicine, Creighton University, Omaha, NE, 68178, USA
| | - Bianca Ituarte
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68105, USA
| | - Sierra Thomas
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68105, USA
| | - Jennifer Adams
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68105, USA
| | - Erin X Wei
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68105, USA.
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3
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Castañeda MFO, Cortés HT, Isaac NG, Cárdenas CM. Skin manifestations in adults with gender dysphoria on hormone treatment in the outpatient clinic of Hospital de San José, Bogotá-Colombia. Int J Dermatol 2024; 63:474-480. [PMID: 38115735 DOI: 10.1111/ijd.16947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Comprehensive healthcare for patients with gender dysphoria includes access to gender-affirming hormone therapy. It may cause cutaneous and adnexal side effects, which often affect quality of life, are underdiagnosed, and do not receive timely treatment. The literature on this subject is scarce. The main objective was to identify skin manifestations secondary to hormone treatment in adults with gender dysphoria. METHODS Observational, descriptive, cross-sectional study. A search was performed in the database of patients with gender dysphoria older than 18 years treated at the dermatology and/or endocrinology outpatient clinic of the Hospital de San José de Bogotá in the period 2015-2021. Medical records of patients on hormone therapy with skin manifestations were selected, while patients using other medications as possible triggers were excluded. RESULTS In total, 85 patients were included, with a predominance of young transgender men (average age was 27 ± 9 years) in whom the main manifestation was acne (87%), followed by androgenetic alopecia and acanthosis nigricans. Transgender women presented more acne, androgenetic alopecia, hypertrichosis, seborrheic dermatitis, and melasma. The majority received treatment, mainly topical therapies. More than half of the patients were treated by the endocrinology and dermatology services. CONCLUSIONS Skin manifestations in patients with gender dysphoria on hormone therapy are frequent, so they should be known and taken into account in the multidisciplinary approach to these patients, which should involve dermatologists. This is the first Colombian and Latin American study focused on documenting skin manifestations in patients with gender dysphoria undergoing hormone therapy.
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Affiliation(s)
- Manuel F O Castañeda
- Department of Dermatology, Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá, Bogotá, Colombia
| | - Henry T Cortés
- Department of Endocrinology, Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá, Bogotá, Colombia
| | - Nicolle G Isaac
- Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá, Bogotá, Colombia
| | - Carolina M Cárdenas
- Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá, Bogotá, Colombia
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4
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Lasheras-Pérez MA, Taberner R, Martínez-Jarreta B. Bioethical Conflicts in Current Dermatology: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00264-3. [PMID: 38556205 DOI: 10.1016/j.ad.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
Both the functions and equipment of dermatologists have increased over the past few years, some examples being cosmetic dermatology, artificial intelligence, tele-dermatology, and social media, which added to the pharmaceutical industry and cosmetic selling has become a source of bioethical conflicts. The objective of this narrative review is to identify the bioethical conflicts of everyday dermatology practice and highlight the proposed solutions. Therefore, we conducted searches across PubMed, Web of Science and Scopus databases. Also, the main Spanish and American deontological codes of physicians and dermatologists have been revised. The authors recommend declaring all conflicts of interest while respecting the patients' autonomy, confidentiality, and privacy. Cosmetic dermatology, cosmetic selling, artificial intelligence, tele-dermatology, and social media are feasible as long as the same standards of conventional dermatology are applied. Nonetheless, the deontological codes associated with these innovations need to be refurbished.
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Affiliation(s)
- M A Lasheras-Pérez
- Servicios de Dermatología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - R Taberner
- Unidad de Dermatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, España.
| | - B Martínez-Jarreta
- Departamento de Medicina Legal y Forense, Universidad de Zaragoza, Zaragoza, España
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5
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Rahman E, Nahai F. Converging on a Singular Path: Revealing Contrasting Perspectives on Evidence Levels in Aesthetic Medicine and Surgery. Aesthet Surg J 2023; 44:NP98-NP103. [PMID: 37477700 DOI: 10.1093/asj/sjad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/22/2023] Open
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6
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Kamrani P, Shamloul N, Cartron A, Hollins LC. Minimally Invasive Gender-Affirming Procedure Exposure and Training: Outcomes of a Resident-Reported Survey. Dermatol Surg 2023; 49:1209-1211. [PMID: 37669085 DOI: 10.1097/dss.0000000000003932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Payvand Kamrani
- Department of Dermatology, Penn State Milton Hershey Medical Center, Hershey, Pennsylvania
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7
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Cortez JL, Turner DN, Durkin JR, Logue ME. Condyloma of the neovaginal vault successfully treated with topical cidofovir therapy. JAAD Case Rep 2023; 41:104-106. [PMID: 37920704 PMCID: PMC10618620 DOI: 10.1016/j.jdcr.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Jose L. Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | | | - John R. Durkin
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Mary E. Logue
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
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8
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Singh G, Doiron P, Dahlke E. We are not 'Other' populations: building research, education and clinical capacity around gender variance in dermatology. Br J Dermatol 2023; 189:126-128. [PMID: 36916538 DOI: 10.1093/bjd/ljad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
Inclusive language and health equity in dermatology are being increasingly recognized and addressed. Developing respectful language and capacity caring for transgender and gender-diverse (trans) patients are critical to building and maintaining relationships with equity-deserving communities, particularly those who have been historically pathologized and mistreated by medical institutions. The authors share several practical trans-inclusive principles to maintain respect and dignity of trans persons learned from the integration of antioppression content into their institution’s dermatology curricula and from their research, clinical and personal experiences working with trans individuals.
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Affiliation(s)
- Gagandeep Singh
- MD Programme, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Philip Doiron
- MD Programme, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Erin Dahlke
- MD Programme, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Women's College Hospital, University Health Network, Toronto, ON, Canada
- St Joseph's Health Centre, Unity Health Network, Toronto, ON, Canada
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9
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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10
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Koehler A, Strauss B, Briken P, Fisch M, Soave A, Riechardt S, Nieder TO. Exploring the Relationship between (De-)Centralized Health Care Delivery, Client-Centeredness, and Health Outcomes-Results of a Retrospective, Single-Center Study of Transgender People Undergoing Vaginoplasty. Healthcare (Basel) 2023; 11:1746. [PMID: 37372864 DOI: 10.3390/healthcare11121746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Transgender health care interventions (e.g., gender-affirming surgery) support transgender and gender-diverse people to transition to their gender and are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different institutions spread over several locations). In this exploratory study, we investigated the relationship between centralized and decentralized delivery of transgender health care, client-centeredness, and psychosocial outcomes. Methods: A retrospective analysis of 45 clients undergoing vaginoplasty at one medical center was conducted. Mann-Whitney U tests assessed differences regarding five dimensions of client-centeredness and psychosocial outcomes between the health care delivery groups. To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identified predictors that were actually related to the outcomes. Results: All aspects of client-centered care were scored average or high. Decentralized delivery of care was more client-centered in terms of involvement in care/shared decision-making and empowerment. However, participants from decentralized health care delivery settings scored lower on psychosocial health (p = 0.038-0.005). Conclusions: The factor of (de-)centralized health care delivery appears to have a significant impact on the provision of transgender health care and should be investigated by future research.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, University Hospital Jena, Stoystrasse 3, 07740 Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Margit Fisch
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Armin Soave
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Silke Riechardt
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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11
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Quigley C, Victory L, Bowe S, Deveney C, Brady R, Yoo H, Lenane P. A survey of Irish dermatologists' confidence in caring for people who identify as transgender patients in dermatology settings. Clin Exp Dermatol 2023; 48:237-238. [PMID: 36763720 DOI: 10.1093/ced/llac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023]
Abstract
We surveyed Irish dermatologists’ confidence in caring for people who identify as transgender patients. The majority of respondents had not previously received education around the care of transgender people in dermatology, and most agreed they would benefit from this.
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Affiliation(s)
- Claire Quigley
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Liana Victory
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephanie Bowe
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciara Deveney
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan Brady
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Helena Yoo
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patsy Lenane
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
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12
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Rutnin S, Suchonwanit P, Kositkuljorn C, Pomsoong C, Korpaisarn S, Arunakul J, Rattananukrom T. Characterizing Dermatological Conditions in the Transgender Population: A Cross-Sectional Study. Transgend Health 2023; 8:89-99. [PMID: 36824384 PMCID: PMC9942180 DOI: 10.1089/trgh.2021.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to demonstrate the effects of gender-affirming hormone therapy (GAHT) and gender-affirming procedures on the skin in transgender individuals. Methods We conducted a cross-sectional study among transgender people. Skin conditions related to GAHT were assessed, including acne (using the Investigator's Global Assessment, IGA), postacne sequelae, melasma, hypertrichosis in androgen-sensitive areas (HAAs) in transgender men (TM) and hirsutism in transgender women (TW) (using the modified Ferriman-Gallwey score, mFG score), and hair loss (using the Hamilton-Norwood and Ludwig scale) at baseline, 6 months after GAHT, and the day on which the questionnaire was completed. Dermatological problems after gender-affirming procedures were evaluated. Results A total of 159 patients, including 134 TM and 25 TW, were eligible to participate. The median duration of GAHT was 23 and 36 months in TM and TW, respectively. In TM, the median IGA score of facial acne increased from 1 at baseline to 3 after 6 months and decreased to 2 after 2 years of GAHT. The mFG score indicated HAA in all TMs after testosterone treatment. A total of 88.1% of TM had no hair loss before hormone therapy. However, after 2 years of GAHT, 76.1% of TM developed male pattern hair loss (MPHL), and 26.1% of them had moderate-to-severe MPHL. In TW, the median IGA and mFG scores decreased after 3 years of hormone therapy, and the proportion of female pattern hair loss (FPHL) in TW increased to 16% after GAHT. In both groups, the most common skin complication after gender-affirming surgery was hypertrophic scarring. Conclusions GAHT in TM resulted in acne and MPHL, whereas GAHT in TW caused melasma and FPHL.
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Affiliation(s)
- Suthinee Rutnin
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sira Korpaisarn
- Divisions of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Arunakul
- Division of Child and Adolescent Health, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Address correspondence to: Teerapong Rattananukrom, MD, MSc, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand,
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13
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Hollingshead N, Hodax JK, Boos MD. Management of acne in transgender and gender diverse youth Part 2: Unique considerations and strategies in medical treatment. Pediatr Dermatol 2022; 39:870-875. [PMID: 35973559 DOI: 10.1111/pde.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
Acne vulgaris is among the most common skin disorders afflicting adolescents worldwide, and though well-established guidelines of care exist for acne management, these guidelines do not uniformly consider or address the unique psychosocial and medical needs of transgender and gender diverse (TGD) youth. Part 2 of this two-part review provides guidance on a stepwise approach to the medical treatment of acne in TGD youth, with an emphasis on safety, efficacy, and the delivery of medical care in a culturally humble, thoughtful, and gender-affirming manner.
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Affiliation(s)
| | - Juanita K Hodax
- Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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14
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The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents. Int J Womens Dermatol 2022; 8:e030. [PMID: 35822191 PMCID: PMC9270600 DOI: 10.1097/jw9.0000000000000030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
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15
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Yousif R, Zheng DX, Chang IA, Wong C, Trinidad J, Carr DR. Readability of online patient educational materials for transgender dermatologic care. J Am Acad Dermatol 2022; 87:922-924. [PMID: 34995677 DOI: 10.1016/j.jaad.2021.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/19/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Rame Yousif
- Department of Dermatology, University of Toledo College of Medicine, Toledo, OH
| | - David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
| | - Irene A Chang
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Christina Wong
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - John Trinidad
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - David R Carr
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH
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Swink SM, Castelo-Soccio L. Dermatologic considerations for transgender and gender diverse youth. Pediatr Dermatol 2021; 38 Suppl 2:58-64. [PMID: 34250638 DOI: 10.1111/pde.14685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sexual and gender minority individuals, including transgender and gender diverse people, are an underserved and vulnerable population in the field of dermatology. While the unique dermatologic needs for adult patients in this group are increasingly documented, the knowledge surrounding pediatric and adolescent transgender/gender diverse patients is lacking. We aim to summarize the unique dermatologic needs of transgender/gender diverse patients, with particular attention paid to the data available in younger groups. This review highlights the unique role pediatric dermatologists can play in the care of transgender and gender diverse youth including but not limited to treating acne and hair pattern changes as well as being knowledgeable about surgical and other cosmetic options for gender affirmation. It also highlights areas for potential future research including dermatologic effects of hormone therapy in children as well as treatments for those side effects.
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Affiliation(s)
- Shane M Swink
- Division of Dermatology, Lehigh Valley Health Network, Allentown, PA, USA
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17
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Ragmanauskaite L, Zhang Q, Kim J, Getahun D, Silverberg MJ, Goodman M, Yeung H. Survey of Dermatologic Procedures in Transgender Adults. Dermatol Surg 2021; 47:1379-1383. [PMID: 34417383 PMCID: PMC8463491 DOI: 10.1097/dss.0000000000003179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dermatologists have the opportunity to provide medically necessary procedures, including laser hair removal, to transgender patients for gender affirmation. Further research is required to better assess the unique dermatologic needs of this population. OBJECTIVE To examine the prevalence of dermatologic procedures among transgender people in the context of gender-affirming treatment. METHODS This cross-sectional study examined survey responses from 696 transgender persons enrolled in the Study of Transition, Outcomes, and Gender cohort. Prevalence of self-reported dermatologic procedures was examined and compared across participant subgroups. RESULTS Electrolysis was the most commonly reported procedure (32.9%). Transfeminine patients were more likely to use dermatologic procedures compared with transmasculine patients. Only 19 participants (2.8%) reported the use of dermal filler injections. CONCLUSION Differences in utilization of dermatologic procedures were noted in transgender populations. Motivations, barriers, and optimal timing for gender-affirming dermatologic procedures among transgender persons should be examined in future studies.
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Affiliation(s)
| | - Qi Zhang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Jin Kim
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Michael Goodman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
- Regional Telehealth Service, VA Veterans Integrated Service Network 7 Southeast Network, Decatur, GA
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18
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Lee MS, Guo LN, Nambudiri VE. Towards gender equity in artificial intelligence and machine learning applications in dermatology. J Am Med Inform Assoc 2021; 29:400-403. [PMID: 34151976 DOI: 10.1093/jamia/ocab113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
There has been increased excitement around the use of machine learning (ML) and artificial intelligence (AI) in dermatology for the diagnosis of skin cancers and assessment of other dermatologic conditions. As these technologies continue to expand, it is essential to ensure they do not create or widen sex- and gender-based disparities in care. While desirable bias may result from the explicit inclusion of sex or gender in diagnostic criteria of diseases with gender-based differences, undesirable biases can result from usage of datasets with an underrepresentation of certain groups. We believe that sex and gender differences should be taken into consideration in ML/AI algorithms in dermatology because there are important differences in the epidemiology and clinical presentation of dermatologic conditions including skin cancers, sex-specific cancers, and autoimmune conditions. We present recommendations for ensuring sex and gender equity in the development of ML/AI tools in dermatology to increase desirable bias and avoid undesirable bias.
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Affiliation(s)
- Michelle S Lee
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa N Guo
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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19
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Pregnall AM, Churchwell AL, Ehrenfeld JM. A Call for LGBTQ Content in Graduate Medical Education Program Requirements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:828-835. [PMID: 34031304 DOI: 10.1097/acm.0000000000003581] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements.
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Affiliation(s)
- Andrew M Pregnall
- A.M. Pregnall is LGBTQ health intern, Vanderbilt Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9629-0636
| | - André L Churchwell
- A.L. Churchwell is professor of medicine (cardiology), professor of radiology and radiological sciences, professor of biomedical engineering, and senior associate dean, Diversity Affairs, Vanderbilt University School of Medicine, and chief diversity officer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jesse M Ehrenfeld
- J.M. Ehrenfeld is senior associate dean and director, Advancing a Healthier Wisconsin Endowment, the Medical College of Wisconsin, Milwaukee, Wisconsin
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20
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De Boulle K, Furuyama N, Heydenrych I, Keaney T, Rivkin A, Wong V, Silberberg M. Considerations for the Use of Minimally Invasive Aesthetic Procedures for Facial Remodeling in Transgender Individuals. Clin Cosmet Investig Dermatol 2021; 14:513-525. [PMID: 34012284 PMCID: PMC8128506 DOI: 10.2147/ccid.s304032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022]
Abstract
There is increasing demand among transgender individuals for minimally invasive aesthetic procedures, such as injectable facial fillers and neurotoxins, for facial remodeling and transformation. These procedures may increase transgender individuals’ satisfaction with their appearance and allow them to more effectively harmonize their physical appearance with their perception of self. There is currently a lack of information in the medical literature regarding guidelines for the use of these products in transgender patients. In this report, the authors provide experience-based treatment considerations and recommendations for use of minimally invasive facial aesthetic procedures in transgender patients, including case studies illustrating the use of these procedures for both male-to-female and female-to-male transitioning patients. This report highlights the success of minimally invasive methods for assisting transgender patients in achieving their facial remodeling goals. Clinicians play an integral role in the transitioning process for transgender patients, and facial transformation is a key element of this process. When conducted with sensitivity and attention to individual patient goals at varying stages of transition, facial procedures can be of great benefit in enhancing patients’ self-perception and overall quality of life.
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Affiliation(s)
| | | | - Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Cape Town, South Africa.,Division of Dermatology, Faculty of Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
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21
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Price KN, Alavi A, Hsiao JL, Shi VY. Gender minority patients in dermatology clinical trials. Int J Womens Dermatol 2020; 6:438-439. [PMID: 33898715 PMCID: PMC8060670 DOI: 10.1016/j.ijwd.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kyla N. Price
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Afsaneh Alavi
- Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Canada
| | - Jennifer L. Hsiao
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, CA, United States
| | - Vivian Y. Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, United States
- Corresponding author.
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22
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Dermatologic disorders in transgender patients: A retrospective cohort of 442 patients. J Am Acad Dermatol 2020; 83:1516-1518. [DOI: 10.1016/j.jaad.2020.06.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022]
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23
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Jackson Cullison SR, Jedrych JJ, James AJ. Porphyria cutanea tarda unmasked by supratherapeutic estrogen during gender-affirming hormone therapy. JAAD Case Rep 2020; 6:675-678. [PMID: 32637521 PMCID: PMC7327305 DOI: 10.1016/j.jdcr.2020.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Jaroslaw J Jedrych
- Department of Dermatology, The Johns Hopkins University, Baltimore, Maryland
| | - Alaina J James
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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24
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Abstract
Lesbian, Gay, Bisexual, and Transgender (LGBT) patients face significant dermatologic health disparities. LGBT patients are often discriminated against, refused healthcare, or otherwise have negative healthcare experiences that may deter future utilization of professional care. While a number of factors may mitigate these negative experiences, the present article focuses on improving organizational and institutional drivers specific to individual dermatology clinics. Clinic workflow and operations, emerging technologies and EHRs, clinic culture, clinic environment and resource availability, and provider and staff education are all characteristics of healthcare clinics that can be improved to better facilitate high-quality dermatologic care for LGBT patients.
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Affiliation(s)
- Justin L Jia
- Department of Dermatology, Stanford University School of Medicine, 455 Broadway Street, MC 8843, Redwood City, CA 94063, USA
| | - Danielle J Polin
- Department of Dermatology, Stanford University School of Medicine, 455 Broadway Street, MC 8843, Redwood City, CA 94063, USA
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, 455 Broadway Street, MC 8843, Redwood City, CA 94063, USA.
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25
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Katz KA. Quality care for lesbian, gay, bisexual, transgender, and queer patients in pediatric dermatology. Pediatr Dermatol 2019; 36:594-595. [PMID: 31529639 DOI: 10.1111/pde.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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