Managing common dermatologic needs in transgender and gender-diverse adolescents

Abstract

Purpose of review: Transgender and gender-diverse (TGD) adolescents often face dermatologic concerns during gender-affirming care but may face limited access to dermatologists. This review aims to provide practical guidance for pediatricians on managing common dermatologic needs in TGD adolescents, including acne, hair growth promotion or removal, and post-surgical scarring within the context of gender-affirming care.

Recent findings: Acne management should consider the impact of testosterone therapy and chest binding, with treatment options including topical retinoids, benzoyl peroxide, oral antibiotics, combined oral contraceptives, and spironolactone. Topical minoxidil may be considered for the promotion of facial, and scalp hair growth. Hair removal methods and complications such as pseudofolliculitis barbae should be discussed with TGD adolescents seeking temporary or permanent hair removal. Hypertrophic scarring and keloids may occur after gender-affirming chest reconstruction, with management involving topical silicone gel and adhesive silicone sheeting.

Summary: TGD adolescents may struggle to identify specialists trained in gender-affirming dermatologic care and may delay or avoid care due to past mistreatment in clinical settings. Pediatricians play a key role in managing the dermatologic concerns of TGD adolescents by creating a gender-affirming, safe, and supportive care environment and facilitating early dermatology referrals when appropriate.

Keywords: adolescent health; dermatology; health disparities; pediatrics; sexual and gender minorities; skin diseases.