In response to Ginsberg et al: "A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community"
To the Editor: We read with interest the article of Ginsberg et al, 'A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community. Ginsberg et al provided an excellent overview of the surgical and cosmetic interventions that dermatologists may provide to patients undergoing a gender transition. Their article also raised important questions regarding medical dermatology for the transgender community, and in particular, the use of isotretinoin. Dermatologists are familiar with the iPLEDGE system, which regulates the use of isotretinoin. The iPLEDGE program patient introductory brochure consistently refers to patient gender in binary terms, but does not account for the fact that for many patients, gender identity and chromosomal sex may be incongruent. With increased visibility of the transgender community and the risk of acneiform eruptions in patients taking hormones to assist in gender transitions, dermatologists have a duty to be more sensitive to the needs of these patients. Not only does the iPLEDGE system potentially alienate transgendered patients with its binary reference to gender, but it also may inadvertently lead to confusion between the transgendered patient and physician. For example, how should a dermatologist treat a patient who was born with the chromosomal sex of a woman, identifies as male gender, and is currently transitioning to male sex? Although the potential for pregnancy is the main concern in determining laboratory monitoring and counseling for isotretinoin, confusion over sex and gender
Journal of the American Academy of Dermatology