Acne is a common concern affecting people of all genders, but it can present unique challenges for transgender individuals undergoing hormone therapy. As we strive to promote inclusivity and support for all, it’s essential to address the specific needs of transgender patients in managing acne aggravated by hormonal changes.
According to recent research, transgender individuals undergoing masculinizing hormone therapy (MHT) may experience an increased prevalence of acne due to hormonal fluctuations.
The development of hormonal acne is notably in the lower third of the face, chest, upper arms, and back – and usually the onset is up to 2 years after the start of the treatment. In fact, recent research conducted in USA by Dr. Matthew Mansh showed that the prevalence of acne in these patients increased from 6.3% to 31.1% following MHT initiation. This highlights the importance of tailored treatment approaches that balance gender-affirming goals with managing acne effectively.
Treatment
Treatment options for transgender individuals with acne are similar to those for cisgender individuals, but with some considerations. In addition to using gender-inclusive language and respecting pronouns, healthcare providers should collaborate closely with hormone specialists to optimize treatment regimens. This may involve monitoring testosterone levels and adjusting hormone doses to minimize acne while supporting gender-affirming care.
For mild to moderate acne, topical retinoids combined with antibiotics and benzoyl peroxide may be recommended. However, certain medications like spironolactone, which blocks androgen receptors, should be avoided to prevent testosterone suppression. In cases of moderate to severe nodulocystic acne, oral isotretinoin can be effective but requires careful timing to avoid interfering with gender-affirming surgeries.
In that regard, the use of personalized medicine goes to meet the special needs of all patients: Not only the traditional, standard, guidelines-based treatments can be provided (for example, adapalene, antibiotics, some acids etc), but also add-on, off-label options to optimize treatment and reduce side effects. Those include nutraceuticals (such as vitamins A, B6, C, D and E, and zinc, selenium, silymarin extract, omega 3, and different strands of Lactobacillus) and non-traditional drugs (such as levamisole, topic N-acetylcysteine, and topic clobetasol). Fagron can provide all those options to the patient.
Personalized medicine
Personalized medicine plays a crucial role in meeting the diverse needs of transgender patients. In addition to conventional treatments, nutraceuticals and non-traditional options may be considered to optimize outcomes and reduce side effects. Cleoderm, a specialized skin rebalancing cream, offers a unique formulation designed to address the needs of acne-prone or oily skin, providing anti-inflammatory and sebum-reducing properties.
Skin rebalancing cream: Cleoderm™
When compounding medicine, the choice of API (active ingredients) is not the only issue to be considered. The vehicles and excipients play an equally important role, because they interfere in the efficacy of the medicine and also need to follow the specific guidelines for the patients’ individual needs.
The vehicle may have substances that can modulate the effects of some drugs, and to some extent, they can have traces of substances that could potentially lead to endocrine disruption, if not produced following GMP (good-manufacturing processes) standards. A good vehicle also provides adequate sensory characteristics, to stimulate the patient to follow the treatment.
Cleoderm™ is a functional vehicle with selected ingredients that makes it the ideal choice for compounding topical treatments for acneic or oily skin. Its main constituents are Cleome gynandra L. leaf extract, palmitoyl tripeptide-8, bisabolol, hyaluronic acid, and functional oils (avocado, jojoba, dog rose, coconut, English lavender, tea tree, rosemary, shea tree, and vitamin E acetate). This unique combination of ingredients provides Cleoderm great anti-inflammatory and humectant properties as well as sebum reduction.
Advantages:
• Highly spreadable;
• Light skin-feel;
• Readily absorbed;
• Non-comedogenic;
• Dermatologically tested;
• Specially developed for acne treatment and topical products for oily skin.
Cleoderm™ is also free from dyes, parabens, mineral oil, sodium lauryl sulfate, propylene glycol, and petrolatum, which makes it a very safe and reliable choice for coadjutant on acne treatment.
On this International Transgender Day of Visibility, let’s reaffirm our commitment to providing inclusive, compassionate care for all individuals, regardless of gender identity. By recognizing and addressing the unique challenges faced by transgender patients, we can promote positive health outcomes and foster a more inclusive healthcare environment.
You can read more about this topic in:
Ref: Hobbins, K. Treating Acne in Transgender Patients Taking Testosterone. Dermatology Times, 37, 2022.
Gold S, Siira M, Willner S, et al. Lived Experience of Acne and Acne Treatment in Transgender Patients. JAMA Dermatol. 2024;160(2):164–171. doi:10.1001/jamadermatol.2023.5355
Radi, R., Gold, S., Acosta, J.P. et al. Treating Acne in Transgender Persons Receiving Testosterone: A Practical Guide. Am J Clin Dermatol 23, 219–229 (2022). https://doi.org/10.1007/s40257-021-00665-w
C.C. Motosko, G.A. Zakhem, M.K. Pomeranz, A. Hazen, Acne: a side‐effect of masculinizing hormonal therapy in transgender patients, British Journal of Dermatology, Volume 180, Issue 1, 1 January 2019, Pages 26–30, https://doi.org/10.1111/bjd.17083
