Prescribing isotretinoin in the United States for transgender individuals: Ethical considerations

Prescribing isotretinoin for transgender youth: A pledge for more inclusive care

“…Continued advocacy for a system that is based on gender-neutral reproductive potential is therefore warranted, as enacting this change would allow for safe and reliable therapy while retaining our young patients' rights to self-identification and determination. 17 Changes to iPLEDGE have been suggested previously for a number of reasons, and we add our voices to the growing chorus of concerned physicians who believe that small changes to the program will allow us to provide more practical, affirming and compassionate care to all of our patients. 15,18 A gender-neutral patient categorization model of iPLEDGE is also supported by the American Medical Association 19 and the American Academy of Dermatology, 20 and we applaud the Society for Pediatric Dermatology's recent decision to formally request both the FDA and iPLEDGE to endorse this model in the name of patient equity and self-determination.…”

“…Given the current restrictions inherent in the iPLEDGE program, ethically it is recommended that transgender patients be registered according to their natal gender (ie, transgender males are advised to register as female) in order to be compliant with iPLEDGE requirements and avoid intentionally misidentifying patients within the system. 15,17 However, for some patients this option may be unacceptable and isotretinoin therapy rejected if a patient is unwilling to register in a manner inconsistent with how they self-identify; alternatively, providers who are uncomfortable discussing gender identity may avoid prescribing isotretinoin even when clinically indicated, leading to adverse patient outcomes. In our clinical experience, adult as well as adolescent transgender males have refused to register as female in iPLEDGE despite ideal candidacy for isotretinoin as they felt that such an action would unacceptably compromise their identity.…”

“…Nevertheless, it is clear that current options are untenable for many transgender patients, resulting in deferral of otherwise indicated treatment by patients and providers alike. Continued advocacy for a system that is based on gender‐neutral reproductive potential is therefore warranted, as enacting this change would allow for safe and reliable therapy while retaining our young patients’ rights to self‐identification and determination . Changes to iPLEDGE have been suggested previously for a number of reasons, and we add our voices to the growing chorus of concerned physicians who believe that small changes to the program will allow us to provide more practical, affirming and compassionate care to all of our patients .…”

Dermatologic care of the transgender patient

“…Consequently, asking a transgender man to register as a female is often psychologically unsettling for the patient, uncomfortable for the provider, and unfortunately a reason why many patients ultimately do not start this beneficial acne treatment. Calls for change of this registration process have appeared recently in medical literature (Katz, 2016, Rieder et al, 2016, Yeung et al, 2016). …”

Quality care for lesbian, gay, bisexual, transgender, and queer patients in pediatric dermatology

“…Importantly, one factor contributing to LGBTQ health disparities, according to Healthy People 2020, is a “shortage of health care providers who are knowledgeable and culturally competent in LGBTQ health.” That shortage underscores the importance of Boos et al's two‐part review of LGBTQ health issues in this issue of Pediatric Dermatology . The review adds to an increasing focus on LGBTQ health in dermatology, including reviews, textbook chapters, and research articles; educational sessions at dermatology conferences; the creation in 2017 of an Expert Resource Group on LGBT/Sexual and Gender Minority Health within the American Academy of Dermatology (AAD); advocacy efforts to make iPLEDGE for isotretinoin and similar FDA‐mandated Risk Evaluation and Mitigation Strategies more inclusive of transgender persons, and to make dermatology education more inclusive of LGBTQ health concerns; and the AAD's adoption, in March 2019, of a position statement strongly supportive of efforts to promote LGBTQ health…”