A side‐effect of masculinizing hormonal therapy
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Acne is a known side effect of masculinizing hormonal therapy used in transgender men. In all people with acne, it can contribute to depression, body image issues and even suicidal ideation. Hormones, particularly testosterone, are often the first treatment for gender dysphoria ‐ the distress that can be caused by feeling and living a different gender to one's assigned gender ‐ in transgender men. These hormones can exacerbate acne, among other hair and skin issues. The aim of this article, from the USA, is to promote understanding for advising and treating transgender men who have acne as a result of masculinizing hormonal therapy. Studies suggest that the severity of acne peaks within the first 4 months of treatment. Although gradual improvement is noted within the first year, acne can be persistent, lasting years after testosterone therapy is started. Severity of acne is variable, with most patients experiencing milder lesions (spots). Acne tends to be most prominent on the back and chest, an area that may already be one of the greatest sources of dissatisfaction among transgender men. Standard acne treatments such as topical medications (creams) and antibiotics can be used, but hormonal therapy is likely to interact with the desired effects of testosterone in transgender men, which requires careful consideration and discussion. In cases that don't improve after these first‐line treatments, a powerful drug called isotretinoin is effective in patients on masculinizing therapy, though multiple courses of treatment may be needed. This drug can have unwanted side‐effects and doctors have to closely monitor patients on this drug. The study discusses other important considerations for doctors. Although the options for treating acne are similar to those used in cis‐gender patients (i.e. whose sense of personal identity and gender corresponds with their birth sex), several medical, social, and psychological considerations must be noted when treating transgender patients.Keywords:
Isotretinoin
Gender Dysphoria
Hormonal Therapy
Hormone Therapy
Acne is a multifactorial disorder, very common among young people, and a frequent reason for Dermatology consultation. When moderate-to-severe acne is not responsive to conventional treatments, oral isotretinoin is a very effective solution. However, there are cases in which this treatment too fails to produce the expected result. In this case, an 18-year-old male patient with acne, unresponsive to traditional acne therapies, experienced only a partial benefit from oral isotretinoin. Endocrinology consultation and hormonal work-up revealed androgen metabolism anomalies suggestive of a non-classical form of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. In this case report, the authors discuss when to suspect, how to diagnose, and how to manage similar cases.
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Isotretinoin is indicated for nodular acne or severe acne that is unresponsive to conventional therapies. The usual dose is 0.5 to 1.0 mg/kg/day for 20 weeks, or a cumulative dose of 120 mg/kg. As side effects are dose-related, the idea of low-dose isotretinoin therapy for less severe forms of acne is attractive, but little data exist on the safety and efficacy of this strategy.
Investigators in Israel conducted a prospective, observational, open-label study of isotretinoin in 638 patients with moderate acne. Patients were divided into two groups. Group 1 contained 495 patients aged 12 to 20 years with …
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Sixteen patients with minimal facial acne but with symptoms of dysmorphophobia related to their acne were treated with isotretinoin, 0.5 mg/kg/day, (n = 5); 1 mg/kg/day (n = 11) for 16 weeks. All 16 had previously received long-term antibiotic therapy with no 'perceived' improvement in their acne. Formal psychiatric assessment was not possible through lack of cooperation. Fourteen of 16 patients derived benefit from isotretinoin therapy in that all 14 were subsequently satisfied with the cosmetic results achieved. However, the incidence of relapse was greater than that for a control group, 14 requiring additional therapy in the form of antibiotics or further isotretinoin (seven patients) within 20 months of completing the original course. Patients with acne and dysmorphophobia represent an important group of patients who benefit from treatment with isotretinoin; if possible this should be in conjunction with psychotherapy.
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Low-dose isotretinoin reduced the number of acne lesions in adult patients with acne vulgaris beginning at 4 weeks and continuing through 32 weeks, with 40% of patients remaining acne free for 3 years. This article discusses data from an unpublished follow-up study that evaluated low-dose isotretinoin for the treatment of adult acne.
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Adults with acne vulgaris tend to have milder disease than younger persons, but a poorer response to therapy. These investigators observed that adult acne patients are also less tolerant of the side effects of isotretinoin. In an attempt to limit adverse effects and decrease costs, they used an intermittent moderate dose of isotretinoin to treat …
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Acne vulgaris is a common inflammatory dermatosis capable of producing significant psychological and physical scarring. The following work describes the benefit of using a questionnaire as a clinical tool to identify acne patients who have developed psychological sequelae as a result of the disease process. In addition, the benefit of isotretinoin on psychological impact has also been highlighted by this work. A prospective clinical study examines the early use of isotretinoin in acne and demonstrates the beneficial effect of early therapy in minimising acne scarring. In summary, oral isotretinoin (Roaccutane®/Accutane®) provides a very effective therapy to prevent acne patients being ‘scarred for life’!
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AbstractOral isotretinoin is increasingly prescribed to patients with less severe acne. Such patients usually show little or no response to more conventional therapy such as long-term oral or topical antibiotics and topical retinoids. There is, however, concern amongst some physicians that patients with less severe acne may be less tolerant of the side-effects of oral isotretinoin. The purpose of this study was to address this particular issue: is oral isotretinoin associated with an increased side-effect profile when prescribed to patients with less severe acne? We recorded the side-effect profile of 492 patients treated with oral isotretinoin. Of these patients, 295 (60.0%) had less severe acne and 197 (40.0%) had severe acne. There were no significant differences in the total side-effect profile between patients with severe and those with less severe acne. However, when analysed at 8 and 16 weeks, both patient groups had significantly fewer side effects at the 16th week compared with the 8th week of treatment (P < 0.001). The conclusion from this study is that there is no difference in the side-effect profile between patients with severe and those with less severe acne receiving oral isotretinoin for acne.Key Words: IsotretinoinAcneSide-effect
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Acne is a chronic inflammatory disease of pilosebaceous units. In addition to an unpleasant appearance, it may result in scarring in some cases. Despite the introduction of different treatments, oral isotretinoin is the most effective treatment and affects all the factors involved in the pathogenesis of this disease. This study was performed on patients with acne to examine the therapeutic effects, recurrence rate, and adverse effects of this drug.One hundred patients with acne, who were visited at the Bou-Ali Hospital during 2000 - 2001, and found eligible to take part in this study were selected. The severity of acne was graded at the beginning, during, and after a 6-month treatment course with oral isotretinoin. Necessary laboratory tests were done.The data of 83 of 100 patients who continued the treatment for 6 months were analyzed. The mean +/- SEM severity score of acne improved from 3.15 +/- 0.10 to 0.58 +/- 0.09 (P < 0.0001). Complete cure was achieved in 65% of patients. The mean +/- SEM follow-up was 8.7 +/- 2.3 months and the acne severity score was 1.04 +/- 0.13 during the follow-up period. Overall, the recurrence rate was 19%; 4% of patients had to undergo retreatment. A rise in triglyceride level was the only significant laboratory alteration observed.Oral isotretinoin appears to have favorable results and the least adverse effects in treatment of carefully-selected patients with acne.
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Background: There is at present little published information on the current indications for isotretinoin as a treatment of acne vulgaris. Objectives: To investigate the factors which influence our current prescribing of isotretinoin: acne severity, response to previous therapy, scarring and psychological effect. Methods: Data on the factors influencing treatment of 200 patients with isotretinoin between January 1993 and May 1994 were examined. Results: 41% of patients were prescribed isotretinoin for partial response to previous therapy, 26% for partial therapy and scarring and 17% for partial response to treatment and psychological disturbance. Only 16 patients received isotretinoin for severe acne. Conclusion: Patients who show only partial response to conventional antibiotic therapy should be prescribed isotretinoin in order to minimize scarring and significant psychological disturbance, independently of the severity of the acne.
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