Sarah Gold, BA
Credit: X (Twitter)
A recent analysis indicates that acne causes social isolation, poor judgment, and low self-esteem among transgender and gender-diverse (TGD) individuals. Acne also increases TGD individuals’ concerns about gender expression and physical appearance. 1.
These results, among others, were produced by a recent study that highlighted the lived experience of TGD individuals with acne. The study aimed to examine these experiences of pimples and treatment in transgender and gender-diverse individuals to identify these factors and further our understanding of these issues for TGD patients.
The study was overseen by Sarah Gold, BA, a dermatologist at Emory University School of Medicine in Atlanta, Georgia.
Gold and colleagues note that “mistrust, operational obstacles, and concerns about being outed” are some reasons why TGD health, including the effects of acne, is poorly characterized. The study aimed to investigate the lived experience of acne in TGD individuals.
The Emory University Institutional Review Board approved the study, which used a parallel mixed-methods layout. The team simultaneously collected survey and interview data from TGD participants to better inform on their experiences and treatment barriers related to acne.
Study participants were selected from an endocrinology/dermatology clinic at an academic center in Atlanta and a comprehensive gender center at a public safety net hospital. Eligible participants were those receiving gender-affirming hormone therapy (GAHT), aged 18 or older, and identifying as transgender or having a gender different from the one assigned at birth.
Using two medical settings allowed for diverse acne severities and various gender identities, increasing the range of responses. The research team collected data on hormone treatments, sociodemographics, and acne treatment-related information using a 15-minute survey.
Between January 2021 and April 2022, the team conducted interviews and surveys. Interviews were guided by topics related to minority stress theory and the socioecological model, and frameworks informing research on transgender disparities in healthcare, while the surveys included assessments of skin-related quality of life, severity of participants’ acne, and acne-specific life through validated instruments.
The team recognized that minority stress theory highlights the effects of anticipated rejection, discrimination, and internalized transphobia on patients’ health outcomes. The socioecological model was known to assess barriers at societal, psychological, and individual levels.
Findings
The research group included 32 participants in total, with a mean age of 32 years, including 11 transgender men, 17 transgender women, and 4 non-binary individuals. The team found that 31% of respondents self-rated their skin as clear or nearly clear, 34% reported mild acne, and 44% had moderate to severe cases.
Survey and interview participants reported experiencing bullying related to their acne, as well as avoidance. This also led to respondents avoiding some social interactions, experiencing depression, and suffering from anxiety.
The researchers noted that transgender women reported interference with their gender expression due to acne, and that acne exacerbated subjects’ dissatisfaction with body image. Transgender men often normalized acne, sometimes viewing it positively as a sign of testosterone action.
Participants frequently tried over-the-counter solutions, with respondents seeking advice from peers, clinicians, online forums, and social media platforms. The team showed that barriers to acne treatments among participants include lack of transgender-specific education, inadequate comprehensive care, high overall costs, and mistrust of healthcare systems.
Clinicians should actively inquire about, monitor, and treat acne to alleviate the patient’s burden and facilitate acne care. They should also conduct further research to guide evidence-based hormonal acne treatment.
