Adolescents benefit from gender-affirming care
MIAMI BEACH, Fla. — Dermatologists are often on the forefront of care for many gender-diverse adolescents and can benefit these patients best by fully understanding and listening while providing that care, according to a speaker here.
“Trans people who do not have gender-affirming care have worse outcomes, a greater risk of depression, anxiety, substance abuse and suicidal ideations,” Klint Peebles, MD, a board-certified dermatologist with Kaiser Permanente in Washington, D.C., said during a presentation at the Masters of Pediatric Dermatology meeting. “Studies are showing time after time that this care is important and is lifesaving and dermatology can actually play a role in it.”
Dermatologists are often on the forefront of care for many gender-diverse adolescents and can benefit these patients best by fully understanding and listening while providing that care.
Gender-affirming care in children is limited to social support and expands to puberty blockers and possibly hormonal therapy later in adolescence, but surgeries are not being performed on individuals at this age, Peebles stressed.
In order to offer this social support, understanding the differences between sex and gender, listening intently to patients and being open and asking specific questions can help adolescent patients to feel secure.
For dermatologists, they are most likely to be treating gender-diverse adolescents for acne, and in that case, having the right tools selected from the armamentarium can be a way to affirm gender identity.
For transfeminine individuals, combined oral contraceptives should not be used if estrogen therapy has begun, as spironolactone is often already being prescribed for this population.
For transmasculine individuals, topical clascoterone is an option, but oral spironolactone should not be used.
“Oral contraceptives do not prevent masculinization,” Peebles said. “But the notion of taking oral contraceptives can trigger dysphoria because of the association of being used in people assigned female at birth.”
For those prescribed isotretinoin, it is important for clinicians to ask specific questions regarding sexual activity, including about the genders and bodies of their partners in order to prevent pregnancy.
“Don’t ask, ‘Are you having sex?’ because what kind of sex is that?” Peebles said. “You want to know if there is receptive penile/vaginal intercourse with an individual who produces sperm. Don’t assume.”