Review Article| Volume 48, ISSUE 2, P429-440, June 2019

Dermatologic Conditions in Transgender Populations

  • Howa Yeung
    Corresponding author. Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, Suite 100, Atlanta, GA 30322.
    Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, Suite 100, Atlanta, GA 30322, USA

    Regional Telehealth Services, Veterans Integrated Service Network 7, 250 N Arcadia Avenue, Decatur, GA 30030, USA
    Search for articles by this author
  • Benjamin Kahn
    Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, Suite 100, Atlanta, GA 30322, USA
    Search for articles by this author
  • Bao Chau Ly
    Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, Suite 100, Atlanta, GA 30322, USA
    Search for articles by this author
  • Vin Tangpricha
    Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle Northeast, WRMB 1301, Atlanta, GA 30322, USA

    Atlanta VA Medical Center, 1670 Clairmont Road Northeast, Decatur, GA 30300, USA
    Search for articles by this author


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Endocrinology and Metabolism Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Owen-Smith A.A.
        • Gerth J.
        • Sineath R.C.
        • et al.
        Association between gender confirmation treatments and perceived gender congruence, body image satisfaction, and mental health in a cohort of transgender individuals.
        J Sex Med. 2018; 15: 591-600
        • Gonzales G.
        • Henning-Smith C.
        Barriers to care among transgender and gender nonconforming adults.
        Milbank Q. 2017; 95: 726-748
        • Hembree W.C.
        • Cohen-Kettenis P.T.
        • Gooren L.
        • et al.
        Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2017; 102: 3869-3903
        • Center of Excellence for Transgender Health
        • Department of Family and Community Medicine
        • University of California San Francisco
        Deutsch M.B. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. 2nd ed. University of California, San Francisco, San Francisco (CA)2016
        • Stevenson S.
        • Thornton J.
        Effect of estrogens on skin aging and the potential role of SERMs.
        Clin Interv Aging. 2007; 2: 283
        • Zaenglein A.L.
        • Graber E.M.
        • Thiboutot D.M.
        Acne vulgaris and acneiform eruptions.
        in: Goldsmith L.A. Katz S.I. Gilchrest B.A. Fitzpatrick's dermatology in general medicine, 8e. The McGraw-Hill Companies, New York2012: 897-917
        • Zaenglein A.L.
        • Pathy A.L.
        • Schlosser B.J.
        • et al.
        Guidelines of care for the management of acne vulgaris.
        J Am Acad Dermatol. 2016; 74: 945-973.e33
        • Elsaie M.L.
        Hormonal treatment of acne vulgaris: an update.
        Clin Cosmet Investig Dermatol. 2016; 9: 241-248
        • Trivedi M.K.
        • Shinkai K.
        • Murase J.E.
        A Review of hormone-based therapies to treat adult acne vulgaris in women.
        Int J Womens Dermatol. 2017; 3: 44-52
        • Ju Q.
        • Tao T.
        • Hu T.
        • et al.
        Sex hormones and acne.
        Clin Dermatol. 2017; 35: 130-137
        • Motosko C.
        • Zakhem G.
        • Pomeranz M.
        • et al.
        Acne: a side effect of masculinizing hormonal therapy in transgender patients.
        Br J Dermatol. 2018; 180: 26-30
        • Dalgard F.
        • Gieler U.
        • Holm J.O.
        • et al.
        Self-esteem and body satisfaction among late adolescents with acne: results from a population survey.
        J Am Acad Dermatol. 2008; 59: 746-751
        • Revol O.
        • Milliez N.
        • Gerard D.
        Psychological impact of acne on 21st-century adolescents: decoding for better care.
        Br J Dermatol. 2015; 172: 52-58
        • Halvorsen J.A.
        • Stern R.S.
        • Dalgard F.
        • et al.
        Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study.
        J Invest Dermatol. 2011; 131: 363-370
        • Gao Y.
        • Wei E.K.
        • Arron S.T.
        • et al.
        Acne, sexual orientation, and mental health among young adults in the United States: a population-based, cross-sectional study.
        J Am Acad Dermatol. 2017; 77: 971-973
        • Giltay E.
        • Gooren L.
        Effects of sex steroid deprivation/administration on hair growth and skin sebum production in transsexual males and females.
        J Clin Endocrinol Metab. 2000; 85: 2913-2921
        • Wierckx K.
        • Van de Peer F.
        • Verhaeghe E.
        • et al.
        Short- and long-term clinical skin effects of testosterone treatment in trans men.
        J Sex Med. 2014; 11: 222-229
        • Turrion-Merino L.
        • Urech-García-de-la-Vega M.
        • Miguel-Gomez L.
        • et al.
        Severe acne in female-to-male transgender patients.
        JAMA Dermatol. 2015; 151: 1260-1261
        • Permpongkosol S.
        • Khupulsup K.
        • Leelaphiwat S.
        • et al.
        Effects of 8-year treatment of long-acting testosterone undecanoate on metabolic parameters, urinary symptoms, bone mineral density, and sexual function in men with late-onset hypogonadism.
        J Sex Med. 2016; 13: 1199-1211
        • Veale J.F.
        • Watson R.J.
        • Peter T.
        • et al.
        Mental health disparities among canadian transgender youth.
        J Adolesc Health. 2017; 60: 44-49
        • Torjesen I.
        Managing acne female-to-male transgender persons.
        2018 (Available at:) (Accessed August 19, 2018)
        • Thiboutot D.M.
        • Dreno B.
        • Abanmi A.
        • et al.
        Practical management of acne for clinicians: an international consensus from the Global Alliance to Improve Outcomes in Acne.
        J Am Acad Dermatol. 2018; 78: S1-S23.e21
        • Leyden J.
        • Stein-Gold L.
        • Weiss J.
        Why topical retinoids are mainstay of therapy for acne.
        Dermatol Ther (Heidelb). 2017; 7: 293-304
        • Yeung H.
        • Chen S.C.
        • Katz K.A.
        • et al.
        Prescribing isotretinoin in the United States for transgender individuals: ethical considerations.
        J Am Acad Dermatol. 2016; 75: 648-651
        • Kelly Y.
        • Blanco A.
        • Tosti A.
        Androgenetic alopecia: an update of treatment options.
        Drugs. 2016; 76: 1349-1364
        • Tas B.
        • Kulacaoglu F.
        • Belli H.
        • et al.
        The tendency towards the development of psychosexual disorders in androgenetic alopecia according to the different stages of hair loss: a cross-sectional study.
        An Bras Dermatol. 2018; 93: 185-190
        • Otberg N.
        • Shapiro J.
        Hair growth disorders.
        in: Goldsmith L.A. Katz S.I. Gilchrest B.A. Fitzpatrick's dermatology in general medicine, 8e. The McGraw-Hill Companies, New York2012: 979-1008
        • Bolognia J.L.
        • Schaffer J.V.
        • Duncan K.O.
        • et al.
        Alopecias. Dermatology essentials.
        1st edition. Saunders, Philadelphia2014
        • Gao Y.
        • Maurer T.
        • Mirmirani P.
        Understanding and addressing hair disorders in transgender individuals.
        Am J Clin Dermatol. 2018; 19: 517-527
        • Ginsberg B.A.
        Dermatologic care of the transgender patient.
        Int J Womens Dermatol. 2017; 3: 65-67
        • Civatte J.C.
        • Laux B.
        • Simpson N.B.
        • et al.
        2% topical minoxidil solution in male-pattern baldness: preliminary European results.
        Dermatology. 1987; 175: 42-49
        • Kanti V.
        • Hillmann K.
        • Kottner J.
        • et al.
        Effect of minoxidil topical foam on frontotemporal and vertex androgenetic alopecia in men: a 104-week open-label clinical trial.
        J Eur Acad Dermatol Venereol. 2016; 30: 1183-1189
        • Mirmirani P.
        • Consolo M.
        • Oyetakin-White P.
        • et al.
        Similar response patterns to topical minoxidil foam 5% in frontal and vertex scalp of men with androgenetic alopecia: a microarray analysis.
        Br J Dermatol. 2015; 172: 1555-1561
        • Olsen E.A.
        • Dunlap F.E.
        • Funicella T.
        • et al.
        A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men.
        J Am Acad Dermatol. 2002; 47: 377-385
        • Choudhry R.
        • Hodgins M.B.
        • Van der Kwast T.H.
        • et al.
        Localization of androgen receptors in human skin by immunohistochemistry: implications for the hormonal regulation of hair growth, sebaceous glands and sweat glands.
        J Endocrinol. 1992; 133: 467-475
        • Mella J.M.
        • Perret M.C.
        • Manzotti M.
        • et al.
        Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review.
        Arch Dermatol. 2010; 146: 1141-1150
        • Moreno-Arrones O.M.
        • Becerra A.
        • Vano-Galvan S.
        Therapeutic experience with oral finasteride for androgenetic alopecia in female-to-male transgender patients.
        Clin Exp Dermatol. 2017; 42: 743-748
        • Hembree W.C.
        • Cohen-Kettenis P.
        • Delemarre-van de Waal H.A.
        • et al.
        Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2009; 94: 3132-3154
        • van de Grift T.C.
        • Cohen-Kettenis P.T.
        • Steensma T.D.
        • et al.
        Body satisfaction and physical appearance in gender dysphoria.
        Arch Sex Behav. 2016; 45: 575-585
      1. World Professional Association for Transgender Health. WPATH recommended benefits policy document: created in partnership with starbucks. Available at: Accessed August 19, 2018.

        • Bridgeman-Shah S.
        The medical and surgical therapy of pseudofolliculitis barbae.
        Dermatol Ther. 2004; 17: 158-163
        • Perry P.K.
        • Cook-Bolden F.E.
        • Rahman Z.
        • et al.
        Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends.
        J Am Acad Dermatol. 2002; 46: S113-S119
        • Agi C.
        • Bosley R.E.
        Pseudofolliculitis barbae and acne keloidalis nuchae.
        in: Aguh C. Okoye G.A. Fundamentals of ethnic hair: the dermatologist's perspective. Springer International Publishing, Cham (Switzerland)2017: 123-133
        • Cook-Bolden F.E.
        • Barba A.
        • Halder R.
        • et al.
        Twice-daily applications of benzoyl peroxide 5%/clindamycin 1% gel versus vehicle in the treatment of pseudofolliculitis barbae.
        Cutis. 2004; 73: 18-24
        • Xia Y.
        • Cho S.
        • Howard R.S.
        • et al.
        Topical eflornithine hydrochloride improves the effectiveness of standard laser hair removal for treating pseudofolliculitis barbae: a randomized, double-blinded, placebo-controlled trial.
        J Am Acad Dermatol. 2012; 67: 694-699
        • Wilson E.
        • Rapues J.
        • Jin H.
        • et al.
        The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013.
        J Sex Med. 2014; 11: 1717-1724
        • Clark K.
        • Fletcher J.B.
        • Holloway I.W.
        • et al.
        Structural inequities and social networks impact hormone use and misuse among transgender women in Los Angeles county.
        Arch Sex Behav. 2018; 47: 953-962
        • Herbst J.H.
        • Jacobs E.D.
        • Finlayson T.J.
        • et al.
        Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review.
        AIDS Behav. 2008; 12: 1-17
        • Sevelius J.M.
        Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color.
        Sex Roles. 2013; 68: 675-689
      2. U.S. Food & Drug Administration. Dermal fillers (soft tissue fillers) - dermal fillers approved by the center for devices and radiological health. Available at: Accessed August 19, 2018.

        • Ogawa R.
        Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis.
        Int J Mol Sci. 2017; 18 ([pii:E606])
        • Chike-Obi C.J.
        • Cole P.D.
        • Brissett A.E.
        Keloids: pathogenesis, clinical features, and management.
        Semin Plast Surg. 2009; 23: 178-184
        • Walliczek U.
        • Engel S.
        • Weiss C.
        • et al.
        Clinical outcome and quality of life after a multimodal therapy approach to ear keloids.
        JAMA Facial Plast Surg. 2015; 17: 333-339
        • Hage J.J.
        • van Kesteren P.J.
        Chest-wall contouring in female-to-male transsexuals: basic considerations and review of the literature.
        Plast Reconstr Surg. 1995; 96: 386-391
        • Trisliana Perdanasari A.
        • Torresetti M.
        • Grassetti L.
        • et al.
        Intralesional injection treatment of hypertrophic scars and keloids: a systematic review regarding outcomes.
        Burns Trauma. 2015; 3: 14
        • Handel A.C.
        • Miot L.D.B.
        • Miot H.A.
        Melasma: a clinical and epidemiological review.
        An Bras Dermatol. 2014; 89: 771-782
        • Davis E.C.
        • Callender V.D.
        Postinflammatory hyperpigmentation.
        J Clin Aesthet Dermatol. 2010; 3: 20-31
        • Balkrishnan R.
        • McMichael A.J.
        • Camacho F.T.
        • et al.
        Development and validation of a health-related quality of life instrument for women with melasma.
        Br J Dermatol. 2003; 149: 572-577
        • Halder R.M.
        • Nootheti P.K.
        Ethnic skin disorders overview.
        J Am Acad Dermatol. 2003; 48: S143-S148
        • Tasker G.L.
        • Wojnarowska F.
        Lichen sclerosus.
        Clin Exp Dermatol. 2003; 28: 128-133
        • McMurray S.L.
        • Overholser E.
        • Patel T.
        A transgender woman with anogenital lichen sclerosus.
        JAMA Dermatol. 2017; 153: 1334-1335
        • Amend B.
        • Seibold J.
        • Toomey P.
        • et al.
        Surgical reconstruction for male-to-female sex reassignment.
        Eur Urol. 2013; 64: 141-149
        • van der Sluis W.B.
        • Buncamper M.E.
        • Bouman M.B.
        • et al.
        Symptomatic HPV-related neovaginal lesions in transgender women: case series and review of literature.
        Sex Transm Infect. 2016; 92: 499-501
        • Bollo J.
        • Balla A.
        • Rodriguez Luppi C.
        • et al.
        HPV-related squamous cell carcinoma in a neovagina after male-to-female gender confirmation surgery.
        Int J STD AIDS. 2018; 29: 306-308
        • Radix A.
        • Sevelius J.
        • Deutsch M.B.
        Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices.
        J Int AIDS Soc. 2016; 19: 20810