Isotretinoin Effective for Acne in Gender-Affirming Therapy Recipients

A recent study indicates that isotretinoin, a medication commonly used to treat severe acne, is both safe and effective for individuals undergoing masculinizing gender-affirming hormonal therapy. The study was published on May 29 in the journal JAMA Dermatology and conducted by James Choe and his colleagues from Brigham and Women's Hospital in Boston.

The research team embarked on a multicenter retrospective case series study to evaluate the clinical outcomes of isotretinoin among transgender and gender-diverse individuals. The study included 55 patients, aged between 12 and 49, all of whom were receiving masculinizing hormone therapy and were prescribed isotretinoin to manage their acne.

The median duration for the isotretinoin treatment course was six months, with patients receiving a median cumulative dose of 132.7 mg/kg. The results were promising: 87.3% of the patients experienced an improvement in their acne, while 47.3% achieved complete clearance of the condition. The effectiveness of the treatment appeared to be dose-dependent. Among the 33 patients who received a cumulative dose of 120 mg/kg or more, the rates of improvement and clearance rose to 97.0% and 63.6%, respectively.

However, the study did note a recurrence rate of 20% among the 20 patients who had achieved acne clearance and subsequently sought further healthcare. The most commonly reported adverse effects were dryness (80.0%), joint pain (14.5%), and eczema (9.1%). Fortunately, laboratory abnormalities were rare, indicating that the medication was generally well-tolerated.

Despite the overall positive outcomes, some patients had to discontinue treatment prematurely due to various reasons such as cost, pharmacy-related issues, adverse effects, logistical challenges, and concerns related to wound healing for those undergoing gender-affirming surgeries.

The authors of the study suggest that isotretinoin could play a significant, yet underappreciated, role in gender-affirming care. This finding is crucial as managing acne effectively can significantly improve the quality of life and mental health of transgender and gender-diverse individuals receiving masculinizing hormone therapy.

It is worth noting that two of the study's authors disclosed connections to the pharmaceutical industry, although this detail does not detract from the study’s primary findings. Nonetheless, the study provides valuable insights into the potential benefits of isotretinoin in a specific population that might otherwise be overlooked in dermatological care.