Effectively managing acne in transgender and gender diverse (TGD) patients on gender affirming hormones requires a thoughtful, individualized approach. Testosterone therapy often worsens acne, while estrogen therapy—especially when combined with anti-androgens like spironolactone—can lead to skin dryness and irritation.

To prevent acne from becoming severe or causing scarring, it's essential to start treatment early. Topical retinoids, such as tretinoin, should be introduced as part of the skincare regimen. For moderate to severe cases, consider oral antibiotics or isotretinoin, particularly if scarring is present. However, keep in mind that isotretinoin involves navigating the iPLEDGE system, which can be emotionally taxing for some TGD patients due to its pregnancy prevention requirements.

The key to success is a personalized acne treatment plan that supports your patient's gender affirming hormone therapy. Open conversations about their skincare needs and potential side effects will ensure they feel empowered and supported throughout the process. And remember: start tretinoin slowly to avoid overwhelming your patients with redness and irritation.

For a deeper dive into this topic, including best practices in acne management, androgenetic alopecia, and other skin issues affecting TGD patients, join QueerCME! Dr. Lindsay Gunnell’s lecture, "Dermatology and Trans Healthcare," offers expert insights you won’t want to miss.