At the Society of Dermatology Physician Assistants Annual Summer Dermatology Conference 2021 in Chicago, IL, Tiffany Pierce, PA-C, discussed what dermatology providers should know when it comes to transgender medicine. Her presentation highlighted the foundational knowledge necessary for providing care, examples of procedures or conditions seen in the dermatology practice, and resources to improve education.

“When I started doing my research for the presentation, I realized I could, in 1 year, read about every single paper on transgender medicine published 10 or 15 years ago, because there were maybe 15 or 30 papers,” started Pierce. She highlighted that the literature has skyrocketed within the past few years, noting a major shift toward inclusive and accepting care. Approximately 1.4 million people (0.6%) of the population in the United States identify as transgender, though some studies estimate the number may be as high as 1.6%.

Providers should work to master basic terminology for patient groups, including:

• Transgender: a person whose gender identity of expression is different from their sex assigned at birth

• Cisgender: A person whose sex assigned at birth is the same as their gender identify or expression

• Gender expression: A person’s outward presentation of their gender (eg, how they dress)

• Gender identity: A person’s internal understanding of their own gender

• Intersex: Umbrella term for unique variations in reproductive or sex anatomy, including chromosomes, genitals, and internal organs (eg, testes, ovaries)

• Sexual identity: A person’s internal understanding of their sexual preference

Further, sex and gender are separate concepts, and providers should be careful not to mistakenly assume a patient’s sexual orientation based on their gender identity. In addition, physicians should not think of gender as binary, because “it is scientifically inaccurate to use ‘female brain’ or ‘male brain,” said Pierce.

“Pronouns are a really, really, really big deal,” said Pierce. She added that including identification options such as transgender, intersex, and other in addition to male and female could potentially lead to higher patient satisfaction. “Dermatology is well-suited to make significant improvements in the lives of transgender patients,” she said. “Just call the people how they want—you may never understand how that can make that person feel.

Transgender considerations in dermatology include changes in hair and sebum production secondary to hormone therapy, and pre- and postoperative interventions for gender-confirming surgeries, and aesthetic techniques for rejuvenation, among others. Dermatologists should also note that transgender patients may show unique presentations of routine skin conditions.

On the horizon, practitioners can look for increased awareness, such as journal publications, organizational support for transgender rights, and updates to the iPLEDGE program to include transgender standards.  

Reference
Pierce T. Transgender medicine. Presented at: Society of Dermatology Physician Assistants Annual Summer Dermatology Conference 2021; July 22-25, 2021; Chicago, IL.