TOPLINE:

Transgender individuals starting hormone therapy, particularly transmasculine individuals, had a higher incidence of acne and moderate-to-severe acne than matched cisgender individuals over 5 years.

METHODOLOGY:

• A retrospective matched cohort study analyzed data on 280,997 individuals without acne at baseline, across four Kaiser Permanente health plan regions in the US, including 11,234 transmasculine individuals whose mean age at the index date (first documentation of transgender status in medical records) was 27.7 years) and 9486 (mean age at index date, 33.2 years) transfeminine individuals matched with 132,462 cisgender men and 127,815 cisgender women. About 53%-55% were White, 7%-10% were Asian, and 6%-10% were Black.
• Researchers tracked participants from January 2006 to February 2022, with up to 5 years of follow-up, focusing on individuals without baseline acne and those initiating gender-affirming hormone therapy after their index date.
• The primary outcome was incident acne after the index date; the secondary outcome was incident moderate-to-severe acne, defined as acne followed by a prescription for isotretinoin or ≥ 30 days of oral antibiotics.

TAKEAWAY:

• The 5-year cumulative acne incidence was 15.8% in transmasculine individuals compared with 3.8% in matched cisgender men and 10.5% in matched cisgender women. Among transfeminine individuals, the 5-year cumulative acne incidence was 6.0% vs 2.9% in matched cisgender men and 8.4% in matched cisgender women.
• Transmasculine individuals had a higher risk for acne in the first year after testosterone was initiated than matched cisgender men (hazard ratio [HR], 8.56; 95% CI, 7.29-10.05) and matched cisgender women (HR, 2.63; 95% CI, 2.33-2.97).
• After starting estradiol, transfeminine individuals showed a higher risk for acne than matched cisgender men (HR, 1.56; 95% CI, 1.31-1.84) but a lower risk than matched cisgender women (HR, 0.53; 95% CI, 0.46-0.62).
• Moderate-to-severe acne patterns followed similar trends, with transmasculine individuals showing a higher incidence (5.9%) of moderate-to-severe acne over 5 years than both matched cisgender groups (1.4% in cisgender men and 3% in cisgender women), while transfeminine individuals demonstrated an intermediate risk (1.4% vs 1.0% in matched cisgender men and 2.1% in matched cisgender women).

IN PRACTICE:

“Clinicians should educate transmasculine individuals about acne risk after testosterone initiation,” the study authors wrote. “Future studies,” they added, “should evaluate potential dermatologic care barriers in transgender health settings, given high rates of moderate-to-severe acne in transmasculine individuals during the first year after testosterone initiation.”

SOURCE:

The study was led by Courtney A. Smith, MS, Department of Dermatology, Emory University School of Medicine, Atlanta, and was published online on January 21 in JAMA Dermatology.

LIMITATIONS:

The study was limited to transgender individuals enrolled in integrated healthcare systems with insurance coverage, which may not represent the overall transgender population in US. Also, acne severity was inferred using treatment proxies rather than direct clinical grading. 

DISCLOSURES:

The study received support from the Patient-Centered Outcomes Research Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Aging. Smith reported receiving grants from the Pediatric Dermatology Research Alliance Research Fellowship Program. Several other authors received grants, personal fees, consulting fees, travel support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, the American Acne and Rosacea Society, American Academy of Dermatology, Epidemiologic Research & Methods, Dermatology Foundation, Amgen, L’Oreal Dermatological Beauty, Pfizer, Sanofi Genzyme, and Eli Lilly.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.