Dermatological aspects of gender affirming medical treatment in transgender and gender diverse people: a systematic review

Abstract

Background Transgender and gender diverse (TGD) people face specific dermatological conditions related to the cutaneous effects of gender affirming medical treatment (GAMT). Dermatological conditions in TGD people are often underdiagnosed and underrecognized despite its potential for treatment to improve quality of life and mental health in this population. There is paucity of literature guiding health care professionals (HCP), including dermatologists, regarding the dermatological aspects that TGD people can experience during medical transition. Aims To conduct a systematic review summarizing and critically appraising the literature describing the dermatological changes in TGD people following gender affirming medical transition. To develop recommendations for health care professionals regarding the dermatological conditions identified in the review. Methods Studies were identified through Google Scholar, PubMed databases, as well as through Google Scholar search alerts. We considered all studies published until February 2024. PICO questions were developed based on the aims of the review. PRISMA guidelines were followed. Two reviewers extracted data from suitable studies and also independently assessed the identified studies’ risk of bias and strength of evidence. Results A total of 22 research studies were included in the systematic review. Prior to 2019 most of the available literature relied on case reports and expert opinions. The vast majority of studies and reviews were published in the last 5 years. Conclusion Gender affirming hormone treatment may cause or affect particular skin conditions such as acne, androgenic alopecia, xerosis, pruritus, persistent hirsutism, atopic dermatitis and melasma. In addition, TGD people undergoing gender affirming surgical treatment are at risk for hypertrophic scar and keloid development. Health care professionals (HCP), including dermatologists have the ability to positively affect the dermatological care of transgender and gender diverse patients. Guidance and several recommendations are made for health care professionals regarding future prevention strategies and treatment that are patient-tailored rather than using an universal approach.