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Authors: Hayley Braun, Medical Student, Emory University School of Medicine, Atlanta, Georgia, USA; Dr Brian Ginsberg, Assistant Clinical Professor of Dermatology, Mount Sinai Hospital, New York, New York, USA; Dr Howa Yeung, Assistant Professor of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA; Dr Patrick E. McCleskey, Dermatologist, Kaiser Permanente, Oakland, California, USA. Medical Editor: Dr Helen Gordon, Auckland, New Zealand. Copy edited by Gus Mitchell. October 2020.
Transgender people identify with a gender that differs from the sex assigned at birth.
Transgender patients commonly report experiencing discrimination in healthcare settings, difficulty accessing medically necessary health care, and stigma caused by medical staff unfamiliar with transgender-related care. Training of medical staff and dedication to ongoing, consistent inclusivity across a medical system, helps improve patients’ willingness to disclose essential information to get the best care.
Medical staff set the tone for office culture, and their behaviour toward transgender patients can create a welcoming environment from the beginning. Training staff is critical to help make transgender or non-binary patients feel comfortable.
Many effects of testosterone begin within one month and reach their peak two years after hormone initiation . Common effects of testosterone on the skin include :
For transgender individuals receiving testosterone, common dermatologic changes include :
Common treatments include:
Most effects of oestrogen occur within the first few months and reach maximum effect after a few years of hormone therapy . Common effects of oestrogen on the skin include:
For transgender women patients, common dermatologic changes include:
Common dermatologic concerns of this population include :
Physical transformation is a critical part of aligning with one’s gender identity for many transgender individuals. For some, they may be satisfied with the effects of hormonal interventions alone. Others may seek to procedurally alter their face and body to help better align their physicality with their identity. Transgender women have shown priority to their faces in this physical transformation, whereas transgender men prioritise their chests, perhaps each reflecting what they feel is the largest barrier to outwardly passing as their identified gender . Importantly, it should never be assumed that an individual wants to do any aspect of physical transitioning, and it should be remembered that many individuals identify somewhere outside of the male/female binary.
Many transgender men choose to bind their chest with a compression garment, tape, or wrap to create a more flattened appearance. Some proceed to mastectomy to permanently remove the breast tissue. Transgender women may choose to get breast implants. Chest surgical intervention is known as “top surgery.”
Skin consequences of chest binding can include:
Genital surgery is more commonly known as gender affirmation surgery, or “bottom surgery” . Genital surgery for transgender men may or may not be accompanied by hysterectomy and/or oophorectomy.
Both vaginoplasty and phalloplasty often require pre-operative laser hair removal . Without laser hair removal, neovaginal hair growth can lead to obstruction and sequelae including infection. Laser hair removal is done prior to phalloplasty to avoid hair running the full length of the neophallus.
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