Mental health outcomes of isotretinoin for acne in transgender and gender diverse patients receiving testosterone compared to cisgender patients
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Presented at: Society for Investigative Dermatology 2025
Date: 2025-05-07 00:00:00
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Summary: Abstract Body: Transgender and gender diverse (TGD) patients receiving testosterone commonly develop acne after starting masculinizing gender affirming hormone therapy (mGAHT). Isotretinoin is highly effective in treating acne, but its use is associated with reports of depression/suicide. TGD patients have a baseline higher risk of depression/suicide, leading to concern about use of isotretinoin in this population. This prospective cohort study evaluated 19 TGD-mGAHT and 16 cisgender adults not receiving testosterone who were starting isotretinoin for acne at Fenway Health between September 2020 to December 2024 and followed for 12 months post-treatment. Mental health was evaluated by monthly Patient Health Questionnaire-9 (PHQ-9) and Dermatology Quality of Life Index (DLQI) surveys. Groups were compared using Wilcoxon (Mann-Whitney) Rank Sum tests, with statistical significance defined as P<0.05. Between TGD-mGAHT and cisgender cohorts, there was a significant difference in baseline PHQ-9 scores (medians (interquartile ranges (IQRs)) of 7 (4-10) vs. 2 (1-5), P<0.01), but not DLQI scores (medians (IQRs) of 8 (3-12) vs. 6 (4-14), respectively). By treatment end, there was no significant difference in PHQ-9 (medians (IQRs) of 4.5 (2-6) vs. 3 (0.5-5.5) and DLQI scores (medians (IQRs) of 2 (1-4) vs. 1 (0-3)) between TGD-mGAHT and cisgender cohorts, respectively. Difference in PHQ-9 score improvement between the cohorts was statistically significant from baseline to end-treatment (P=0.01) but not significantly different for baseline to 12-month follow-up (P=0.52). There was no statistically significant difference in DLQI improvement between the cohorts between baseline to end-of-treatment (P=0.59) or to 12-month follow-up (P=1.00). No patients discontinued isotretinoin due to adverse mental health effects. In conclusion, isotretinoin has similar safety in terms of mental health outcomes in the treatment of acne among TGD patients on testosterone compared to cisgender patients. Julia L. Gao<sup>1</sup>, Austin Rios<sup>1</sup>, Erica Dommasch<sup>1, 2</sup> 1. Fenway Institute, Boston, MA, United States. 2. Dermatology, Atrius Health Inc, Newton, MA, United States. Clinical Research: Epidemiology and Observational Research