Acanthosis nigricans in transmasculine patients is associated with cardiometabolic comorbidities and race/ethnicity, but not exogenous testosterone

Summary: Abstract Body: Acanthosis nigricans (AN) is a highly visible skin condition associated with metabolic disease and case reports of testosterone (T) usage in men. Transgender patients using T are a growing population, and some transmasculine patients have delayed T usage due to concern for AN, but systematic data on AN in this population is scarce. Here, we assess the factors that associate with AN in transmasculine patients. After IRB approval, we performed a retrospective chart review utilizing the Stanford Research Repository from 2016-2023. Search terms for transmasculine patients were applied with inclusion criteria of age >8 years and older. Exclusions: patients who did not identify as transmasculine per manual chart review. Our analysis cohort consisted of 945 transmasculine patients, with 623 patients on T for ≥2 months (median duration 4.0 years, IQR 2.3-6.5 years). Overall, AN prevalence was 4.6%. Univariate analysis showed AN was positively associated with metabolic syndrome (OR [95% CI]: 25.5 [8.8-73.1]), obesity (18.3 [9.4-37.1]), Native American race (11.2 [3.0-41.9]), type 2 diabetes (9.6 [3.6-24.3]), prediabetes (8.9 [3.7-20.0]), Black race (5.0 [1.8-14.3]), hypertension (4.8 [2.1-10.5]), Hispanic ethnicity (4.5 [2.4-8.3]), and hyperlipidemia (2.3 [1.2-4.6]). Multivariate logistic regression showed that AN associated with metabolic syndrome (5.5 [1.4-22.9]), obesity (10.6 [4.9-23.4]), prediabetes (3.9 [1.3-11.2]), hypertension (3.7 [1.2-10.0]), and Hispanic ethnicity (2.4 [1.1-5.2]). T usage was not associated with AN in transmasculine patients (0.8 [0.4-1.4]) despite >99% power to identify an association between AN and T. Our data suggests that in transmasculine patients, AN is associated with cardiometabolic comorbidities and race/ethnicity, but not exogenous T. Future multicenter, prospective confirmatory studies are needed. Twan Sia¹, Farah Abou-Taleb¹, Connie Ma¹, Shufeng Li¹, Anne Lynn S. Chang¹ 1. Dermatology, Stanford Medicine, Stanford, CA, United States. Minoritized Populations and Health Disparities Research