P05 The efficacy and safety of isotretinoin in transgender males receiving gender-affirming hormonal therapy with youth subgroup analysis: a systematic review

Journal article

Background: Acne is a frequent effect of testosterone-based gender-affirming hormone therapy (GAHT), affecting up to 30% of transgender males within the first year. No formal guidelines address acne management or isotretinoin use in this population, and current recommendations rely on cisgender data. This review evaluates isotretinoin’s efficacy and safety in transgender males, including adolescents, to clarify evidence gaps. Methods: Following PRISMA 2020 and PROSPERO registration, we included studies of transgender males on GAHT treated with oral isotretinoin. Case reports and series were eligible. Searches across major databases and grey literature were unrestricted by language. Extracted data included demographics, GAHT regimen, dosing, efficacy, and psychiatric outcomes, with narrative synthesis. Results: Of 366 records, seven eligible studies (five with full text) reported on 67 transgender males on testosterone therapy, including seven adolescents. Acne often developed or worsened after GAHT initiation or dose increases. Isotretinoin led to marked or complete improvement in 87% of cases, though relapse and repeat courses were common. Thirty-seven patients discontinued early due to follow-up loss, adverse effects, surgery, or logistical barriers. Psychiatric symptoms were rare with uncertain causality. Overall study quality was low to moderate. Conclusion: Isotretinoin appears effective and generally safe for severe testosterone-associated acne in transgender males. Psychiatric effects did not exceed expected background rates but support integrated mental health care. Prospective studies are needed to guide standardized acne management in gender-affirming care.

Authors: Pugh, R; McPherson, T

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: British Journal of Dermatology
• Volume: 193
• Issue: Supplement_3
• Article number: ljaf465.013
• Publication date: 2025-12-19
• DOI: 10.1093/bjd/ljaf465.013
• EISSN: 1365-2133
• ISSN: 0007-0963
• Language: English