{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:57:44Z","timestamp":1791669464756,"version":"4.3.4"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"\n Importance<\/jats:title>\n While acne is common in transgender and gender-diverse people and is associated with gender-affirming hormone therapy, little research has examined these factors and their impact in gender minority groups.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the lived experiences of acne and acne treatment in transgender and gender-diverse participants.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This mixed-methods analysis was conducted at a multidisciplinary gender center at a public safety-net hospital and endocrinology and dermatology clinics at a tertiary academic center from January 4, 2021, to April 7, 2022, using semistructured interviews and surveys. Participants were transgender or gender-diverse adults who had received gender-affirming hormone therapy. Data analysis was performed from November 11, 2021, to March 31, 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Current diagnosis of acne.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Interviews exploring the experience of acne and acne treatment were audio recorded, transcribed verbatim, coded using minority stress theory and the socioecological model, and analyzed using thematic analysis. Themes were triangulated with survey data on gender, self-reported acne severity, skin-specific quality-of-life impact, and treatment experience.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 32 participants were included in the study (mean [range] age, 32 [18-57] years; 17 transgender men, 11 transgender women, and 4 nonbinary participants). Ten participants (31%) self-rated their skin as currently clear or almost clear, 11 (34%) reported mild acne, and 11 (34%) had moderate to severe acne. Participants described experiences of rejection and bullying related to acne and admitted avoiding social interactions in which they anticipated acne-related discrimination, which led to feelings of depression and anxiety. Acne worsened body appearance dissatisfaction. Transgender women reported acne interfering with feminine gender expression. Transgender men often normalized acne development, sometimes viewing acne positively as an early sign of testosterone action. Most participants tried over-the-counter acne treatments and commonly sought acne treatment advice from physicians, peers, online forums, and social media. Barriers to acne treatments included cost, lack of multidisciplinary care, mistrust toward the health care system, and lack of transgender-specific acne care education.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this mixed-methods study, transgender and gender-diverse individuals reported experiencing acne-related stigma and facing barriers to acne treatment. Multilevel changes, such as developing strategies to reduce acne stigma, providing transgender-specific acne care education, facilitating multidisciplinary acne care, and expanding transgender-friendly clinical environments, are recommended to reduce the impact of acne in transgender individuals.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.5355","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T11:02:20Z","timestamp":1704279740000},"page":"164","source":"Crossref","is-referenced-by-count":17,"title":["Lived Experience of Acne and Acne Treatment in Transgender Patients"],"prefix":"10.1001","volume":"160","author":[{"given":"Sarah","family":"Gold","sequence":"first","affiliation":[{"name":"Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meron","family":"Siira","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigal","family":"Willner","sequence":"additional","affiliation":[{"name":"Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crescent","family":"Alcid","sequence":"additional","affiliation":[{"name":"Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suephy C.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Duke University School of Medicine and Durham VA Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vin","family":"Tangpricha","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cam","family":"Escoffery","sequence":"additional","affiliation":[{"name":"Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashli","family":"Owen-Smith","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howa","family":"Yeung","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia"},{"name":"Clinical Resource Hub, Veterans Administration Veterans Integrated Service Network 7 Southeast Network, Decatur, Georgia"},{"name":"Associate Editor, JAMA Dermatology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"doi230063r1","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.jaad.2020.02.040","article-title":"Acne vulgaris and risk of depression and anxiety: a meta-analytic review.","volume":"83","author":"Samuels","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"9","key":"doi230063r2","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1001\/jamadermatol.2021.2185","article-title":"Patient perspectives on the lived experience of acne and its treatment among adult women with acne: a qualitative study.","volume":"157","author":"Barbieri","year":"2021","journal-title":"JAMA Dermatol"},{"issue":"2","key":"doi230063r3","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1111\/bjd.v183.2","article-title":"Young people\u2019s perceptions of acne and acne treatments: secondary analysis of qualitative interview data.","volume":"183","author":"Ip","year":"2020","journal-title":"Br J Dermatol"},{"issue":"1","key":"doi230063r5","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1111\/jsm.12366","article-title":"Short- and long-term clinical skin effects of testosterone treatment in trans men.","volume":"11","author":"Wierckx","year":"2014","journal-title":"J Sex Med"},{"issue":"3","key":"doi230063r6","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1001\/jamadermatol.2020.5347","article-title":"Incidence and factors associated with acne among transgender patients receiving masculinizing hormone therapy.","volume":"157","author":"Thoreson","year":"2021","journal-title":"JAMA Dermatol"},{"issue":"1","key":"doi230063r7","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1089\/trgh.2016.0023","article-title":"Perceptions of barriers to and facilitators of participation in health research among transgender people.","volume":"1","author":"Owen-Smith","year":"2016","journal-title":"Transgend Health"},{"key":"doi230063r8","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1080\/26895269.2022.2100644","article-title":"Standards of care for the health of transgender and gender diverse people.","volume":"23","author":"Coleman","year":"2022","journal-title":"Int J Transgender Health"},{"issue":"1","key":"doi230063r9","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jaad.2019.09.008","article-title":"Achieving consensus on patient-reported outcome measures in clinical practice for inflammatory skin disorders.","volume":"88","author":"Perez-Chada","year":"2023","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"doi230063r10","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/120347540100500202","article-title":"Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases.","volume":"5","author":"Chren","year":"2001","journal-title":"J Cutan Med Surg"},{"issue":"3","key":"doi230063r11","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1177\/1203475418756379","article-title":"Development of a comprehensive quality-of-life measure for facial and torso acne.","volume":"22","author":"McLellan","year":"2018","journal-title":"J Cutan Med Surg"},{"issue":"8","key":"doi230063r12","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1001\/jamadermatol.2022.2260","article-title":"Patient-reported outcome measures for health-related quality of life in patients with acne vulgaris: a systematic review of measure development and measurement properties.","volume":"158","author":"Hopkins","year":"2022","journal-title":"JAMA Dermatol"},{"key":"doi230063r14","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1037\/a0029597","article-title":"A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model.","volume":"43","author":"Hendricks","year":"2012","journal-title":"Prof Psychol Res Pr"},{"issue":"1","key":"doi230063r15","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1089\/trgh.2016.0012","article-title":"Expecting rejection: understanding the minority stress experiences of transgender and gender-nonconforming individuals.","volume":"1","author":"Rood","year":"2016","journal-title":"Transgend Health"},{"issue":"11","key":"doi230063r18","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.1001\/jamadermatol.2015.0761","article-title":"Severe acne in female-to-male transgender patients.","volume":"151","author":"Turrion-Merino","year":"2015","journal-title":"JAMA Dermatol"},{"issue":"3","key":"doi230063r19","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/j.jaad.2016.03.042","article-title":"Prescribing isotretinoin in the United States for transgender individuals: ethical considerations.","volume":"75","author":"Yeung","year":"2016","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"doi230063r20","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"5","key":"doi230063r21","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1188\/14.ONF.545-547","article-title":"The use of triangulation in qualitative research.","volume":"41","author":"Carter","year":"2014","journal-title":"Oncol Nurs Forum"},{"issue":"8","key":"doi230063r22","first-page":"978","article-title":"Psychological sequelae of acne vulgaris: results of a qualitative study.","volume":"52","author":"Magin","year":"2006","journal-title":"Can Fam Physician"},{"issue":"1","key":"doi230063r23","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s13555-018-0224-7","article-title":"A Qualitative investigation of the impact of acne on health-related quality of life (HRQL): development of a conceptual model.","volume":"8","author":"Fabbrocini","year":"2018","journal-title":"Dermatol Ther (Heidelb)"},{"issue":"Pt 2","key":"doi230063r24","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1348\/135910705X26128","article-title":"\u2018Nobody likes damaged goods\u2019: the experience of adult visible acne.","volume":"10","author":"Murray","year":"2005","journal-title":"Br J Health Psychol"},{"issue":"1","key":"doi230063r25","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1089\/lgbt.2018.0265","article-title":"The transgender identity survey: a measure of internalized transphobia.","volume":"7","author":"Bockting","year":"2020","journal-title":"LGBT Health"},{"key":"doi230063r26","doi-asserted-by":"publisher","DOI":"10.2340\/actadv.v103.5123","article-title":"Truncal acne in adolescents and young adults: self-reported perception.","volume":"103","author":"Ballanger","year":"2023","journal-title":"Acta Derm Venereol"},{"issue":"7","key":"doi230063r27","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-3834","article-title":"Beyond the face: the hidden burden of truncal acne.","volume":"101","author":"Dr\u00e9no","year":"2021","journal-title":"Acta Derm Venereol"},{"issue":"5","key":"doi230063r28","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.eprac.2023.02.002","article-title":"Incidence and factors associated with acne in transgender adolescents on testosterone: a retrospective cohort study.","volume":"29","author":"Chu","year":"2023","journal-title":"Endocr Pract"},{"issue":"9","key":"doi230063r29","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.11124\/JBISRIR-2017-003869","article-title":"Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review.","volume":"17","author":"Rowniak","year":"2019","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"3","key":"doi230063r30","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1001\/jamadermatol.2020.5353","article-title":"Moderate-to-severe acne and mental health symptoms in transmasculine persons who have received testosterone.","volume":"157","author":"Braun","year":"2021","journal-title":"JAMA Dermatol"},{"issue":"2","key":"doi230063r31","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s40257-021-00665-w","article-title":"Treating acne in transgender persons receiving testosterone: a practical guide.","volume":"23","author":"Radi","year":"2022","journal-title":"Am J Clin Dermatol"},{"issue":"3","key":"doi230063r32","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.jaad.2018.02.042","article-title":"Dermatologic care for lesbian, gay, bisexual, and transgender persons: terminology, demographics, health disparities, and approaches to care.","volume":"80","author":"Yeung","year":"2019","journal-title":"J Am Acad Dermatol"},{"issue":"3","key":"doi230063r33","doi-asserted-by":"publisher","first-page":"E18","DOI":"10.12788\/cutis","article-title":"Removal of isotretinoin gender-based guidelines: inclusivity takes precedence.","volume":"109","author":"Nanda","year":"2022","journal-title":"Cutis"},{"issue":"2","key":"doi230063r36","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.ajog.2019.07.043","article-title":"Contraception across the transmasculine spectrum.","volume":"222","author":"Krempasky","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"doi230063r37","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.contraception.2020.04.001","article-title":"Society of family planning clinical recommendations: contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth.","volume":"102","author":"Bonnington","year":"2020","journal-title":"Contraception"},{"issue":"10","key":"doi230063r38","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1001\/jamadermatol.2019.1416","article-title":"Psychiatric adverse events in patients taking isotretinoin as reported in a Food and Drug Administration database from 1997 to 2017.","volume":"155","author":"Singer","year":"2019","journal-title":"JAMA Dermatol"},{"key":"doi230063r39","doi-asserted-by":"publisher","first-page":"c5812","DOI":"10.1136\/bmj.c5812","article-title":"Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study.","volume":"341","author":"Sundstr\u00f6m","year":"2010","journal-title":"BMJ"},{"issue":"1","key":"doi230063r40","doi-asserted-by":"publisher","first-page":"37","DOI":"10.4088\/JCP.10r05993","article-title":"Retinoic acid and affective disorders: the evidence for an association.","volume":"73","author":"Bremner","year":"2012","journal-title":"J Clin Psychiatry"},{"issue":"1","key":"doi230063r41","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-021549","article-title":"Use of isotretinoin and risk of depression in patients with acne: a systematic review and meta-analysis.","volume":"9","author":"Li","year":"2019","journal-title":"BMJ Open"},{"issue":"3","key":"doi230063r42","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1037\/a0031774","article-title":"Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping.","volume":"81","author":"Budge","year":"2013","journal-title":"J Consult Clin Psychol"},{"issue":"4","key":"doi230063r43","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.jadohealth.2015.04.027","article-title":"Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria.","volume":"57","author":"Olson","year":"2015","journal-title":"J Adolesc Health"},{"key":"doi230063r13","volume-title":"The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding","author":"Graham","year":"2011"},{"key":"doi230063r4","unstructured":"Jones? JM. LGBT identification in US ticks up to 7.1%. Published February 17, 2022. Accessed September 21, 2022. https:\/\/news.gallup.com\/poll\/389792\/lgbt-identification-ticks-up.aspx"},{"key":"doi230063r16","unstructured":"iPLEDGE patient information\/informed consent (for all patients). Accessed September 21, 2022. https:\/\/ipledgeprogram.com\/#Main\/Resources"},{"key":"doi230063r17","unstructured":"Isotretinoin iPLEDGE shared system REMS. Accessed September 21, 2022. https:\/\/www.accessdata.fda.gov\/scripts\/cder\/rems\/index.cfm?event=RemsDetails.page&REMS=24"},{"key":"doi230063r34","unstructured":"US Food and Drug Administration. iPLEDGE risk evaluation and mitigation strategy (REMS). Accessed September 21, 2022. https:\/\/ipledgeprogram.com\/#Main"},{"key":"doi230063r35","unstructured":"iPLEDGE REMS guide for patients who can get pregnant. Accessed September 21, 2022. https:\/\/ipledgeprogram.com\/#Main\/Resources"}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2813277\/jamadermatology_gold_2024_oi_230063_1707346934.63785.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T11:02:07Z","timestamp":1708513327000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2813277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,1]]},"references-count":43,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2023.5355","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2024,2,1]]}}}