Thread by @gabmayer

Hey #medtwitter and #medstudenttwitter! A while ago, I gave a #dermatology presentation on the intersection of derm and #trans health.

I learned a lot. So here's a #medthread on some of the takeaways I found most valuable.

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Let's start with our transfeminine pts.

Derm can provide a number of facial feminization procedures (FFP): e.g. botox, soft-tissue augmentation.

These FFPs can be more affordable/less invasive than feminizing surgeries such as forehead or mandibular contouring.

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Note: tho traditionally considered "cosmetic", these interventions have MATERIAL psychosocial benefits – studies show that facial feminization has a demonstrated positive impact on QoL + mental health outcomes.

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ncbi.nlm.nih.gov/pubmed/26818277

ncbi.nlm.nih.gov/pubmed/20461468

Be cognizant that not all pts can get FFPs from medical providers. Reasons why include a lack of health insurance/ability to pay, & discomfort in healthcare settings d/t stigma.

An impt reminder of the #SDOH forces that impact our trans pts.

ncbi.nlm.nih.gov/pubmed/24810672

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All of this to say: be sure to check in with your patients about complications from FFPs (ulceration, granulomas, infection) as these can be common in transfeminine patients, likely due to illicit filler use.

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Moving on to a second important derm intervention: hair removal!

Commonly done on the face (as facial hair
usually does not change with hormone therapy!)

However, also has an important role before vaginoplasty to prevent intra-vaginal hair growth in the neovagina.

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2 pearls here for me:

1. This intra-vaginal hair growth can cause a lot of complications (irritation, infection, hairballs).

…sciencedirect-com.ezproxy.med.nyu.edu/science/articl…

These complications, in turn, can contribute to low post-surgery satisfaction rates.

link.springer.com/article/10.100…

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2. As far as which hair removal method to use?

Specifically for this area of the body:
electrolysis has limited efficacy/higher recurrence rates, however there is promising data on laser hair removal.

ncbi.nlm.nih.gov/pmc/articles/P…

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To close this, wanted to briefly mention a more "bread and butter" derm condition: melasma!

It's known to be E-sensitive (commonly see in pregnant pts) and in fact can be “unmasked” by sudden systemic hormone therapy.

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Alright, this is long enough for now! Will continue with "part 2" on how derm can help our transmasculine patients at another point in time.

Hope this was useful to some of you!

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