Pennsylvania Centre for Dermatology (PCD) is dedicated to serving the needs of our lesbian, gay, bisexual, transgender, queer and non-gender conforming community members with integrity and excellence.
For our GSM (gender and sexual minorities) patients, interactions with the medical community can sometimes be awkward, uncomfortable or just unhelpful. Historically, doctors and other care providers have been guilty of assuming heterosexuality and cis-gender identity. These assumptions can at least prevent a meaningful relationship between a provider and their patient, and at worst can lead to poor care and missed opportunities to optimize health. Even when providers know how a patient identifies, their own stereotypes about that identity can lead to incorrect assumptions about a patient’s health or lifestyle; for example, assuming a transgender patient is gay or lesbian or assuming a queer person is not in a monogamous relationship.
At PCD, we strive to understand and care for our patients as individuals, not as stereotypes or assumptions. We want all our patients to feel welcomed and the health of all members of our community to be improved by our service.
To that end, this blog post will highlight some recent research into dermatologic issues that are of importance to the LGBTQ+ community. We hope this information will start a conversation that patients feel comfortable to continue with their PCD care provider.
Skin cancer can affect us all, but there has been some published data to suggest that both gay men and lesbians are not receiving the appropriate prevention messages and/or screening skin cancers. A 2010 report in the American Journal of Public Health (http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.174169) found that lesbians are less likely to have preventative health screenings, including skin exams. A 2015 study examining the indoor tanning habits of gay men described increased risk of both indoor tanning and subsequent nonmelanoma skin cancers (http://jamanetwork.com/journals/jamadermatology/fullarticle/2453327) in this population. At PCD we offer and encourage full skin exams to screen for skin cancers for all our patients. Your provider can also discuss appropriate screening and sun protection to help prevent the development of skin cancers.
Sexually transmitted infections (STIs)
STIs have been shown to affect GSM patients disproportionally. Dermatologists are experts in common STIs, and can play a critical role in addressing STIs with patients. First, a dermatologist can provide accurate, clear information on how to prevent and detect STIs, can order appropriate screening tests for STIs, and can determine if a patient’s symptoms are due to an STI. Second, conversations about sexual behavior and risks for STIs can be difficult and require a provider to ask questions, not make any assumptions, and understand that risk is based on a patient’s own behavior. Although there are data suggesting that some GSM groups, particularly men who have sex with men, are at increased risk for STIs, research also shows that any patient who is abstinent or in a long-term mutually monogamous relationship is at very low risk. For some patients, it will be important to have conversations about risk for STIs like the human papillomavirus (HVP), genital warts, genital herpes, or syphilis with your dermatologist.
Skin health for transitioning patients
Beyond education about, and diagnosis of, certain skin-related problems, dermatologists are also able to care for patients’ appearance and maximize skin health and beauty.
During a transgender person’s transition, they might seek to make physical changes, both permanent and temporary, to their face, body or both. Dermatologists have a major role to play in helping patients understand their options for these procedures and in carrying them out. For example, injectable fillers for the face can significantly alter a person’s look to be more feminine. For some patients, fillers are preferable to facial surgery for their minimal invasiveness, their relative lower costs, and the option for refinement and adjustment in the future. It is important for patients to have access to medical-grade, high quality fillers, like the type that are used at PCD. Use of high quality fillers can prevent infections, scarring, and other complications that can arise from “black-market” fillers like substandard silicone.
Laser hair removal
In addition to fillers, laser hair removal can play an important role to a transitioning patient. Laser hair removal both for the face and/or the body can help a patient achieve an appearance that is in keeping with their gender identity. Like fillers, it is important that laser hair removal is performed in a safe, medical facility like PCD
Skin side effects of testosterone, specifically cystic acne of the face or body, are a common issue for transgender men. Patients might feel they just need to “deal with it,” but dermatologists have many tools to use to combat even cystic, testosterone-induced acne. Topical therapies, light therapy, chemical peeling or microderm abrasion, or oral medications such as antibiotics or isotretinoin are all often options for a transgender patient with acne.
From medical issues to cosmetic questions, dermatologic issues are common for the LGBTQ+ community, as described above. The other PCD providers, staff and I are here to answer your questions and care for the dermatologic needs of all members of our community.