A Cross-sectional Survey of Knowledge, Attitude, and Practice in Prescription of Isotretinoin for Transgender Patients amongst Academic Dermatologists

Multiple reports have called attention to the complexity of assigning transgender patients to a category within the iPLEDGE system 1–3 , especially transgender men (female to male) on testosterone therapy who retain their reproductive organs and have the potential to become pregnant 4 . Prescribers must choose between enrolling transgender patients under gender assigned at birth (which is discordant with their gender identity) or the gender they align with (which is noncompliant with iPLEDGE). Additionally, to accurately determine reproductive potential in transgender patients, dermatologists must be knowledgeable regarding the effects of hormonal treatments on fertility. This cross-sectional study was conducted to assess the knowledge, attitude, and practice of academic dermatologists towards the prescription of isotretinoin for transgender patients. After Institutional Review Board approval, an anonymous 18-item survey was emailed to the 385 members of the Association of Professors of Dermatology, whom were encouraged to distribute to faculty and resident physicians. Respondents answered questions regarding demographics, how they would enroll a transgender patient in iPLEDGE in 3 different case-based scenarios, 3 true or false questions regarding fertility in transgender patients on or after hormonal therapy, and 6 questions regarding their attitude and practice towards the prescription of isotretinoin in transgender patients.