Dermatologists should use neutral terminology when discussing reproductive potential with transgender patients, according to findings from a report published in the Journal of the European Academy of Dermatology and Venereology.
Transgender individuals can have complex medical problems, including dermatologic issues. Therefore, dermatologists should identify the specific dermatologic needs and nuances in treatment in this population of patients, as well as discuss these issues using appropriate terminology that puts the patients at ease, the researchers advised.
Transmasculine patients frequently require isotretinoin for severe acne that results from testosterone therapy. The use of teratogenic medications requires additional consideration when treating patients who identify as transgender, as discussions about reproductive potential can enhance gender dysphoria, such as being asked to do a pregnancy test, noted the authors.
Neutral and inclusive terminology is important for creating an environment that is culturally welcoming for all patients. Making assumptions of gender identity, pronoun choice, or sexual identity can adversely affect the clinician-patient relationship. Providers should use patient-centered language, including the patients’ name and chosen pronouns and their terms for their sexual orientation, gender identity, sexual behavior, and anatomy, the researchers recommended.
Clinicians also are advised to have an open discussion with their patients regarding their anatomy and pregnancy potential and current or future sexual practices that could result in pregnancy. Counseling is recommended for pregnancy prevention, which should focus on the patients’ reproductive potential as opposed to their gender assigned at birth.
An organ inventory also is recommended, as it can help clinicians identify patients with reproductive potential and may lead to discussion of the need for regular pregnancy testing and/or contraception. Clinicians have been advised to avoid words such as “breast,” “vagina,” or “penis” and instead use words such as “chest” and “genital”’ to avoid eliciting gender dysphoria. Transmasculine patients who were assigned female at birth and have a functioning uterus and ovaries should still be considered as having reproductive potential, even if they are currently receiving testosterone therapy and are currently amenorrhoeic.
“In essence, the discussion of reproductive potential in transgender patients is a highly sensitive conversation and we would encourage the use of neutral terminology and the use of an organ inventory when discussing contraception and reproductive potential with this patient group,” stated the researchers. “This helps maintain patient rapport while also ensuring pregnancy potential and contraception requirements are adequately discussed with transgender patients.”
Quigley C, Storan ER. Discussing reproductive potential with transgender patients in dermatology clinics – a plea for more considerate terminology. J Eur Acad Dermatol Venereol. Published online December 3, 2022. doi:10.1111/jdv.18798