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Promoting Inclusive Care for Transgender Youth

Isotretinoin is frequently prescribed to treat and prevent severe inflammatory or scarring acne, but due to teratogenic risk, isotretinoin therapy is closely regulated by the Food and Drug Administration (FDA) via the iPLEDGE program. The iPLEDGE program requires patients to identify as either male, a female who can get pregnant, or a female who cannot get pregnant. These categories pose an issue for inclusive care with respect to transgender patients who do not clearly fit into any of these categories. Transgender youth already face barriers within the health care system, including access to equitable and gender-affirming care. If a patient requires isotretinoin they may be forced to register using their natal gender. This option is unacceptable to many, and rejecting to others. In addition, providers may be uncomfortable even raising the issue and thus may not provide the best clinical management of the patient’s condition.

A recent article described efforts to modify the iPLEDGE system to allow for non-binary categorization of patients. The authors argue that iPLEDGE represents an area where advocacy for transgender youth can be promoted towards the goal of providing a high level of inclusive care. The authors note that a gender-neutral iPLEDGE would allow for greater access to medications while also preserving patient dignity, reducing stigma, and affirming identity. The authors state that if the iPLEDGE (and other similarly restrictive Risk Evaluation and Mitigation Strategy (REMS) programs), remains in its current form, even inclusive and welcoming practices will be forced to provide care that is not gender-affirming. They note that transgender youth are at greater risk for a host of challenges such as depression, anxiety, suicidality, or substance abuse, and emphasize that providing thoughtful, affirming care will likely benefit patients’ overall health.

The authors support a gender neutral patient categorization for iPLEDGE to provide the most ethically sound care for transgender patients. The authors state that advocacy for this change is necessary to allow for safe and reliable therapy while retaining patients’ rights to self‐identification and determination.


Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: November 19, 2018

Source: NCBI
Adapted from the original article.

[Image: Ronnie Chua /]