Another essential linguistic consideration is the need for masculinization and feminization descriptors to seek insurance coverage for procedures that alleviate gender dysphoria.21 Since the inclusion of gender dysphoria in the DSM-5, there is hope that more medical, surgical, and minimally invasive procedures will be covered by insurance as medically necessary interventions for transgender and genderfluid patients who seek them.22,23 In these cases, the physician should explain the usage of this historically gendered language as needed to their patients.
Going Forward
Transgender and nonbinary individuals are a vulnerable population that still face many challenges, including misgendering and judgements in social and medical contexts.24 Making an appointment to see a physician for gender confirming care or aesthetics in general can itself be a prohibitively difficult and limiting step.18 We invite and encourage all dermatologists to adopt inclusive and friendly information, language, and symbols on their websites and in marketing materials to give much-needed reassurance to prospective and existing patients. When a patient does present to a dermatologist seeking genderaffirming care, a genderfluid approach supersedes paternalistic and historical preconceptions of gendered beauty ideals and makes way for an inclusive, practical, and empowering physician-patient relationship. By adopting these up-to-date standards, dermatologists will lead the way to better physicianpatient interactions across all specialties.
DISCLOSURES
Dr. Marc Beuttler and Dr. Jennifer MacGregor have no conflicts
of interest to disclose.
REFERENCES
1. Boulle K de, Furuyama N, Heydenrych I, et al. considerations for the use of minimally invasive aesthetic procedures for facial remodeling in transgender individuals. Clin Cosmet Investig Dermatol. 2021;14:513. doi:10.2147/CCID. S304032
2. JL M, YC C. Minimally invasive procedures for gender affirmation. Dermatol Clin. 2020;38(2):249-260. doi:10.1016/J.DET.2019.10.014
3. BA G, M C, NM S, D D. A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community. J Am Acad Dermatol. 2016;74(2):303- 308. doi:10.1016/J.JAAD.2015.10.013
4. Dermatologic care of the transgender patient: Highlighting a practice gap within dermatology. J Am Acad Dermatol. 2016;74(5):AB29. doi:10.1016/J. JAAD.2016.02.117
5. Gender Dysphoria. Accessed July 10, 2021. https://www.psychiatry.org/ patients-families/gender-dysphoria
6. File:Hanne Gaby Odiele Photographed by Ed Kavishe for Fashionwirepress. jpg - Wikimedia Commons. Accessed July 7, 2021. https://commons. wikimedia.org/wiki/File:Hanne_Gaby_Odiele_Photographed_by_Ed_ Kavishe_for_Fashionwirepress.jpg
7. File: Model Geena Rocero Coming out Transgender (13563189244) (cropped). jpg - Wikimedia Commons. Accessed July 7, 2021. https://commons. wikimedia.org/wiki/File:Model_Geena_Rocero_Coming_out_Transgender_ (13563189244)_(cropped).jpg
8. A M, A W, K F, et al. Self-reported patient motivations for seeking cosmetic procedures. JAMA Dermatol. 2018;154(10):1167-1174. doi:10.1001/ JAMADERMATOL.2018.2357
9. A W, A M, A W, et al. Patients believe that cosmetic procedures affect their quality of life: An interview study of patient-reported motivations. J Am Acad Dermatol. 2019;80(6):1671-1681. doi:10.1016/J.JAAD.2019.01.059
10. LM B, K P, J M, P K, JS D, MS K. The effects of neurotoxin and soft tissue fillers on gender perception in transgender individuals: A pilot prospective surveybased study. J Am Acad Dermatol. Published online 2021. doi:10.1016/J. JAAD.2021.02.080
11. The Rise of Tweakments: Why Facial Optimization Is Trending | Glamour. Accessed July 10, 2021. https://www.glamour.com/story/tweakments-facialoptimization- procedures
12. RA W, SD W, JM G-K. The ethics of performing noninvasive, reversible gender-affirming procedures on transgender adolescents. J Am Acad Dermatol. 2018;79(6):1166-1168. doi:10.1016/J.JAAD.2017.12.052
13. PW H, JK N, M T, G G. Ideals of facial beauty. Cutis. 2017;100(4):222-224. Accessed July 10, 2021. https://pubmed.ncbi.nlm.nih.gov/29136056/
14. Criticism of Skin Lighteners Brings Retreat by Unilever and Johnson & Johnson - The New York Times. Accessed July 10, 2021. https://www. nytimes.com/2020/06/25/business/unilever-jj-skin-care-lightening.html
15. L’Oreal to remove words like “whitening” from skin products. Accessed July 10, 2021. https://apnews.com/article/europe-international-news-cosmeticsbusiness- lifestyle-a4bd8559a742184924010635267196c7
16. Fenty Beauty Launches 40 Foundation Shades for Light and Dark Skin - Rihanna Fenty Makeup. Accessed July 10, 2021. https://www.cosmopolitan. com/style-beauty/beauty/a12466929/fenty-beauty-review/
17. Makeup Companies Are All Launching 40 Foundation Shades - The Fenty Effect. Accessed July 10, 2021. https://www.elle.com/beauty/makeup-skincare/ a20967710/makeup-companies-40-foundation-shades-fenty-beautyinfluence/
18. AE R. Addressing needs of transgender patients: the role of family physicians. J Am Board Fam Med. 2020;33(2):314-321. doi:10.3122/ JABFM.2020.02.180228
19. DA K, SL P, ET G. Caring for transgender and gender-diverse persons: what clinicians should know. Am Fam Physician. 2018;98(11):645-653. Accessed July 10, 2021. https://pubmed.ncbi.nlm.nih.gov/30485050/
20. MB D, D B. Electronic health records and transgender patients--practical recommendations for the collection of gender identity data. J Gen Intern Med. 2015;30(6):843-847. doi:10.1007/S11606-014-3148-7
21. K P, B K, BK S, H Y. Insurance Coverage for Hair Removal Procedures in the Treatment of Gender Dysphoria. Dermatol Surg: official publication for American Society for Dermatologic Surgery [et al]. 2021;47(2):306-308. doi:10.1097/DSS.0000000000002234
22. WV P, S H, JD C. Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost- Effectiveness Analysis. J Gen Intern Med. 2016;31(4):394-401. doi:10.1007/ S11606-015-3529-6
23. Learmonth C, Viloria R, Lambert C, Goldhammer H, Keuroghlian AS. Barriers to insurance coverage for transgender patients. Am J Obstet Gynecol. 2018;219(3):272.e1-272.e4. doi:10.1016/J.AJOG.2018.04.046
24. Trinh M-H, Agénor M, Austin SB, Jackson CL. Health and healthcare disparities among U.S. women and men at the intersection of sexual orientation and race/ethnicity: a nationally representative cross-sectional study. BMC Public Health 2017 17:1. 2017;17(1):1-11. doi:10.1186/S12889-017-4937-9
2. JL M, YC C. Minimally invasive procedures for gender affirmation. Dermatol Clin. 2020;38(2):249-260. doi:10.1016/J.DET.2019.10.014
3. BA G, M C, NM S, D D. A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community. J Am Acad Dermatol. 2016;74(2):303- 308. doi:10.1016/J.JAAD.2015.10.013
4. Dermatologic care of the transgender patient: Highlighting a practice gap within dermatology. J Am Acad Dermatol. 2016;74(5):AB29. doi:10.1016/J. JAAD.2016.02.117
5. Gender Dysphoria. Accessed July 10, 2021. https://www.psychiatry.org/ patients-families/gender-dysphoria
6. File:Hanne Gaby Odiele Photographed by Ed Kavishe for Fashionwirepress. jpg - Wikimedia Commons. Accessed July 7, 2021. https://commons. wikimedia.org/wiki/File:Hanne_Gaby_Odiele_Photographed_by_Ed_ Kavishe_for_Fashionwirepress.jpg
7. File: Model Geena Rocero Coming out Transgender (13563189244) (cropped). jpg - Wikimedia Commons. Accessed July 7, 2021. https://commons. wikimedia.org/wiki/File:Model_Geena_Rocero_Coming_out_Transgender_ (13563189244)_(cropped).jpg
8. A M, A W, K F, et al. Self-reported patient motivations for seeking cosmetic procedures. JAMA Dermatol. 2018;154(10):1167-1174. doi:10.1001/ JAMADERMATOL.2018.2357
9. A W, A M, A W, et al. Patients believe that cosmetic procedures affect their quality of life: An interview study of patient-reported motivations. J Am Acad Dermatol. 2019;80(6):1671-1681. doi:10.1016/J.JAAD.2019.01.059
10. LM B, K P, J M, P K, JS D, MS K. The effects of neurotoxin and soft tissue fillers on gender perception in transgender individuals: A pilot prospective surveybased study. J Am Acad Dermatol. Published online 2021. doi:10.1016/J. JAAD.2021.02.080
11. The Rise of Tweakments: Why Facial Optimization Is Trending | Glamour. Accessed July 10, 2021. https://www.glamour.com/story/tweakments-facialoptimization- procedures
12. RA W, SD W, JM G-K. The ethics of performing noninvasive, reversible gender-affirming procedures on transgender adolescents. J Am Acad Dermatol. 2018;79(6):1166-1168. doi:10.1016/J.JAAD.2017.12.052
13. PW H, JK N, M T, G G. Ideals of facial beauty. Cutis. 2017;100(4):222-224. Accessed July 10, 2021. https://pubmed.ncbi.nlm.nih.gov/29136056/
14. Criticism of Skin Lighteners Brings Retreat by Unilever and Johnson & Johnson - The New York Times. Accessed July 10, 2021. https://www. nytimes.com/2020/06/25/business/unilever-jj-skin-care-lightening.html
15. L’Oreal to remove words like “whitening” from skin products. Accessed July 10, 2021. https://apnews.com/article/europe-international-news-cosmeticsbusiness- lifestyle-a4bd8559a742184924010635267196c7
16. Fenty Beauty Launches 40 Foundation Shades for Light and Dark Skin - Rihanna Fenty Makeup. Accessed July 10, 2021. https://www.cosmopolitan. com/style-beauty/beauty/a12466929/fenty-beauty-review/
17. Makeup Companies Are All Launching 40 Foundation Shades - The Fenty Effect. Accessed July 10, 2021. https://www.elle.com/beauty/makeup-skincare/ a20967710/makeup-companies-40-foundation-shades-fenty-beautyinfluence/
18. AE R. Addressing needs of transgender patients: the role of family physicians. J Am Board Fam Med. 2020;33(2):314-321. doi:10.3122/ JABFM.2020.02.180228
19. DA K, SL P, ET G. Caring for transgender and gender-diverse persons: what clinicians should know. Am Fam Physician. 2018;98(11):645-653. Accessed July 10, 2021. https://pubmed.ncbi.nlm.nih.gov/30485050/
20. MB D, D B. Electronic health records and transgender patients--practical recommendations for the collection of gender identity data. J Gen Intern Med. 2015;30(6):843-847. doi:10.1007/S11606-014-3148-7
21. K P, B K, BK S, H Y. Insurance Coverage for Hair Removal Procedures in the Treatment of Gender Dysphoria. Dermatol Surg: official publication for American Society for Dermatologic Surgery [et al]. 2021;47(2):306-308. doi:10.1097/DSS.0000000000002234
22. WV P, S H, JD C. Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost- Effectiveness Analysis. J Gen Intern Med. 2016;31(4):394-401. doi:10.1007/ S11606-015-3529-6
23. Learmonth C, Viloria R, Lambert C, Goldhammer H, Keuroghlian AS. Barriers to insurance coverage for transgender patients. Am J Obstet Gynecol. 2018;219(3):272.e1-272.e4. doi:10.1016/J.AJOG.2018.04.046
24. Trinh M-H, Agénor M, Austin SB, Jackson CL. Health and healthcare disparities among U.S. women and men at the intersection of sexual orientation and race/ethnicity: a nationally representative cross-sectional study. BMC Public Health 2017 17:1. 2017;17(1):1-11. doi:10.1186/S12889-017-4937-9
AUTHOR CORRESPONDENCE
Marc M. Beuttler MD mbeutt@lsuhsc.edu
