Ethics of reversible dermatologic care in transgender and gender-diverse adolescents under restrictive and ambiguous laws.

Gender dysphoria causes significant distress in transgender and gender-diverse (TGD) adolescents, often impacting their mental health. Evidence-based gender-affirming interventions, such as hormone therapy, have been shown to reduce this distress and lower suicide risk, and dermatological treatments may help alleviate gender dysphoria. However, recent state-specific legal restrictions and ambiguous laws in the United States (US) have created barriers for TGD adolescents from accessing these treatments; some states have passed new laws that restrict TGD youth access to surgical and even medical gender affirming services as hormone treatment. We explore dermatologists' challenges in providing care to TGD adolescents in legally ambiguous and restrictive states in the context of the core ethical principles of autonomy, beneficence, nonmaleficence, and justice. Using exemplary case studies, we discuss ethical dilemmas involving dermal fillers, laser hair removal, hair growth treatments, and acne management for TGD adolescents living in such states. We find that as such treatments are available in other geographic locations, available for cis-gender individuals and not necessarily permanent, there is a violation of the core principle of justice. Dermatologists should navigate these legal and ethical complexities to provide safe, compassionate care for TGD adolescents. Advocacy for clear state-specific guidelines, equitable access to care, and ongoing research are essential to support this vulnerable population.