SPD 2026: Clinical Considerations and Inclusive Communication in Pediatric Gender-Affirming Dermatology

Earlier today, at the Society for Pediatric Dermatology Annual Meeting, Markus Boos, MD, PhD, attending pediatric dermatologist at Seattle Children's Hospital, challenged attendees to think beyond diagnoses and treatment algorithms, arguing that the stories society tells about gender minority youth—and the stories clinicians help write in the exam room—can profoundly influence health outcomes. His presentation, “Storytelling, Love, and Caring for Gender Minority Youth,” combined evidence from the medical literature with practical communication strategies to help dermatologists provide affirming, patient-centered care.

Boos opened by examining storytelling as a powerful social force that shapes public attitudes and personal identity. Stories, he said, influence how individuals understand themselves and others, while also affecting policy, clinical practice, and health care experiences. Representation—and the lack of it—can influence hope, belonging, and well-being. Boos, who is also an associate professor and residency program director in the department of pediatrics at the University of Washington School of Medicine, emphasized that clinicians also become part of their patients' stories through the care they provide.

Dispelling Misconceptions and Addressing Care Restrictions

He then addressed misconceptions surrounding gender-affirming care, highlighting contemporary research demonstrating that many widely circulated narratives do not reflect clinical reality. National survey data indicate that approximately 1% of US adults identify as transgender, while estimates among adolescents are modestly higher, reflecting greater openness in discussing gender identity. Large population-based studies further show that gender-affirming surgical procedures are exceedingly uncommon among minors, with the overwhelming majority of chest reduction surgeries performed in adolescents occurring in cisgender patients rather than transgender youth. Likewise, prescriptions for puberty blockers and gender-affirming hormones represent only a small fraction of pediatric medical care.

“This narrative that people are going to their pediatrician and there’s a bowl full of estrogen and spironolactone on their way out...it’s just not true,” Boos said in his talk.

Rather than focusing solely on utilization, Boos emphasized the consequences of restricted access to care. Surveys of parents and clinicians have documented concerns about patient safety, discrimination, and diminished access to evidence-based treatment. Importantly, he reviewed data demonstrating that adolescents who receive gender-affirming care experience improved mental health outcomes compared with peers who do not, with earlier access associated with greater benefit. He encouraged dermatologists to recognize that gender-affirming care extends beyond endocrinology or surgery; respectful interactions during routine dermatologic visits also contribute meaningfully to patients' well-being.

Team-Based Inclusive Care and Patient Confidentiality

The session then shifted to practical recommendations for creating an inclusive dermatology practice. These tips can foster trust without adding significant time to the visit:

• Use open-ended, inclusive language when introducing and obtaining patient histories
• Ask patients what name and pronouns they use
• Avoid assumptions about relationships or identity
• Follow the patient's lead during conversations 
• Acknowledge mistakes if incorrect terminology is used 
• Demonstrate a willingness to learn

Creating an affirming environment also requires engagement from the entire clinical team. Scheduling staff, medical assistants, nurses, and physicians all contribute to patients' experiences. Boos recommended educating staff on respectful communication, maintaining accurate demographic information, protecting patient privacy, and recognizing that supportive family structures may extend beyond biological relatives. For adolescents in particular, he emphasized the importance of spending part of each visit alone with the patient, allowing confidential conversations while carefully determining who is aware of the patient's gender identity before discussing sensitive topics with parents or caregivers.

“The most important thing that you can do is ask,” Boos noted.

Dermatology-Specific Considerations and Patient Perspectives

Boos also highlighted several dermatology-specific considerations. Physical examinations should be conducted thoughtfully to improve patient comfort, with careful explanation beforehand and flexibility when gender dysphoria makes certain examinations distressing. He further encouraged dermatologists to recognize that gender identity may influence attitudes toward skin disease and treatment. For example, some transgender boys may perceive acne as aligning with masculine puberty and may have treatment goals that differ from cisgender peers. Others may avoid skin care routines because they associate them with femininity or because certain practices exacerbate gender dysphoria. Asking patients about these perspectives allows clinicians to individualize treatment recommendations rather than assuming conventional cosmetic goals.

In closing, Boos reminded attendees that dermatologists often see adolescents more frequently than many other specialists, placing them in a unique position to positively influence patients' lives. By validating identities, maintaining privacy, using inclusive communication, educating office staff, and remaining willing to ask respectful questions, clinicians can help ensure that gender minority youth experience not only competent dermatologic care, but also compassion, dignity, and belonging. As Boos concluded, listening carefully to patients' stories is itself a meaningful form of care.

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