Suitable For All Skin Types –Are We Sure?

In this month’s column we take a look at the challenges faced when we leap onto yet another bandwagon before we look — transgender skin types.

No-one can deny that if we were able to create a skincare routine that was suitable for all skin types life would be much easier – if less profitable. However, as we should know, life is not like this and we have billions of different skin types, all requiring varying degrees of attention. From dry skin to oily skin; baby skin to adult skin; Celtic skin to African skin; male skin to female skin; and everything in between from, sensitive skins to “normal” skins; wrinkles to fine lines; zits to atopy; blotches to tattoos; you name it, the cosmetic industry is adept to “jumping”. Claims abound keeping the likes of me and others, on their toes.

However, products “suitable for all skin types” is an understandable desire, whereby the products would be suitable for children, adult females and adult males. This is typical of soaps and shower gels and even shampoos and conditioners for “all the family”. Furthermore, who hasn’t passed the big blue pot of Nivea around the family at some point, or even aftersun gels. All well
and good. Careful investigations have demonstrated that for the basic products this is possible, if the products are well formulated, safety scrutinised, and testing is conducted on all age groups – both male and female – producing both age neutral and gender neutral products.

Now I am throwing a “spanner in the works”!

We have seen in recent weeks, the uproar over the so-called woke agenda when it comes to the gender transition debate. The backlash ¹ was so strong it caused market shares to tumble, and
even strong criticism from a number of men who had “transitioned” e.g. Caitlyn Jenner. What I am talking about is the lack of judgement when brands jumped on yet another bandwagon before real consideration of what they were doing in order to make another fast buck – it did not work. Beer aside, cosmetic brands also supporting this particular trans lobby need to be careful – especially those brands whose products were not developed for either “males” or “suitable for all skin types”. Moral, ethical, and political issues aside, let’s look at the issues from a “scientific”
vantage, as well as claims compliance.

In order for an XX female to transition to “male” traits, or an XY male to transition to “female” traits, they have to undergo a series of treatments and procedures, that are not for the faint-of-heart, and with many of these patients some compassion is required.
From the dermatological aspect, the barrage of hormonal intervention results in a number of visible changes such as acne, atopy, hirsutism, cellulite, and menopausal issues, to name a few.^2–8 Moreover, does the skin of a transitioner at the age of 50 years have the same characteristics as a transitioner aged 50 who had transitioned when they were 20 years old?

Unfortunately, the scientific literature is almost devoid of preclinical studies focusing on hormonal, physiological, biochemical and structural changes in transgender skin (pre-pubescent and post-pubescent), in terms of the epidermis, dermis and hypodermis.
A transitioned male is still male genetically, and a transitioned female is still female, and often interventions such as botox and plastic aesthetics are required to feminise or vice versa.
The male/female traits may be “suppressed” with hormones and the like, but the genetic reality (XY/XX), can’t be undone.

Without a clear understanding of the triggering of skin changes, how can effective skin care for these two “new” skin types, be developed? Suggesting that current and established anti-ageing or barrier affirming products are “suitable”, when they were in fact developed and tested on non-transitioned females and in some cases non-transitioned males, is insufficient to be properly claims compliant. Investigation into “trans” skin types requires further focused study, and skincare ranges for those skin types developed.
If it is found that during the course of research I am suggesting, that current skin care lines are suitable for these skin types, then and only then could the claim “suitable for all skin types” be justified. What bandwagon these brands then choose to jump on is between them, the consumer, investors, and regulatory authorities. Given the overt FMCG nature of the industry, it has to decide if this is worth pursuing given the high cost of investment versus the ROI, for such a small section of society?

References:

1. https://www.dailymail.co.uk/debate/article-11961599/DAN-WOOTTON-hatefilled-gender-lobby-deny-reality.html
2. Swink, SM, Castelo-Soccio, L. Dermatologic considerations for transgenderand gender diverse youth. Pediatr Dermatol. 2021; 38: 58-64. https://doi.org/10.1111/pde.14685
3. Yeung H, Kahn B, Ly BC, Tangpricha V. Dermatologic Conditions inTransgender Populations. Endocrinol Metab Clin North Am. 2019Jun;48(2):429-440. doi: 10.1016/j.ecl.2019.01.005
4. Ginsberg BA. Dermatologic care of the transgender patient. Int J WomensDermatol. 2016 Dec 22;3(1):65-67. doi: 10.1016/j.ijwd.2016.11.007.
5. Huang C, Gold S, Radi R, Amos S, Yeung H. Managing Dermatologic Effectsof Gender-Affirming Therapy in Transgender Adolescents. Adolesc HealthMed Ther. 2022 Oct 7;13:93-106. doi: 10.2147/AHMT.S344078.
6. https://dermnetnz.org/topics/transgender-patients-and-their-skin
7. Sabra JJ, Fang CX, Kundu RV. A Knowledge-Based Assessment of Dermato-logical Care for Transgender Women. Transgend Health. 2018 May 1;3(1):71-doi: 10.1089/trgh.2018.0001
8. Wiik A, Andersson DP, Brismar TB, Chanpen S, Dhejne C, Ekström TJ, Fla-nagan JN, Holmberg M, Kere J, Lilja M, Lindholm ME, Lundberg TR, Maret E, Melin M, Olsson SM, Rullman E, Wåhlén K, Arver S, Gustafsson T. Metabolic and functional changes in transgender individuals following cross-sex hor-mone treatment: Design and methods of the GEnder Dysphoria Treatment in Sweden (GETS) study. Contemp Clin Trials Commun. 2018 Apr 12;10:148-doi: 10.1016/j.conctc.2018.04.005.