LAUSR

HT: hormone therapy PCT: porphyria cutanea tarda INTRODUCTION Providing medically competent care for gender minorities has become a public health focus. Bodygender incongruence, antitransgender biases, and social isolation contribute to a lifetime risk of suicide attempts in this population greatly exceeding that of the overall US population (25%-43% vs 4.6%). Gender-affirming hormone therapy (HT) provides several desired physical and physiologic changes and can reduce suicidal ideation by nearly one half; however, it can also induce unwanted dermatologic side effects. A growing body of literature is emerging to define these effects and their management, which commonly include acne, changes in hair distribution or density, and hyperpigmentation. An increased susceptibility to female predominant autoimmune conditions has also been suggested, raising concern that transgender females on long-term HTmay additionally be at risk for other conditions commonly linked to estrogen exposure, such as porphyria cutanea tarda (PCT), erythema nodosum, vascular lesions, and cutaneous manifestations of changes in bile or lipid metabolism. We report the case of a 55-year-old woman (maleto-female transgender) who presented with PCT following a change in HT that led to supratherapeutic estrogen. To our knowledge, PCT arising in a transgender patient taking HT has not been reported. The current lack of clear evidence-based HT treatment algorithms and barriers to HT access foster therapeutic inconsistency and hormone level fluctuations, which increase the risk of PCT and other cutaneous side effects of HT in transgender females.