PROJECT SUMMARY / ABSTRACT The overall objective of this K23 proposal is to support new research training and experience crucial for the candidate, Howa Yeung, MD MSc, to become an independent, patient-oriented investigator addressing sexual and gender minority disparities in skin diseases – such as acne in transgender persons. Acne significantly impairs health-related quality of life and is associated with depression, low self-esteem, and suicidal ideation. Little is known about the interplay of endogenous and exogenous hormones on acne incidence, severity, impact, treatment, and experience. Our prior studies noted higher acne prevalence associated with hormone therapy and identified specific barriers for severe acne treatment in transgender persons. This proposal aims to examine the epidemiology, impact, and experience of acne in the context of hormone therapy in transgender persons – a health disparity population with significant knowledge gaps in skin health. The epidemiology of acne will be examined using data from the existing large-scale, validated, multicenter Study of Transition, Outcomes and Gender (STRONG). Factors that mediate differences in acne experience, treatment, and research participation will be newly elicited using mixed methods. Development and pilot testing of a recruitment protocol and collection of preliminary data on acne outcomes and mental health comorbidity will help initiate a prospective cohort study of acne in transgender persons receiving hormone therapy. To achieve these aims, the candidate will require additional training through a combination of formal didactics, practical research experience, and expert multidisciplinary mentorship. The candidate will build expertise in sexual and gender minority health and health disparities research, patient-oriented outcomes research in acne, mixed- methods research techniques, as well as experience in community-engaged research and patient recruitment. The candidate’s mentored training and research plans will enable him to launch a successful career as an independent patient-oriented investigator addressing sexual and gender minority disparities in skin diseases – such as acne in transgender persons. Key results will inform new acne and gender-affirming hormone treatment paradigms and the design and implementation of future interventions, aimed to reduce the identified acne disparities, optimize acne clinical outcomes, and to improve patient-centeredness of hormone therapy in transgender persons.

PROJECT NARRATIVE Acne significantly impairs quality of life and is associated with higher risks of mental health disorders. Little is known about how internal and external hormones interact on the burden and outcomes of acne, particularly for transgender persons requiring long-term hormone treatment. This proposal aims to identify and better understand the burden, experience, and outcomes of acne with the ultimate goal to improve skin, mental health, and quality of life outcomes from acne and hormone treatments.