Hidradenitis Suppurativa in Transgender and Gender Diverse Populations: Bridging Gaps in Care and Knowledge

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that imposes a significant physical and psychosocial burden yet remains under-recognized in transgender and gender diverse (TGD) populations. This narrative review synthesizes existing evidence on HS pathophysiology in the context of gender-affirming therapies and identifies key gaps in research and clinical practice affecting TGD individuals with HS. Hormonal influences, particularly exogenous testosterone in transmasculine individuals, may exacerbate HS through androgen-driven sebaceous and inflammatory pathways, whereas estrogen and anti-androgen therapies may confer protective effects in transfeminine patients. Practices such as chest binding and gender-affirming surgeries introduce mechanical and anatomical changes that may further modulate HS risk and presentation. However, TGD individuals are routinely excluded from epidemiologic datasets, clinical trials, and treatment guidelines, impeding accurate diagnosis and equitable care. Compounded by systemic barriers, including insurance denials, provider bias, and limited access to gender-competent care, TGD individuals face disproportionate delays and under-treatment. We highlight the need for inclusive data collection, hormone-specific treatment studies, trauma-informed care protocols, and community-engaged research models. By centering the experiences of TGD individuals living with HS, this review provides a foundation for more precise, affirming, and equitable dermatologic care.