Prioritizing Ethical Care and Understanding in LGBTQ Dermatology

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Steven Daniel Daveluy, MD, FAAD, associate professor, program director, and clinical educator at Wayne State University, emphasizes the importance of cultural humility in addressing unconscious bias within dermatology, suggesting that doctors approach patient interactions with curiosity and respect, acknowledging their own potential knowledge gaps.

Daveluy stresses the dermatologist's role in providing informed and supportive care, while navigating legal complexities. He highlights the value of existing dermatological techniques, such as cosmetic procedures and laser hair removal, in aiding gender affirmation. Daveluy presented the session, "LGBTQ/SGM Health in Dermatology: Essentials and Updates," at the American Academy of Dermatology 2025 annual conference.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How can dermatologists address unconscious bias and ensure they provide equitable care to all patients, regardless of sexual orientation or gender identity?

I think one of the biggest steps you can take toward addressing unconscious bias is to learn about cultural humility. We used to talk about cultural competence, but you can't really be competent in someone else's culture. Cultural humility is a different way of looking at it that says, "I'm going to acknowledge that I will not know as much about your culture as you will, and I'm going to approach it with curiosity and respect." If you kind of think of it that way, that if this patient brings something up and I don't understand what they're talking about or what they're saying, I want to make them comfortable and allow myself to ask questions in a nonjudgmental way. That way, you'll learn and figure out what your biases are because all of a sudden you'll think, "Oh, I was thinking this, but it turns out that's not actually true for this patient".

Then education can be great, too. This is a journey of learning all the time, so the more you learn about it and engage in sessions that can talk about cultures that you don't understand as much, like maybe the LGBTQ community, you can start that process of sort of realizing your biases so then you can be cognizant of them and try not to let them impact your behavior.

We live in a great age where there are a lot of good resources online. The AAD actually has as part of their online learning center, a module that you can go through that covers LGBT dermatology, covers some of the basics, the terminology, gives you that background information and how the patient's identity might impact their care in your office. The Fenway Institute is also fantastic, and they have great online resources. Then, the CDC also has focuses on LGBT health, and sometimes they call it sexual and gender minority so you can also get some information there.

What are the ethical considerations in providing dermatological care to LGBTQ patients, particularly in the context of gender-affirming treatments?

Right now, society is a little tumultuous, and we have some controversies around gender-affirming care. I think that's where it's really important for us to question our own ethics and figure out what is best for these patients. We're the doctors, we're the ones who understand what gender identity is and what gender dysphoria is. We can really be a value to our patients in providing gender-affirming care.

Of course, we want to be careful and navigate the legalities in your state. You don't want to become a target for anything if it's not legal in your state, but if you can, it's a great service to offer, and a lot of the things we're already doing in the derm[atology] office can benefit our patients.

We have cosmetic techniques that can help to masculinize or feminize appearance. We have laser hair removal that can help before surgery. If you don't understand gender identity, you can learn more about it. Like I said, the AAD has some resources online where you can educate yourself, but it's a really important service to provide patients, especially in these tumultuous times where they sometimes feel like no one cares about them anymore.

Can you share any experiences that have shaped your understanding of LGBTQ health in dermatology?

Research has really helped me understand what things present more frequently in our LGBT patients, how to approach gender-affirming therapy, and I'm so grateful to so many of my colleagues who are out there doing this research and making these publications. I like to keep an eye on the publications.

The AAD also has an LGBT expert resource group, and through our website, if you sort of search for it online, we try to share some of the latest information in terms of recent publications, to keep people up to date. That's really helped me to get a good idea of how does this impact the care I'm giving.

For example, we know in gay men, there's a higher risk of skin cancer and a higher risk of indoor tanning, and it might be cultural pressures to have that tanned appearance, and so it's a nice thing that you can sort of bring up with patients in clinic and make sure that you're asking about these risky sun behaviors or indoor tanning, and help to mitigate those problems.