The purpose of this pre-screening form is to see if you meet the criteria for taking part in our research study of a topical treatment for acne in transgender patients who are on masculinizing hormone therapy. This form will take approximately 5 minutes to complete. You may choose not to answer these questions.  You also may choose to stop participating in this pre-screening at any time.

Information about you that you provide in this pre-screening form will be kept as confidential as possible as required by law.  It is possible that the Food and Drug Administration, and other federal and state authorities, may inspect this record.

You can choose if you want or do not want to take part in this research screening procedure – it is up to you.  If you refuse to answer the questions or stop answering them at any time, there will be no penalty, and you will not lose any benefits to which you otherwise would be entitled.

The risk to taking part in this pre-screening is very small.  The pre-screening is not designed to ask you for sensitive personal information, but it is possible that some people may feel uncomfortable answering these questions with a person they do not know. If you qualify to take part in the study and are interested in taking part, then please fill out the pre-screening questions below, and someone from the study team will contact you. The information provided below will be kept confidential, but there is a small risk that people outside of the research team or Stanford Medicine Hospital and Clinics could learn this information.  If you are not interested in the study, then do not fill out the pre-screening form.

The benefit to you of taking part in this pre-screening is that you will find out whether you can take part in the study of a topical treatment for acne in transgender patients who are on masculinizing hormone therapy. You will also receive $100 as a gift card after each study visit. This study involves being on either a topical cream called clascoterone or a placebo cream which you will use twice a day for 12 weeks. As part of the study, we will perform blood pressure checks, blood draws and pregnancy test, measure your oil levels with a special paper, collect samples of microbes on the surface of your skin using a swab, count the acne on your face and ask you to take surveys. This might be of benefit because, as you may know, masculinizing hormone therapy may cause acne, but some of the typical acne treatments aren’t available for transgender male patients to obtain. But we think this new acne treatment called clascoterone which has been approved by the FDA for acne may be of particular use in patients on hormone therapy.

If you do not want to answer these questions, you have other choices.  You can talk to your doctor about treating your acne. You also may want to continue with your current course of care.                                                                               

You will not be paid for answering questions in this pre-screening since it is only to see whether you qualify to take part in the study.   

If you have any questions, concerns, or complaints about this form, contact Dr. Anne Lynn S. Chang at 650-644-7318. If you want to talk to someone separate from the research team about a concern or complaint or your rights as a possible research subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed person who is separate from the research team, at 650-723-5244 (for medical studies), 650-723-2480 (for nonmedical studies), or toll-free at 1-866-680-2906.