A 22-year-old transgender man presents to the dermatology clinic with severe inflammatory acne vulgaris not responsive to topical clindamycin, topical benzoyl peroxide, and long-term oral doxycycline. He identifies as a heterosexual man and reports monogamy with his girlfriend. He denies prior or current sexual intercourse with men. He receives weekly intramuscular testosterone cypionate injections for gender dysphoria. He has had bilateral chest reconstruction surgery but has no plan for hysterectomy or tubal ligation. He reports being currently amenorrheic. He is interested in isotretinoin therapy and has no medical or psychiatric contraindications. The dermatologist notes that iPLEDGE, the US Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy for isotretinoin, requires physicians to register patients taking isotretinoin in 1 of 3 categories: male, female of nonchildbearing potential, or female of childbearing potential.