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Case #10

My Queer Skincare Secrets; Taking Accutane as a queer woman means being doubted and disbelieved


My skin is so clear it almost glows. I am a poreless moonbeam, a Glossier hunk, the epidermal equivalent of quartz. I am proud of this otherworldly sheen, but it is in no way natural.


People often ask me how I got my skin to look this way. Is it a serum, an exfoliant, or a retinoid? Do I jade roll, sheet mask, or double cleanse? My answer always disappoints.

My skin is beautiful because it was artificially engineered, the culmination of seven months of pregnancy tests, sobriety, muscle aches, and insane amounts of Vitamin A. It was the result of a grueling seven months spent on Accutane, the now-defunct brand name of isotretinoin — the final line of defense against acne. There is nothing else in the world like Accutane. It is a miracle and a nightmare.


There is a common Accutane story: people talk about how hard it was for their skin to look bad — so oily, and bumpy! — and, then, how suddenly wonderful it felt for their skin to look good. They talk about how nothing worked, absolutely nothing, for so many years, until this drug of last resort swept in like a medical deus ex machina. They write about the purge phase, where the gunk inside your pores crawls out, lemon-yellow caterpillars that you must remember to scrape off before they grow too long. And the peeling, white crescents of your dried-out cheek like the inner rind of an orange. Then, finally, you wake up one day, look into a mirror, and see your face as you always wanted it to be. This, many say, is our shared journey, we the people with pimples who aren’t afraid to take the scorched-earth route to clear skin.


I, too, had a terrible time on Accutane, but not because of the purging or the peeling or even the muscle aches. To take Accutane as a woman, especially a queer woman, is to submit yourself to a system that does not trust your judgment or your body. Taking Accutane as a queer woman means being doubted and disbelieved, reminded that your words are never enough and that certain medicines are only available to you if you prove yourself worthy, and if you play by their rules.


I knew I had acne before I knew I was gay. It plagued my childhood. My whiteheads were so big they looked almost topographical, rings of pale yellow and angry pink alternating toward the head. I grew cysts as hard as jawbreakers, one of which lingered in my cheek for months until a surgeon cut it out. For years, I tried everything: Proactiv, Benzoyl peroxide, a no-dairy diet, tea tree oil, blackhead facials, antibiotics, acids, and during one particularly rough month— praying. Nothing worked.


The day I decided to take Accutane also happened to be the day my second-ever girlfriend broke up with me. I knew the breakup was coming, so I simply had to return her bag of personal effects (bookbinding paper, a coral cactus, and a dildo) from my room, weep, and catch the bus to a dermatologist with middling reviews on Yelp. When the doctor saw me, I was in tears, but not about the relationship. I told him I had been on antibiotics for over six years and that I thought they were making me depressed. The pills had names like heroines in Greek tragedies — Minocycline, Doxycycline, Erythromycin, Sulfameth — and often made me wish I was one of them, because at least then I could turn into a tree or die in a cave.


I hadn’t lasted a day without crying for the past four months. He said Accutane was my best bet. I was about to graduate and move to Seattle. He said I should start Accutane as soon as I knew I’d be settled for at least six months.


I found a doctor a few weeks after moving. He was a bespectacled man who spoke with a monotone. I told him I needed Accutane, please, as soon as possible. He warned me that Accutane caused severe birth defects — specifically, it would give my baby a cone-head. When I asked him what he meant by a cone-head, he pulled out a laminated sheet of paper adorned with two baby’s silhouettes. One skull round, one skull slicked back like a legume. Both smiling, seemingly unbothered. I told him there was no danger of me getting pregnant anytime soon.


“Well, you never know what could happen,” he said.

“I don’t have sex with men,” I clarified.

“You never know what could happen,” my doctor repeated, turning his gaze back toward a computer screen brimming with the statistics of my body: 130 pounds; no major surgeries; asthma; on my mom’s side, a history of breast cancer; on my dad’s, stroke.


I guess I really didn’t know what could happen. Maybe, as my doctor seemed to be implying, I might slip up and have sex with a man, or I might be raped. I began to wonder if perhaps he was right and I shouldn’t be trusted. Maybe no one can promise not to get raped.


Not being believed by your dermatologist can feel somehow less serious than not being believed by a doctor of greater consequence, like a gynecologist or cardiologist. But it is a very scary thing to know that layers and layers of proof stand between you and the only thing in the world that can clear your skin. Because it’s not just the unsightly pustules or blackheads the size of poppy seeds. It’s the pain that shivers through the pearls that stud your chin. The blood that drips after you lance your cysts, the closest you can come to cutting them out of your body. The fear that you are too vain or too immature to ever love yourself with acne.

To avoid ushering in a generation of cone-headed babies, the FDA implemented a program called iPledge that forces people who take Accutane to prove, over and over, that they are not pregnant. I was required to have two negative pregnancy tests a month apart before I could get the prescription. I had to be on two types of birth control throughout the treatment. I took a pregnancy test at my doctor’s office every month before they prescribed my month’s supply. If I didn’t pick up my pills in seven days, I had to go back, and be retested.


I got my blood drawn every month. I answered dozens of questions on “safe sex” on the archaic iPledge website every single month. I had to agree to tell iPledge if, against all these odds, I did get pregnant so they could counsel me about abortion. This was not explicit, but strongly implied.


Things went wrong, because of course they did. A nurse forgot to register my first negative pregnancy test so I had to wait two months before I could even fill my first prescription. When I indicated my chosen method of birth control would be abstinence — which iPledge defines as not having sex with men — the online questionnaire informed me that abstinence was not recommended as patients were likely to fail, and that it was up to my doctor to decide whether to believe my promise to be “abstinent.”


So I lied and said I was using condoms and an IUD, petrified that my doctor would learn that I did not in fact have a tiny plastic t-bone wedged in my womb, ripping hormones through my body. I failed the first safe sex questionnaire, stumped by questions about fertility and male condoms that I just couldn’t answer, which meant I had to spend an hour listening to the glitchy, apocalyptic hold music of the Accutane hotline while sitting on the floor of a Bartell Drugs, trying not to cry.


My internship didn’t give me benefits, and Zenatane, the cheapest generic version of my month’s 60-pack of pills cost a fifth of my monthly stipend, pre-tax. Five months into the program, the manufacturer of Zenatane recalled thousands of packages of the drug after it failed a routine test. The only pharmacy in the Pacific Northwest that still had Zenatane on its shelves after that was a tiny town two hours away. I drove out after work to seize their last package, weeping with happiness that I could pay just $600 for my generic pills, instead of $800 for the brand name.


It was seven months of hell. My despair flowed out of me freely. I pleaded with strangers over the phone and wept in three different pharmacy chains. I began to feel like I did not own my body. I gave overworked phlebotomists tubes of my blood and handed listless receptionists warm cups of my pee. Eventually, pummeled by the sheer absurdity of it all, I laughed more than I cried.


Accutane is a nightmare, but isotretinoin is a miracle. The drug belongs in a family of chemical compounds called retinoids, all of which source their power from vitamin A. Isotretinoin alters your DNA transcription, shrinking the size and output from your sebaceous glands, which produce your body’s natural oil. Without oil, your skin becomes a far less hospitable breeding ground for acne. Simple enough.


Accutane’s packaging made me wonder if I was taking something radioactive. One side included a diagram of the smiling, cone-headed baby. On the other, a grid of cardboard tabs with the silhouette of a pregnant woman, stamped out behind a red prohibition sign. As if I could forget. I had to entirely rip away her perforated body before I could ingest each oblong turquoise pill and throw the small tab into the trash — or recycle it, if you’re a real queer.


There are a host of very serious potential side effects, which happen to some: blurry vision, night blindness, nausea, liver damage, bowel disease. And there are the inevitable side effects, which happen to everyone: muscle and bone aches, skin that mummifies until it feels like parchment and molts flaky sheets of dead tissue. My skin grew so dry that I lost my fingerprints, and instead developed grooved, scowling fissures that meant I couldn’t use Touch ID for seven months.


“Even my phone doesn’t recognize me anymore!” I said to my doctor, my roommates, my coworkers, and strangers at the dive bar, holding up my raw and desiccated hands like someone drowning. I knew that Accutane could cause depression, but I knew that having acne did make me depressed, so what was I going to do, stop taking the drug after all I’d been through?


Once I started taking Accutane, my acne got worse before it improved. Then, it got better and better and better until one day I looked in the mirror and saw nothing. I stretched my cheeks out and pulled at every angle and felt no strange knobs or pinpricks of oil. It felt like everything and nothing, the happiest kind of empty. My acne was gone.

Isotretinoin lingers in your body for weeks after your last pill. It makes your wounds heal slowly, even a year after treatment ends. For this reason, you are warned against any kind of elective or aesthetic treatments, such as waxing or piercing or tattooing. A reminder that your body still does not belong to you.


But I couldn’t stop myself. Like many queer people, I’ve relied on tattoos to ground me in my skin. Tattoos help me feel at home in a body whose gender doesn’t always feel right, whose blend of two races feels slippery and at times inaccessible. And my seven months on pimple pills left me more evacuated from my body than I’d ever been before.


I made it two months before I got a tattoo of a rice sack on my arm with magnolia flowers. As the needle screamed into my still-raw skin, I stared at a dying spider plant in a window and cried quiet, astonished tears. I forgot exactly what tattoos felt like before Accutane, but I knew they didn’t feel like this.


It didn’t heal perfectly, or even well. The edges of the rice sack bleed into my skin like a vapor. The block letters smudge into each other. The spot on my arm aches when I am tired, though perhaps it’s just my imagination.


Neither of these bodily manipulations were necessary by most medical definitions. At its best, acne is a nuisance; at its worst it will not kill you. At their best, tattoos can make you feel cool — at their worst, a lifetime of regret. But I felt the same unmistakable euphoria while sitting in that black leather chair with a man driving a needle into my arm as I’d had driving away from that tiny pharmacy with Seattle’s last pack of Zenatane.


Like I had gamed some impossible system at some improbable cost, but finally got what I needed. Like I had been born into a difficult body and was finding my own route out.


*Original story - https://gay.medium.com/my-queer-skincare-secrets-2b0bb719057a